Patologie dutiny ústní - ustavpatologie.upol.czustavpatologie.upol.cz/_data/section-1/235.pdf ·...
Transcript of Patologie dutiny ústní - ustavpatologie.upol.czustavpatologie.upol.cz/_data/section-1/235.pdf ·...
Facial cleft – disorder in the migration of neural crest cells failure of the fusion process and failure of inwards growth of
the mesoderm genetics play a part in the development of facial clefts Lateral cleft –the commonest -cheiloschisis (harelip)
-incomplete cleft–coloboma labii
-cleft extending to the nose cavity - labium leporinum
-cleft palate, soft palate - uranoschisis, jaw - gnatoschisis and uvula-staphyloschisis
Medial, transverse,oblique cleft,
Developmental disorders
Vestibular defect Accesory mouth Macrostomy Microstomy Aglossia Microglossia Macroglossia Ankyloglossia Lingua plicata (scrotal tongue) Mikrognatia, progenia, prognatia Fordyce´s spots Dermoid cyst Heterotopic gastric and intestinal mucoses Heterotopic nerve tissue White nevus(white sponge n, AD inheritance intracellular edema
Developmental disorders
Mechanical Chemical (arsenic, acid, lye, drugs – aspirin) Scurvy (Scorbut) Hemoblastosis Infections Allergy (ATB, metals) Autoimmunity (Wegener granulomatosis,
Lupus erytematodes….)
Necrosis
atrophy of mucosa and processus alveolares old age diabetes disorders of inervation, Plummer –Vinson‘s sy (atrophic glossitis
+ epithelial dysplasia in pernitious anemia anemia
Atrophy
melanin:
physiological in darked races
Hormonal: Graphite spots in Addison‘s disease
melanin spots in Peutz-Jeghers syndrome
Reactive: pigmentation in lichen planus
actinic keratosis
Therapy associated: Oral contraceptives Antimalarials Phenothiazines Methyldopa
Pigmentation of the oral cavity
Pigmentation of the oral cavity
hemosiderin
after trauma
rarely in hemochromatosis
exogenic pigmentation – chronic poisoning by heavy metals-- lead,
mercury,zinc, amalgam
Addison´s disease
stomatitis – the whole oral cavity
cheilitis- lip,
glossitis- tongue
gingivitis- gingiva
Inflammation of the oral cavity
Non-specific inflammation
Inflammation with exsudate predominance: serous catharral purulent Inflammation with alteration predominance (tissue
damage) pseudomembranous ulcerative gangrenous
Serous inflammation – stomatitis acuta simplex
Inflammatory erythema The mildest form May be local or
accompany systemic diseases
All known causative agents
Transient, without consequences
Catharral inflammation
Catharrals – serous exsudate + mucus overproduction Etiology: similar as in serous i.
Purulent inflammation – stomatitis purulenta
Mosty odontogenic etiology
flegmonous inflammation may spread to sublingual, submandibular,
parapharyngeal areas - angina Ludovici (Ludwig´s angina= angina
maligna=morbus strangularis)
-cheilitis phlegmonosa – orinates from furuncle, serious complication –
spread through vessels to cranial cavity with brain sinuses tromboflebitis
splavů, leptomeningitis
glossitis abscedens- foreign body
actinomycosis- anaerobic mikrobes actinomyces- abscending and
granulomatous reacton with scarring
Periodontal inflammation and osteomyelitis.
-
Ludwig´s angina
Actinomycosis
Pseudomembranous inflammation
Pseudomembrane :
necrotic tissue infiltrated by fibrin and PMN
Causes: -bacterial (diptheria, scarlet fever) scarlet fever– beta hemolytic
streptococcus group A, rapsberry tongue , lymphadenopathy, (peritonsil abscessus, otitis, meningitis…)
-viral: inf. mononucleosis, influenza
- immunosuppression -chemicals- acid, lye burns,
Ulcerative inflammation
1. Preceding vesiculous diseases a. Infectious – herpetic stomatitis (herpes virus 1,2) – Herpes zoster ( varicella-zoster) – Herpangina, Hand-foot-mouth disease
(Coxsackie A,B)
b. Non-infectious – Pemphigus vulgaris – Pemphigoid – Dermatitis herpetiformis
2. Without preceding vesiculous diseases
a. Infectious – tbc – syphilis – cytomegalovirus b. Non-infectious – trauma – chemical burning – apthous stomatitis – systemic diseases(SLE) – drug reactions – malignant tumors
Characterised by blisters formation (vesicula, bulla with rapid maceration and ulceration
Mechanisms 1. Spongiosis 2. Cytolysis and baloon
degeneration 3. Akantolysis = dissolution
of intercellular adhesions 4. Epidermolysis
(separation of the epidermis in the basement membrane)
Vesiculous inflammation
Viral vesiculous inflammations
a. Herpes simplex 1,2
Infection of non-immunized organisms –
Primary gingivostomatitis -childhood, adulthood Fever, systemic symptoms
resembling flu Mucosal edema, erythema, small
ulcers
-
Infection of immunized organisms
(recurrent)
HSV persist in nerve ganglias, in
activation arises herpes labialis-
(lip, gingiva) – painful lesiosn
healed within 7 days
Dentists 2-10 days after contact –
herpetic panaritium(HSV1),
may last even 2 month
sometime axillary lymphadenitids
Dif. dg: Necrotising ulcerative periodontitis
Pemphigus vulgaris
Erythema multiforme
Erozive lichen planus
Herpetic stomatitis
Virus varicela zoster Elderly people Immunosuppression, often in lymphomas ( Hodgkin´s and T lymphomas),
leukemias Efflorescence spread from one or more ganglia along nerves of an
affected segment and infect the corresponding dermatome (an area of skin supplied by one spinal nerve)
How the virus remains latent in the body, and subsequently re-activates is not understood.
