1 / 28

Systemic disorders and sydromes with H & N manifestation

Systemic disorders and sydromes with H & N manifestation. Jan Laco, M.D., Ph.D. Cardiovascular diseases. Infective endocarditis source: bacteraemia after tooth brushing or extraction < 15% IE valve defects: congenital x rheumatic fever prosthetic valves

xaria
Download Presentation

Systemic disorders and sydromes with H & N manifestation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Systemic disorders and sydromes with H & N manifestation Jan Laco, M.D., Ph.D.

  2. Cardiovascular diseases • Infective endocarditis • source: bacteraemia after tooth brushing or extraction • < 15% IE • valve defects: congenital x rheumatic fever • prosthetic valves • colonisation of cardiac valves  vegetations  valve destruction • !!! ATB cover !!!

  3. Cardiovascular diseases • Kawasaki disease = mucocutaneous LN syndrome • Japan • Children • Mucositis • cervical lymphadenopathy • coronary arteritis  aneurysm  myocardial infarction

  4. Cardiovascular diseases • antihypertensive drugs • nifedipine  gingival hyperplasia

  5. Respiratory tract diseases • Tuberculosis • rare complication of open lung TBC • painless ulcer on dorsum of tongue • cervical lymphadenopathy • Mi: caseating granulomas

  6. Respiratory tract diseases • Sarcoidosis • chronic granulomatous disease of unknown origin • lungs, LN (hilar), salivary glands • oral: painless swelling – gingivae, lips • diagnosis: biopsy of labial glands • Mi: non-caseating granulomas + calcifications • Heerfordt´s syndrome: parotis with sarcoidosis + xerostomia + uveitis + fever

  7. Lethal midline granuloma syndrome • clinically: destruction of central facial tissue + fatal outcome • Wegener´s granulomatosis • systemic necrotising vasculitis (ANCA+) • granulomas of upper and lower RT • glomerulonephritis • Angiocentric T cell lymphoma

  8. Gastrointestinal diseases • Crohn´s disease • inflammatory disease of unknown origin • ileocaecal region - thickening and ulceration • oral: lips swelling cobble stone thickening of buccal mucosa with painful small ulcers • Mi: small granulomas

  9. Gastrointestinal diseases • Gardner´s syndrome (AD inheritance) = multiple jaw osteomas + polyposis coli with malignant potential • dental defects, epidermal cysts • Peutz-Jeghers syndrome • pigmented macules around lips + intestinal polyposis (small bowel)

  10. Nutritional deficiencies • vitamin A • squamous metaplasia  keratinisation (leukoplakias ?) • vitamin B2 • angular stomatitis - painful red fissures at angles • vitamin B12 - pernicious anaemia • glossitis • vitamin C - scurvy • gingival swelling and bleeding • vitamin D - rickets

  11. Endocrine disorders and pregnancy • Pituitary hyperfunction of growth hormone • gigantism • acromegaly jaws (condylar growth) + hands + feet

  12. Endocrine disorders and pregnancy • Adrenocortical diseases • Addison´s disease = cortical insufficiency • failure of cortisol and aldosteron secretion • early sign – oral pigmentations – gingivae, buccal mucosa, lips • Adrenal medulla • MEN IIb = phaeochromocytoma + hyperparathyroidism + thyroid medullary carcinoma + oral mucosal neurofibromas

  13. Endocrine disorders and pregnancy • Diabetes mellitus • relative or absolute deficiency of insulin • oral: candidosis acceleration of periodontal diseases dry mouth oral lichenoid reactions (drugs)

  14. Endocrine disorders and pregnancy • Pregnancy • gingivitis • pregnancy epulis formation • recurrent aphthae

  15. Haematological disorders - anaemias • iron deficiency (microcytic a.) • chronic menstrual blood loss • chronic bleeding from peptic ulcer • pernicious anaemia (macrocytic a.) • middle aged women • autoimmune chronic gastritis  vitamin B12 deficiency + neurological disease: degeneration of spinal cord

  16. Haematological disorders - anaemias • mucosal and skin pallor + fatigue + breathlessness + tachycardia • atrophic glossitis (B 12) - first sign • atrophy of filiform papillae • angular stomatitis • candidosis

  17. Haematological disorders - leukaemias • = neoplastic disorder of bone marrow • acute x chronic • lymphoblastic x myeloblastic • ALL - children • AML - adults • anaemia + infection + bleeding tendency • hepatosplenomegaly + lymphadenopathy • oral: gingival swelling + mucosal ulcerations + purpura

  18. Haematological disorders - haemorrhagic diseases • bleeding after tooth extraction > 1 day • 1. vascular disorder • 2. platelet disorders • purpura, petechiae, ecchymoses • imm. follow trauma  spontaneous stop • 3. clotting disorders • long severe bleeding after short delay

  19. Haematological disorders - haemorrhagic diseases • Idiopathic thrombocytopenic purpura • antibodies x platelets  low number in blood • children, young women • von Willebrand´s disease (AD inheritance) • low level of vW factor (part of FVIII) • drugs associated • aspirin

  20. Haematological disorders - haemorrhagic diseases • Haemophilia A (X inheritance) • most common • FVIII deficiency • childhood • bleeding into muscles or joints (haemarthros) • Acquired disorders • liver diseases • vitamin K deficiency • anticoagulant treatment - warfarin

  21. Cervical lymphadenopathy- infections • Bacterial • teeth, tonsils, face • TBC • cat-scratch disease • Viral • herpetic stomatitis • infectious mononucleosis • HIV infection • Parasitic • toxoplasmosis

  22. Cervical lymphadenopathy- neoplasms • Primary • Hodgkin´s lymphoma • non-Hodgkin lymphomas • Secondary • carcinomas • melanoma • leukaemias

  23. Autoimmune diseases • middle aged women • antibodies in blood • rheumatoid arthritis • Sjögren´s syndrome • systemic lupus erythematosus • systemic sclerosis

  24. Autoimmune diseases • Systemic lupus erythematosus • antinuclear factors • 20% patients have oral symptoms • skin rash (butterfly) + arthritis + pleuritis + glomerulonephritis • oral: lichenoid lesions • Systemic sclerosis • subcutaneous and visceral fibrosis (GIT, lungs, …) • mask-like face + limited oral opening

  25. AIDS • retrovirus HIV 1 • sexual + i.v. drugs + blood transmission • deterioration of cell immunity (CD 4 T cell) • opportunistic infections • 75% patients have orofacial diseases • infections • tumors • cervical lymphadenopathy

  26. AIDS – oral infections • Fungal • trush or other forms of candidosis • 70% patients • Viral • HSV stomatitis • EBV – hairy leukoplakia • Bacterial • gingivitis + periodontitis

  27. AIDS – hairy leukoplakia • almost unique to AIDS !!! • EBV virus • lateral borders of tongue • soft white painless area with corrugated surface • Mi: hyperkeratosis + koilocytes • No premalignant lesion • indicator of low immune status  poor prognosis • may regress spontaneously

  28. AIDS - tumors • 50% patients • Kaposi´s sarcoma – HSV 8 • purplish bleeding area or nodule on palate • Mi: vascular tumor - minute proliferating blood vessels • Non-Hodgkin lymphomas • painless swelling of palate + gingiva • Mi: high grade B cell lymphomas

More Related