Acute and chronic diseases of the oral cavity, pharynx and larynx

STUDY
PLAY

Terms in this set (...)

Stomatitis is
An inflammation of the mouth
Types of Stomatitis
1. Catharral stomatitis
2. Herpetic stomatitis
3. Apthous stomatitis
Catharral stomatitis are divided into
Acute
Subacute
Chronic
Lesions of Catharrall stomatitis are
Superficial
Diffused or circumscribed
Causes of Catharral stomatitis
bacterial or viral infection, preceded by mechanical, chemical or thermic injury
Symptoms of Catharral stomatitis
burning pain while eating
problems with swallowing
enlarged secretion of saliva.
Gross findings- Catharral stomatitis
erythema (redness) of the mucosa
small oedema
while acute turns into chronic - blue-red dry mucous membrane
Treatment of Catharral stomatitis
elimination of irritating factors
disinfectants locally
vitamins B, C supplementation
Herpetic stomatitis epidemiology
Mostly seen in children until age 6
Herpatic stomatitis lesions
Cyst (bullas) or aphtous lesions (worse progress of the disease)

Accompanied with general infections or exposure to the sun
Etiology of Herpatic stomatitis
Herpes simplex virus type 1 rarely 2
Symptoms of Herpatic stomatitis
Burning pain
malaise
fever
lymphadenopathy
increase in salivation
Gross findings in HS
bullas that rupture into ulcerations filled with white deposite and red border
Time to heal for HS
Healing -after 7-14 days without scars
Treatment of HS
disinfectants locally
analgetics
antifebrile
aciclovir
Aphtous stomatitis are
well bordered lesion, oval shape, with red border and with white or yellow cover consisted of fibrin
Types of aphtous stomatitis
1. Type 1 - Recurrent aphtous stomatitis
2. Type 2 - Recurrent necrotizing stomatitis
3. Type 3 - Recurrent aphtous eczema
Recurrent aphtous stomatitis gross
small aphtas
Etiology of Recurrent aphtous stomatitis
Unknown
Findings in Recurrent aphtous stomatitis
Higher TNF
Symtpoms of Recurrent aphtous stomatitis
burning pain
malaise
fever
lymphadenopathy
enlarged salivation

lesions recur in days, week, months, even years
Recurrent necrotizing stomatitis gross
Big Sutton's aphtas - 1-3 cm
Deep ulcerations lasting weeks or months
Healing with scars
Recurrent aphtous eczema gross
The smallest aphtas, similar like in herpetic stomatitis but with no bullas at the beginning
Aphtous Stomatitis treatment
Locally: disinfectants, proper diet, analgetics, adhesives (Solcoseryl), antibiotics in bacterial infections of the aphtas, vitamins
Fungal infection of the mouth etiology
Candida albicans infection

