Методичні розробки 3 модуль

Common ages: At birth (Congenital) or shortly after birth,

Common site: Tongue leading to macroglossia and the lip leading to macropheilia.

The superficially located lesion appears as painless nodular or papillary swelling with the same color or slightly redder than the surrouding mucosa. The deeper lesions show diffuse nodules without significant changes in the surface texture or color. On palpation it may produce a crepitant sound due to pushing of lymphatic fluid form one area to another.

Limphangiomatous malformation may occur in the neck region in early development leading to cystic hygroma which presents as a large fluctuant swellings up to 10 cm in diameter and may extend to involve vital structure in the neck with respiratory distress, hemorrhage and disfigurement.

Histopathological features

Microscopically lymphagioma composed of thin-walled vascular spaces, containing pinkish amorphous material as the result of fixation of limph.

Treatment

-Surgical excision with reccurence, because of lack of encapsulation.

-The treatment of cystic hygroma may need stages surgical procedures to control the lesion.

6. Types of individual work of students.

A.To study the following questions:

1.X-ray pictures of patients with hemangioma of bones of facial skeleton.

2.Photos of patients with the vascular tumors of face.

B.Tasks for self-control:

1.Patient, 20 years old, has asymmetry of face due to the tumor of upper lip on left. Skin under neoplasm is blue, positive symptoms of "compression" and "filling" are determined.

What most credible diagnosis?

(Answer: Cavernous hemangioma).

2.A patient, 17 years old, complains of the presence of tumor on a low lip. Anamnesis of disease: tumor was determined after birth, slowly increasing, but for the last year acute increased in a size. At a review on a low lip there is a tumor of red color, soft, at pressure becomes empty and pale.

What previous diagnosis?

(Answer: hemangioma of low lip).

3.A patient, 20 years old, appealed to the surgeon with a tumor on the left cheek. The presence of neoplasm marks from birth. At a review on the skin of the left cheek flat rounded form spot, to 1,5 cm in a diameter, pink-red color. At pressure on a tumor by a finger or instrument neoplasm turns pale.

Define a diagnosis. (Answer: hemangioma).

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

1.The basic clinical sign of branched hemangioma is:

А. Pulsation.

В. Presence of phlebolith.

С. Pain at palpation.

D. Sickly infiltration.

Е. Vensan‘s symptom. (Right answer: А)

2.The basic methods of treatment of capillary hemangioma is: A. Sclerotherapy.

B.Sewing.

C.Electro-coagulation.

D.Radial therapy.

Е. Excision of tumor. (Right Answer: А).

3. Clinically a lymphangioma is characterized by varieties:

A.Porous, cystic, lytic.

B.Polymorphic, monomorphic, proliferative.

C.Capillary, cystic, cavitary.

D.Dissipated, local.

Е. Solid, monomorphic. (Answer: С).

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

1.A patient appealed to the clinic with complaints of the considerable increasing of low lip. There is increasing of low lip, pinky color, tissues of lips painless and densely-elastic at palpation.

Define a diagnosis, conduct differential diagnostics, appoint treatment. (Answer: lymphangioma of low lip, operative treatment).

2.A patient, 25 years old, appealed to the policlinic with complaints of he presence of the swelling in the left parotid-masticatory area. At inclination of head the symptom of "filling" is determined in the left parotid-masticatory area. In the cavity of mouth the mucous membrane of this area in a color is not changed.

Define a diagnosis, conduct differential diagnostics, appoint treatment.

(Answer: hemangioma of parotid-masticatory area, sclerotherapy with next operative intervention).

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.

Epithelial tumors of soft tissues, especially such as a naevus, are often observed on an ambulatory reception. Usually they do not present a threat to the health of patient, but under certain conditions they can transform into a malignant tumor. In addition, some malignant tumors can appear under the guise of these new formations, first of all such dangerous tumor as melanoma. Clear knowledge of clinical displays of this group of tumors will help a doctor to prevent diagnostic errors.

2.SPECIFIC GOALS:

2.1.To analyze prevalence of tumors of the melanogenic system.

2.2.To explain operating of unfavorable factors of environment on the flow of tumors of the melanogenic system.

2.3.To offer to the tactician of the deontologic approach to patients with the tumors of melanogenic system.

2.4.To classify naevuss.

2.5.To interpret data of cytological and histological researches at the tumors of the melanogenic

system.

2.6.To draw the charts of plan of additional methods of examination of patients with tumors of the melanogenic system.

2.7.To analyze signs of malignant degeneration of naevus.

2.8.To work out a plan of examination and treatment of patients with the tumors of the melanogenic system.

3.BASIC LEVEL OF PREPARATION.

4.TASK FOR INDIVIDUAL WORK DURING PREPARATION TO LESSON.

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

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

1.To conduct palpation of lymphatic nodes at patient with tumor of the melanogenic system of facial and neck skin.

