Pre-malignant lesions of Oral cavity
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Pre-malignant lesions of Oral cavity Dr.SHANKHASHUBHRA GHOSH DLO,2 ND YR Stanley Medical College Chennai www.nayyarENT.com 1
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Pre-malignant lesions of Oral cavity. Dr.SHANKHASHUBHRA GHOSH DLO,2 ND YR Stanley Medical College Chennai. Benign lesions. Solid- papilloma fibroma hemangioma granuloma torus palatinus - PowerPoint PPT Presentation
Transcript of Pre-malignant lesions of Oral cavity
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Pre-malignant lesionsof Oral cavity
Dr.SHANKHASHUBHRA GHOSH DLO,2ND YR
Stanley Medical College Chennai
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Benign lesions Solid- papilloma fibroma hemangioma granuloma torus palatinus
Cystic - retention cyst ranula dermoid
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Premalignant lesions Leukoplakia Erythroplakia Submucous fibrosis Lichen planus Laryngeal keratosis Actinic cheliosis Smooth,red tongue of Plummer-Vinson
syndrome
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Predisposing factors EIGHT -- “S” Smoking syphilis spices sharp tooth submucosal fibrosis siderophenic dysphagia sepsis spirit(alcohol)
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Leukoplakia -etiology Tobacco chewing and smoking Alcohol Local irritants Vitamin deficiency-vit A & B Endocrine disturbances Syphilis
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leukoplakia
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leukoplakia White patch in mucosa that does not
rub off & cannot be clinically identified Most are asymptomatic,only 20% show
evidence of dysplasia or carcinoma. Buccal mucosa and oral commissures
are most common sites Mostly fourth decade, male>female
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Non –homogenous leukoplakia
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Management Proper history Prevention of cause Surgical excision of small lesion Topical chemotherapy and radiation
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Erythroplakia Red lesion that cannot be classified as
another entity. 91% shows signs of dysplasia Flat, macular, velvety appearance and
may be speckled with white spots representing foci of keratosis
Most common site-lower alveolar mucosa, gingivobuccal sulcus
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Types:- A)Homogenous type: appears as bright red soft velvety lesions and extensive in size. commonly found-buccal mucosa and soft palate. B)Speckled type: soft red lesions,slightly elevated with irregular outline surface being granular-speckled
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Submucous fibrosis Subepithelial inflammatory response to
the irritants mainly due to betel nut chewing
Arecoline-active alkaloid found in betel nuts-stimulate fibroblasts to increase production of collagen by 150%
White fibrotic bands extending from retromolar trigone to soft palate,buccal mucosa , tongue.
It continues even after cessation of areca nut chewing
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Clinical features The most common initial symptom-
burning sensation of oral mucosa aggravated by spicy food followed by either hypersalivation or dryness of mouth
In advanced cases,the mucosa becomes tough and leathery, with numerous vertical fibrous band.
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Clinical staging Stage1-stomatitis..vesicles,mucosal ulcers,
mucosal petechie Stage2-fibrosis in ruptured vesicles and
ulcers. a)early-blanching.. b)late-vertical and circular palpable fibrous bands, trismus, blanched leathery floor of mouth, fibrotic and depigmented gingiva. Stage3-leukoplakia(>25%) and speech &
hearing deficits.
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Treatment Prescription of chewable pellets of
hydrocortisone Absteinence from alcohol,tea,coffee Submucosal inj of hydrocortisone Submucosal inj of human chorionic
gonadotropin Surgical treatment-multiple release
deep to mucosa,submucosa and fibrotic tissue & suturing the gap so created by mucosal flap obtained by tongue and Z-plasty.
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Cont….. In this procedure,multiple deep z
shaped incisions are made into fibrotic tissue and sutured in straight fashion
Pentoxifylline-vasodilating properties and increased mucosal vascularity used as adjunct therapy.
Stem cell therapy-intralesional inj of autologus bone marrow stem cell –angiogenesis of area and decreases fibrosis.
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Lichen planus Malignant potential is matter of dispute Prudent practice to biopsy the lesion at
first visit to confirm diagnosis or monitor changes.
Lesion appear white lace like pattern in buccal mucosa.
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Relative risk factors for oral cancerNone
1%Bettle nut Chewing
4%Smoking only
3-6%Bettel chewing+Tobacco chewing
15%Bettel chewing+Smoking
25%Bettel+Tobacco+smoking
20%
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Treatment If carcinoma-in-situ proved—excision by
CO2 or KTP532 laser Chemoprevention-beta-carotene and
retinoids as antioxidant supplements
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Thank you
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