6.2.2 Oral Cavity Examination

Добавил:

Sekretar kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.

Вуз:

Ростовский Государственный Медицинский Университет

Предмет:

Медицина общая

Файл:

Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4440_Библиотеки_им_академика_М_И_Перельмана.pdf

Скачиваний:

Добавлен:

30.08.2026

Размер:

51 Мб

Скачать

☆

<<< < Предыдущая 14 15 16 17 18 19 20 21 22 23 24 2526 / 5026 27 28 29 30 31 32 33 34 35 36 37 38 > Следующая >>>

240

6 History andExamination ofLip andOral Cavity

dibular abscess/Ludwig angina), inammatory (allergic angioedema) and neoplastic causes (pharyngeal or oesophageal masses). Another cause of impaired swallowing is neurological impairment (multiple cranial nerve dysfunction, severe brain injury and neurodegenerative disease), which causes peripheral denervation or loss of central motor coordination and idiopathic.

(l) Dental occlusion—Occlusion is dened as

the way the teeth meet when the lower jaw (mandible) and upper jaw (maxilla) come together. It is how the teeth contact in any type of functional relationship. Static occlusion refers to contact between teeth when the jaw is closed and stationary, while dynamic occlusion refers to occlusal contacts made when the jaw is moving.

• Normal occlusion—Upper teeth are slightly anterior to lower teeth

• Abnormal occlusion (malocclusion)

– Class I malocclusion (overlay

crowded)

– Class II malocclusion (overbite)—

Upper incisor too far infront lower incisor

– Class III malocclusion (underbite)—

Upper incisor far behind lower incisor

(m) Loose teeth or loss of teeth—The loose

teeth or missing teeth may present with or without gum diseases like swollen gum, bleeding gum and red gum.

• Duration

– Acute—Trauma – Chronic—Ageing, carcinoma,

periodontitis

• Mode of onset

– Sudden—Trauma – Gradual—Infection, carries, carci-

noma, stress, periodontitis

• Associated symptoms—Trauma, infection, radiation, carcinoma, gum diseases, tooth grinding or bruxism, H/O phenytoin intake, diabetes, cancer, arthritis, osteoporosis

(n) Bleeding from the oral cavity

• Site of bleeding – Gum—Gingivitis, trauma, microaneu-

rysm, bleeding disorders, ill-tting denture, scurvy

– Tongue—Haemangioma, trauma,

granuloma, carcinoma, post-radiation

– Cheek—Ulcer, trauma, granuloma,

carcinoma, bleeding papule

– Hard palate—Trauma, carcinoma,

ulcer

• Duration—Acute or chronic or recurrent

• Mode of onset—Sudden or gradual

• Amount of blood loss—Mild, moderate

or severe

• Associated symptoms—Fever

• H/O bleeding diathesis, trauma, medica-

tion, bleeding from other sites, lung diseases, alcoholic liver disease, neoplasm, tooth extraction, trauma, cough, melena, epistaxis.

(o) Slurred speech (dysarthria)—The produc-

tion of vocal sounds is a function of the larynx. Sounds are then modulated as they pass through the nasopharynx and mouth, which act as resonators. Articulation consists of contractions of the pharynx, palate, tongue and lips, which alter the vocal sounds. Vowels are of laryngeal origin, whereas most consonants are formed during articulation. The consonants M, B and P are labial; I and t are lingual; and nk and ng are guttural (pharynx and soft palate). Test phrases or rapid repetition of lingual, labial and guttural consonants can bring out the particular abnormality (e.g. Ia-la-la, me-me-me, k-k- k). Dysarthia is a motor speech disorder in which the muscles that are used to produce speech are damaged, paralyzed or weakened. A person with dys- arthria cannot control his or her tongue, larynx, vocal cords and surrounding muscles, which makes it difcult for the person to form and pronounce words.