2.To conduct taking of material for cytological and histological puncture.

5. ORGANIZATION OF THE MAINTENANCE OF THE TRAINING MATERIAL.

Hamartoma when occurs in skin and mucous membrane is referred to as naevus.

Naevus (birth mark) Naevus is a developmental malformation, presents as tumor like mass, arising from abnormal proliferation of cells native to the skin or mucous membrane.

Classification of naevi

According to the tissue origin, naevi can be classified into: 1- Keratotic naevi: (white naevi) (white spongy naevus) 2- Vascular naevi: (red naevi) haemangioima

3-Melanotic naevi: (black naevi) (mole or pigmented naevus)

Keratotic naevi (white naevus)

(White sponge naevus -Familial white folded gingivostomatitis)

White sponge naevus is a hereditare developmental malformation of oral mucosa, and it's transmitted as autosomal dominant disease.

Clinical features

Common age: At birth or early child hood or may not become evident until adolescence. Common sits: Any site of oral mucosa, but commonly, buccal mucosa, floor of the mouth, venlral

surface of the tongue. Vagina and nasal cavity may also be involved.

White sponge naevus appears as a thick soft spongy, shaggy or folded, greyish white area; the edges of the lesion are not well defined but gradually merge with the normal mucosa.

Histopatological features

The covering epithelium of white sponge naevus shows hyperkeratosis. The prickle cell layers show acanthosis with the characteristic features of marked intracellular edema of the prickle cells and parakeratinizcd cell layers, giving the so called basket wave appearance.

Diffcrential diagnosis

The differential diagnosis of white sponge naevus includes:

1.Hereditary benign intraepithelial dyskeratosis

2.Pachyonychia congenital

3.Traumatic and frictional keratosis

Treatment

No treatment, reassure the patient about the benign nature of the lesion.

Melanotic naevi

The mole or pigmented naevi are hamartomatous lesions formed by the proliferation of the melanocyte or their precursor cells. The origin of the naevus cells has been postulaled lo be derived from pigment cells that migrate from the neural crest to the epithelium or dermis. The function of melanocyte is to produce melanin and transfers it to the basal cells to protect their nuclei from the harmful effect of the actinic radiation.

Clinical features

Common age: Child hood and adolescence (every person develops between 20 to 30 naevi) Common site: Skinrare in the oral cavity, but when occur in the mouth commonly seen in palate.

buccal mucoca, labial mucosa and gingiva.

Clinically the melanotic naevi appears as small slightly elevated pigmented papules.

Mole or pigmented naevus

Histopathotological features

Microscopically, several subtypes of pigmented naevi are recognized, depending on the location of the naevus cells as follows:

Junctional naevus

It is a condition in which the nests of melanocyte cells are present along the epiilielial-connective tissue junction. It is the first stage in the natural history of melanotic naevi.

Compound naevus

It is a condition in which nests of cells present at the epithelium-connective tissue junction and group of naevus cells are present in the under lying connective tissue, due to dropping-off from the Junctional epithelium, with time. (a lesion with Junctional and connective tissue components).

Intradermal (Imramucosal) naevus

It is a lesion in which the nests of naevus cell present in the connective tissue, because as the lesion mature. The Junctional activity disappears and the lesion is located entirely within the connective tissue or dermis. Most of the oral melanocytic naevi are of this type.

Blue naevus

Blue naevus is the second most common type of intraoral naevi, in which the cells are spindle shaped and found deep in the connective tissue, than the intra dermal naevus. Although the naevus cell nests are heavity pigmented, it appears blue because of its deeper location. It is derived from melanocyte that has failed in their fetal migration to reach the basal layer of the epithelium. The blue naevus is not a part from the natural history of the other naevi described.

The malignant transformation of benign naevus is generally rare and it is believed lo arise from the Junctional naevus or the Junctional element of a compound naevus, through what is known as Junctional activity. The suspected oral pigmented producing lesion is mandatory to be biopsied lo identity any of those with malignant potential.

Treatment

Because of its confusion with malignant melanoma and its difficult differention on clinical bases for the Junctional changes, any oral naevi with size less than 1cm in diameter is excisionally biopsied.

6. Types of individual work of students.

A.To study the following questions:

1.Charts of examinations of oncologic patients.

2.Photos of patients with new formations of the melanogenic system of skin of head and neck.

B.Tasks for self-control:

1.Patient, 38 years old, appealed to the doctor with complaints of new formation on limit of hair cover and skin of neck, it‘s permanent trauma by clothes. Objectively: neoplasm to 2 cm in a diameter, dark brown color, uneven, the signs of inflammation are absent, at palpation painless, regional lymphatic nodes are not palpated.

What tactics of doctor.

(Answer: Removal of naevus at plan order. Clinical supervision during one year).

