Bệnh học miệng ở trẻ em

8/6/2019 Bnh hc ming tr em

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BNH HC MING THNG GP TR EMPhn I

TS. V Trng Nh NgcTnh trng bnh l trong ming c th c xem xt da trn m hoc c quan c

lin quan.A.Nhng bnh l ca li:1.Li nh:

- L tnh trng pht trin bt thng khng thng gp ca li, trong li c kch thc nh hn bnh thng.

- Trong nhng trng hp him gp, c th khng thy ton b li, gi lkhng c li.

- Li nh thng i km vi thiu sn xng hm di v c th khngc cc rng ca di. N c th km cung hm hp v cn cho rng sau.

- iu tr bao gm phu thut chnh hnh v sau l chnh nha.Nhng trng hp hm rt hp, cn phi ch xem kch thc li (linh) hoc li c t th bt thng

2.Li to:- Tnh trng li c kch thc to hn bnh thng.- Tnh trng ny c th l bm sinh hoc mc phi.- Li to bm sinh, do s pht trin qu mc ca m c hoc t chc mch

mu ca li, ngy cng r rng khi tr ln ln.- Li to bt thng l mt c im ca tnh trng thiu nng tuyn gip,

khi , li b x rnh v c th pht trin rng ra khi ming.- Li to cng thng gp trong bnh ri lon d tr glycogen type II,

bnh x thn kinh type I v hi chng Beckwith Wiedmann.- N c th l tnh trng ring l v him gp nhng cng c th kh

thng gp (di truyn gen tri).- Li to vi t l bt thng c th gy nn tnh trng tng trng khng

bnh thng ca xng hm v

lch lc khp cn.

Li to c th dn tixe cc rng trc hm di v khp cn loi III theo Angle.

- tr nh, li to thng a ra pha trc, tr khng ng kn ming,cng c th thy nc bt chy ra ngoi, ting th to v kh cho tr n,ung.


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- iu tr li to ty thuc vonguyn nhn v mc trm trng,

phu thut thu nh kch thc lic th cn thit ty trng hp.

3.Dnh li:- Tnh trng pht trin bt thng ca

li c trng bi phanh li ngnv dy, thng dnh gn u li.

- Dnh li mt phn thng gp hnv c gi l tongue tie.

- Dnh li hon ton xut hin do qu trnh tch i gia li v snming. Li c du hiu hai thy khi a ln cao.

- Do phanh li ngn, chuyn ng ca li b hn ch. Li khng tha ln cao hoc sang hai bn, thm ch khng th chm c vmming.

- Tnh trng ny nh hng ti n nhai, ni v cc chc nng khc cali.

- Nu tnh trng dnh li khng c sa cha, c th gy trt, mt mli, nim mc li.

- Phu thut phanh li c ch nh khi gy nh hng ti vic n ungca tr v ch thc hin khi tnh trng bnh nhn cho php.

4.Li x rnh:- Tnh trng rt thng gp khi xut hin nhng rnh hoc ng trn mt

lng li.- Bnh cn cha c bit r, c th do di truyn.- Mt lng li xut hin nhiu rnh c su t 2 ti 6mm.- Nhiu rnh chia b mt li thnh nhiu vng khc nhau, dng nh tch

bit vi nhau bi cc rnh ny.- Hu ht bnh nhn c mt rnh ln chnh gia, cng vi nhng rnh

nh hn phn nhnh ra t gc phi.- Mt s bnh nhn phn nn v cm gic bng rt v au c bit khi n

thc n cay.- Tnh trng ny cng l mt phn ca hi chng Melkerssen Rosenthal.


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- Khng cn iu tr g, nn ch hn khi nh rng lm sch ba thcn trong cc rnh.

5.Median Rhomboid Glossitis (vim li dng hnh thoi gia):- L tnh trng bt thng bm sinh li, do phn c gia khng bin

mt trc khi c s hp nht ca hai na bn ca li, do c mt phntrng dng nh nm gia hai na li.

- Gi thuyt v nguyn nhn do nhim nm Candida albicans c nghn nhiu.

- Dng hnh thoi, trn, nm trn ng gia mt lng li, ngay trcnh dng i (circumvallate papillae)

- Vng ny khc bit vi cc vng khc bi n khng c nh dng ch.- iu tr chng nm nu c biu hin nhim nm Candida, nu khng

khng cn iu tr g.

6. Vim li cp lan ta/di tr:- Tn thng cha r nguyn nhn, biu hin bng nhng vng lan ta trn

b mt li.- Cho thy c lin quan ti stress, t l b nam/n = 1:2, gp nhiu la

tui 5 18.- Nhiu vng trc vy ca cc nh dng ch, dng bt thng hay dng

trn.- Trung tm tn thng b vim trong khi phn bn ngoi mng v bao

quanh bi 1 di mu trng vng.