• Type of dysarthria (Table6.18)

• Causes of dysarthria (Table6.19)

(p) Aphasia—Aphasia is an impairment of lan-

guage, affecting the production or compre-

6.1 Symptoms/Chief Complaint/History ofLip andOral Cavity Disorders

Table 6.18 Shows the presentation of various types of dysarthria

Type of dysarthria Symptoms and signs Spastic dysarthria Slow speech rate, with strained or strangled voice quality, monotone and effortful

speech

Flaccid dysarthria Nasal-sounding speech, breathy voice, talk in short phrases, audible breathing,

imprecise consonant

Hypokinetic dysarthria Monotone and typically quiet speech, lots of inappropriate silences and increased or

rushed

U/L upper motor neuron, dysarthria

Hyperkinetic dysarthria Hyperkinetic dysarthria is characterized by abnormal involuntary movements

Dyskinetic dysarthria Ataxic dysarthria This is drunk-sounding dysarthria presented as incoordination and slurred speech. Dystonic dysarthria

Table 6.19 Shows causes of dysarthria

Flaccid Spastic Rigid Ataxic Mixed Progressive bulbar

palsy Myasthenia gravis Lyme disease

U/L lower facial weakness, slow speech rate, quiet voice and intermittent speech sound error

affecting respiratory, phonatory and articulatory structures, impacting speech and deglutition presents as slurred or slow speech, shaky voice, shortness of speech or fatigue while speaking, muscle spasm and tremors, abnormal jerking and falling movement and abnormal muscle tone

Pseudo-bulbar palsy Stroke Anterior opercular syndrome

Parkinson’s disease Choreal myoclonus Cerebral palsy

Cerebellar lesion

Multiple sclerosis Amyotrophic lateral sclerosis Neoplasm

241

Table 6.20 Shows signs and symptoms of various types of aphasia

Type of Aphasia Symptoms and signs Expressive aphasia (non-uent) Person knows what he or she wants to say, yet has difculty communicating it

to others.

Receptive aphasia (uent) Person can hear a voice or read the print, but may not understand the meaning

of the message.

Anomic aphasia Person has word-nding difculties. This is called anomia. Because of the

difculties, the person struggles to nd the right words for speaking and writing.

Global aphasia This is the most severe type of aphasia. The person has difculty speaking and

understanding words. In addition, the person is unable to read or write.

Primary progressive aphasia Rare disorder where people slowly lose their ability to talk, read, write and

comprehend what they hear in conversation over a period of time.

hension of speech and the ability to read or write. It is always due to injury to the brain— most commonly from a stroke, particularly in older individuals. People who have aphasia may have difculty speaking and nding the ‘right’ words to complete their thoughts.

• Type of aphasia (Table6.20)

(q) Disturbance/alteration of taste sensa-

tion—There are four genuine taste qualities:

salty, sweet, sour and bitter. Recently a fth taste quality, ‘umami’, the taste of glutamate, aspartate and certain ribonucleotides, has been described.

• Type of altered disturbed taste (Table6.21)

• Symptoms or presentation of altered/disturbed taste

– Gums turned brownish then white.

242

Table 6.21 Shows types of altered taste with denitions and causes

Type of disturbed taste Denition Causes

Hypogeusia Decrease ability to taste COVID-19, post-radiation, head injury, middle ear surgery, vitamin

B12 deciency, poor oro-dental hygiene, GERD, xerostomia

Dysgeusia/ parageusia

Ageusia Inability to taste Covid 19, radiation therapy, diabetes, hypothyroidism, Sjogren

Hypergeusia Increase sensibility to

Phantogeusia Phantom taste (foul,

Table 6.22 Shows causes of altered taste

Common causes Less common causes Uncommon Primary smell disorder

URI Poor oral health Medication Chorda tympani injury Age

A person’s perception of taste is altered or distorted

taste

salty, rancid, metallic)

Burning mouth syndrome, age, Bell’s palsy, GERD, Crohn’s disease, pregnancy, zinc deciency, radiation, chemotherapy, lead poisoning, glossopharyngeal nerve palsy

syndrome, Parkinson’s disease

Drugs (metronidazole, aspirin, terbinane, clindamycin, lincomycin, tinidazole, Vit. D, allopurinol, ethambutol)

Nutritional deciency Renal disease Diabetes mellitus Head and neck cancer Radiation therapy

6 History andExamination ofLip andOral Cavity

Gustatory Psychiatric condition Endocrine disorders Head trauma Toxins

– Multiple lesions on gums, tongue,

throat and palate. – Sore and bloody mouth and gums. – Only some places on the tongue can

raise taste. – Foul breath along with foul taste and

foul smell. – Sudden weight loss occurs in patients

with hypogeusia. – Anorexia occurs due to less attraction

towards food. – Oral thrush is a common symptom of

hypogeusia. – Most of the time patients do not feel

any taste. – Too much pain in the gums and teeth,

also in the throat and mouth. – Swelling of mouth. – Sometimes patient is not able to even

smell anything properly along with

the taste.

