Методичні розробки 3 модуль

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 of muscular and fatty tissue are not often observed on an ambulatory reception, but knowledge of their clinical displays is obliged to surgeon-stomatology in order to prevent of diagnostic errors, because the symptoms which accompany these neoplasms quite often alike with the clinic of other tumors. In addition, some of tumors of muscular and fatty tissue can malignant and knowledge of signs of malignant degeneration of tumors extremely needs for practical doctor-stomatology.

2.SPECIFIC GOALS:

2.1.To analyze the clinical displays of different forms of myoma and lipoma.

2.2.To explain the etiologic and patogenic factors of development of tumor-like formations of muscular and fatty tissue.

2.3.To offer the plan of examination of patients with myoma and lipoma.

2.4.To classify tumor-like formations of muscular and fatty tissue.

2.5.To interpret principles of diagnostics and treatment of muscular and fatty tissue.

2.6.To draw the graphology chart of theme.

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

2.8.To diagrammatize treatment of patients with myoma and lipoma.

3. BASIC LEVEL OF PREPARATION.

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 for lesson:

13.To transfer factors which are make for origin of myoma and lipoma.

14.To describe a clinical picture of myoblastoma.

15.To describe the clinical picture of rhabdomyoma.

16.To describe the clinical picture of leiomyoma.

17.To describe the clinical picture of lipoma.

18.To describe the clinical picture of lipomatosis.

19.Methods of diagnostics and additional methods of examination of patients.

20.Differential diagnostics of tumors of muscular and fatty tissue.

21.Prophylaxis of origin of tumors of muscular and fatty tissue.

22.Differential diagnostics of tumor of muscular and fatty tissue.

23.Clinical displays of malignant degeneration of tumors of muscular and fatty tissue.

24.Methods of treatment of tumors of muscular and fatty tissue.

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

1.To conduct palpation of tumor maxillofacial region.

2.To conduct diagnostic puncture.

5.ORGANIZATION OF THE MAINTENANCE OF THE TRAINING MATERIAL.CONTENTS OF THEME:

Classification

Tumors and tumor-like formations of muscular and fatty

Clinic, diagnostics, treatment

Myoma is the general name of benign tumors, which grows from muscular tissue. There are a few its varieties.

Leiomyoma is the benign tumor from smooth muscular tissue. It can develops from the smooth muscles of skin and vessels, grows slowly and painlessly. Clinically looks as a node with clear limits, soft and painless at palpation. The surface of tumor is smooth. Leiomyoma common site intraorally in the tongue. There is no smooth muscle in the oral cavity except walls of blood vessels. Leiomyoma is able to regenerate in leiomyosarcoma. Treatment is surgical excision (with borders of the unchanged tissues).

Rabdomyoma is a the benign tumor which develops from striated muscle. It meets rarely, located more frequent all in the layer of tongue. It grows slowly and painlessly. It not inherent infiltrative growth, there is tumor of brown color on a cut. Rabdomyoma has an expressly certain capsule. Occasionally it can regenerate in rabdomysarcoma. Treatment is surgical excision (with borders of the unchanged tissues).

Myoblastoma is a benign tumor which develops from myoblasts of striated musculature. It more frequent all is observed in the layer of tongue and gums. It grows slowly and painlessly, but this tumor has infiltrative growth (it does not have a capsule). Objectively: node with relatively clear borders, painless, elastic consistency. If it is localized in the layer of tongue, there are deformation and to violation of movement of tongue. Tumor on the cut has pink color, poor on blood vessels. Myoblastoma is able to violate in a malignant tumor.

Treatment consists in removing of tumor with part of healthy tissues. After a removing tumor able to give relapses.

Lipoma is a benign neoplasm of fatty or adipose tissues. It is localized in the different areas of face and neck. A clinical picture depends on the depth of bedding of tumor. More often it appears as a painless, slowly growing soft, elastic yellowith rounded or lobulated swelling, commonly occurs in the cheek and tongue. Lipoma grows slowly, it can be soft or dense depending on correlation of fatty and fibrotic tissue. It is painless, has lobed surface. Lipoma has a thin capsule. The mobile of lipoma depends on the depth of its bedding. Microscopically lipoma shows a well circumscribed, lobulated mass of mature fat cells.

Sometimes there is diffuse excrescence of fatty tissue on a neck as an apron. It is illness of Madelung or lipomatosis of neck.