Oportonistic infection due to:
decreased immunity
antibiotic drugs
chemotherapy
steroids
radiotherapy
diabetes
HIV
bad hygiene of the mouth
dental caries
Types of fungal infection of the mouth
1.Acute candidiosis of infants
2.Pseudomembranous candidiosis
3. Erythematous candidiosis
4. Atrophic candidiosis
5. Chronic proliferative candidiosis
Acute candidiosis of infant
white patch on red inflammatory ground
Pseudomembranous candidiosis
the most common, white easily to removed patches, but after removing red bloody damaged mucous occures
Erythematous candidiosis
red lesions on the mucous membrane as the complication of antibiotics
Atrophic candidiosis
acute-red mucous, thinning cuticule, ruptures and ulerations of the tongue. After antibiotics, in tobacco smokers and dental prosteses. Symptoms - burning pain.
Chronic proliferative candidiosis
long-lasting fungal infection with proliferative response of the mucous membrane.
Treatment of fungal infection of the mouth
Hygiene of the mouth Locally -
disinfectants,
nystatin,
natamycin,
amfotericin B,
imidazoles (f.e. Ketokonazole)
Systemic antifungal drugs per os (e. ketokonazole)
Long treatment 7-14 days after disappearing lesions
Gingivitis
Inflammation of the Gingiva
Gingivitis local etiology
Local etiology - dental infection
Gingitivits Systemic etiology
Systemic etiology -
avitaminosis
hormonal (usually hypertrophic)
drugs (fenytoin, calcium antagonists), intoxication(gold, arsenic, bismuth, mercury)
leukemia.
Necro-ulcerative gingivitis, Plaut-Vincent's stomatitis are caused by?
treponemas, fusobacterium
Necro-ulcerative gingivitis, Plaut-Vincent's stomatitis - Signs and symptoms
deep lesions,
ulcers,
bad smell,
salivation,
lymphnodulopathy,
fever
Necro-ulcerative gingivitis, Plaut-Vincent's stomatitis -treatment
local and systemic antibiotics
Diseases of the tounge
1. Nonspecyfic inflamation of the tongue
2. Abscess of the tongue
Nonspecyfic inflamation of the tongue etiology
injuries, hypovitaminosis, diebetes, GERD.
Nonspecyfic inflamation of the tongue symptoms
burning pain, LE - redness, small oedema
Nonspecyfic inflamation of the tongue treatment
disinfectants, proper diet.
Abscess of the tongue etiology
bacterias from broken teeth,
LE - inflammatory tumour of the tongue,
Abscess of the tongue treatment
puncture under USG, oral or intravenous antibiotics
Pharyngitis
1. pharyngitis
2. tonsillitis (angina)
3. pharyngotonsillitis
Pharyngitis Etiology
1. Viruses(adeno-,entero-,flu,EBV, rhino-,corona-)
2. Bacterias (streptococci, staphylococci, moraxella, heamophilus
Pharyngitis signs and symptoms
Viral:
1. red throat
2. pain
3. cough, can spred towards the larynx and trachea
4. general symptoms: head and muscle's pain, fever, lasts 3-7 days.

Bacterial:
1. white coat on the tonsils
2. pus in crypts
Treatment of Viral pharyngitis
analgetics, disinfectants
Treatment of bacterial pharyngitis
Local and systemic antibiotics
Bacterial Angina (Tonsillitis) Signs & Symptoms
Symptoms
1. Fever and chills
2. headache
3. pain of the throat

Signs
1. enlarged tonsils
2.red & white cover, white cover of the tongue,
3. lymphadenopathy

CENTOR criteria!
Bacterial Angina etiology
Group A β-hemolytic streptococcus
Evaluation of Bacterial angina
Blood morfology
ASO (antistreptolisin antybodies)
bacteriological examination
Treatment of Bacterial Angina
1. penicillin
2. cephalosporins
3. macrolides
What is Vincent's angina or Plaut-Vincent angina?
Neuro-ulcerative one-sided tonsillitis caused by an infection of Bacillus fusiformis, spirochaeta and treponema.
Vincent's angina or Plaut-Vincent angina risk factors
1. young
2. hypovitamin
3. bad hygiene of the mouth
4. dental caries
Vincent's angina or Plaut-Vincent Symptoms
1. dirty, grey cover on the tonsil
2. deep ulcerations
3. enlarged lymph nodes
Vincent Angina Differential diagnosis
1. diphteria (direct smear decides)
2. agranulocytic angina or acute leukemia (blood smear decides)
3. neoplasm (biopsy decides).
What differentiates streptococcal Angina from Cornyobacterium Diphteriae Angina?
Throat and tonsils are covered by pseudomembrane, which removing causes bleeding
Diphteriael Angina diagnosis
Microbiological examination
fluorescent test available
Diphteria Angina treatment
1.Anatoxin
2. penicillins
3. macrolides
Diphteriael Angina complications
1. Heart inflammation
2. cranial nerves palsies
Types of chronic pharyngitis
1. Simple
2. Hypertrophic
3. Atrophic
Chronic pharyngitis etiology
1. Irritating factors
2. hormonal
3. avitaminosis
4. diabetes
5. Allergy
6. GERD
Chronic pharyngitis Symptoms
discomfort in the throat, itching, burning
Chronic pharyngitis treatment
Local
Hypertrophic chronic pharyngitis
Result of many previous anginas