• Mode of onset – Sudden—Covid-19, drugs, viral,

Bell’s palsy, fractured temporal bone

– Gradual—Burning mouth syndrome,

vitamin B3 def., zinc def., radiation therapy, ageing

• Duration – Acute—Covid-19, drugs, glossitis,

head trauma

– Chronic—Burning mouth syndrome,

vitamin B3 def., zinc def., radiation therapy, ageing

• Associated symptoms—Oral infection,

mucosal lesion, poor oral hygiene, ageing, poor nutrition, URI, DM, pregnancy, AIDS

• Ruled out any past history—Head injury,

radiation, chemotherapy, ear surgery

– Multiple sclerosis, facial paralysis,

use of articial denture, B/L ear surgery

– Medication (ethambutol, clindamycin,

renal disorder, head and neck cancer, radiation)

• Causes of taste disturbance (Table6.22)

• Differences between non-cancerous,

pre-cancerous and cancerous lesion (Table6.23)

6.2 Examination ofLips andOral Cavity

Table 6.23 Shows clinical difference among the benign lesion, pre-cancerous and cancerous oral lesions

Non-cancerous tumours Pre-cancerous lesion Cancerous lesion Papilloma is a smooth lump or

wart-like growth.

Benign tumour of the minor salivary glands is a growth that

develops in the minor salivary glands. Haemangioma is a growth made up of dilated (enlarged or widened) blood vessels. Lymphangioma is a growth made up of dilated lymph vessels. Lipoma is a growth made up of fat cells. Fibroma is a growth that starts in the tissue that surrounds and supports various organs in the body (called brous connective tissue). Neuroma is a growth that starts in nerve cells (neurons).

Leukoplakia Erythroplakia Lichen planus Oral submucous brosis

Squamous cell carcinoma

Verrucous carcinoma lymphomas Minor salivary gland carcinoma there are many types of minor salivary gland cancers, including adenoid cystic carcinoma, mucoepidermoid carcinoma and polymorphous low-grade adenocarcinoma. To learn more about these cancers, as well as benign salivary gland tumours

243

6.2 Examination ofLips andOral Cavity

Oral mucosa covers the lip and cheek and is generally pink in colour and highly keratinized, but masticatory mucosa covers the hard palate and dorsal surface of the tongue, and the gingiva is rm, stippled and pale.

6.2.1 Examination ofLip

Upper and lower lips—The normal lips are usually smooth and pliable, and the labial mucosa is smooth, soft and well lubricated. The examination of lips should be carried out by following the given parameters below.

1. General examination of lip—This part of the

examination includes the colour of lips, texture of lip, size of lip, any deformity, etc.

Inspection of lips

(a) Colour of lips

• Pinkish—Normal

• White—Reticular lesions of lichen planus, leukoplakia, candidiasis, OSMF

• Red—Inammation, atrophic epithelium, hyperplasia

• Black—Melanoplakia, tattoo, nevus

• Bluish—Haemangioma

• Translucent blue—Retention cyst

• Grey—Silver amalgam, graphite, lead, mercury

• Yellow—Adipose tissue, gland

(b) Texture of lips—A normal lip is smooth

and pliable.

• Normal

• Abnormal—Hypertrophied, double lip

(d) Deformities of lips—These deformities

have been discussed in detail in Chap. 16.

• Types of deformities

– Cleft deformities—This is the most

common congenital deformity of the upper lip.

– Unilateral cleft lip—Failure of the

maxillary prominence on the affected side to join with the merged medial nasal prominences, resulting in a persistent unilateral cleft lip.

– Bilateral cleft lip—Failure of the

mesenchymal masses of the maxil-

244

6 History andExamination ofLip andOral Cavity

lary prominences to meet and merge with the merged medial nasal prominences. Defects may or may not be similar, with varying degrees of defects on each side.