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- Nhng vng trc vy nh dng nm biu hin l nhng chm nhcao.

- Nhng vng trc vy tn ti mt thi gian ngn mt khu vc nht nhri lnh thng v xut hin mt v tr khc, cho thy tnh cht di tr

trn ton b li.- Thng ti pht, sau khi t lin thng.- Xut hin cng li x rnh.- Nhng tn thng tng t c th xut hin nhng khu vc khc trong

ming nh nim mc m, li, mi chng c gi l li bn ngoi (ectopic geographic tongue).

7.Li mc lng- Bnh cn ca hin tng ny c cho l do nhim nm v c th khng

hn l 1 trng hp pht trin bt thng.- c trng bi s pht trin to bt thng ca cc nh dng ch v thiu

s trc vy thng thng. iu ny dn ti vng nh dng ch dy v trirng trn mt lng li.

- Mu sc ty thuc vo cc tc nhn bn ngoi nh thuc l, n tru vc th c mu nu en.

- Trong nhng trng hp nng, nhng nh ny c th pht trin chm vovm ming, gy cn tr.

- Ton b b mt lng li c lng.- iu tr ch yu tp trung vo vic v sinh li bng bn chi, trnh lng

ng thc n v kch thch.8.Bnh li lin quan ti tuyn gip

- Gp tui 20, nhiu hn n.- Trn ng gia li xut hin nhng cc u ln dn ln, c b mt trn

hoc ni mch mu.- Pht trin tui dy th v khi mang thai, m tuyn gip thng khng

bnh thng.

- Nu biu hin triu chng th la chn iu tr c th l ct v thay thhormone tuyn gip.

B.Nhng bnh l vng nim mc ming1. Fordyces granules:

- Tnh trng pht trin bt thng c trng bi vng tp trung tuyn bbt thng nhiu vng khc nhau ca nim mc ming.


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- Trong qu trnh pht trin hm trn v hm di, mt s t chc ngoi bca vng da ln cn xm nhp vo nhng vng ny gy nn s xut hinca tuyn b trong ming.

- Nhiu mn nh mu trng vng.- Ch yu gp trong nim mc ming, ngoi ra c th gp vin mi trn,

hnh nhn khu ci- C th dng nt nim mc m do tp trung nhiu mn nh.- Do khng gy triu chng g nn khng ch nh iu tr.

2.Bch sn- Tnh trng thng gp nim mc ming, xut hin nhng vng trng

c nh sa.- Khng r bnh cn, gp nhiu ngi da en hn da trng.- Ch yu gp nim mc m, nim mc mu trng c nh sa hay trngxm.- B mt nim mc gp np, hnh thnh nhiu np nhn hay nhng sc

trng.- Tn thng khng th no b.- Thng hai bn, c th lan ln nim mc mi.- Khi m b ko cng, nhng mng trng c th bin mt.- Bch sn khng phi tnh trng tin c tnh v khng c kh nng chuyn

dng c tnh.- Khng cn iu tr g.

3. Tng sn biu m trung tm- Tn thng dng nt thng gp mi di v nim mc ming. C th

gp mi trn, li, khe mi.- Dng nt, kch thc 1 5mm, khng cung.- Mm v ging mu nim mc.- Gp nhiu tr 3 18 tui.- C th bin mt sau 6 thng. Tn thng v hi nn khng cn iu tr g.

C.Nhng bnh l mi1.H khe mi

- Nhng ch lm trn nim mc xut hin gc ming, trn ng vinmi.

- Biu hin s ha nhp m hc khng bnh thng trong qu trnh hnhthnh n hm trn v hm di.


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- Gp nhiu hn ngi ln (12-20%), t hn tr em (0,2-0,7%). Nhiu nam.

- Mc d bm sinh nhng nhng h thc s c th pht trin mun hn.- 1 bn hay 2 bn.- Khng triu chng.- Mt s c th c nhng tuyn nc bt su bn di nn khi ht hi c

th gy bn nc bt.- Khng lin quan ti khe h mt v vm ming.- Khng cn iu tr g.

2.Mi kp- Tnh trng bt thng him gp, do s gp np ca t chc m nim

mc mi.

- Thng bm sinh nhng cng c th mc phi.- Thng gp nhiu hn mi trn.- Hai mi him khi b cng nhau.- Tnh trng c nhn bit khi mi b ko cng nh lc ci.- Khng cn iu tr g.

3.Khe h mi- Mt trong hai dng quan trng ca khe h vng hm mt (KHM v

KHVM).- Do s ha nhp bt thng gia ca n mi v n hm trn.- Thng xut hin cng KHVM.- C th xut hin ring l nhng c th nm trong hi chng (khong 250

hi chng c xc nh).- Phn loi:

o KH khng hon b 1 bn.o KH ton b 1 bn.o KH khng ton b 2 bn.o KH ton b 2 bn (st mi).