Strong painful rash Often n. trigeminus+ n facialis (paresis) Postherpetic neuralgia
Herpes zoster
Herpangina
Small kids
Summer time
Sudden onset
Diffuse pharyngitis
Apthous inflammations
Apthous stomatitis /recurrent aphta/- very common,
10-25% of population. Etiology unknown - genetic - infection - Immunopathologic state (T
lymphocytes) - Hormonal disturbances - Hematologic diseases - Stress - Some food (citrus, cherry) - Folate and B12 def. - Abnormal response to trauma - GIT disease
Typical features: - Minor apthous ulceration
- Duration -10 days - Regular intervals (cyclic) - Free period usually 3 weeks - Healed without scar
- Major apthous ulceration
- 1-2 ulcers - Size 10mm - Duration – may be month - Non- cyclic - Healed with scars - More commom genital
involvement
Apthous inflammations
Minor apthous ulceration.
Major apthous ulceration
Autoimmune vesiculous diseases
Pemphigus vulgaris It is an autoimmune disease caused by antibodies directed against both desmoglein 1 and desmoglein 3 resulting in the loss of cohesion between keratinocytes in the epidermis, classified as a type II hypersensitivity reaction. It is characterized by extensive flaccid blisters and mucocutaneous erosions. Potentially fatal 50% of cases begins in mouth Paraneoplastic pemphigus (usually fatal) Pemphigoid
Autoimmune disease with subepithelial bullae – epidermolysis Female preponderance Elderly people
Pemhigus vulgaris
Necrotizing and gangrenous inflammation
Noma Noma is a rapidly progressive, polymicrobial, opportunistic infection that occurs
during periods of compromised immune function.Fusobacterium
necrophorumand Prevotella intermedia are thought to be key players in the process and interact with one or more other bacterial organisms (such as Borrelia vincentii ,
Staphylococcus aureus and nonhemolytic Streptococcus
The reported predisposing factors: Malnutrition or dehydration Poor oral hygiene Poor sanitation Unsafe drinking water Recent illness Malignancy An immunodeficiency disorders, including AIDS
Necrotizing and gangrenous inflammation
Acute ulcerative gingivitis Vincent´s angina (Vincent´s organisms Borrelia
vincentii and Fusiformis) Interdental papillae Healthy individuals Immunocompromised
Mycotic infections
Candidiasis /disease of the diseased/
forms: pseudomembranous atrophic hypertpphic Causes: -immature immune system -ATB therapy -HIV -diabetes -anaemias -immunosuppression -
Less frequently: aspergillosis,
Deep mycosis (blastomycosis, cryptomycosis) – opportunistic inf. - tissue necrosis (because of vessels occlusion)
Chronic inflammation chronic gingivitis - insufficient oral hygiene, tartar, diabetes, avitaminosis, May be comined with resorption of alveolar processes chronic hyperplastic gingivitis - in pregnant, antiepileptic drugs Granuloma fissuratum Stomatitis nicotinica (palate, mucosal hyperplasia sliznice with
hyperkeratosis) Atrophic glossitis (Hunter‘s) - pernitious anaemis Anguli infectiosi (stomatitis angularis, angulae cheilitis) salivary maceration, Fe, vitamin B deficiencies, malabsorption
Chronic inflammation granulomatous cheilitis cheilitis granulomatosa - unknown etiology,
macrocheilia, perivascular granullomas Melkersson-Rosenthal‘s syndrome (paresis of facial nerve+ lingua plicata)
Specific inflammation
Syphilis TBC – rare, as complication of pulmonary TBC
Acquired syphilis
-Treponema pallidum 1. stage: chancre (tongue, lips) Healed spontaneously
within 3 month
Acquired syphilis
2. stage: condylomata lata Flat placques or ulcerations
Acquired syphilis
3. stage: (30% of patients) gumma (very often as intersticial glossitis)
Congenital syphilis
– Hutchinson´s teeth (peg shaped) Imperfect formation of enamel Hutchinsonova trias: + labyrintitis Keratitis Others: Gothic palate, saddle nose
Progressive changes
Macroglosia Gingival hyperplasia Leukoplakia Granullomas Epulis
Epulides Epulis (Galén) Epulis is a soft tissue swelling of the gingival margins Hyperplastic inflammatory lesions arising from periodontal tissues Epulis granulomatosa Epulis fibromatosa Epulis gravidarum Epulis gigantocelularis (giant cell)
Epulis fibromatoza
Giant cell epulis
Giant cell epulis
Progressive changes of the tongue
Makroglossia congenital (lymphangioma, Down´s syndrom) acquired (acromegaly, AL amyloidosis) Lingua villosa nigra Elongation of filliforme papillae+propagation of chromogenic
bacterias, bad hygiene, smoking, drugs, Fuligo lingue
Granulomatous disease
Foreign body granuloma Pyogenic granuloma (teleangiectaticum) – dark red,
(5mm), similar to capillary hemangioma + neutrophils Oro-facial granulomatosi (swollen lip) Crohn´s disease Sarcoidosis Melkersson-Rosenthal‘s syndroms Wegener´s granulomatosis Histiocytoses Central giant cell granuloma
local reactive intraosseal neoplasia, dif.dg – osteoklastoma
Pyogenic granuloma
Precanceroses
Leukoplakia - white patch
acanthosis, hypekeratosis
zvláštním typem je chronická hyperplastická kandidioza
Hairy leukoplakia - tongue margins, in HIV
Plummer-Vinson‘s syndrome- atrophic glossitis+ dysplasia
erythroplasia- bright red patches with dysplasia