– Median cleft lip—This is very rare

and is caused by a mesodermal deciency. Partial or complete failure of the medial nasal prominences to merge and form the intermaxil-

lary segment. – Non-cleft deformities. – Lip pits—Depression located on

the vermilion of the lower lip, usu-

ally paramedian. – Commissural pit—Depression

located at an oral commissure. – Cupid bow—Absent or

exaggerated. – Lip freckle—Increase lip focal

pigmentation of the vermilion of

the lip. – Prominent nasolabial fold—

Exaggerated bulkiness of the crease

or fold of skin running from the lat-

eral margin of the nose, where the

nasal base meets the skin of the

(e) Ulcerations of lips face, to a point just lateral to the corner of the mouth.

– Underdeveloped nasolabial

fold—Reduced bulkiness of the crease or fold of skin running from the lateral margin of the nose, where the nasal base meets the skin of the face, to a point just lateral to the corner of the mouth.

– Everted vermilion of lower lip—

Inner aspect of the lower lip vermilion (normally opposing the teeth) visible in a frontal view.

– Thick vermilion of lower lip—

Height of the vermilion of the lower lip in the midline is more than 2 SD above the mean.

– Thin vermilion of lower lip—

Height of the vermilion of the medial part of the lower lip is more than 2 SD below the mean.

– Everted vermilion of upper lip—

Inner aspect of the upper lip vermilion (normally opposing the teeth) is visible in a frontal view.

– Tented vermilion upper lip—

Triangular appearance of the oral aperture with the apex in the midpoint of the upper vermilion and the lower vermilion forming the base.

– Thick vermilion upper lip—

Height of the vermilion of the upper lip in the midline more than 2 SD above the mean.

– Thin vermilion upper lip—Height

of the vermilion of the upper lip in the midline more than 2 SD above the mean.

– U-shaped vermilion upper lip—

Gentle upward curve of the upper lip vermilion such that the centre is placed well superior to the commissures.

• Site of deformities – Upper lip—Cleft lip with or with-

out cleft palate

– Lower lip—Cleft lip

• Type of ulcer—Aphthous ulcer (canker

sores), RAS

• Site of ulcer—Upper lip, lower lip,

angle of mouth or labial mucosa

– Upper lip—Cold sores (herpetic

ulcer), aphthous ulcer (cancer sore), BCC

– Lower lip—Cold sores (herpetic

ulcer), aphthous ulcer (cancer sore), SCC

– Angle of mouth—Angular

stomatitis

– Both lip—Steven-Johnson syn-

drome, cold sore

• Localized or generalized

• Margins of ulcer—Everted, insulated

• Number of ulcer – Solitary—Trauma, BCC, SCC – Multiple—Cold sore, canker sore

• Bed of ulcer—Necrotic tissue, red,

debris

6.2 Examination ofLips andOral Cavity

245

(f) Lip vesicles

• Herpes simplex (cold sore, fever blister)

(g) Lip ssures

• Angular stomatitis or cheilosis (perleche)

• Cheilitis

(h) Lip pigmented lesions.

• Mucous retention cyst (mucocele)

• Peutz-Jeghers syndrome

(i) Lip swelling

• Upper lip swelling (Table6.24)

• Lower lip swelling—Injury (cuts, bites, burns or trauma), cheilitis glandularis, lip carcinoma

• Both lips—Allergies, oral allergy syndrome, angioedema, anaphylaxis, Miescher-Melkersson-Rosenthal syndrome, cellulitis, erythema multiforme

• Angle of mouth—Cold sores, herpes infection

• Commissure of lip—Angular stomatitis is common in vitamin deciency, iron deciency, overclosure of the jaw.

Palpation of lip—The lip should be palpated for induration, tenderness, lip tone, swelling and bleeding on touch.

2. Aesthetic examination of lip—However, it is important to keep in mind that the lips are only one element that makes a smile attractive. Some of the other factors that determine the lower face and smile aesthetic include skeletal components (position of the jawbone relative to the maxilla), soft tissue factors (prominence of the chin and nose, as well as

lip and soft tissue morphology) and factors related to the dentitions, gingivae and alveolar bone (crown length and width, incisor crown angulation, the incisal plane, the midline, gingival margin, open gingival embrasure and gingiva-to-lip distance).

