Методичні розробки 3 модуль

6. MATERIALS FOR SELF-CHECKING: A. To study the following questions:

Keratoacanthoma of lower lip

Skin horn of upper lip

B. Test tasks for self checking:

1.An old patient complaints of a presence of painless, hard neoplasm on the lower lip, which exists already a few months, slowly increased. Objectively: on the skin of lower lip cone-shaped dark-brown color neoplasm on wide basis is determined, size of lesion is up to 1 cm at long, it is hard and painless at palpation.

What diagnosis is most reliable? (Answer: skin horn)

2.A patient complains of the presence of painless neoplasm on the skin of cheek, which grows quickly. Objectively: there is new formation on the skin of the left cheek (size – 1,5*1,5 cm, saucer-shaped form with a smooth surface and crater-shaped depressing in a center, that is filled horny mass.

What diagnosis is most reliable? (Answer: keratoacanthoma)

3.At patient under the unchanged skin of forehead mobile formation of spherical form 2*2 cm is determined, neoplasm has elastic consistency, smooth surface and painless at palpation. At an attempt to collect a skin in a fold above formation, a skin acquires type of «lemon peel». According to patient formation appeared a few years ago as a little marble under a skin.

What diagnosis does take place in this case? (Answer: atheroma)

C Materials for test control. Test tasks with the individual right answer (α=2):

1. Atheroma is:

A.Tumor of fatty tissues.

B.Epithelial tumor.

C.Tumor from muscular tissues.

D.Retentional cyst of sebaceous gland.

E.Tumor of skin.

(Right answer: D) 2. Rhinophyma is:

A.Retentional cyst of sebaceous gland.

B.Tumor of skin of nose.

C.Hypertrophy of skin of nose.

D.Hyperplasia of sebaceous glands of skin of nose.

E.Tumor of nervous tissues.

(Right answer: D)

3. Keratoacanthoma is:

A.Tumor from bone tissues.

B.Tumor from muscular tissues.

C.Tumor from nervous tissues.

D.Tumor from connectively tissues.

E.Tumor of epithelial origin. (Right answer: E)

D.Educational problems of the 3rd level (atypical tasks):

1.A patient complains of the presence of painless new formation on the skin of cheek, which grows quickly. Objectively: on the skin of the left cheek there is new formation 1,5*1,5 cm, acetabuliform form with a smooth surface and falling back in a center as a crater, that is filled horny mass.

Define a diagnosis, conduct differential diagnostics, appoint treatment. (Answer: keratoacanthoma; removal within borders of healthy tissues.)

2.The elderly patient, that likes an alcohol, grumbles about distortion of form of nose. Objectively: deformation of tag and wings of nose due to the presence of the knotted painless excrescences of skin, that feebly displaced at palpation. Skin of nose is blue-red color with the extended pores and telangioectasis.

What diagnosis is most reliable, appoint treatment.

(Answer: rhinophyma, removal within the limits of healthy tissues and skin transplantation.)

3.At patient under the unchanged skin of forehead mobile formation of spherical form 2*2 cm is determined, neoplasm has elastic consistency, smooth surface and painless at palpation. At an attempt to collect a skin in a fold above formation, a skin acquires type of «lemon peel». According to patient formation appeared a few years ago as a little marble under a skin.

What diagnosis takes place in this case, conduct differential diagnostics and appoint treatment. (Answer: atheroma, removal of capsule with the area of skin.)

7. Literature:

7.1.Basic literature:

1.Wray D. General and oral surgery / D. Wray, D. Stenhouse, D. Lee, A. Clark. – Edinburg, London, New York, Philadelphia, Sydney, Toronto: Churchill Livingstone, 2003. – 336 p.

2.Miloro M. Peterson‘s Principles of Oral and Maxillofacial Surgery / M. Miloro, G.E. Ghali, P.E. Larsen, P.D. Waite. – Hamilton, London, Ontario: BC Decker Inc, 2004. – 1461p.

3.Moore U.J. Principles of Oral and Maxillofacial Surgery / U.J. Moore. – Blacwell Science, 2005.

– 273p.

4.Coulthard P. Master Dentistry / P. Coulthard, K. Horner, Ph. Sloan, D.E. Theader. – Edinburg, London, New York, Philadelphia, Sydney, Toronto: Churchill Livingstone, 2003. – 251 p.

5.Pedlar J. Oral and Maxillofacial Surgery / J. Pedlar, J. Frame. – Edinburg, London, New York, Philadelphia, Sydney, Toronto: Churchill Livingstone, 2003. – 325 p.

