GROUP4REG NO:

10/06/GS/300210/06/GS/299310/06/GS/299410/06/GS/298810/06/PS/318610/06/GS/ 3088

CellulitisPresented by 10/06/GS/2993

Cellulitis is an infection of the deeper layers of the skin and the underlying tissue

Etiology• It is caused by a bacterial skin infection of Streptococci

throught the:•cut •graze •burn •animal, human or insect bite •puncture wound •skin ulcer

Risk factors• obesity and Weak immunity• diabetes and circulation problems • chickenpox and shingles •intravenous drug use •having previous episodes of cellulitis

• Clinical presentation• It begins as a small area of– tenderness – Swelling– redness tend to spread to adjacent skin.

• The affected person may develop a – fever – chills – sweats – swollen lymph nodes– swollen glands near the area of infected skin.

pathogenesis• Invasion of S. aureus and S. pyogenes by using

1. M-protein to inhibit phagocytosis2. Protein F to bind the M protein to fibronectin3. lipoteichoic acid for adherence4. hyaluronic acid capsule to inhibit phagocytosis5. invasins ( as streptokinase,streptodornase and hyaluronidaseThen,there is Overcomes of the defensive cells in our body,which includes

mast cells, eosinophils,basophils, and neutrophils as immuno response.

• DiagnosisAssessing the symptoms and examining the skin.

Management• Antibiotics to control Infection• Analgesic for temperature or vomiting• Self-care• Drink plenty of water to prevent dehydration.• If your leg is affected by cellulitis, keep it raised. • Pain relief• Paracetamol and ibuprofen.

Ludwig’s anginaConnective tissue infection, of the floor of the mouth, usually

occurring in adults with concomitant dental infections.

Aetiology• It is caused by• bacteria factors include staphylococcus spp,streptococcus spp

and enterobacter• Mandibular fracture • penetrating injuryPathogenesis• The anaerobic and aerobic bacteria produce the endotoxin like• protease,hyalironidase,collagenase that cause synergic effect and

allow th rapid spread of cellulitis

Clinical features• Bilateral infection of

sublingual,submandibular spaces• Brawnly oedema with elevation of the

tongue,airway abstruction and very little pus.

Diagnosis• We find • Redness,swelling of the upper neck,chin,floor

of the mouth.• the tongue may be swollen or out of place.• Culture of fluid from the tissue may show

bacteria

Managment• Maintainance of airway• High dose antibiotic such as:

• Penicillin or penicillin-like

• Removal of saurce infection(tooth extraction)• Parenteral hydration,early surgical,drainage.

• Referance: wikpedia.com• Altavista.com

Gingival hyperplasiapresented by10/0,6/GS/3002

• refers to excessive growth of the gums, Etiology:Imflammatory enlargment:• Chronic imflammation caused by prolonged exposure to bacterial plaque.Drug -induced enlargment • Anticonvulsants, such as phenytoin, valproate, phenobarbital, vigabatrin, topiramate and primidone.• Calcium channel blockers, such as verapamil and nifedipine• Immunosuppresants such as cyclosporineEnlargment associated with systemic factors such as: • Pregnancy• Puberty • Vitamin C deficiency.Systemic disease :• Leukemia• Granulomatous disease• Neoplasm:

– Begnin and malignant

PathogenesisThe pathogenesis of drug –induced hyperplasia is uncertain. the interaction between drug and/or metabolite, with the gingival

fibroblasts begin the action. Factors like age, genetic predisposition, pharmacokinetic variables,

plaque-induced inflammatory and immunological changes and activation of growth factors intervien in protection or damaging.

these genetic factors which give rise to fibroblast heterogeneity, gingival inflammation, and pharmacokinetic variables appear to be significant in the expression of gingival overgrowth.