- Khe h khng ton b ko di ti nhn trung v c th lin quan vi vmming.

- Khe h ton b qua nhn trung v thng lin quan ti vm ming hn.- Khe h phi hp thng gp v nghim trng hn nam, thng gp

bn tri nhiu hn.


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4.Hi chng Peutz Jegher:- Bao gm xut hin polyp rut, nhng im nhim mu trn mt,

khoang ming, tay v chn c tnh cht gia nh.- Mng nhim mu melanin trn mi v nim mc ming xut hin t khi

sinh.- Nhng vt nh mu nu ng knh 1 5mm.- Trong ming, b phn ln nim mc ming, ri n vm ming cng v

li.- t khi gp nhim mu li.- Mt nim mc ca mi di b nhim sc t rng.- Sc t trn mt c th nht dn i khi ln ln nhng mu trn nim mc

mi v m vn tn ti.

- Polyp c th xut hin cc on rut khc nhau nhng gp nhiu hn rut non. Nhiu bnh nhn b au bt thng v c du hiu tc rut.- Hi chng khng lin quan ti gii tnh, c nam v n b vi t l nh

nhau v u mang nguyn nhn.- Chn on thng do nha s a ra khi pht hin s nhim sc t vng

ming.D.Bt thng hnh th rng1.Rng nh:

- Rng c kch thc nh bt thng.- 3 loi:

o Rng nh ton b thc s (true generalized): ton b rng nh hnbnh thng, y l tnh trng him gp khi m tt c cc rng ccu trc bnh thng nhng kch thc nh.

o Rng nh ton b tng i (relative generalized): rng c kchthc bnh thng hoc hi nh nhng trn 1 cung hm ln hn

bnh thng to nn cm gic rng nh, y l tnh trng bt cnxng rng hm v nguyn nhn do di truyn kh r rng.

o Rng nh n l: tnh trng thng gp rng ca bn hm trn vrng khn, thng gp nht l rng ca bn dng mi gio.

2.Rng to- Kch thc rng to hn bnh thng.- 3 loi:


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o Rng to ton b thc s: tt c rng ln hn bnh thng, tnhtrng him gp lin quan ti bnh khng l tuyn yn.

o Rng to ton b tng i: thng gp hn, rng ln hn bnhthng trn cung hm nh hn bnh thng, yu t di truyn c vai

tr r rt.o Rng to n l: kh t gp, nguyn nhn cha r.

3.Dilaceration:- Thn rng hoc chn rng b gp gc trong qu trnh hnh thnh.- Do chn thng trong qu trnh hnh thnh rng, kt qu l s khong

ha ca rng xy ra v tr mi.- Ch gp gc c th bt c v tr no ca rng.- Vn c th xy ra do nh rng hay iu tr ty, gy sang chn mm

rng bn di.

4.Nm rng dng mng:- Mt cu trc nh pht trin ging hnh mng i bng t cingulum ca

rng ca vnh vin hm trn hay hm di.- Mi ny ha nhp vi cu trc rng nhng c mt rnh su gia nm

v mt li hi dc ca rng.- Cu to bi lp men, ng bnh thng v c sng ty bn di.


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- nh hng ti thm m, su rng v cn tr cn.- Gp vi t l cao ngi c hi chng Rubinstein Taybi.

5.Rng ln ra ngoi (nm ph)- Biu hin trn lm sng vi s xut hin ca mi ph hay nt men trnmt nhai gia mi ngoi v mi trong cc rng hm nh hm di.- C th xut hin mt bn hay c hai bn.- Him gp rng hm ln, rng nanh hay rng ca.- C s ln ra ngoi ca t chc biu m ca lp men bn trong.- Mi tha c th gy cn tr mc rng, sai v tr rng, v/hoc h ty gy

nhim khun sau khi b mt b v hay mn.6.Rng trong rng

-Tnh trng bt thng c s lm v

o ca men rng mt li.- Xut hin rng sa v rng vnh vin. Thng gp nht rng ca bn

vnh vin hm trn.- C th do di truyn tri vi biu hin a dng v c l c s ha nhp

khng hon ton.- Cc rng trc c tnh trng rng trong rng thng c kch thc v

hnh dng bnh thng, i vi cc rng khc c th c hnh dng btthng.

- C mt ng lm trn men v s xut hin ca l c th to s thngthng gia ch lm v bung ty.

- Trm sealant hay phc hi ng vo ca ch lm trnh nh hngn ty rng.

- Nu tnh trng c pht hin trc khi rng mc hon ton, c th chnh vic ct t chc li xung quanh phc hi sm.