6.Fradiskos D. Fradiiskos. Oral Surgery / Fradiskos D. Fradiiskos. – Springer, 2005. – 365 p.

7.Skikevich M.G. Benign tumors and tumor-like formations of maxilla-facial region / M.G. Skikevich, V.N. Gavrilyev. – Poltava: ASMI, 2008. – 132 p.

7.2.Additional literature:

1.Mitchell D. An Introduction to Oral and Maxillofacial Surgery / D. Mitchell. – Oxford University Press, Jan, 2006. – 356 p.

2.Skikevich M.G. The basics of stomatology / M.G. Skikevich, D.S. Aveticov. – Poltava. – ASMI, 2012. – 176 p.

3.Tkachenko P.I. Propaedeutics of surgical stomatology and inflammatory diseases of maxillofacial region / P.I. Tkachenko, A.I. Pan‘kevich, K.Yu. Rezvina. – Poltava. – ASMI, 201. – 283 p.

Ministry of health Ukraine

Higher state educational establishment of Ukraine

«Ukrainian medical stomatological academy»

It is «ratified» at meeting of chair of surgical stomatology and maxillofacial surgery with plastic and reconstructive surgery of the head and neck

The Head of the chair doctor of medicine Aveticov D. S.

METHODICAL INSTRUCTION

FOR INDEPENDENT WORK OF STUDENTS DURING PREPARATION FOR PRACTICAL

(SEMINAR) LESSON

Poltava – 2012

1. ACTUALITY OF THEME.

Tumors and tumor-like formations from fibrotic tissue, such, as a fibroma and epulid, are observed on an ambulatory reception of dentist comparatively more frequent from other benign tumors of cavity of mouth. Therefore, clear knowledge of clinical displays of this group of new formations is necessary to the doctor for correct diagnosis and prevention of diagnostic errors.

2.SPECIFIC GOALS:

2.1.To analyze the clinical displays of fibroma, fibromatosis of gums, epulis.

2.2.To explain the etiologic and patogenic factors of development of tumors and tumor-like lesions of fibrotic tissue.

2.3.To offer the plan of examination of patient with a fibroma, fibromatosis of gums, epulis.

2.4.To classify tumor-like formations of fibrotic tissue.

2.5.To interpret principles of diagnostics and treatment of tumors and tumorlike formations of

fibrotic tissue.

2.6.To draw the graphology chart of theme.

2.7.To analyze the results of laboratory and instrumental examinations.

2.8.To diagrammatize treatment of patients with a fibroma, fibromatosis of gums, epulis.

3.BASIC LEVEL OF PREPARETION

4. TASKS FOR INDEPENDENT WORK DURING PREPARATION FOR LESSON.

4.1. The list of the main terms, parameters, characteristics which the student should know during preparation for lesson:

4.2. Theoretical questions to lesson:

1.To transfer factors which provoke to tumor and tumor-like formations of fibrotic tissue.

2.To describe the clinical picture of fibroma.

3.To describe the clinical picture of fibromatosis of gums.

4.To describe the clinical picture of fibrotic epulid.

5.To describe the clinical picture of vascular epulid.

6.Methods of diagnostics and additional methods of research of patients.

7.Differential diagnostics of tumor and tumor-like formations from fibrotic tissue.

8.Prophylaxis of origin of tumor and tumor-like lesions from fibrotic tissue.

9.Clinical displays of malignant regeneration of tumor and tumor-like formations from fibrotic tissue.

10.Methods of treatment of tumor and tumor-like formations from fibrotic tissue.

4.3. Practical works (tasks) which are carried out on lesson:

To conduct palpation of regional lymphatic nodes of maxillofacial region and neck.

5. ORGANIZATION OF THE MAINTENANCE OF THE TRAINING MATERIAL. TABLE OF CONTENTS OF TOPIC:

Classification

Tumor and tumor-like formations of fibrous tissue

Desmoid

Clinic, diagnostics, treatment

Fibroma is a benign tumor which develops from the fibred connective tissue. It can be localized on the skin of any area of head and neck or on the oral mucosa.

Fibroma is divided into hard (does not contain fatty tissues) and soft (contains the elements of fatty tissues).

Fibroma of skin is painless neoplasm densely elastic or soft consistency, it is located in skin or comes forward above its surface as a hemisphere. Fibroma is limitedly mobile, it has wide basis and color of normal skin (it can be pink or brown color). A surface of fibroma is smooth (hard fibroma) or in folds (soft fibroma).

The varieties of fibroma is dermatofibroma and desmoid. Both forms feel like інфільтруючого

growth.