Lipoma is able to regenerate in a malignant tumor – liposarcoma.

Treatment of lipoma is surgical, quite often related to technical difficulties (in the case of distribution of tumor of intermuscular and interfascial spaces).

Differential diagnostics of tumors of muscular and fatty tissues

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

Lipoma of cheek

B.Test tasks for self checking:

1.Elderly patient complaints of a presence of painless neoplasm in the layer of tongue which limits movement of tongue and exists already a few months, slowly increased. Objectively: painless node with clear border is palpated in the tongue. Neoplasm is to 2 sm in a diameter. The mucosa of tongue is not changed.

What diagnosis is most reliable? (Answer: myoma)

2.A patient grumbles about a cosmetic defect because of deformation of neck. Objectively: in the area of front surface of neck there is a diffuse bulge of tissues as an apron which is stretched out from the lower edge of jaw to the clavicles. A skin is not changed in a color, excrescences are mobile, painless, lobed surface is determined at palpation.

What disease does take place in this case? (Answer: illness of Madelung)

3.Patient complaints of the presence of neoplasm under low jaw which exists during a few years, slowly increasing. Objectively: in the left inframandibular area node is determined (a size of neoplasm is 3-5 sm), with clear limits, painless, pasty consistencies, mildly mobile, covered by unchanged skin. At palpation: surface of neolasm is lobed.

What disease did a patient appeal with? (Right answer: lipoma)

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

1. Mioma is:

A.Tumor from fatty tissue.

B.Epithelial tumor.

C.Tumor from muscular tissue.

D.Retentional cyst of sebaceous glands.

E.Tumor from nervous tissue.

(Right answer: C). 2. Lipoma is:

A.Tumor of fatty tissue.

B.Tumor from nervous tissue.

C.Epithelial tumor.

D.Tumor from muscular tissue.

E.Retentional cyst of sebaceous glands. (Right answer: A).

3. Rhabdomyoma is:

A.Tumor from bone tissue.

B.Tumor from striated muscular tissue.

C.Tumor from nervous tissue.

D.Tumor from connecting tissue.

E.Tumor of epithelial origin.

(Right answer: B).

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

1.During the review of a patient doctor found out new formation under low jaw which exists during few years, slowly increasing. Objectively: in the submandibular area to the right there is new formation as a node 4-6 cm by a size, with clear limits, painless, paste consistence, mildly mobile, covered with unchanged skin. At palpation the surface of a new formation is lobed.

Define a diagnosis, conduct differential diagnostics, appoint treatment. (Answer: lipoma, removal together with a capsule.)

2.At the doctor reception the elderly patient complains of the presence of painless induration in the tongue, which interferes tongue and exists few months, slowly increasing. Objectively: in the tongue painless node with unclear limits is palpated. There is neoplasm 3 cm in diameter. The mucosa of tongue is not changed.

Define a diagnosis, conduct differential diagnostics, appoint treatment.

(Answer: мyoma, removal within healthy tissues.)

3.A patient grumbles about a cosmetic defect as a result of distortion of neck. Objectively: the front surface of neck is distorted by the diffuse thickening of tissues as an apron which stretches out from the lower edge of jaw up to the clavicle. A skin color is not changed, at palpation excrescences are mobile, painless, a lobed surface is determined .

Define a diagnosis, conduct differential diagnostics, appoint treatment. (Answer: a lipomatosis of neck, removal within the limits of healthy tissues.)

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 chairof 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. SUBJECT URGENCY.

Stomatologists of any profile sometimes find the necessity of inspection and treatment of patients with the tumors of blood and lymphatic vessels of soft tissues and jaws. An important moment is realization of differential diagnostics between benign and malignant tumors, that requires from the doctor of theoretical knowledge and practical abilities of clinical and paraclinical examination of patients, abilities to interpret data of additional methods of examinations and appoint adequate treatment to every concrete patient, in fact quality of life of patient depends in future on it.

2.SPECIFIC GOALS:

2.1.To analyze etiology and pathogeny of tumors of blood and lymphatic vessels of

maxillofacial area.боьт

2.2.To explain factors which provoke the origin of tumors of blood and lymphatic vessels of maxillofacial region.

2.3.To offer new approaches in diagnostics of tumors of blood and lymphatic vessels of maxillofacial area.

2.4.To classify the tumors of blood and lymphatic vessels of maxillofacial area.

