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Salivary Gland Disease 49

https://t.me/med1917

TNM OF SALIVARY GLAND CANCER

Outline of the tumour component of the salivary gland cancer TNM classication.

●

T1 – up to 2cm

●

T2 – up to 4cm

●

T3 – more than 4cm OR extraparenchymal

●

T4a – local structures (skin, mandible, ear, nerve)

●

T4b – distant structures (pterygoid, skull base, carotid)

FURTHER READING

Shiboski SC, Shiboski CH, Criswell L, etal. American College of

Rheumatology classiﬁcation criteria for Sjögren’s syndrome: Adata-driven, expert consensus approach in the Sjögren’s International Collaborative Clinical Alliance cohort. Arthritis Care Res. 2012;64:475–87.

Vitali C, Bombardieri S, Jonsson R, etal. Classiﬁcation criteria for

Sjogren’s syndrome: Arevised version of the European crite ria proposed by the American-European Consensus Group. Ann Rheum Dis. 2002;61(6):554–58.

t.me/Dr_Mouayyad_AlbtousH

https://t.me/med1917

Oral Medicine and Pathology

BEHCET’S INTERNATIONAL DIAGNOSTIC CRITERIA

e following list describes diagnostic criteria for Behcet’s disease; diagnosis requires a total of four points.

Two points for each of

●

Oral

●

Genital

●

Ocular

One point for each of

●

Skin

●

CNS

●

Vascular

●

Pathergy test positive

DOI: 10.1201/9781003156895-6 51

t.me/Dr_Mouayyad_AlbtousH

52 Classiﬁcations and Lists in Oral and Maxillofacial Surgery

https://t.me/med1917

BURNING MOUTH SYNDROME CRITERIA

e following list outlines criteria for the diagnosis of burning mouth syndrome

●

Nothing to nd intraorally

●

Daily

●

>2hours per day

●

>3 months

●

Burning

●

Mucosal

●

No neurological decit allowed

MONTANDON CLASSIFICATION OF NOMADEFECTS

This classification describes the extent of noma according to the anatomical structures of the face involved in orofacial gangrene.

1. Commissure and cheek

2. Upper lip and nose

3. Lower lip and chin

4. Extensive

MEDICINE-RELATED OSTEORADIONECROSIS OF THE JAW (MRONJ) STAGING BY RUGGIERO

This system describes the stages and management options of medicine-related osteoradionecrosis of the jaw (MRONJ). More advanced stages correspond to symptomatic presentations and require superficial debridement and antibacterial therapy.

●

‘At r isk’

●

0 – non-specic symptoms (analgesia and antibiotics if indicated)

t.me/Dr_Mouayyad_AlbtousH

Oral Medicine and Pathology 53

https://t.me/med1917

●

1 – exposed bone, asymptomatic, 3-month follow-up, chlorhexidine, review meds

●

2 – symptoms, supercial debridement and antibiotics (Abx)

●

3 – complications (fracture, stula, down to lower border of mandible or oor sinus), resect and antibiotics

ORAL PRE-MALIGNANT LESIONS AND CONDITIONS

e following list outlines common pre-malignant lesions of the oral mucosa and their associated malignant transformation rates (MTRs).

Lesions:

●

Erythroplakia (25% MTR)

●

Leukoplakia (6% MTR overall but subtypes are homogeneous, speckled or proliferative)

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Verrucous leukoplakia (MTR as high as 50–80%)

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Oral submucous brosis (OSMF) (8% MTR)

●

Erosive lichen planus (1% MTR)

Others:

●

Syphilitic glossitis

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Plummer Vinson syndrome

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Fanconi anaemia (need quarterly screening and aggressive biopsy policy plus HPV vaccination)

●

Discoid lupus erythematosus

t.me/Dr_Mouayyad_AlbtousH

54 Classiﬁcations and Lists in Oral and Maxillofacial Surgery

https://t.me/med1917

ORAL SUBMUCOUS FIBROSIS (OSMF) GROUPING BY KHANNA AND ANDRADE

e classication that follows describes oral submucous brosis (OSMF) grades based on restriction of mouth opening. Pathological processes involve abnormal collagen deposition and chronic inammation, which can lead to brosis and scarring. Most advanced lesions are associated with pre-malignant changes.

Based on maximal incisal opening (MIO)

1. >35mm MIO

2. 26–35mm MIO

3. 15–26mm MIO 4a. <15mm MIO 4b. Advanced – pre-malignant lesions

OSMF STAGES

e following list outlines stages of OSMF and their associated clinical presentation.

1. Stomatitis

2. Fibrosis

a. Early/blanching b. Old/marble

3. Sequelae

a. Leukoplakia b. Speech/hearing problems

OSMF TREATMENT

Summary of management strategies for OSMF. Early stages can be treated with topical and systemic steroid therapy, whilst advanced lesions require surgical management.

●

Steroid topically/systemically

●

Intra-lesional hyaluronidase/steroids

●

Pentoxifylline, interferon gamma, surgery

t.me/Dr_Mouayyad_AlbtousH

Oral Medicine and Pathology 55

https://t.me/med1917

FURTHER READING

Davatchi F. Diagnosis/classiﬁcation criteria for Behcet’s disease.

Patholog Res Int. 2012;2012:607921.

Gurvits GE, Tan A. Burning mouth syndrome. World J

Gastroenterol. 2013;19(5):665–72.

Khanna JN, Andrade NN. Oral submucous ﬁbrosis: Anew con-

cept in surgical management. Report of 100 cases. Int J Oral Maxillofac Surg. 1995;24:433–39.

Mustafa E, Parmar S, Praveen P. Premalignant lesions and condi-

tions of the oral cavity. In: Bonanthaya K, Panneerselvam E, Manuel S, Kumar VV, Rai A, eds. Oral and maxillofacial surgery for the clinician. Singapore: Springer; 2021.