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7. Taurodontism (rng b tt)- Thn rng to v m rng ti phn chn rng.- Gi l rng b do hnh th rng ging vi rng ca ng vt n c.- C th c dng rng b mc nh, trung bnh hay nng. trng hp

nng, c th c c s chia hai hoc chia 3 vng chp rng.- Lin quan ti hi chng Klinefelter.- C th nh hng c rng sa v rng vnh vin, gp cc rng hm

ln.- Rng khng c biu hin bt thng trn lm sng.- Tnh trng c nhn bit khi cn iu tr ty.- Trn phim Xquang thy hnh nh bung ty rt ln v ty khng c ch

tht c rng nh bnh thng.

8. Tha chn rng- C th gp bt k rng no.- Cn ch khi nh rng trn lm sng, d dn ti gy chn rng v gy

vim nhim.9.Rng dnh

- Khi c s kt hp ca 2 rng sa hoc vnh vin c lp.- Hu nh ch gp nhm rng trc v c xu hng gia nh.- Trn phim Xquang cho thy s ha nhp ch gii hn phn thn v

chn rng, rng dnh c bung ty v ng ty tch bit.- Su rng d xut hin rnh kt hp trn thn rng v cn c trm li.- Thng thy rng sa dnh nhau khng c s hin din bm sinh ca 1

rng vnh vin tng ng.


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10.Rng sinh i

- S chia i ca mt mm rng ring l do s lm vo xut hin giaion pht sinh trong vng tng trng ca rng.

- S bt thng c th do yu t di truyn gp c rng sa v rng vnhvin mc d thng gp rng sa hn.

- Trn lm sng xut hin mt rng c thn rng b ch i trn mt chnrng. Thn rng thng rng hn bnh thng, c mt rnh nng i t racn ti c rng.

11.Rng lin kt (concrescence)- Dng kt hp xy ra sau khi chn rng hon thin.- Ch kt hp b mt cement.- C th do chn thng hoc chen chc rng lm tiu xng k gia cc

rng.- Cn chn on tnh trng ny trc khi nh rng trnh tnh trng nh c 2

rng.


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12.U rng (odontome)- T bo biu m v m

lin kt bit ha btthng dn ti cu trc

bt thng ca men vng.

- 2 loi: u rng phc hp vu rng a hp.

- U rng a hp: rng vnc cu trc gii phu bnhthng mc no .

- U rng phc hp: khi btthng ca m rngkhng ging cu trc rng

bnh thng.- Bnh cn cha r c th

do chn thng hocnhim trng.

- C th pht trin ln gysng v mt cn i mt.

- iu tr phu thut loib.

E.Bt thng s lng rng:1. Tha rng:

- Pht trin t n rng th 3 pht sinh t l rng v tr gn n rng vnhvin hoc cng c th do n rng vnh vin t chia ra. 1 s trng hp cxu hng di truyn.

- C th gp bt c v tr no nhng cng u tin 1 s vng. Hay gpnht l mesiodens, rng tha nm gia rng ca gia v rng ca bn

hm trn, xut hin 1 bn hay c 2, mc ra ngoi hoc kt hoc thmch ngc. Rng k thng nh, thn rng hnh cn v chn rng ngn.Rng k l tnh trng di truyn tri.

- Hay gp tip theo l rng hm ln th 4 hm trn, nm pha xa rngkhn, hm di t gp hn.


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- Ngoi ra c th gp rng tha: rng cnh rng hm hm trn, rng hmnh hm di, rng ca bn hm trn. Rng cnh rng hm l nhng rngth, nh c th nm pha m hay pha li ca rng hm ln hm trnhay nm ch tip xc gia rng hm ln th nht, th hai hoc th 3

hm trn.- 90% rng tha hm trn.- t gp rng sa.- Mm rng tha thng gy lch v tr v

cn tr mc rng ln cn.

2.Khng c rng (anodontia):- Hon ton khng c s pht trin ca

rng.- Khi xut hin ring l, b rng sa

khng b nh hng, do s di truynln.

- La chn iu tr l hm gi ton b.3. Thiu rng (hypodontia):

- Thiu 1 s rng trn cung rng, thiunhiu rng (oligodontia) khi thiu hn 6rng vnh vin (tr rng khn).

- C th xut hin khng c tin s gianh d thng c lin quan ti yu tgia nh.

- C th xut hin trong hi chng, c bit lon sn ngoi b.- Hay gp nht l thiu rng hm nh th hai hm di, rng ca bn hm

trn v rng hm nh th hai hm trn. C th thiu 1 hoc 2 bn.- iu tr thay th cc rng mt.

4.Lon sn ngoi b- c trng bi nhiu bt thng bt ngun t ngoi b bao gm c hm

rng sa v vnh vin, da, tc, mng.- Kh him gp thiu rng sa bm sinh.- Khi thiu mt s rng sa, cc bt thng khc ca ngoi b c th cng

xut hin.