(a) Assessment of lower lip fullness in rela-

tionship to Ricketts E-line: (1) normal, (2) retrusive and (3) full lower lip.

(b) The lower lip line can inuence the inci-

sor position. (1) A high lower lip line is associated with retroclined upper incisors and (2) a low lower lip line is associated with incisor proclination and poor stability of overjet correction.

lips is indicated by puckering of the chin due to mentalis contraction.

(d) A number of factors determine lip com-

petency. (1) Competent lips. Incompetent lips due to (2) an increased LAFH, (3) mandibular retrognathia, (4) a short upper lip and (5) incisor protrusion.

(e) Methods of achieving an anterior oral

seal: (1) lip to lip, (2) tongue to lower lip, (3) lower lip to palate and (4) tongue to upper lip contact.

(f) A vigorous digit sucking habit can leave a

tell-tale colour on the digit sucked where it rubs against the incisal edges.

(g) The nasolabial angle may be (1) normal,

(2) obtuse due to a poor upper lip position, (3) obtuse due to an upwardly sloping columella and normal upper lip position and (4) acute due to a protrusive upper lip.

Table 6.24 Shows differential diagnosis of upper lip swellings

Salivary gland tumour Mesenchymal tumour Infection Others Pleomorphic tumour,

canalicular adenoma, mucoepidermoid carcinoma

Lipoma, leiomyoma, neurobroma, neurilemmoma, schwannoma, benign brous histiocytoma, oral focal mucinosis, glandular cell tumour

Periapical abscess, tuberculosis, syphilitic Gumma, deep fungal infection

Angioneurotic oedema

246

6 History andExamination ofLip andOral Cavity

6.2.2 Oral Cavity Examination

1. General examination of the oral cavity

(a) Oro-dental hygiene

• Grading of oral hygiene—Good/average/bad

• Type of bad odour (halitosis or bad breath)

– Rotten egg smell (Table6.25) – Fruity or sweet smell—The breath

having a sweet, fruity odour is often present in ketoacidosis (a complication of diabetes). Ketones produced due to the breakdown of fat produce a fruity odour.

– Mouldy or fungus smell—Sinus

infections often cause thick, yellowish- green mucus to drip from the nose to the back of the throat which smells like mould or fungus.

– Faecal smell—Intestinal obstruc-

tion causes such smell.

– Fishy smell—A damaged kidney

no longer can lter the waste and toxins. These toxins and waste start to accumulate throughout the body, resulting in a shy breath smell.

(b) Mouth opening: The normal range of

mouth opening differs from person to person, varying between 40 and 60mm and averaging between 35 and 55 mm, which is equal to the width of three ngers.

• Grading of trismus (Table6.26)

• Staging of oral submucous brosis (Table6.27)

between the maxillary (upper) and mandibular (lower) teeth when they approach each other, as occurs during chewing or at rest.

• Types of dental occlusion—It is of three types (Table6.28)

(d) Malocclusion: There are different types

of malocclusions, from crooked teeth to overbites. And they are not all mutually exclusive.

• Overcrowding—This is also known as dental crowding, which is due to not having enough space in the mouth for permanent teeth to grow straight. As a result, people with this form of malocclusion (misalignment) have crooked teeth that overlap each other. It can

Table 6.25 Shows the causes of the rotten egg smell

Oral causes Nasal causes Pulmonary causes Oesophageal Tongue—Crypt in lingual

tonsils Gingiva—Periodontal diseases Tonsil—Debris, tonsillolith Xerostomia Oral malignancy

Table 6.26 Showing grading of the trismus

Grade Denition Grade 1 Maximum inter-incisional mouth opening up to or >35mm Grade 2 Maximum inter-incisional mouth opening between 25 and 35mm Grade 3 Maximum inter-incisional mouth opening between 15 and 25mm Grade4 Maximum inter-incisional mouth opening between 5 and 15mm Grade 5 Maximum inter-incisional mouth opening <5mm or Nil

