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Angular Cheilitis

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AKA "Cheilosis" or "Angular Stomatitis" Inflammatory lesion at the labial commissure Prone to secondary infection by Candida Usually seen in elderly. May be seen with malnutrition, nutritional deficiency or Fe-deficiency anemia May also be seen in cold weather climates

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Glossitis

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Inflammation or infection of the tongue, causing the tongue to swell Difficulty swallowing Causes may include viral (HSV) or bacterial infections, mechanical injury from burns, sharp edges of teeth or tongue piercings Alcohol and smoking may also cause this Goal of Tx is to reduce inflammation with good oral hygiene

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Stomatitis

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Inflammation of mucous membranes of any oral cavity structures Inflammation may be caused by poor oral hygiene, ill-fitting dentures, mouth burns, cigarette smoking, or infections Severe iron-deficiency enemia may cause this.

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Oral Mucocele

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AKA Mucus Retention Cyst Swelling connective tissue consisting of collected musin from a ruptured minor salivary gland duct Mostly found in children and young adults Most common location is the surface of the lower lip and inner buccal mucosa Round, bluish, firm lesion Histologically contains mucin and granulation tissue

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Aphthous Ulcer

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AKA Canker Sore Painful, open sore caused by a break in the mucous membrane 10% of population One of most common oral conditions Women are more effected Exact cause unknown, associated with lip biting and vigorous brushing Oval, white to yellow ulder with an inflamed red border Usually self-limited

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Squamous Papilloma

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Most common benign epithelial neoplams of oral cavity Affects men more than women, most commonly in ages 30-60 Any oral site may be effected symptomless mass Majority are solitary Possible Viral etiology Exophytic, pink to tan lesions with warty appearance and vary in size. NOT malignant, no malignant potential, treated with surgical removal.

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Lymphangioma

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Benign proliferation of lymphatic vessels that occur as a focal superficial lesion within the oral cavity MC on tongue and mucous membrane of cheek Asymptomatic, painless, soft and slightly raised clear to pink nodule or vesicle Can be present at birth No encapsulation, but still benign Tx is surgical removal

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Fibroma

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MC connective tissue "tumor" of oral cavity MC on buccal mucosa, followed by labial mucosa, tongue and gingiva but can be anywhere. Typically presents as smooth surfaced, firm nodule with broad sessile base. Asymptomatic

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Minor Salivary Gland Adenoma

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Involvement of minor salivary glands occur most frequently on the hard and soft palate, followed by the lips Tend to be lobular or polypoid, encapsulated tan-white masses. Histologically resemble major salivary gland pleomorphic adenomas Slow growing, painless mass. May cause difficulty chewing, dysphagia and hoarseness

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Tori Mandibularis

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Harmless growth of bone in oral cavity Mandible area, hard palate, or inner cheek Slow growing, vary in size, usually dont interfere with chewing or speech Not cancerous or pre cancerous Usually asymptomatic

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Head and Neck Cancers

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Predominantly consist of oral cavity and lip cancers, but also include the nasal cavity and sinuses, pharynx, and larynx Cast majority of these are SCC (95%) Strong association with smoking and alcohol along with exposure to HPV Over 35,000 new cases in US each year

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Oral Cancer General Considerations/Demographics

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Oral Cancers are more common in men - associated with higher incidence of tobacco and alcohol use. 2:1 ratio Average age is 50-70. Usually >40y/o MC cancer in men from India due to chewing Paan.

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Oral Cancer Risk Factors

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Tobacco (Smoking and chewing) Alcohol Sunlight (UV Light) (specific to lips) Dental irritation and poor oral hygiene Immunosuppression Leukoplakia and Erythroplakia HPV Epstein-Barr Virus

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Precancerous Leukoplakia

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Greek for "White plaques" Asymptomatic white patch on the surface of mucous membrane NOT a tumor - but can result in malignant transfer to SCC Equal occurrence in males and females Clinical term, not a Dx MC in buccal mucosa, tongue and floor of mouth Plaques may be solitary or multiple, vary in size, and cannot be scarped 10% are superficial cancer, 8% are invasive carcinoma Eventually 20% become malignant

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Erythroplakia

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More precancerous than Leukoplakia "Red Leukoplakia" or "Dysplastic Leukoplakia" Red, velvety and eroded area Epithelial changes are markedly atypical, leading to higher risk of malignant transformation - <50%

