Transcript DENTAL ASPECTS OF MULTIPLE MYELOMA

Lesions of the Palate ,Tongue,
Floor of the Mouth
Shafa Amirsoltani D.D.S.
Lesions of the Palate
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Torus Palatinus
Incisiva Canal Cyst
Palatal Abscess
Benign Lymphoid Hyperplasia
Necrotizing Sialometaplasia
Pleomorphic Adenoma
Monomorphic Adenoma
Mucoepidermoid Carcinoma
Adenoid Cystic Carcinoma
Lymphoma Of the Palate
Torus Palatinus
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bony exostosis
20% of adult
slowly increases in size
single ,smooth ,dome-shape bony hard swelling
midline of the hard palate
asymptomatic
unless traumatized
Incisive Canal Cyst
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developmental
anywhere along the course of incisive canal
generally confined to the palatal bone between #8 & #9
asymptomatic
a well developed incisive canal cyst may swell the entire
anterior third of the hard palate
radiographically :
– delineated , symmetrically oval or heart shape radiolucency located
between roots of vital central incisors
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if located more posterorly in palate has been raffered to as
the Median Palatal Cyst
Treatment is surgical enucleation
Periapical Abscess
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fluctuant soft- tissue swelling
bacterial infection of the pulp
tender to percussion
you should know everything about this by now
Benign Lymphoid Hyperplasia
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reactive process
proliferation of the lymphoid tissue of the palate
age over 50 more affected
unknown etiology
usually soft , nonulcerated, dome-shape or lumpy
surgical exsicision
Necrotizing sialometaplasia
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reactive lesion ,chiefly of accessory salivary
glands
begins after trauma as a rapidly growing nodular
swelling on the lateral aspect of the hard palate
usually after dental traeatment
tissue infarction due to vasoconstriction and
ischemia
initially small painlesss nodule
eventually enlarges and ulcerates and becomes
painfull
heals in 4-8 weeks
Pleomorphic Adenoma
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most common benign neoplasm of accessory
salivary gland
major and minor salivary glands
55% on the palate
occcours to the lateral to the midline
firm painless ,nonulcerated, irregulary domeshaped swelling
slow persistent enlargement over period of years
through excisional biopsy
Mucoepidermoid Carcinoma and
Adenoid Cysytic Carcinoma
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two most common introral malignant accessory
salivary gland neoplasms
ages 20 to 50 affected by mucoepidermoid
carcinoma
ages over 50 affected by adenoid carcinoma
asymptomatic, firm, dome- shaped, swelling on
lateral to midline of the palate
in duration and spontaneous ulceration indicating
rapid malignant growth
bluish appearance and/or mucous exudate
Tongue
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lateral border of the tongue is the site of 25% of
all oral squamous cell carcinoma and 50% of
intraoral lesions
normal tongue anantomy; circumvallate papillae,
folliate papilla, lingual tonsil, fissured tongue
ankyloglossia
vercosity
scalloped tongue
macroglossia
hairy tongue
Tongue contiued
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hairy leukoplakia
geographic tongue
anemia
xerostomia
median rhomboid glossitis
atophic csnadidtis
granular cell tumor
lingual thyroid
Ankyloglossia
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lingual frenum attached to ventral tongue and
genial tubercles of mandible
speech may disturbed
Treatment surgical correction
Macroglossia
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abnormally enlarged tongue
congential muscular hypotherapy, muscular
hemihypotherapy
acquired passive enlargemenet of the tongue after
losing mandibular teeth
Hairy Tongue
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abnormal elongation of the filiform papillae
poor oral hygeine
cancer therapy
infection with candida albicans
smoking
white, yellow, brown, or black
Treatment, vigourous brusshing, topical antifungal
agents
Hairy Leukoplakia
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HIV patient
lateral border of tingue
Epstein-Barr virus
do not rub off
bilatereral occurrence is common
antiviral agent reduces the size
Geographic Tongue
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benign inflammatory condition
unknown etiology, stress, and nutritional
deficiency, and heredity
single or multiple pink to red denuded patches
1% ot 2% of population
topical anesthetic or topical steroid for
symptomatic patient
Median Romboid Glossitis
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permanent end result of a candidad albicans
infection in conjuction with other factors:
– smoking
– oral PH change
smooth denoted beefy red patch
with time becomes granular ,lobular, and
indurated
midline of the dorsum of the tongue is the most
common site
asymptomatic
Lingual Thyroid
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when embryonic tissue from the thyroid gland
fails to migrate to antrolateral surface of the
trachia
raised asymptomatic mass about 2 cm in diameter
hemorraghe dysphogia, dysphonia, sympotoms of
hypothyroidism can be associated with this
condition
Granular Cell Tumor
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submucosal mass
most dorsal or lateral aspects of the tongue
firm submucosal nodule or plaque
the surface of the mucosa is usually intact
growth is very slow and painless
Treatment is excision
Lesion of The Floor of The
Mouth
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20% of oral carcinoma
3rd most common site of al intraoral
Ranula
Salivary Calculi
Mucous Retention Phenomenon
Dermoid Cyst
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soft tissue swelling
developmental anywhere on skin
floor of the mouth is more common
painless midline, domeshaped mass
tongue is slightly elevated
dough-like consistency
patient might complain of pain during eating and
speaking
slow growth
Ranula
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same as mucus retention phenomenon but in
greater size
large mucine containing cyst in the floor of the
mouth
as a result of inhibition of normal salivary flow
unilateral domeshaped fluculant and asymptomatic
Sialoliths
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salivary calculi or stones may obstruct salivary
flow
causes the floor of the mouth to swell, which
creates pain and is firm
twice as often in male than female
usually in submandibular gland
acute symptoms often occur during mealtime
secondary infrection result in pus emanating from