DiagnosisIt is based on IFN –gamma stimulated Gene expression using

oligonucleotide microorganism.This determine difference between benign and malgnant gingival

hyperplasia based on evolution by IFN-gamma complexClinical presentation• firm, benign and painless swelling in the gums • The doctor sees for bleeding in the gums.• He also notes the level of mouth discomfort due to the enlargement. He

notices if there are any slowly enlarging mass or masses along the gingival margin.

http://dermnetnz.org/common/image.php?path=/reactions/img/ac-gingiva.jpg

Managment

• brushing and flossing • .chlorhexidine • Ultrasonic treatments • Erythromycin • Discontinuation of cousative drug

• Referance • Wikipedia.com

Granuloma pyogenicum• is a primarily oral disease which appears as an overgrowth of tissue due to irritation physical

trauma or hormonal factorsEtiologyIrritation caused by• poor oral hygiene • Chronic oral irritants • Bacterial infection• Traumatic injury• Hormonal factors

• Pathogenesis

• inflammatory cytokines have been implied to play the major roles .

• their links to female steroid hormones still remain to be elucidated.

Clinical presentation• color ranging from red/pink to purple, and can be smooth or

lobulated

Management

• surgical excision. For gingival lesions, • scaling adjacent teeth to remove any calculus and plaque

that may be a source of continuing irritation is recommended

Chondromaby 10/06/GS/3088

• A chondroma is a benign tumor formed in cartilage.• Etiology:Unknown causePathogenesis:This tumor is thought to arise from primitive element

of the bone marrow or mesenchymal cells.Most are also associated with a translocation of

chromosome 11and 22.

Clinical features

• swelling or the sensation of a lump which is fixed to the underlying bone.

• Pain may appear as the tumor grows and impinges on the surrounding structures.

• The tumor may remain symptomless and may go undetected

Diagnosis: X rays shows the tumor as an area of decreased

density within the involved bone. The remaining bone may be thinned out and expanded.

Managment:• Surgery• Incidentally discovered tumors that have no

symptoms require no treatment except for regular observation.

Osteoma

• Etiology:The cause is unknown,But trauma ,Infections

and developmental defect have been suggested as possible causes.

Clinical presentation:Clinically,soft tissue osteoma appears as a well

defined,assymptomatic,hard tumor covered by a thin and smooth

normal epithelium.

• Pathogenesis

• Is a benign tumor consisting of mature compact or cancellous bone.osteomas may be classified either periosteal occuring on the surface of bone or endosteal,occuring in the bone. Althought,the osteoma may also occur in the facial bone,such as the sinus areas.the osteoma is slow growing but may eventuallly reach larger sizes causing expasion and deformity.

Diagnosis• histopathology examination.

Managementsurgial excision.

• Reference:general and oral pathology for dental hygienist by Leslie De

Long,NancyW.Burkhart.

Lipoma by:10/06/GS/2988

is a benign tumor of adipose tissue that occurs more commonly between 40-60years of ages. The buccal mucosa and tongue are commonly the predominant sites in adults

AETIOLOGYAs with many tumours the aetiology of lipomas remains obscure. The repeated mild trauma may trigger the proliferation of fatty tissue and finally causes a lipoma

PATHOGENESISThe pathogenesis of lipoma is still unclear

despite its close similary to normal adipose tissue.

It is presumed to occur in obese individuals

• Clinical Features• slowly enlarging, soft, smooth-surfaced mass of

the submucosal tissues • yellow or pink surface discoloration for

superficial• Painless• Well defined tumor• Varying in size from a few millimeters to several

centimeters(a mucosal oral lipoma may increase to 5-6 cm)

Diagnosis

• Histopathological examination

• MANAGEMENT

• Conservative surgical removal(excision) is the treatment of choice for oral lipoma.

• REFERENCES

• Wikepedia.com

• Color atlas of oral diseases

Lipoma pictures

• NEUROFIBROMA• Neurofibroma is a benign overgrow of nerve

tissue origin.• CLINICAL FEATURES

• Painless well-defined• Firm tumors• Covered by normal epithelium• Size changes from several millimeters to several

centimeters

• PATHOGENESIS• The solitary neurofibroma may be found on

any nerve where it presents as a slow growing.