Pindborg JJ. Oral submucous ﬁbrosis: Areview. Ann Acad Med

Singap. 1989;18(5):603–7.

Ruggiero SL. Diagnosis and staging of medication-related

osteonecrosis of the jaw. Oral Maxillofac Surg Clin North Am. 2015;27(4):479–87.

Speiser S, Langridge B, Birkl MM, Kubiena H, Rodgers W. Update

on Noma: Systematic review on classiﬁcation, outcomes and follow-up of patients undergoing reconstructive surgery after Noma disease. BMJ Open. 2021;11(8):e046303.

t.me/Dr_Mouayyad_AlbtousH

https://t.me/med1917

Conditions of Skin and Facial Cutaneous Surgery

ACTINIC KERATOSIS GRADING BY OLSEN

is classication describes the clinical appearance of actinic keratosis; it was developed by Olsen in 1991.

1. Flat pink, on inspection and palpation look ‘thin’

2. On inspection and palpation look ‘medium’

3. On inspection and palpation, appear to be very thick, ‘hypertrophic’

nolevulinate photodynamic therapy (MAL-PDT), 5-uorouracil (5-FU), imiquimod

DOI: 10.1201/9781003156895-7 57

t.me/Dr_Mouayyad_AlbtousH

58 Classiﬁcations and Lists in Oral and Maxillofacial Surgery

https://t.me/med1917

FITZPATRICK SUN-REACTIVE TYPES FOR SKIN

is classication describes and classies skin types by their reaction to exposure to sunlight.

1. Always burns, never tans

2. Always burns, sometimes tans

3. Sometimes burns, easily tans

4. Never burns, always tans (Mediterranean)

5. Moderately pigmented (brown)

6. Black skin

Types 1 and 2 heal best with resurfacing procedures, but as they get deep tension lines, they are the least likely to benet from peels/dermabrasion/laser, etc.

NON-MELANOTIC SKIN CANCER (NMSC) FOLLOW-UP

is list describes the follow-up required for non-melanocytic skin cancers, including basal cell carcinomas and squamous cell carcinomas as well as high-risk lesions.

●

Single basal cell carcinoma (BCC) – none

●

Multiple/recurrent – annual

●

High-risk squamous cell carcinoma (SCC) – every 3–6 months for 2years then annually

CRITERIA OF HIGH-RISK NMSC

ese criteria describe features consistent with high-risk NMSC that would warrant more extensive excision margins.

●

More than 2cm (more than 6mm is T3)

●

Recurrent/treatment failed

●

Immunosuppression

●

PERINEURAL (T3)/perivascular

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Conditions of Skin and Facial Cutaneous Surgery 59

https://t.me/med1917

NB: Plus if BCC – central face, poorly dened margins, high-risk histology ndings

NB: If SCC – ear/hair-bearing lip, histology: poorly dierentiated/ Clark 5/>2mm thick as 4% metastasis rate (if >6mm thick, met rate is 12% AND IT IS AT3 BY DEFAULT)

NMSC STAGING

is classication describes the staging of NMSCs, which are staged according to the tumour (T), nodes (N) and metastases (M) staging system. T corresponds to the size and extent of the main tumour, N refers to the number of lymph nodes involved and M refers to metastases.

●

T1 – up to 2cm (maximum of one high-risk factor)

●

T2 – more than 2cm (or more than one high-risk factor)

●

T3 – into maxilla, mandible, orbit, temporal bone (if perineural invasion or more than 6mm deep/thick, it is t3 by default)

●

T4 – into axial/appendicular skeleton or skull base

●

IIIA=T3, IIIB=N1

●

IVA=N2, IVB=N3, IVC=T4, IVD=M1

CASES FOR THE MULTIDISCIPLINARY TEAM(MDT)

e following is a list of specic indications that would warrant discussion with the MDT.

●

High risk [specically including involved/close (<1mm) margins or recurrent]

●

Metastases

●

Specic treatment (Moh’s, DXT, trials)

●

Immunocompromised/genetics

●

Challenging management issues (comorbidity/social)

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60 Classiﬁcations and Lists in Oral and Maxillofacial Surgery

https://t.me/med1917

INDICATIONS FOR MOHS MICROGRAPHIC SURGERY

e following are the reasons to consider Mohs micrographic surgery, which involves removal of tissue followed by immediate tissue examination under microscopy to assess for tumour cells. is is the gold standard for achi eving complete ma rgin control during sk in cancer exci sion.

1. Recurrent

2. High-risk factors

3. Anatomy

4. Additional: dermatobrosarcoma protuberans

NECK TREATMENT IN NMSC

The following will discuss the various management options for patients who have neck nodal involvement associated with their skin cancer.

●

N0? – monitor

●

Node positive but parotid negative? – anterior neck (1–4 with EJN)/ posterior neck (2–5 with EJN), include parotid if anterior to ear

●

Node positive AND parotid positive? – modied radical neck dissection (MRND) or selective neck dissection (SND) levels 1–4, with radiotherapy (DXT) to level 5

●

Node negative but parotid positive? – levels 1–3 with EJN and parotidectomy

●

Adjuvant DXT needed? – used if more than N1 or ECS

MELANOMA BRESLOW THICKNESS (MEASURED FROM GRANULAR LAYER DOWN)VERSUS CLARK SCALE

Breslow’s thickness describes the thickness of the melanoma from the surface of the skin to its maximal depth. Clark’s scale describes how deeply the melanoma has grown into the skin and the levels of the skin aected.

●

Breslow 1mm equates to Clark 1 (epidermis)

●

2mm 2 (papillary dermis) has 80% 5-year survival

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