耳鼻喉科Otolaryngology topic fifteen: Diseases of oral cavity

Diseases of oral cavity

1. Oral cavity and pharynx: border
-- junction of hard and soft palate
-- circumvallate papillae

2. LN drainage

From "Cancer Research UK"

3. Taste
-- anterior 2/3 of tongue: CN7, chorda tympani
-- posterior 1/3 of tongue: CN9, glossopharyngeal nerve

4. Gland secretion
-- stimulated: parotid gland
-- automatic: submandibular gland

5. Diseases of oral cavity

Infection: viral or bacterial or fungal(Candida albicans)

Fungal infection
--> acute atrophic candidiasis
--> angular cheilitis (DDx: vitamin B2 deficiency)
-- treatment: neomycin
-- white spot: can be removed

Herpangina
-- young children, more common in summer and autumn
-- Coxsackie A mainly
-- DDx: bacterial infection (pus-like lesions!)

Hand-Foot-and-Mouth
-- Coxsackie A
-- may develope into meningitis, myocarditis

Herpes simplex
-- recurrent cold sore

VZV
-- may associate with Ram-Say-Hunt syndrome

Papilloma
-- associated with HPV infection
-- Oral papilloma is much more benign than recurrent respiratory papillomatosis.

Others

Leukoplakia
-- beware of malig. change

Aphthous stomatitis
-- herpetiform ulcers: fused ulcers, painful
-- treatment: CCl3COOH,  AgNO3

Lichen planus
-- DDx: leukoplakia

Burning Mouth syndrome
-- peri-/post- menopausal women
-- PE: no findings
-- local neuropathy
-- treatment: ani-epileptic drug
-- DDx: LPR

Geographic tongue (benign migratory glossitis)
-- unknown cause

Fissured tongue 
-- unknown cause
-- no treatment

Hairy tongue 
-- unknown cause
-- treatment: hygiene-->brushing

Ranula
-- recurrent sublingual gland obstruction 
-- treatment: marsupialization, remove wall/sublingual gland

Benign neoplasm
-- torus
-- lingual thyroid: midline in area of foramen cecum, +thyroglossal duct cyst, 70% hypothyroidism
-- cysts: F/U if no symptoms
-- fibroma, pyogenic granuloma: response to chronic stimultion
-- neurofibroma: smooth, may occur at other sites at the same time
-- hemangioma: do not bleed as much as hemangioma at other sites
-- pleomorphic adenoma: benign if from salivary gland

Oral cavity cancer
-- most common @ tongue, buccal mucosa
-- risk factor: including drinking alcohol
-- examination tools: upper GI endoscope, chest CT(N2b↑), head and neck CT, PET/MRI... 
-- micro: most common-->SCC, tumor thickness directly associated with meta. and survival
-- treatment: surgery, >0.5 cm --> need neck dissection (LN!)