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- Tr thiu mt s rng sa v rng vnh vin c th c mt vi hoc tonb du hiu ca mt dng lon sn ngoi b, cn phi c nh gi thmv cc thay i h thng.

5.Lon sn ngoi b khng tit m hi:- 1 dng thng gp hn ca lon

sn ngoi b. Quan h cng huytthng tng nguy c biu hin dotnh trng di truyn ln.

- c im: thiu rng, thiu snrng, lng tc km pht trin, kmhoc khng pht trin tuyn mhi.

- Cc c im khc: gim tit ncbt. mi nh ra, sng mi hnh ynnga.

- Da thng kh v bong vy, cng rnh gc ming.

- Thiu rng dn n km pht trinxng rng.

- Cu trc xng khc bnh thng.- Nhng rng sa c mc c kch

thc bnh thng hoc nh.- Cc rng trc hnh nn l c

im thng gp ca thiu nhiurng v cc dng lon sn ngoi b.

- Cc rng hm sa khng c rngvnh vin thay th thng c xuhng b dnh khp, iu ny cha c l gii r rng.

- Km pht trin tuyn m hi khin qu trnh iu nhit b kh khn, trc tuyn m hi km hoc khng pht trin c bit kh chu khi thi titnng, phi sinh sng nhng ni kh hu mt.

- Tr b lon sn ngoi b c tm l pht trin bnh thng v c tui thbnh thng.

- Tr thiu nhiu rng sa c th cn hm gi tng phn ci thin khnng n nhai v tnh trng dinh dng. Hm gi cn c iu chnh v


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lm li nh k cc rng vnh vin mc v xng hm pht trin. Lmhm gi l cn thit gim nhng vn v tm l khi tr thy mnhkhc vi cc bn v m bo hiu qu n nhai.

- Nu rng vnh vin mc ng v tr v tng quan gia cc rng tt, hmgi tng phn s c gi ti khi tr ln cy implant hoc lm cuc nh.

F. Bt thng cu trc rng:1. Thiu sn men / km khong ha men rng:

- Qu trinh sinh men gm 2 giai ono Giai on 1: hnh thnh khung hu c.o Giai on 2: g khong ha.

Tc nhn ti ch hay ton thn tc ng vo vic hnh thnh khung hu c

gy nn bt thng b mt men v nhng bt thng ny thng c gi lthiu sn men. Nhng yu t c th tc ng vo giai on khong ha vtrng thnh ca men rng, khi c gi l men rng km khong ha.- Thiu sn men rng sa sau khi sinh cng thng gp nh thiu sn men

rng vnh vin d rng sa t khi gp tnh trng nng hn. Tuy nhin,thiu sn rng sa hnh thnh trc khi sinh him gp.

- Thiu sn men c th nh, xut hin nhng h nh trn b mt men hocnhng ng ngang trn thn rng. Nu hot ng ca nguyn bo tomen b nh hng trong 1 thi gian di, cu trc men se bt thng trn 1vng ln.

- Thiu sn men thng biu hin nh 1 phn ca nhiu hi chng v cth do nhiu nguyn nhn nh:

o Thiu dinh dng: Vit A, C, D, Canxi, Phospho.o Tn thng no, bt thng thn kinh.o Hi chng thn h.o D ng.o Nhim c ch mn tnh tr em.o Chn thng v nhim trng ti ch: nh thiu sn Turner.o Khe h mi v vm ming.o Tia X.o Nhim rubella phi thai.


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2. inh ng bt ton (ng trng c di truyn)

- Di truyn tri, t l gp 1/8000.- Trn lm sng, rng sa v rng vnh vin c mu nu hoc trng

xm.- Men rng thng b v ra cn cc rng trc v mt nhai cc rng sau.- Phn ng mm b mn rt nhanh, c th ti mc b mt ng nhn,

bong lin tip vi m li.- Chn rng ngn.

3.Sinh men bt ton-

Tnh trng pht trin bt thng ca men c nguyn nhn di truyn, nhhng ti c b rng sa v vnh vin.- T l gp trong cng ng: 1/14000 1/16000 v c nhiu dng biu

hin trn lm sng.- t nht 3 loi c bit ti:

o Km khong ha


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o Km trng thnho Hypoplastic

- Bt thng ch gii hn cu trc men.- Trn phim Xquang, ng vin ty bnh thng, hnh th chn rng

khng ging bnh thng.- S khc bit v hnh dng v s lng men rng c cho l do bt

thng xy ra nhng giai on khc nhau ca qu trnh pht trin camen rng.

- C th do sai st trong khi hnh thnh khung hu c hay khi khong ha. Nu g hnh thnh khung hu c, men rng c hnh thi bt thngnhng mc khong ha bnh thng. Nu bt thng g khong ha,men rng s mm.

