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DISEASES OF THE ORAL CAVITY

DISEASES OF THE ORAL CAVITY. Yrd . Doç.Dr . Rasim YILMAZER Otolaryngology Department Yeditepe University School of Medicine. ANATOMY OF THE ORAL CAVITY. anterior : vermillion border of the lips posterior: oropharynx

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DISEASES OF THE ORAL CAVITY

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  1. DISEASES OF THE ORAL CAVITY Yrd.Doç.Dr. Rasim YILMAZER Otolaryngology Department Yeditepe University School of Medicine

  2. ANATOMY OF THE ORAL CAVITY • anterior : vermillion border of the lips • posterior: oropharynx • oropharyngeal isthmus : (superior) junction of the hard and soft plates . (lateral) anterior tonsillar pillars (inferior) the line of the circumvallate papillae

  3. ANATOMY OF THE ORAL CAVITY 1- Lips 2- Anterior portion of the tongue 3- Buccal mucosa 4- Upper and lower alveolar ridges 5- Retromolar trigone 6- Floor of the mouth 7- Hard palate

  4. Exam: Lips

  5. Exam: Lips-palpation • Color, consistency • Area for blocked minor salivary glands • Lesions, ulcers

  6. Pyogenic granuloma

  7. Fibroma

  8. Lip cancer

  9. Lower lip carcinoma

  10. CANCERS OF THE LIP • 88-98% lower lip • 2-7% upper lip • 0,09-6,1% oral commisure • Male and older than 60 years old  • SCC  • Basal cell ca, melanoma, minör salivary gland tm.

  11. Sensory innervation of the tongue • 1 – chorda tympani and lingual nerve • 2 – glossopharyngeal nerve • 3 – vagal nerve

  12. Motor innervation of the tongue • Extrinsic muscles of the tongue are innervated by cranial nerve XII -Genioglossus -Hyoglossus -Styloglossus -Palatoglossus • Intrinsic muscles of the tongue are also innervated by cranial nerve XII -Superior longutudinal -Inferior longutudinal -Vertical -Transverse

  13. Exam: Tongue

  14. Exam: Tongue • You may observe lingual varicosities

  15. Exam: Tongue • You may observe geographic tongue (erythema migrans)

  16. Exam: Tongue • You may observe drug reaction

  17. Exam: Tongue • Observe signs of nutritional deficiencies

  18. Hairy Leukoplakia

  19. Hemangioma

  20. Granular Cell Tumor

  21. Exam: Tongue • You may observe cancer

  22. CANCER OF THE ANTERIOR PORTION OF THE TONGUE

  23. Tongue ca.

  24. Tongue ca.

  25. CANCERS OF TONGUE • Lateral border • Ocult met. 30% • No  supraomohyoid dissection • T1- T2 surgery or RT • T3- T4 surgery+RT • Stage, nodal metastases, lenfovasculer, perineural invasion and thickness of tumor are important prognostic factors.

  26. Examination: Buccal Mucosa • Linea alba • Stenson’s duct

  27. Examination: Buccal Mucosa • Lesions – white, red • Lichen Planus, Leukedema

  28. CANCER OF THE BUCCAL MUCOSA • Advanced stage • Tm pterigoid muscles, maxilla, mandible, skin • clinic N(+)RND or MRND + cheek resection • There is no natural barrier • T1 surgery or RT • T2 surgery or RT • T3 and T4 surgery+ RT

  29. Ameloblastoma

  30. Gingival cyst

  31. Malignant Melanoma

  32. Mucoepidermoid tumor

  33. CANCERS OF THE GINGIVA AND ALVEOLAR RIDGE • 80 % lower gingiva and 1/3 posterior region. • Incidance of mandibular invasion rate is high • upper gingiva invasion of maksillary sinus • Pull out the tooth invasion of bone marrow • uncommon • Lower jaw ( posterior 1/3 dental arch) • Marginal mandibular resection • Stage 1-2 , surgery • Stage 3-4 ,surgery+ (+) neck MRND (-) Neck Rtx

  34. Exam: Retromolar trigone

  35. Exam: Retromolar trigone Edentulous

  36. RETROMOLAR TRİGONE CA • Uncommon • Invasion of mandible • Late diagnose , advanced stage, cervical metastases are bad prognostic factors • T1 T2 surgery or RT • T3 T4 surgery + RT

  37. Exam: Floor of mouth • Visualize, palpate - bimanually • Wharton’s duct • Must dry to observe • Does “lesion” wipe off? • Where are the two most likely areas for oral cancer? • lateral border of the tongue • Floor of mouth

  38. Exam: Floor of mouth

  39. Palpation of the floor of the mouth

  40. Exam: Floor of mouth • Squamous Cell Carcinoma

  41. Squamous Cell Carcinoma

  42. FLOOR OF THE MOUTH CA. • Incidance of mandibular invasion rate is high • Ocult met  10-30% • Primary resection of the floor of the mouth is peformed with ipsilateral or bilateral neck dissection (if the tumor is located at the midline)

  43. Exam: Hard palate • Minor salivary glands

  44. Median Palatal Cyst

  45. CANCER OF THE HARD PALATE • uncommon • SCC and Adenoid cystic ca • Misdiagnosed as maxillary sinus tm • Incidance of neck metastases is low • Elective neck treatment is unnecessary • Prostodontist

  46. ORAL PREMALİGNANCY • Leukoplakia • Erythroplakia • Mucosal atrophy

  47. MALIGNANT LESIONS • SQUAMOUS CELL CARCINOMA • VERRUCOUS CARCINOMA • MINOR SALIVARY GLAND TUMOURS • SARCOMATOID CARCINOMAS • MALIGNANT MELANOMA

  48. PATIENT EVALUATION Diagnosis Neoplasms of the oral cavity Complete head and neck examination Chest x-ray and liver function tests plus additional laboratory tests dictated by patient’s medical history CT/MRI scan for extent of primary and possible cervical nodal evaluation Dental evaluation Radiotherapy evaluation Staging endoscopy and biopsy

  49. Risk factors for oral cavity and oropharyngeal cancer include: Cigarette Alcohol Exposure to the human papilloma virus (HPV) or Epstein-Barr virus (EBV) ionizing radiation Prolonged sun exposure, especially linked to cancer in the lip area and skin cancer. Fair skin, also linked to lip cancer and skin cancer. Age. People over the age of 45 years old are at increased risk for oral cancers (though it can develop in people of any age). Poor nutrition. Irritation from poorly fitting dentures in people who use alcohol and tobacco products. Chewing betel nuts, a nut containing a mild stimulant popular in Asia. Weakened immune system. Vitamin A deficiency. A rare condition called Plummer-Vinson Syndrome, which involves iron deficiency and causes difficulty swallowing. Gender. Men are more likely to get lip cancer than women. lichen planus discoid lupus erythematosus dystrophic epidermolysis bullosa ETIOLOGY

  50. Symptoms • Otalgia • Odynofagia • Bleeding • Dysfagia • Loss of teeth • Restriction of mouth movement • Trismus

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