Oral Cavity

Who: Females, <20 years, approx. 40% of population

Where: Oral mucosa/Pharynx

What: Painful noncontagious ulcer (small - few millimeters) - white exudate with red rim, lasts/heals within 7-10 days, no scarring, recurs 3-4 times per year

Why: Idiopathic (possibly genetics, smoking, stress, trauma, foods)

Aphthous Ulcer (Canker Sore)

Who: Childhood to age 40

Where: Oral mucosa/pharynx

What: Recur monthly (canker sores)

Why: Idiopathic

Recurrent (Aphthous) Ulcers

Who: n/a

Where: Oral mucosa/pharynx

What: >1cm (more painful) ulcer, heals within 10-30 days, can scar, recurs frequently

Why: Idiopathic

Major Aphthous Ulcers

Who: Females

Where: Oral mucosa/pharynx

What: Tiny discrete ulcers - coalesce into ulcerated patches, heals within 10 days, recurs frequently

Why: Idiopathic

NOT linked to herpes

Herpetiform Ulcers

Who: Children (2-4), 80% asymptomatic; acute herpetic gingivostomatitis

Where: Oral cavity & face

What: infection; sudden onset of herpetic vesicles

Why: HSV-1

Oral Herpes (Cold Sores)

Who: 60% are carriers, (CN V), recurrent herpetic stomatitis

Where: Lips, nose, inner cheeks, gums, hard palate

What: outbreak of small group/vesicles; resolves in 7-10 days

Why: latent HSV-1; physical trauma, allergies, UV light, temps, URI immuno, pregnancy, menses

Oral Herpes (Cold Sores)

Encephalitis-retrograde spread

MC is HSV-1 into cerebral tissues via CNs V or I

Diagnosis via spinal tap

70% fatal in absence of antiretrovirals

Herpesviral Encephalitis

Who: immunosuppressed, diabetes, Antibiotic use 40% of all neonates

Where: inner cheek, tongue, hums, peritonsillar

What: white/grayish (red underneath) pseudo-membranes, self-limiting, inflamed, it can NOT be scrapped off

Why: Candida Albicans overgrowth

Oral Candidiasis (Thrush)

white/grayish (red underneath) pseudo-membranes, that are able to be scrapped off - erythematous

Leukoplakia, Oral Cancer, or Milk

Who: n/a

Where: Along bite line (submucosal fibrosis)

What: Nodular mass

Why: Chronic inflammation/Irritation (hyperplasia and fibrosis)

Fibroma

Who: Pregnant Women, Children

Where: Gingiva

What: hemangioma on gingiva, red/purple, grows rapidly

Why: Hormonal factors

Treatment - remove irritant or surgery

Pyogenic Granuloma (pregnancy tumor)

Who: 3% of population, males 2x more likely than females, ages 40-70

Where: Oral cavity

What: Raised white patches, hyperkeratosis, cellular dysplasia

Why: All tobacco products, alcohol, candidiasis (inflammation)

*the patches are NOT able to be scrapped off; 25% of the time it is pre-cancerous to oral squamous cell carcinoma

Leukoplakia

Who: Males, ages 40-70

Where: Oral cavity

What: Red, velvety lesions; cellular dysplasia

Why: All tobacco products, alcohol, candidiasis (inflammation)

Aggressive! 50% of the time it is precancerous to squamous cell carcinoma

Erythroplakia

Who: >30 years old, Males 2x more likely than females (especially males of a minority)

What: Oropharyngeal pain/dysfunction, raised firm lesion, whitish-gray or erythematous (leukoplakia or erythroplakia); irregular borders, possible ulceration, Multiple Primary tumors (common)

2 types:

1-Where: Ventral (inferior) tongue (MC), floor/mouth, lower lip, soft palate, gingiva; local invasion and metastasis - cervical nodes (MC), mediastinal nodes (chest), lungs and liver

Why: Alcohol, Tobacco

*TP53 mutation common; poor prognosis (<50% long-term survival); early detection improves prognosis but MC diagnosed in advanced stages

2-Where: Base/Tongue (MC), Tonsillar Crypts

Why: HPV associated

More favorable, has less mutations

Squamous Cell Carcinoma

Who: 20% of those >70 years old

Where: n/a

What: Dry mouth(decreased saliva production), dysphagia and dysarthria, fissures and/or ulcerations, risk for dental caries and candidiasis

Why: ADR, Irradiation

Xerostomia

Autoimmune attack on Salivary and Lacrimal Glands

Sjogren Syndrome

Who: MC pediatrics - delf resolve; adults - pancreatitis and orchitis; viral - MC mumps virus (parotid gland); bacterial - MC Staph. Aureus; risk of dehydration or obstruction

Where: Salivary gland

What: Inflammation and enlargement in kids (parotid gland), adults (pancreas or testicule)

Why: Trauma, Autoimmunity, Infections (viral or bacterial)

Sialadenitis

Who: n/a

Where: Lower lip, Postprandial

What: Mucous filled cyst, non-painful

Why: Saliva collects in tissue - inflamed cyst

Mucocele

Who: 60-80 years old, Females

Where: MC parotid gland (75%; 25% are malignant); Submandibular glands (10%; 40% malignant); Sublingual and Minor Salivary glands (15%, 75% malignant)

What: n/a

Why: n/a

Rare (<2% of all tumors), smaller tumors are least common but greater Cancer risk

Salivary Gland Neoplasms

Who: n/a

Where: parotid gland (up to 10% malignant)

What: large superficial swelling, painless, mobile, encapsulated, mixed tissues, may recur (w/ incomplete treatment)

Why: mixed tissue (grandular epithelium + cartilaginous tisse + osseous tissue)

MC benign tumor, >1/2 of parotid tumors; 10% progress to cancer

Pleomorphic Adenoma (parotid gland neoplasm)

Who: n/a

Where: n/a

What: Invasive, affixed

Why: unrecognized or neglected pleomorphic adenoma

Aggressive! 50% lethal, 30-50% 5-year span

Carcinoma Ex Pleomorphic Adenoma (parotid gland Neoplasm)

Who: n/a

Where: lower pharyngeal, outpouching (superior to UES)

What: May be large (several CMs), bolus accumulates - halitosis; dysphagia, regurgitation, aspiration/food

Why: from increased pressure in the pharynx, from uncoordinated swallowing, A/O, cricopharyngeal spasm

Diagnosis via barium swallow and video fluoroscopy

Zenker's Diverticulum (Pharyngoesophageal Diverticulum)