- iu tr ty thuc mc nghim trng v yu cu thm m.4.Lon sn ng:

- Do nhng tc nhn him gp tc ng n qu trnh to ng, c 2 loi:o Lon n ng chn rng (I)o Lon sn ng thn rng (II)

- Nguyn nhn c bit ti l do gen lin kt.4.1. Lon sn ng type I:- C rng sa v rng nanh u b nh hng, type I l dng di truyn tri.- Trn phim Xquang, chn rng ngn v c th nhn hn bnh thng,

thng khng thy bung ty v cc ng ty.- Hnh thi v mu sc thn rng thng bnh thng, cng c khi c mu

hi trng c, xanh hoc nu.- C th c vng thu quang quanh chp rng tn thng.4.2. Lon sn ng type II:- Tnh trng di truyn tri, hm rng sa c mu trng c.- Trn phimXquang thy bung ty b tc.- B rng vnh vin c mu bnh thng.- Trn phim c th thy hnh nh gai ng ty do si ty.

G.Nhng khi u lnh tnh trong khoang ming:1. U mu:

- Gp trong 10 nm u ca cuc i, nhiu hn n.- Thng xut hin mi, li v nim mc ming.


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- Tn thng mu xanh c th khu tr hay lan ta.- Dng phng, mm hay u li.- iu tr bng phu thut ct b hoc liu php lm lnh.

2. U lympho:- Gp trong 10 nm u i, khng phn bit gii tnh.- Thng xut hin li, mi, nim mc ming, sn ming v c.- C th khu tr hay lan ta, tn thng rng mu xanh hay trong m.- C th c nhiu tn thng.- La chn iu tr sinh thit ct b, him khi thoi lui.

3.Epulis bm sinh:- Gp tr s sinh, nhiu hn n.- Thng khu tr xng rng vng sng hm rng trc hm trn.- Dng sng c cung, trn nhn.- iu tr ct b.

4. U x thn kinh:- 7% s tn thng gp trong khoang ming, phn cn li gp khp c

th.- Dng nt ca m thn kinh, c th nh, ring l v trn nhn hay thm

ch c cung.- Khng cn iu tr g.

5.Bt dng bt mu trng:- Bt thng di truyn tri.- Thng gp nim mc ming.- Khng triu chng, lan rng, nim mc ming gp np dy ln.- Khng cn iu tr g.

6.Bt mu xanh:- Gp trong 10 nm tip theo ca cuc i, nhiu hn n.- Thng xut hin vm ming cng, nim mc ming, mi v li.- Nhng nt tng sn ranh gii r, mu nu en hoc xanh.


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- Khng triu chng.- Tn thng trong ming b kch thch lin tc c nguy c chuyn dng c

tnh.- iu tr sinh thit ct b.

H.Tn thng nang trong khoang ming:1.Nang nguyn thy:

- Pht trin trc khi nhng thnh phn cu to nn rng c hnh thnh,do lin quan n tnh trng thiu rng bm sinh.

- a dng v kch thc, c kh nng lan rng vo trong xng v thay thrng lin quan.

- Khng gy au.- Trn phim Xquang cho thy tn thng thu quang ranh gii r hnh trn

hay oval, c th c vin x ha.- C th 1 khoang hay nhiu khoang.- iu tr phu thut loi b km gia xng.

2.Nang rng (nang thn rng):- Xut hin khi thn rng hon thin, hnh thnh bi s lng ng dch

gia biu m men lp ngoi v thn rng.- Thng gp nht vng rng khn hm trn v hm di, rng nanh

hm trn.- Nang rng gn nh lun lun bao gm hoc c lin quan ti 1 thn rng

vnh vin bnh thng.- Him khi lin quan vi rng sa.- C th bao quanh 1 u rng phc hp hay lin quan vi rng tha.- Vng sng hm ni rng mc c th thy sng, di ng, ranh gii r.- Trn phim Xquang thy vng thu quang c lin quan vi 1 thn rng

cha mc. Nang rng thng trn, c th 1 hay nhiu khoang.- Tn thng nh c th c phu thut ly b d dng, tn thng nang

ln gy tiu xng nhiu v lm mng xng 1 cch nguy him thngc iu tr bng phu thut t ng dn lu hay t ti.

3.Nang rng sng ha- Xut hin sau 10 tui, gp nhiu hn nam.- pha sau cnh ngang v cnh ln xng hm di, vng rng khn v

rng nanh hm trn.


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- Gy au.- Xquang: vng thu quang r mt hay nhiu khoang vi ranh gii mng

cn quang r.- C th gy tiu chn rng hoc y lch rng ln cn.- iu tr phu thut ct b v gia xng.