Sinusitis, nasal foreign body

Pulmonary infection GERD

6.2 Examination ofLips andOral Cavity

Table 6.27 Shows staging of oral submucous brosis

Stage Clinical Functional Stage 1 Palpable brous band in the faucial pillar Mouth opening >20mm Stage 2 Faucial and buccal band Mouth opening 11–19mm Stage 3 Faucial, buccal and labial band Mouth opening <10mm

Table 6.28 Showing dental occlusion

Type/Class 1 Orbital line is perpendicular to the

Frankfurt line, and it should pass through the distal third of the upper canine or through the mental foramen

Type/Class 2—Posterior positioning of the mandible

When the orbital line runs anterior to the mental foramen of the mandible, it is termed a retraction

Type/Class 3—Anterior positioning of the mandible

When the orbital line runs posterior to mental foramen of the mandible, it is termed as protraction

247

either be mild, moderate or severe, depending on the patient’s jaw size and the number of teeth involved (Fig.6.1a).

• Overjet—It is a type of malocclusion, or ‘bad bite’, that occurs when the top front teeth stick out past the bottom teeth, leaving a horizontal gap between the top and bottom rows of teeth. But when it comes to an overjet, the upper teeth protrude past the bottom teeth at a specic angle (Fig.6.1b).

• Overbite—The upper teeth protrude past the bottom teeth, but they remain straight or downward without an angle. The overbite condition is also known as buck teeth. Interestingly enough, both of these issues are related to sleep apnoea and snoring (Fig.6.1c).

• Crossbite—A crossbite is a dental condition that affects the way your teeth are aligned. The main sign of having a crossbite is that your upper teeth t behind your lower teeth when your mouth is closed or at rest. This can

affect teeth in the front of your mouth or toward the back of your mouth (Fig.6.1d).

• Underbite—An underbite is a dental condition in which lower teeth extend further than upper teeth. Usually, it results from a misalignment of the jaw. This is known as a Class III malocclusion (Fig.6.1e).

• Spacing—Teeth spacing is a condition in which the anterior (front) teeth are separated by large gaps (Fig.6.1f).

• Open bite—An open bite occurs when the top and bottom teeth do not touch at the front or back of the mouth when the jaw is fully shut, leaving a space between them. Open bites are a form of malocclusion or ‘bad bite’ (Fig.6.1g).

(e) Mucosa of oral cavity

• General appearance of oral cavity mucosa (colour)

– Pinkish—Normal – White—Reticular lesions of lichen

planus, leukoplakia, candidiasis, OSMF

248

6 History andExamination ofLip andOral Cavity

b c

Fig. 6.1 Showing (a) overcrowding, (b) Overjet, (c) Overbite, (d) Cross bite, (e) Underbite, (f) Spacing, (g) Open bite

– Red—Erythroplakia, inammation,

atrophic epithelium, hyperplasia

– Black—Melanoplakia, tattoo,

nevus – Bluish—Haemangioma – Translucent blue—Retention cyst – Grey—Silver amalgam, graphite,

lead, mercury – Yellow—Adipose tissue, gland

• Ulcerations of mucosa of oral cavity—Ulcers have different parts: the oor (uncovered ulcer surface), the base (ulcer rest seat), the margin (interface among the wall of ulcer and normal epithelium) and the edge (the

Squamous papilloma—It is an exophytic, pedunculated, painless growth made up of numerous small nger-like projections, which result in a lesion with a roughened, verrucous or cauliower surface. Common sites are the tongue, lips, buccal mucosa and gingiva.

Common wart—It is a tumour skin analogue to oral papilloma.

Cowden syndrome—Papillomatous lesions and bromas of various sites in the oral cavity are recognized as one of the many manifestations of multiple hamartoma and neoplasia.

Keratoacanthoma—It is common in skin people and sun-exposed areas like the face, neck and dorsum of upper extremities. Lesions are solitary and elevated.

Oral nevi/oral melanocytic nevi—It is dened as a benign proliferation of nevus cells in the epithelial layer, submucosal layer or both.

part of the margin and oor) (Table6.29).