In the mouth cavity fibroma is localized more frequent on the mucous membrane of cheeks, alveolar process and tongue. There is a symmetric location of fibroma as fusiform neoplasm from the lingual or palatal side of alveolar process is the so-called symmetric fibroma.

The traumatic fibroma or fibro-epithelial polip is cliniccaly and histologically identical to fibrous epulis of the gingival, commonly the cheeks particularly along the occlusal line, then the lip and tongue. The differential diagnosis of traumatic fibroma includes: neurofibroma, neurolemmoma, granular cell tumor,

A fibromatosis of gums is excrescence of gums to the level of transitional fold as diffuse excrescence of gums or as particles in the area of a few teeth, sometimes during all alveolar process. Excrescences can be soft or dense, painless.

Epulid (Epulis) literally means on the gum. Epulis are the commonest of the oral hyperplastic lesions, sub gingival placue and calculus are considered to be the main etiological factors of epulis as a reactive hyperplastic lesion. Epulis on histological ground can be classified into:

a.Fibrous epulis,

b.Vascular epulis (pyogenic granuloma, pregnancy epulis),

c.Giant cell epulis (Peripheral giant cell granuloma).

All types of epulis share the following clinical features:

-They are more common in female.

-They are commonly occurring anterior to maxillary molar teeth (intercanine area).

-All types of epulis show tendency to recure with different recurrent rates; (2%) for fibrous epulis, (14%) for the vascular epulis and (36%) for the giant cell epulis.

A.Fibrous epulis Clinical features Common age: adults.

Fibrous epulis is the commonest of all types of epulis (65% of all types of epulis). Fibrous epulis appears as a firm pedunculated or sessile mass of similar color to the adjacent gingival tissue. The surface of the lesion may ulcerate due to trauma.

Histological features

Histologically fibrous epulis shows proliferating fibroblast, highly collagenous and relatively avascular, and may contain a mild to modrate chronic inflammatory cell infiltration. Island of ossification may be present and in such condition the lesion is termed as peripheral ossifying fibroma, with no difference in their clinical behavior.

Different diagnosis

The different diagnosis of fibrous epulis includes:

1.Vascular epulis

2.Giant cell epulis. Treatment is surgical excision.

B.Vascular epulis

Vascular epulis accounts for about 28% of all epulis and is composed of pyogenic granuloma and

pregnancy epulis.

1.Pyogenic granuloma

The term pyogenic is a misnomer term as it is not pus producing lesion.

Clinical features

Pyogenic granuloma appears as a soft, deep reddish, purple, sessile or pedunculated swelling, often ulcerated. Hemorrhage may occur spontaneously or following minor trauma.

Histological features

Pyogenic granuloma histologically composed of masses of hyperplastic granulation tissues, characterized by high vascular proliferation, variable numbers of chronic inflammatory cells may be seen.

Treatment

Surgical excision together with removal of underlying cause.

2.Pregnency epulis

Pregnancy epulis, clinically andhistologically identical to pyogenic granuloma and it is considered as a pyogenic granuloma occurs in pregnant female.

Treatment

The treatment of pregnancy epulis is surgical excision which preferred to be done until after birth because lesions excised during pregnancy show frequent recurrence.

C. Giant cell epulis

Giant cell epulis is an unusual reactive hyperplastic connective tissues response to injury of the gingival tissues. It is the less common type of epulis, it account for about (7%) of all types of epulis.

Clinical features

Giant cell epulis appears as a dark red, pedunculated or sessile swelling commonly ulcerated. In dentate area the lesion usually arises interdentally with buccal or palatal swelling, joints by a narrow waist between teeth.

Histological features

Microscopically giant cell epulis shows hyperplastic granulation tissue that composed of: multinucleated giant cells, few trabeculae or osteoid bone tissue may occasionally present and variable numbers of chronic inflammatory cells infiltration may be present.

TreatmentThe treatment of choice of giant cell epulis is radical surgical excision with rate of recurrence.

Differential diagnostics of tumors and tumor-like formations from fibrotic tissue

6. MATERIALS FOR SELF-CHECKING: A. To study the following questions:

Giant cell epulid of lower jaw

Vascular epulid lower jaw

Fibrotic epulid maxilla

B.Tasks for self-control:

1.A patient grumbles about a presence of painless neoplasm on the mucosa of cheek, which is a few years and slowly increasing. Objectively: semispherical form new formation is determined on the mucosa of the left cheek; neoplasm has wide basis, to 1 sm in a diameter, dense, painless, with clear limits, light pink color.

What diagnosis is most reliable? (Answer: fibroma)

2. A patient complains of the presence of proliferation of gums of maxilla. Objectively: gums of upper jaw are diffusely incrassate during all alveolar process from a vestibular side. Proliferation spreads to the transitional fold, painless, densely elastic consistencies, closes the vestibular surface of crowns of teeth.