4.Nang chn rng:- C th gp nhiu la tui, nhiu hn hm trn v lin quan vi mt

rng cht ty.- Xquang: vng thu quang trn hay dng trng quanh chp rng.- iu tr ct nang.

5.Nang ng mi khu ci:- Nang c ngun gc t s gin n ca ng mi khu ci.- N l vng sng khng gy au khu vc l ng rng ca.- Xquang: vng thu quang hnh tri tim pha trc ng gia hm trn.- iu tr ct nang.

6. Globulomaxillary cyst:- Nang nm gia rng ca bn v rng nanh hm trn.- iu tr ct nang.

7.Nang l rng tr s sinh (nang li tr s sinh, Epsteins pearls, Bohnsnodules):- Thng nhiu nang, i khi xut hin n l, biu hin l nhng nt trn

xng rng vng sng hm tr s sinh hay tr nh, l nhng nang cngun gc t phn st li ca l rng.

- Epsteins pearls: nhng nt dng nang cha y keratin dc theo nggia khu ci.

- Bohns nodules:nang cha keratine nm trn vm ming cng, c bitti ni giao gia vm ming cng v vm ming mm.

- Trn lm sng l ch sng nh mu trng ri rc trn sng hm.- Khng gy au.- Khng cn iu tr g.

I. Bnh l ca xng hm:1.Khng xng hm (agnathia):


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- Bnh l bm sinh cc k him gp biu hin bng khng c xng hmtrn hay hm di.

- Thng gp thiu 1 phn xng hm hn, c bit xng hm di.2.Xng hm nh:

- Tnh trng bm sinh nhng cng c th mc phi. Xng hm di bnh hng nhiu hn.

- Nguyn nhn c cho l do di truyn.- Ngi m thiu dinh dng hay nhng sang chn trong t cung gy nn

nhng p lc hay chn thng cng c th l nguyn nhn.- Xng hm nh cng c th l h qu ca khe h vm ming v

glossoptosis.- Tr nh c xng hm nh gp kh khn trong vic th v c nhng giai

on xanh tm.- Phn trc xng hm di khng nng cho li lm li tt ra

pha sau gy cn tr.- V xng hm di tip tc tng trng ti cui tui v thnh nin nn

vn c th hy vng thm m mt nghing c ci thin khi ln.- B bnh c th dng iu tr nh xng hm di bm sinh do gip

thc hin ng chc nng xng hm di.- Chng nh xng hm mc phi c th pht trin dn dn v khng c

pht hin ti khi tr 4 6 tui. Dnh khp do sang chn khi sinh hocchn thng sau ny c th gy nh xng hm mc phi. Nhim trngkhp thi dng hm gy nn pht trin bt thng ca li cu v dn tinh xng hm. Trong trng hp dnh khp thc s, phi to hnh khp

3.Xng hm to- Xng hm ln 1 cch bt thng.- Lin quan ti bnh khng l tuyn yn, bnh Pagets, bnh to cc.- Gp nhiu hn xng hm di.- Bnh cn cha r, mt s trng hp lin quan ti yu t di truyn.- c im: tng chiu cao cnh ln, tng di thn xng hm di,

tng gc hm, cho pha trc, gim chiu di xng hm trn, cmnh trc.

4. Vim xng ty (osteomyelitis):- Gp trong 20 nm u i, khng khc bit gii tnh.- Xut hin vng pha sau xng hm di.


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- i km vi st, p xe quanh cung rng, cc rng su, gy au v phnng ca h bch huyt.

- Xquang: vng thu quang lan rng ranh gii khng r.- iu tr ct v dn lu cng vi iu tr cc rng su.

5.Lon sn x:- Gp trong 20 nm u i, khng khc bit gii tnh.- Thng gp xng hm trn hn.- c im: bn xng pha tin nh tng sn, biu hin 1 bn v khng

gy triu chng g.- Xquang: c th thu quang hay cn quang c, dng thy tinh trn?- Khng cn iu tr g.

6. Cherubism:- Di truyn tri.- Xut hin sm.- Khng au, tin trin, khi xng i xng 2 bn XHT hay XHD to

nn khun mt phng phnh in hnh.- B rng sa c th khng pht trin hon ton.- Rng vnh vin c th b nh hng.- Xquang: s ph hy xng hm vi vic m rng v lm mng dn bn

xng.- Gim dn theo tui, khng cn iu chnh nu khng v l do thm m.

J. Bnh l vng mt1. Qu sn na mt

- S pht trin ln ca mt bn u v mt.- Bnh cn c th do s mt cn bng hormone, kt hp khng hon ton,

nhng thay i ti ch trong qu trnh pht trin bo thai, bt thngnhim sc th, bt thng mch mu, thn kinh, bch huyt.

- Dng nh c 1 s lin quan gia qu sn na mt v nhng khi u thn, gan v v tuyn thng thn tr em.