(f) Swelling of oral cavity (Table6.30)

6.2 Examination ofLips andOral Cavity

Table 6.29 Showing characteristic features of oral ulceration

Type of ulcer Description on examination Aphthous ulcer It is well-demarcated, shallow, ovoid or round and has a necrotic Centre with a

yellow-grey pseudo-membrane, a red halo and slightly raised red margins (Fig.6.11a, b).

Minor RAS This is a group of around ve small ulcers, each <1cm in diameter. It appears on

the non-keratinized sites in the mouth such as buccal mucosa, labial mucosa or the oor of the mouth (Fig.6.11c, d).

Major RAS This is a single or a group of <3 ulcers, each >1cm in diameter. It can appear on

any site (Fig.6.11e).

Factitious ulceration (self bite)

Thermal injury This is due to hot food or beverages; burns are usually on the palate or posterior

Electric burn It commonly affects the oral commissure (corner of the mouth). The lesions are

Chemical burn It is caused by caustic chemicals, holding aspirin tablets, eugenol, chloramphenicol,

Irradiation Radiation-induced stomatitis, associated with mucosal erosions and ulceration,

Acute necrotizing ulcerative gingivostomatitis

Haematinic deciency Iron, vitamin B12 or folic acid Oral lichen planus It appears as bilateral and symmetrical white, lacy patches, red, swollen tissues or

Lichenoid drug reaction It is characterized by a symmetric eruption of at- topped, erythematous or

Herpetic gingivostomatitis Blisters of primary herpetic gingivostomatitis rupture rapidly to produce blood-

This is due to include biting the cheek, tongue or lips or rubbing a ngernail, pen or toothpick inside the mouth. The lingual frenum is also vulnerable to ulceration by repeated friction during oral sexual activity.

buccal mucosa, on examination. It appears as zones of erythema and ulceration with necrotic epithelium peripherally.

usually initially painless, charred and yellow with little bleeding, then swelling develops, and by the fourth day following the burn, the area becomes necrotic and the epithelium sloughs off.

hydrogen peroxide, silver nitrate, phenol.

xerostomia (dry mouth), mucosal atrophy (thinning) Necrotizing ulcerative gingivitis is a painful infection of the gums. Symptoms are

acute pain, bleeding and foul breath.

open sores which principally affect the buccal mucosae, labial mucosa, tongue and attached gingivae.

violaceous papules resembling lichen planus on the trunk and extremities.

crusted lips and multiple small ulcers affecting any site in the mouth.

249

Table 6.30 Showing differential diagnosis of oral cavity swelling

Site Examination ndings Diagnosis Soft palate, hard palate, uvula,

tongue and lips Anywhere in oral cavity Mucosa covered, pedunculated

All sites Bluish in colour Haemangioma Anterior 2/3 of tongue Lymphangioma Hard palate, mandible Solitary nodule or lobulated mass Torus Anterior tongue or cheek Soft smooth, reddish to purple,

Posterior 1/3 of tongue Smooth hard mass Solitary brous tumour Lower lip Bluish, soft, cystic mass Mucocele Floor of mouth Cystic translucent Ranula (Fig.6.12b) Floor of mouth Whitis swelling through mucosa Dermoid

Irregular surface, pedunculated, <1cm

tumour, soft to rm

bleed-to-touch mass

Squamous Papilloma (Fig.6.12a)

Fibroma (Fig.6.13a)

Pyogenic granuloma

<<< < Предыдущая 14 15 16 17 18 19 20 21 22 23 24 2526 / 5026 27 28 29 30 31 32 33 34 35 36 37 38 > Следующая >>>

Соседние файлы в папке Библиотека им академика М.И. Перельмана

#
30.08.202658 Мб0Книга_4434_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202655 Мб0Книга_4436_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202655 Мб0Книга_4437_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202653 Мб0Книга_4438_Библиотеки_им_академика_М_И_Перельмана.djvu
#
30.08.202652 Мб0Книга_4439_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202651 Мб0Книга_4440_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202650 Мб0Книга_4442_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202649 Мб0Книга_4443_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202649 Мб0Книга_4444_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202649 Мб0Книга_4445_Библиотеки_им_академика_М_И_Перельмана.pdf
#
30.08.202649 Мб0Книга_4446_Библиотеки_им_академика_М_И_Перельмана.pdf