What diagnosis is most reliable? (Answer: fibromatosis of gums)

3. Patient has neoplasm in the area of neck of molars of lower jaw at right from a vestibular side of alveolar process. New formation has mushroom-like form, smooth surface and wide basis. Neoplasm is painless, dense consistency, limitedly mobile, light pink color.

What diagnosis does take place in this case? (Answer: fibrotic epulid)

C.Materials for test control. Test tasks with the single right answer (a=II):

1.Fibroma is:

A.Tumor of fatty tissue.

B.Epithelial tumor.

C.Tumor from muscular tissue.

D.Retencional cysts

E.Tumor from connecting tissue. (Right answer: A).

2. Whatever tumor behaves to the fibroma:

A.Hard fibroma.

B.Soft fibroma.

C.Desmoid.

D.Histiocytoma.

E.Ateroma. (Right answer: E). 3. Epulid is:

A.Benign tumor.

B.Malignant tumor.

C.Inflammatory disease.

D.Dystrophic disease.

E.Tumor-like formation (Right answer: E).

D.Educational tasks of 3-th levels (atypical tasks):

1.During a prophylactic review at sick from a vestibular side of alveolar process of maxilla in the area of

frontal teeth doctor founded new formation of gums of spherical form of bright red color which bleeds at touching. New formation is painless, located on a wide leg in the area of gingival margo.

Define a diagnosis, conduct differential diagnostics, appoint treatment.

(Answer: vascular еpulid, removal within limits of healthy tissues, diathermocoagulation of bone bed.)

2.Patient has new formation of mushroom-like form in the area of neck of mollars of lower jaw at right from a vestibular side of alveolar process with smooth surface on wide basis. Neoplasm is painless, dense consistency, limitedly mobile, pinky color.

Define a diagnosis, conduct differential diagnostics, appoint treatment.

(Answer: fibrotic еpulid, carving within the border of healthy tissues, coagulation of bone bed.)

3.Patient complains of the presence of proliferation of gums of maxilla. Objectively: gums of supramaxilla are diffusely incrassate during all alveolar process from a vestibular side. Excrescence spreads to the transitional fold, painless, densely elastic consistencies, close the vestibular surface of crowns of teeth.

Define a diagnosis, conduct differential diagnostics, appoint treatment.

(Answer: fibromatosis of gums, removal within the border of the unchanged gums together with a periosteum.)

7. Literature:

7.1. Basic literature:

1.Wray D. General and oral surgery / D. Wray, D. Stenhouse, D. Lee, A. Clark. – Edinburg, London, New York, Philadelphia, Sydney, Toronto: Churchill Livingstone, 2003. – 336 p.

2.Miloro M. Peterson‘s Principles of Oral and Maxillofacial Surgery / M. Miloro, G.E.

Ghali, P.E. Larsen, P.D. Waite. – Hamilton, London, Ontario: BC Decker Inc, 2004. – 1461p.

3.Moore U.J. Principles of Oral and Maxillofacial Surgery / U.J. Moore. – Blacwell Science, 2005. – 273p.

4.Coulthard P. Master Dentistry / P. Coulthard, K. Horner, Ph. Sloan, D.E. Theader. – Edinburg, London, New York, Philadelphia, Sydney, Toronto: Churchill Livingstone, 2003. – 251 p.

5.Pedlar J. Oral and Maxillofacial Surgery / J. Pedlar, J. Frame. – Edinburg, London, New York, Philadelphia, Sydney, Toronto: Churchill Livingstone, 2003. – 325 p.

6.Fradiskos D. Fradiiskos. Oral Surgery / Fradiskos D. Fradiiskos. – Springer, 2005. – 365

p.

7. Skikevich M.G. Benign tumors and tumor-like formations of maxilla-facial region / M.G. Skikevich, V.N. Gavrilyev. – Poltava: ASMI, 2008. – 132 p.

7.2. Additional literature:

1.Mitchell D. An Introduction to Oral and Maxillofacial Surgery / D. Mitchell. – Oxford University Press, Jan, 2006. – 356 p.

2.Skikevich M.G. The basics of stomatology / M.G. Skikevich, D.S. Aveticov. – Poltava. – ASMI, 2012. – 176 p.

3.Tkachenko P.I. Propaedeutics of surgical stomatology and inflammatory diseases of maxillofacial region / P.I. Tkachenko, A.I. Pan‘kevich, K.Yu. Rezvina. – Poltava. – ASMI, 201. – 283 p.