2.5.To interpret the additional methods of examination at diagnostics of tumors of blood and lymphatic vessels of maxillofacial area.

2.6.To draw the charts of roentgenologic picture of tumors of blood and lymphatic vessels of bones of facial skeleton.

2.7.To analyze data of additional methods of examination of patients with tumors of blood and lymphatic vessels of maxillofacial area.

2.8.To lay down the plan of treatment of patients with the tumors of blood and lymphatic vessels of maxillofacial area.

3.BASIC LEVEL OF PREPARATION.

4.TASKS FOR INDIVIDUAL WORK DURING PREPARATION TO LESSON.

4.1. List of basic terms, parameters, characteristics, which student must master at preparation to lesson:

4.2.Theoretical questions to lesson:

1.Statistics of tumors of blood and lymphatic vessels of soft tissues and jaws.

2.Circulatory system of face.

3.Lymphatic system of face.

4.Classification of tumors of blood and lymphatic vessels of soft tissue and jaws.

5.Clinic of tumors of blood and lymphatic vessels of soft tissues and jaws.

6.Features of diagnostics of tumors of blood and lymphatic vessels of soft tissues and jaws.

7.Statistics of postoperative complications at the tumors of blood and lymphatic vessels of soft tissues and jaws.

4.3.Practical works (task) which are executed on lesson:

1.To conduct palpation of tumor maxillofacial region.

2.To conduct diagnostic puncture.

3.Working off the algorithm of examination and treatment of the patients with the vascular tumors of face.

5. ORGANIZATION OF THE MAINTENANCE OF THE TRAINING MATERIAL. Haemangioma

Haemangioma is generally accepted to be hamartomatous lesion rather than true neoplasm.

Clinical features

Common age: At birth, or early after birth, some lesions may not be noted until later. Common six: Female more than male.

Common site: Head and neck region more than other part of the body. Intraorally common on the lip, tongue, cheek and palate.

Intraoral mucosal haemangioma appear as flat or nodular, soft dark reddish or purplish pinkish lesion, that may bleed following mild trauma. Haemangioma characteristically blanch under pressure, this may help lo differentiate it from other soft tissue hemorrhagic lesion e.g. ecechymosis.

bubble appearance. Haemangioma is usually solitary lesion but multiple lesions may occur rarely as part of some generalized angiomatous syndrome such as (SturgeWeber syndrome) (Encephatotrigaminal angiomatosis) and (Hereditary haemorrhagic telangectasi,) (Rendu-Osler- Weber syndrome).

Sturge-Weber syndrome (Encephalotrigaminal angiomatosis)

Sturge-Weber syndrome is a congenital disorder characterized by the following main features:

1.Ipsilateral haemangiomotous lesion of the face following the distribution of one or more of the branches of the trigeminal nerve, (port-wine staine). The facial lesion may extend intraorally involving the buccal mucosa and gingiva.

2.Calcification of leptomeninges over the cerebral cortex.

3.Convulsion of the limb, on the opposite side of the body.

4.Ocular lesion also may be present.

Sturge-Weber syndrome (port-wine stain)

Hereditary hemorrhagic telangectasia (Rendu-Osler-Weber Syndrome)

Hereditary hemorrhagic telangectasia ii a hereditary disorder transmitted as autosomal dominant and characterized by:

-Multiple knots of dilated malformed capillares (telangectasia) present in skin, mucous membrane of oral cavity and nasal cavity Fig.

-Frequent nose bleeding is the commonest presenting sign of Rendu -Osler-Weber Syndrome. Hereditary hemorrhagic telangectasia of toungue

Histopathological features

Histologically haemangioma is classified into capillary, or cavernous or mixed, depending upon the size of the vascular spaces, these spaces are lincd by endothelium without muscular support. Clinically there is no significant difference between capillary and cavernous haemangioma.

Capillary haemangioma (histological features)

Diagnosis of haemangioma

Clinical examination shows congenital vascular lesion that blanch on pressure.

• The boney lesion shows honey comb appearance radiographically.

Treatment

- Surgical excision, following localization of the lesion through selective arteriole embolization.

-Sclerosant therapy or cryosurgery.

-The laser therapy is now used as a primary treatment of selected vascular lesion.

Lymphangioma

Lymphangioma is considered as a hamartomatous, rather than being true neoplasm and it is less common than haemangioma.

Clinical features