- Gp nhiu hn n.- Rng vnh vin bn b nh hng c kch thc ln, pht trin nhanh

hn v mc trc rng bn i din.- Chn rng ngn,- Xng hm trn v hm di cng pht trin ln.- Nh li cng c th tng sn.


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2. Thiu sn na mt- S teo nh ca 1 vi hoc ton b m 1 bn mt.- Bnh cn c th do sai chc nng h thn kinh giao cm, chn thng,

nhim khun, di truyn, x cng b khu tr.

- c pht hin trong 10 hay 20 nm u i bi ng rnh trng 1bn mt hay lng my gn ng gia.

- Tn thng c th gm s km pht trin ca da, c, xng, m.- M v mt hm li.- Phn ng ca bn b teo vi kch thch in khng thay i.- Da bn nh hng c mu ti.- Thng gp mt lng pha bn mt b nh hng.- Km pht trin mi v li.- C th nh hng ti s pht trin ca rng.- C th bt thng trong pht trin chn rng.- Rng bn nh hng c th chm mc.

Nhim vi khun:1.Bnh tinh hng nhit (Scarlatina):

- Gp nhiu tr vo ma ng.- Nhim Streptococcus nhm tan mu Beeta, loi gy c hng cu.- Thi k bnh t 3 5 ngy.- Triu chng: vim hng, vim amidan nng, au u, gai st, nn. Km

theo phn ng hch vng c.- Mn , lan ta trn da xut hin vo ngy th 2 hoc 3. Mn gp

nhiu nhng vng da gp, l kt qu ca vic nhim c ni mc mchmu gy gin n nhng mch mu nh dn ti hin tng sung huyt.

- Vng nim mc, c bit khu ci sung huyt, hng rc.- Hnh nhn v tr khu ci thng sng v i khi c ph bi lp dch

xm.- S thay i trn li rt quan trng: ban u c ph bi 1 lp mu

trng, cc nh dng nm sung huyt v nh ln trn b mt to thnhnhng nt , c gi l li qu du. Lp ph bn ngoi li nhanhchng bong ra, t u li ti 2 bn v li tr nn sm, sng bong,trn tr nhng vng nh sung huyt, khi ny c gi l li qu mmxi.

- Da trc vy trong vng 1 tun n 10 ngy.


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- iu tr bng liu php khng sinh.2.Bnh bch hu:

- Bnh ly nhim cp tnh gy ra bi trc khun Gram dngCorynebacterium diphtheria hay trc khun Klebs Loeffler.

- Gp nhiu nht vo nhng thng ma thu v ng.- Bnh c truyn qua tip xc trc tip hay nc bt.- Thi gian bnh ch t ngy.- Bnh khi u vi tnh trng kh chu, au u, st v i khi nn.- C th km au hng, ph v hu hng, phn ng hch lympho.- Trn hch nhn xut hin nhng mng ri rc sau ln dn ln, ha

nhp v ph khp b mt. Lp mng ny mu xm, dy, dng si, tit

dch dng gelatin, cha nhng t bo cht, bch cu, vi khun trn tchc lot hoi t ca nim mc, ph ln trn hnh nhn, hng, thanhqun. Mng rt dnh v khi bc gy chy mu.

- Nu vi khun i vo ng h hp, thanh qun c th d ph n, b phbi lp gi mc, gy cn tr c hc.

- Phng bnh bng cch tim phng vacxin cha c t bch hu.- Khi nhim bnh, iu tr bng chng c kt hp khng sinh.

3.Bnh lao:- Bnh lao l bnh nhim khun dng u ht do vi khun a acid

Mycobacterium tuberculosis.- Lao phi l dng ph bin nht ca bnh nhng cc c quan khc cng

c th b nh hng nh ng rut, hu, da.- Nhim lao vng di hm hay cc hch lympho vng c, gi l lao hch,

c th tin trin thnh 1 p xe thc s hay ch tn ti di dng tnthng u ht. Chng c th nh hoc gy au v thng thy c phn ngvim vng da ph bn trn.

- Tn thng lao trong khoang ming l tn thng th pht ca bnhphi.

- Cc t chc c a vo nc bt v xm nhp vo nim mc quanhng ch nt nh trn b mt.


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- Tn thng c th xut hin bt k v tr no trn nim mc mingnhng li l phn hay b nh hng nht, tip l vm ming, mi,nim mc m, li v li g.

- Thng thng, tn thng l tn thng lot khng c hnh dng nhtinh, trn b mt hoc su, gy au v c xu hng tng kch thcchm.

- Nha s c th b mc lao do tip xc trc tip vi tn thng lao anghot ng.

- Vim li do lao l dng him gp ca bnh lao, thng di dng nt haynh sung huyt, lan ta m li.

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