Enlargement of tonsills - children (not always- older children and young adults)
Hypertrohphic chronic pharyngitis Sigs and symptoms
Sigs
Chronic inflammations in the tonsills and crypts
Fibrosis of lymphoid tissue

Symptoms
Enlargement of tonsills
Hypertrophic chronic pharyngitis usually seen in what age?
Children (but also older children and young adults)
Hypertrophic chronic pharyngitis treatment
Tonsillectomy
Hypertrophy of the Adenoid in chronic inflammation is usually seen in:
Children
Symptoms of Hypertrophy of the Adenoid
1. obstruction of the nose
2. rhinorhea
3. SOM
4. sleep- apnoe syndrome, snorring
Treatment of Hypertrophy of the Adenoid
Adenotomy
Peritonsillar abcess or infiltration is a
Complication of angina
Symptoms of peritonsillar abcesses
1. sore throat, painful
2. problems with swallowing
3. trismus (lockjaw)
4. salivation
5. Asymmetry of tonsillar arches
Treatment of peritonsillar abcesses
1.Abscess - puncture and if the pus appears cuting the abscess
2.antibiotics
Foreign body in the throat is usually found in
The tonsils
Treatment of foreign body in throat
Removing under local anestesia
Types of edema of the Larynx
1. Reincke's oedema - due to nicotinism, treatment - surgical or laser removing

2.Allergic oedema - tratment - tracheotomy, intubation, antiallergic drugs

3. Vasomotor Quincke's oedema
Acute laryngitis etiology
At first viral, than bacterial, the same as in the throat.

Viral:
Adenovirus (Most common)
Orthomyxoviridae - causes influenzae
Epstein-Barr virus
Herpes complex
Measels
Common cold: Rhinovirus, Adenovirus

Bacteria:
Group A streptococcus, but others include Streptococcus pneumoniae,
Haemophilus influenzae
Acute laryngitis signs and symptoms
Signs
1. Red vocal cords
3. Covered by the phlegm

Symptoms
1.Cough
2.hoarseness
Acute laryngitis treatment
Inhalatory steroids
antibiotics
mucolytics
Acute epiglottitis
Bacterial Inflammatory oedema of the epiglottis leading to abscess
Acute epiglottitis epidemiology
Disease of children
Acute epiglottitis symptoms
Problems with swallowing (Dysphagia)
Fever
Salivation
Changing voice
Breathlessness!!
Increase in pulse
Increased Anxiety
Acute epiglottitis treatment
Treatment in the hospital - intravenous antbiotics, intubation
Acute subglottic laryngitis is
Inflammatory oedema of the mucosa in subglottic region
Acute subglottic laryngitis symptoms
1.Breathlessness
2.cough
3. unchanged voice
Acute subglottic laryngitis Etiology
Viral
allergic
GERD
bacterial
Acute subglottic laryngitis treatment
Treatment in hospital!
Antiallergic drugs
tracheotomy
antibiotics
Chronic Laryngitis is division and etiology
1. Simple, atrophic and hypertrophic
irritating factors: smoke, dust

2. Posterior laryngitis
GERD

3. Polyps, Reinckes edema
Smoke

4. contact ulcer, vocal nodules
wrong voice emission

5. Granuloma
After intubation
Chronic Laryngitis Treatment
1.Surgical removing
2.Histopathological examination to exclude the cancer
Leukoplakia is
1. Leukoplakia is a predominantly white lesion of the oral mucosa that cannot be characterized as any other definable lesion (definition according to WHO)

2. Precancerous state
Leukoplakia histopathology
hyperkeratosis due to irritating factor, usually smoke
Leukoplakia localization
mouth, larynx
IMPORTANT TO EXCLUDE CANCER
Laryngeal papillomatosis is caused by
HPV infection types 6, 11, also 16,18 or 31,33,35
Laryngeal papillomatosis treatment
Surgical removal
Sometimes tracheotomy
Intraoperative drug - cidofovir
Precancerous states
1. Leukoplakia - risk of cancer 10-35%
2. Erytroplakia - 50%
2. Hiperkeratosis
3. Dysplasia
4. Papillomatosis of the larynx 1-7%