the ductal opening or in redness of the swollen
floor of the mouth
Pigmented Lesion
Shafa Amirsoltani, DDS
Macule
circumscribed area
 less than 1 cm or smaller
 not elevated or depressed
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Papule
elevated solid lesion
 less than 1 cm
 may be attached by a stalk
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Nodule
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like papules but extends to deeper tissue
Benign Pigmented Lesion
Production and extra cellular deposition of
melanin
 lesions with melanin in basal cells appear
brown
 lesions with melanin in keratinand spinous
cells appear black
 lesions with melanin in connective tissue
appear blue
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Melanitic Macules
physiologic or reactive
 small, flat , brown areas
 two kinds :
 labial melanotic macule / lip lesion
 oral melanotic macule / oral mucosa lesion
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Labial Melanotic Macule
asymptomatic
 primarily found on vermilion border of the
lower lip
 usually solitary
 less than 5 mm in diameter
 flat
 brown to brownish- black
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Oral Melanotic Macule
asymptomatic less than 1 cm in diameter
 occurrs on the gingiva ,buccal mucosa , and
palate
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Oral Melanoacanthomas
20 -40 years old African American
 develp within a few month resolves without
Treatment
 solitary , multiple
 dark brown to black
 5 mm to 2 cm
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Treatment
accurate diagnosis may not be attainable
through clinical examination alone
 if lesion arise within a short period of time
excisional biopsy is indicated
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Smoker’s melanosis
associated w/ prolonged smoking
 increase in melnin production
 most in max. /man./anterior labial region
 soft palatal melanosis might indicate
bronchogenic carcinoma and emphysema ,
so accurate diagnosis is important
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Treatment
stop smoking
 biopsy
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Melanoma
malignant neoplasm
 skin/ mucosa
 rare in oral mucosa
 dark brown, bluish- black
 papule
 nodule
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Phases of oral cavity
melanoma’s growth
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radial
– confined to the surface epithelium
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vertical
– neoplastic cells invade and papulate the
connective tissue
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growth phase duration differs in different
types of melanoma
Types of Melanoma
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superficial -spreading of melanoma
– skin and oral mucosa
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nodular
– skin and oral mucosa
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lentigo maligna melanoma
– skin
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acral lentigo melanoma
– skin
Superficial Spreading
Melanoma
most common 80% of all lesions
 irregular shape
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brown-black macule with jagged border
 multiple satellite lesions
 radial phase
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– may take days to months
– lesion becomes
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larger
more intense
nodular / ulcerated frank invasion of connective tissue by
tumor cells
Treatment
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early diagnosis when lesion still is in
radial stage is the key
– less than 0.76 mm thick rarely metastasize
chemotherapy/immunotherapy in
experimental stage
 poor prognosis for nodular melanoma with
vertical growth
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Nevi
benign
 exophytic
 pigmented
 mole
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Classification of Ne`vi
intramucosal (intradermal)
 junctional
 compound
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Intramucosal (Intradermal)
Nevos
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benign
young pts.
mole
asymptomatic
pigmented brown to black
slightly elevated papule / flat macule
grows slowly
less than 1 cm in diameter
do not recur
histopathology
– nests of nevos cells confind to the connective tisue
Treatment
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excisional biopsy
Junctional Nevos
benign
 less common
 pigmented macule
 histopathology
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– nests of nevos cells in the basilar region of the
epithelium / epithelial rete pegs
– carefull examination / simmilar to early phase
of melanoma
– might transform to melanoma
Treatment
excisional biopsy
 do not recur
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Compound Nevos
more common in skin
 pigmented papule or macule
 histopathology
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– nevos cells in the basal region and adjuacent
connective tissue
Blue Nevus
benign
 pigmented /dark blue
 dome shape / or flat macule
 histopathology
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– spindled
Treatment
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excional biopsy
Ephelides( Freckles)
lip
 skin
 dark brown macule
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Peutz- Jeghers Syndrome
autosomal dominant
 multiple melanotic mucocataneous macules
 gastrointestinal polyposis
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Addison’s disease
failure of the feedback loop from the
adrenal gland
 results in increases (ACTH )
adrenocorticotrophic hormones which
 results in Increase of MSH which
 results in increase the deposition of melanin
 replacement therapy with corticosteroids
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– results gradual decrease of the
hyperpigmentation
Tattoo
implantation of exogenous pigments in the
mucosa
 accidentally
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– amalgam tattoo
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intentionally
Amalgam Tattoo
entrapment of amalgam in wounded soft
tissue
 blue black
 non elevated
 radiographic evidence
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Heavy Metal Pigmentation
lead
 silver
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Varix
reactive proliferation
 vascular lesions of the lip and oral mucosa
 may arise in adulthood
 focal venous dilatation
 may become hyperplastic
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Treatment
most untreated
 may be excised for cosmetic reason
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