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Locations of Oral Cancers

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Tongue Lower Lip Floor of Mouth Gingiva and Edentulous Alveolar Ridge Hard Palate Buccal Mucosa

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Cancer of the Tongue

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25-30% or all oral cancers Most common site - Lateral and ventral aspect of anterior 2/3rds Main etiology is tobacco and alcohol

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Cancer of the Tongue Physical Finding

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Painless ulcerated or exophytic mass

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Cancer of the Lower Lip

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20-25% of oral cancers Less common in women Has higher survival rates due to cosmetic location

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Cancer of the Lower Lip Physical Finding

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May also appear on the upper lip (10%) Lipstick is protective

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Cancer of the Floor of the Mouth

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20% of all oral cancers Etiology linked to tobacco and alcohol Presents as an ulcerated mass with pain, bleeding, and excessive salivation Chance of invasion into underlying bone (15-30% of patients)

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Cancer of the Gingiva and Alveolar Ridge

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6% of oral cancers Lower jaw more common than upper jaw Edentulous areas more commonly affected than areas with teeth Presents with non-specific findings (Sore throat, difficulty opening mouth) MC clinical appearance is an ulcerated exophytic mass

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Cancer of the Hard Palate

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Among the rarest primary intraoral site of SCC in US More common in southern India Linked to tobacco and alcohol use Presents with ulcerative and exophytic lesion with or without associated pain and/or bleeding 1/3rd have underlying bone invasion in late stages.

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Cancer of the Buccal Mucosa

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2% of oral cancers Early lesions may present with irregular leukoplakic or erythroplakic plaques. Advanced lesiosn appear as ulcerative and infiltrative exophytic masses. Known to spread to other oral regions Etiology associated with smoking, chewing, dip and alcohol.

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Oral Cancer - Clinical Features

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Small lesions may be asymptomatic with minimal clinical findings and vague symptoms Large lesions may present with local or referred pain, difficulty swallowing, speaking, chewing or opening of the mouth. Weight loss may present with extensive metastasis. Metastasize primarily to submandibular, superficial, and deep cervical lymph nodes more than 1/2 of patients to die have distant blood-borne metastasis to liver, lungs, GI or bone. Begin in-situ (Superficially) MC are raised, firm, pearly white lesions with central necrosis and rolled borders

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Stage 1 of Clinical Staging of Oral Cancers

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Cancer is less than 1 inch in size and no lymph node involvement

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Stage II of Clinical Staging of Oral Cancers

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Cancer is more than 1 inch but less than 2 inches with no lymph node involvement

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Stage III of Clinical Staging of Oral Cancers

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Cancer is greater than two inches, with only one lymph node positive on the same side as the lesion

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Stage IV of Clinical Staging of Oral Cancers

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Cancer is of any size with spread to several lymph nodes on one or both sides as the lesion and/or distant metastasis.

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Treatment and Behavior or Oral Cancers

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Early stages (I or II) - Surgery, radiotherapy, or combination Advanced (III or IV) - combination or surgery, radiation and chemotherapy 75% of intraoral SCC are diagnoses at late stages, negatively effecting prognosis

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Human Papilloma Virus (HPV)

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Double-Stranded DNA virus that infects epithelial cells or skin and mucosa Several serotypes with preference to certain areas of the body Most visible form causes common warts

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Cancer of the Nasal Cavity and Sinuses

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Over 60% of SCC arise here Pathogenesis relates to exposure to certain industrial chemicals - Chromium, nickel, and aromatic hydrocarbons. Also associated with woodworking and leather occupations due to cutting oils and textiles More common in males over age 50%

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Cancer of Nasopharynx

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SCC associated with EBV Most frequent of all malignant tumors in China parts of Africa. EBV found in 90% of tumor cells and patients show anti-bodies to EBV in serum in these areas Genetic association in Chinese Most remain asymptomatic for years Tumor can invade into parapharyngeal space, orbit, and cranial cavity resulting in neurologic symptoms of the cranial nerves. Radio sensitive with survival rate <5 years

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Cancer of Larynx

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SCC originating from glottis, epiglottis and subglottis respectively. Most cases related to smoking and alcohol 1% of cancer deaths in US Symptoms of hoarseness, cough and dysphagia Spreads via direct extension to skin, regional cervical lymph nodes, or into blood to lungs

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