اورام الفم و الحلق و اللسان و الفك-كتبته بنفسى- لغة انجليزية mouth swelling

[mohamed_ameer]

اورام و تقرحات الفم والحلق و اللسان-بحث انجليزى-research on mouth,throat and tongue swellings

notices:-

1- type of patient :- congenital anomalies are met with infants and children; chronic superficial glossitis and carcinoma in elderly males.

2- symptoms :- in ulcers of the tongue, pain is a very important symptom. traumatic, dental, dyspeptic and tuberculous ulcers are peculiarly painful for their size where as syphilitic lesions and early cancers are painless. The pain is usually felt locally in the tongue but may also be referred, particularly to the ear via the corda tympani nerve and the auricular branch of the vagus.

ask about any bleeding or difficulty in mastication, swallowing, talking, opening the mouth or protrusion of the tongue. while the patient is talking, note if there is any abnormality of speech, foetor of the breath or salivation.

3- past history:- ask about any history of trauma, such as biting the tongue or injury by a foreign body a piece of glass or bone. inquire about diabetes, syphilis, tuberculosis, indigestion, excessive smoking or drinking or intake of drugs.

Local examination

1- lips and cheeks:-inspect and palpate the lips and cheeks for any pigmentation, excoriations, scars, ulcers, swellings or other abnormalities. evert the lip fully to examine the mucuous surface of its inner aspect, the gingivolabial fold and the orifices of the partoid ducts.

multiple pigmented spots on and about the vermilion surfaces of the lips should at once raises the suspicion of the syndrome of peutz. inquire regarding the occurence of similar spots on the lips of blood relations, for the condition is strongly familial. ask about gastrointestinal symptoms since the spots are the outward sign that the patient suffers from adenomatous polyposis of the small intestine, especially the jejunum. such polyps often give rise to gastrointestinal bleeding, intussusception or carcinoma

angular stomatitis is characterized by brownish superficial ulceration at the corners of the mouth with scabbing, which is often picked up or licked off by the patient. the condition may arise from several causes. it occurs as a simple infection in children, when it is known as perleche. other causes include ariboflavinosis, gastrectomy, the plummer-vinson syndrome and severe anaemia.

rhagades take the form of linear scars radiating from the corners of the mouth. they suggest immediately previous syphilitic ulceration and should indicate a search for other stigma

apart from primary chancre and carbuncle, which are commoner on the upper lip, the lower lip is the site of election for ulcers, cysts and tumours

تقرحات الشفة
Ulcers of the lips:-

1- cracked lip is common in cold weather. the crazk usually affects the middle of the lower lip and often becomes chronically inflamed and bleeds readily.

2- primary chancre may occur on the upper lip as a smooth elevated ulcer with characteristic overwhelming enlargement of the submental and submandibular lymph nodes on both sides. the spirochate may be detected in the discharge by dark ground illumination.

3- carcinoma of the lip occurs typically in males between 50 and 70 years of age. it is commonest in country men exposed continously to sunlight. the lesion is usually situated on the lower lip midway between the midline and the angle of the mouth. it may form a flat shallow ulcer or a deep excavating lesion with a raised everted irregular edge and a red indurated base. the ulcer advances slowly, destroying the lip and eventually invading the cheek , gum or alveolus and spreads to the submental and submandibular lymph glands.

ابحث فى محرك البحث جوجل عن تقرحات الفم و اللسان و الاورام فى هذه الاماكن
search on website of google about ulcers and cysts of mouth and tongue in these areas or places.

ulcers of tongue
1- dental ulcer
2- dyspeptic ulcers
3-froenal ulcer
4-herpetic ulcers
5- tuberculous ulcers
6- syphilitic ulcers
7-chronic superfaicial glossitis
8-malignant ulcer


Cysts of the mouth
1- ramula
2-mucous cyst
3-sublingual dermoid cyst
4-thyroglossal cyst
5-






cysts of the mouth

1- ramula is a bluish transluecent cystic swelling in the mouth, filling the angle between the floor and undersurface of the tongue. it is usually situated on one side of the fraenum linguae but sometimes it extends beneath the fraenum to the opposite side. occasionally, it may extend into the neck, forming a cystic swelling in the submandibular triangle. wharton's duct can often be made out over the dome of the cyst and tortuous veins may be seen.

