HEAD NECK 9 Leukoplakia

HYPERKERATOSIS

White patches are sometimes seen on oral mucosa called

leukoplakia.  

This is a specific premalignant lesion.

 

*  Microscopic change show hyperplasia, keratosis and

   dyskeratosis, i.e. loss of normal stratification, irregularity

   in   the   size  and  shape  of   cells,   abnormal   staining

   characteristics.

 

*  Palpation will reveal a definite firmness of the mucosa.

 

*  Cancer will develop in 5% of such patients.

 

*  Local irritant associated with this lesion are smoking, sepsis,

   sharp  tooth,  spirits  and spices (in  betel  chewing)  these

   should be eliminated.

 

Local   excision   may   be   useful.    

Radiation therapy is contraindicated.

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HEAD NECK 8

4.4 GIANT CELL (REPARATIVE) GRANULOMA

 

Usually  occurs on the gums as a red epulis or intra bony  lesion

of  maxillary  or mandibular bones because of a bleed in  to  the

marrow and is slow growing, reddish, smooth sessile tumour  which

bleeds easily.

 

Histologically  lesions show stratified squamous epithelium  with

interspersed  fibroblastic  proliferation,  multinucleated  giant

cells and heamosiderin pigments, all these constitute  diagnostic

microscopic criteria.

 

Treatment of this soft tissue lesion is by complete excision  and

curreting  

 

4.5 HEMANGIOMA

 

Capillary hemangioma are sometimes seen on the mucosa of the oral

cavity  in  infants and like hemangiomas elsewhere  they  regress

spontaneously.

 

*  Rarely  large vascular malformations will involve  the  entire

   side  of  the mouth including the tongue; gingiva  and  buccal

   mucosa.

 

Treatment  is  difficult expectant treatment in follow up they  do regress with age

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HEAD NECK 7 Mouth ulcers Cysts

Usually  a  single ulcer opposite a sharp tooth  or  ill  fitting

denture usually along lateral margin of tongue.

A dental consultation is required.

Cysts  are a common lesion occuring in the posterior  surface  of

the lip, floor of the mouth; tongue and buccal mucosa.

* These are the salivary gland-bearing areas.  These cysts  mucus

  result  from  the  obstruction of the duct  of  minor  salivary

  glands.

* Treatment is by excision under local anaesthesia.

4.3 RANULA

This is a cyst caused by obstruction or damage of the mouth of  a

sub-lingual gland of the floor of the oral cavity. Fig.14.1

*  The cyst elevates the floor of the mouth and pushes the tongue

   to the opposite side.

*  Treatment is by excision of the cyst.

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HEAD & NECK 6

4. ORAL CAVITY

 

4.1 ORAL ULCERATION

 

Ulcers do occur in the oral cavity and the cause of these  ulcers

are infection, trauma (teeth) and dyspeptic.

 

The ulcers most commonly seen are aphtous  ulcer are  superficial

(shallow),  round or oval and they are painful to touch  and  are

soft. They usually settle in 1.2 weeks.

 

Oral  hygiene  and look for dental trauma,  local  mouthwash  can

help.

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HEAD & NECK 5 lymphoma

3.2 PRIMARY LYMPHOMA

Lymph  glands  with a typical rubbery feel,  firm  discrete  (not

matted)  at  multiple sites and are the  usual  presentation  that indicates of primary lymphoma (non hodgkin).

Hodgkins lymphoma is seen in adult of 20-30 years and 55-70 years

and  is  less common, the gland enlargment is painless.  

There  is however feeling of illness and fever. There may be loss of  appetite

and weight.

TREATMENT

Treatment is with chemotherapy and radiotherapy.

Burkitt`s  lymphoma is found in the tropics, 

suspected to be of viral origin.

In lymph gland enlargments a biopsy is required for diagnosis.

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HEAD & NECK 4

3. LYMPH GLAND ENLARGEMENTS

 

There  a few hundred lymph glands located in the head  and  neck. 

They  are  in the main distributed in  the  superficial  location

shown in Fig.Above  

They are enlarged whenever there is an inflamatory disorder in the area of drainage of these glands.  

In later  life they  are enlarged because of malignant tumours in the  area  of their  drainage.   

Therefore in lymph gland enlargements  of  the

neck the oral cavity, oesophagus  lungs and thyroid need physical examination and investigations. 

 

Lymph   glands   also  get  enlarged  in   cases   of   glandular

fever(Infections,   mononucleosis).   This   produces   bilateral

multiple  lymph  nodes fever and sore throat.  This  is  a  viral fever.

 

3.1 TUBERCULAR LYMPH GLAND enlargement  

 

These  glands present as chronic enlarged matted lymph nodes,  and are  seen in developing countries.  

One or more of  these  glands may be associated with a discharging sinus.

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HEAD NECK 3 Cysts

2.2 THYROGLOSSAL DUCT CYSTS (Fig above)

The  cyst occurs in the midline in the neck and  originates  fromthe  remnant  of the thyroglossal duct. It marks  the  path  of

descent of the thyroid from the foramen caecum of the tongue. 

The cyst  appears  when the duct or a part of it fails  to  disappearduring development.

Presents  as  a  painless  lump in the  midline  which  moves  ondeglutation and on protrusion of the tongue.

Treatment is Surgical Excision.

2.3 BRANCHIAL CYST (Pharyngeal pouch remnant)

Presents  as a lump anterior to the sternomastoid in upper  third but  may  be lower.  

It presents between 20-30  years  rarely  in

childhood it is fluctuant and transilluminant.  It sometimes gets infected  and  a sinus appears in the  neck.    

Sometimes  rarely there is an internal opening resulting in a fistula.

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