• DIAGNOSIS• Is based on a series of clinical criteria.• Histopathological examination

• MANAGEMENT

• Total or partial resection of neurofibromatous lesions (Surgical excision)

• REFERENCE

• Wikepedia.com

• Color atlas of oral diseases

Fig 1. A: intraoral view showing a protruding lesion from tooth 2.4 to the ipsilateral tuberosity

Lymphangiomapresented by 10/06/Ps/3186

Lymphangiomas are malformations of the lymphatic system, which is the network of vessels responsiblefor

returning to the venous ystem excess fluid from tissues

Etiology The direct cause of lymphangioma is a blockage of the lymphatic system as a fetus develops, although symptoms may not become visible until after the baby is born. This blockage is thought to be

caused by a number of factors, including maternal alcohol use and viral infections during pregnancy.

classification• Lymphangiomas have traditionally been classified into three subtypes:

capillary and cavernous lymphangiomas and cystic hygromas. This classification is based on their microscopic characteristics. A fourth subtype, the hemangiolymphangioma is also recognized.

1. Capillary lymphangiomas : Capillary lymphangiomas are composed of small, capillary-sized lymphatic vessels and are characteristically located in the epidermis 2.Cavernous lymphangiomas: Composed of dilated lymphatic channels, cavernous lymphangiomas characteristically invade surrounding tissues. 3.Cystic hygromas :Cystic hygromas are large, macrocystic lymphangioma. 4.Hemangiolymphangioma As suggested by their name, hemangiolymphangiomas are lymphangiomas with a vascular component.

• Lymphangiomas may be also classified based on the size of their cyst:

• 1.macrocystic• 2. microcystic• 3.mixed

• CLINICAL FEATURE

• They resembles to the clusters of small blisters ranging in color from pink to dark red.They are benign and do not require medical treatment, although some patients may choose to have them surgically removed for cosmetic reasons

Common site relevent in dentistry

• typically on the neck, tongue and lips, and vary widely in size, ranging from as small as several wide.

• Diagnosis• Cases of lymphangioma are diagnosed by histopathology inspection. In

prenatal cases, cystic lymphangioma is diagnosed using an ultrasound

Pathogenesis

• lymphatic cisterns in the deep subcutaneous plane are separated from the normal network of lymph vessels.

• They communicate with the superficial lymph vesicles through vertical dilated lymph channels.

• The typical history of Lymphangioma shows a small number of vesicles on the skin at birth or shortly after.

• In subsequent years, they tend to increase in number, and the area of skin involved continues to expand.

• Vesicles or other skin abnormalities may not be noticed until several years after birth.

Treatment and prognosis• Drainage• Lymphangioma can be healed when treated with a flashlamp • Treatment for cystic lymphangioma involves the removal of

the abnormal tissue;• Surgical removal of the tumor is the typical treatment

provided, with the understanding that additional removal procedures will most likely be required as the lymphangioma grows.

• References:Wikipedia,the free Encyclopedia

• Hemangioma• It is the abnormal buildup of blood vessels in

the skin or internal organ.• It is benignEtiolgy:• Vascular malformation

The pathogenesis • is still not understood. • But there are factors :• hormonal and mechanical influences that

affect the abnormal proliferation of endothelial cells

• the primary, causative defect in hemangiogenesis remains unknown and no genetic alteration has been implicated

ClInical features The common site :the are seen on the tongue,lips and buccal

mucosa. They are lesion with blue discoloration. Diagnosis

• The use of aglass slide(diascopy) Management

• Non symptomatic:non reaction• symptomatic: surgecal excision, cryotherapy, sclerosing and

embolisation

Burkett's lymphoma by 10/06/Gs/2994

• High grade malignant B-cell lymphoma arising from germinal cell or lymph node.or or MALT

• Aetiology:the cause is unknown but epstein Barr virus can take place.

• Associated wieh maralia

• Clinical presentation:

• Because of rapid growth of Burkett's tumour,patient may quickly manifest significant metabolic derangement and renal function supairment.

It can present also skin nodules, acute lymphocytic leukemia with fever,anaemia bleeding and adenopathy.

• Pathogenesis• In immunosuppressed individuals, such as

patients with AIDS patients treated with immunosuppressive agents in the

setting of organ transplantation, suppressed by normal T-cell immunity. With diminished T-cell function,

• Then, there is an infection of EBV which may progress to malignant lymphoma.

• And as EBV infection correlates with CNS tropism of lymphoma.

• The tumor displayed diffuse and strong immunoreactivity for smooth muscle actin, H-caldesmon; focal positivity for desmin; and strong and diffuse positivity for Epstein-Barr virus RNA on in situ hybridization.

Diagnosis• biopsy of the tumor mass for histopathology,

immunochemistry and flow cytometry.