2.Patient, 24 years old, appealed to the clinic of maxillofacial surgery with complaints about a "birthmark" on the lateral side of neck. Patient wants to removal of neoplasm. Objectively: on the left side of neck neoplasm to 0,5 cm in a diameter takes place. New formation is flat, light brown color, painless at palpation.

What actions of doctor?

(Answer: to convince a patient to give up the removal of new formation).

3. Patient, 57 years old complaints about new formation of right cheek, pain, bleeding. Objectively: in the right cheek area of new formation of pale-brown color, softly-elastic consistency with the signs of inflammation near basis, feebly painful at palpation, sybmandible lymphatic nodes at right are increase and painless.

What tactics of surgeon-stomatology. (Answer: Consultation of the oncologist).

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

1.The patient complaints of the presence of "birth-mark" that increases in sizes, it‘s shelling, feeling of itch At an objective examination in infraorbital area at left the intensively spot of brown color to 2 cm in size is determined, with small knots on a surface; oval form, speaker above a skin, with the signs of shelling, painless at palpation. Regional lymphatic nodes are increase, soldered with a skin, painless.

A . Melanoma.

B. Naevus pigment. C. Naevus warty. D. Cancer.

E. Papillomatosis.

(Right answer: А)

2.A patient complaints about strengthening of height of tumor from a bear naevus on a cheek, that was often enough injured during shaving. Objectivly: warty tumor is pigmented, size 1,5 *1 sm. Regional lymphatic nodes are not megascopic.

A . Cancer. B. Basalioma. C. Melanoma.

D. Warty precancer.

E. Inflammation to the naevus. (Right answer: С)

3.Patient complaints of the presence of tumor in a right cheek area, that itches and considerably increased in latter days. There is the tumor of wrong form, size to 1,5 cm, black, brilliant.

A . Melanoma of skin. B. Pigmental naevus. C. Basalioma of skin. D. Cancer of skin.

E. Leather horn.

(Right answer: А)

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

1.Patient, 48 years old, on hair part of head noticed the increase of birth-mark (6 mouth ago), for medical help appealed at first. Last three weeks patient complaints of pain in right subriber area, decrease of body‘s mass, rapid offensive of tiredness during day.

What pathological process can be suspected at a patient? (Answer: Metastasis of melanoma to a liver).

2.A patient, 30 years old, noticed that the last year the amount of birth-marks increased on the skin of neck. It is found out from anamnesis, that a patient practices upon the visit of solarium.

What tactics of doctor?

(Answer: To conduct conversation with the observance of ethics and deontology about possible complications from this type of procedures).

3.Doctor suspected at patient the melanoma of facial skin.

How to convince a patient without harm for his emotional state to appeal to the oncologic clinic. (Answer: To explain this necessity a presence in the oncologic clinic of the most "modern equipment" for realization of additional examination).

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. SUBJECT URGENCY.

Tumors and tumor-like lesions of peripheral nerves of face are not often observed at ambulatory reception (1,5% from all tumors of face), but knowledge of their clinical displays is obliged to surgeonstomatologist in order to prevent the diagnostic errors.

2.SPECIFIC GOALS:

2.1.To analyze reasons of origin of tumors of peripheral nerves of face.

2.2.To explain the histological structure of tumors of peripheral nerves of face.

2.3.To offer the new ethical-deontological approaches to the problems of oncostomatology.

2.4.To classify tumors and tumor-like lesions of peripheral nerves of face.

2.5.To interpret the results of cytological and histological investigations at the tumors of peripheral nerves of face.

2.6.To draw the charts of innervation of maxillofacial area.

2.7.To analyze possible prognoses at tumors and tumor-like lesions of peripheral nerves of face.

2.8.To work out a plan of examination and treatment of patients with the tumors of peripheral nerves of face.

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.Etiology and pathogeny of tumors and tumor-like lesions of peripheral nerves of face.

2.Classification of tumor and tumor-like lesions of peripheral nerves of face.

3.Clinical presentation of neurofibroma, neurofibromatosis of face, traumatic neuroma.

4.Diagnostics and differential diagnostics of tumor and tumor-like lesions of peripheral nerves of

face.

5.Methods of treatment of tumor and tumor-like lesions of peripheral nerves of face.

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

1.To inspect a patient with a tumor, define a diagnosis and to appoint treatment.

2.To able to conduct puncture or take material for cytological or histological research.

5. ORGANIZATION OF THE MAINTENANCE OF THE TRAINING MATERIAL. Neurofibroma is uncommon benign tumor of nerve sheath origin. It occurs in two forms: either

as single lesion, which is true neoplasm or as multiple lesions which considered as hamartomas rather than neoplasms. The multiple lesions are also known as neurofibromatosis or Von Recklinghausen‘s disease of skin.

The single neurofibroma commonly occurs in the tongue and buccal mucosa and appears as smooth painless fusiform nodules, covered by normal mucosa. Neurofibroma also may occur intraosseously. The multiple or neurofibromatosis appear as a numerous discrete or separated nodules on