• Management • Monitor serumchemistries,intravenous

antibiotics• References:Ali H kambar

• Kaposi's sarcomaEtiology• human herpes virusClinical features • nodules and blochetes(that may be red brown

or black),lesion easily damaged by chewing and bleeding, interference eating and speaking.

Pathogenesis• the tumor is high vascular containing

abnormally dense and irregular blood vessels with leak red blood cells into surrounding tissue.

• These high vascularity give the dark color, inflammation around the tumor then swelling and pain occur.

Diagnosis• biopsy and microscopic examination to find the spindle cells.• detection of Kaposi's simplex herpes virus(KSHV protein

LANA in tumor cell)

• Management:• Treat the cause of immune system dysfunction• radiotherapy • cryosurgery• interferon alpha, liposomal.• References:Ali H kambar

LymphangiomaLymphangiomas are malformations of the lymphatic

system, which is the network of vessels responsiblefor returning to the venous ystem excess fluid from tissues

Etiology The direct cause of lymphangioma is a blockage of the

lymphatic system as a fetus develops, although symptoms may not become visible until after the baby is born. This blockage is

thought to be caused by a number of factors, including maternal alcohol use and viral infections during pregnancy.

• classification• Lymphangiomas have traditionally been classified into three subtypes:

capillary and cavernous lymphangiomas and cystic hygromas. This classification is based on their microscopic characteristics. A fourth subtype, the hemangiolymphangioma is also recognized.

1. Capillary lymphangiomas : Capillary lymphangiomas are composed of small, capillary-sized lymphatic vessels and are characteristically located in the epidermis 2.Cavernous lymphangiomas: Composed of dilated lymphatic channels, cavernous lymphangiomas characteristically invade surrounding tissues. 3.Cystic hygromas :Cystic hygromas are large, macrocystic lymphangioma. 4.Hemangiolymphangioma As suggested by their name, hemangiolymphangiomas are lymphangiomas with a vascular component.

• Lymphangiomas may be also classified based on the size of their cyst:

• 1.macrocystic• 2. microcystic• 3.mixed

• CLINICAL FEATURE

• They resembles to the clusters of small blisters ranging in color from pink to dark red.They are benign and do not require medical treatment, although some patients may choose to have them surgically removed for cosmetic reasons

• Common site relevent in dentistry

• typically on the neck, tongue and lips, and vary widely in size, ranging from as small as several wide.

• Diagnosis• Cases of lymphangioma are diagnosed by histopathology inspection. In

prenatal cases, cystic lymphangioma is diagnosed using an ultrasound

• Pathogenesis• finding lymphatic cisterns(waterproof or water collection) in the

deep subcutaneous plane are separated from the normal network of lymph vessels. They communicate with the superficial lymph vesicles through vertical, dilated lymph channels

• Microscopically, the vesicles in lymphangioma are greatly dilated lymph channels that cause the papillary dermis to expand

• The typical history of Lymphangioma shows a small number of vesicles on the skin at birth or shortly after. In subsequent years, they tend to increase in number, and the area of skin involved continues to expand. Vesicles or other skin abnormalities may not be noticed until several years after birth

• Treatment and prognosis• Drainage• Lymphangioma can be healed when treated with a flashlamp • Treatment for cystic lymphangioma involves the removal of the

abnormal tissue;• Surgical removal of the tumor is the typical treatment provided,

with the understanding that additional removal procedures will most likely be required as the lymphangioma grows.

• References:Wikipedia,the free Encyclopedia

• Hemangioma• It is the abnormal buildup of blood vessels in

the skin or internal organ.• It is benignEtiolgy:• Vascular malformation

Clinical features The common site :the are seen on the tangwe,lips and buccal

mucosa. They are lesion with blue discoloration.

Diagnosis• The use of aglass slide(diascopy)

Management• Non symptomatic:non reaction• symptomatic: surgecal excision,cryotherapy,sclerosing and

emboliation

• Pathogenesis• Is still not understood. • but growth factors :• hormonal and mechanical influences affect

the abnormal proliferation of endothelial cells in hemangioma

• the primary, causative defect in hemangiogenesis remains unknown and no genetic alteration has been implicated.

• Referance:Dr Isyagi and wikipedia