2- mucous cyst is a retention cyst of one of the mucous glands of the mouth. it occurs in any part of the mucous membrane as a translucent globular swelling which may become drawn out on a pedicle by the continous movements of the mouth and tongue.

3-sublingual dermoid cyst may be median or rarely lateral and either above or below the mylohyoid. a median cyst protrudes into the floor of the mouth and bulges below the chin. a lateral cyst forms an opaque swelling in the floor of the mouth to one side of the middle line and may bulge into the submaxillary region.

4-thyroglossal cyst can occur anywhere in the middle line between the foramen caecum and the hyoid body. the suprahyoid position is uncommon. the cyst usually lies in the floor of the mouth in front of the tongue and rarely occurs at the foramen caecum producing dyspnoea and dysphagia

5- cystic tumours, such as haemangioma and lymphangioma, are not uncommon in the floor of the mouth. they are readily recognized by their colour, lobulated surface and compressibility.

تقرحات اللسان:-
ulcers of the tongue :-

dental ulcer occurs at the sides and tip in relation to a jagged tooth or irregular denture. it forms an elongated shallow lesion surrounded by an area of erythema. in chronic cases, the edges of the ulcer become heaped up and the surrounding tissues indurated.

2- dyspeptic ulcers occur near the tip of the tongue as multiple small rounded painful erosions with white centres and hyperaemic margins.

3- froenal ulcer occurs at the fraenum linguae from irritation of the under surface of the tongue against the incisor teeth. it is usually seen in children with whooping cough.

4- herpetic ulcers occur in infants and children as multiple small ulcers preceded by superficial blistering. they are commonest on the anterior two-thirds of the tongue and affect both the upper and lower surfaces. they are painless and have no relation to herpes.

5- tuberculous ulcers occur in patients with pulmonary or laryngeal tuberculosis. the ulcers are usually situated near the tip or back of the tongue due to contact with coughed up sputum. they are often multiple and associated with severe pain and impairement of mastication and articulation. they have undermined edges and shallow floors covered with pale granulations and the base is not indurated.


syphilitic ulcers may occur in the three stages of the disease a) primary chancre is unusual on the tongue. it commences as a pustule near the tip of the tongue which soon bursts to form a small indurated ulcer. as in chancre of the lip, the submental and submandibular lymph nodes are grossly enlarged.

b) secondary ulcers occur on either side of the middle line of the tongue as long shallow ulcers glistening with adherent mucus (snail-track ulcers)

c) gummatous ulcers occur in the middle line of the dorsum of the tongue. the absence of pain, the punched out edge and relatively small amount of surrounding induration clarify the diagnosis.

7- chronic superficial glossitis is a disease of males in later middle life. one third of the patients give a history of syphilis and in the remainder some form of chronic irritation is present, such as sharp teeth, oral sepsis, smoking, spices and spirits. four stages are described but they are usually found together:

a) hypertrophied papillae produce red hyperaemic patches which can not be clearly seen unless the tongue is carefully dried:

b) leukoplakia consists of white patches of thickened cornified epithelium which look like "white paint that has hardened , dried and cracked

c) red glazed tongue follows shedding of the white patches and loss of the papillae

d) cracks and fissures result from submucous fibrosis and often take the form of one median fissures with transverse furrows dividing the dorsum into rectangular compartments. fissures ulcers and warty projections are precancerous and should be examined thoroughly for hardness and other signs of malignancy.

8- malignant ulcer (epithelioma) is the commonest malignant lesion of the mouth. most patients are over 60 years of age and 90% are males. the sites of election are the sides, the base and the under surface of the tongue. the lesion may start as a nodule, wart of fissure but rapidly breaks down to form a painful ulcer with a deep irregular floor, a raised nodular everted edge and a fixed indurated base. it is associated with salivation, foetor of the breath, bleeding, interference with speech, mastication and swallowing, and later with ankyloglossia and trismus. the lymph nodes on either side of the neck should be examined for enlargement, hardness and fixity. whenever doubt exists about ulcer, a fragment should be excised for histological examination. the .W.R is misleading, for commonly a patient with carcinoma of the tongue that has syphilis.

[mohamed_ameer]

notices- observations:-

اورام الفك فى الفم- بحث طبى-لغة انجليزية-research on jaw swellings and tumours

1- age and sex :- excluding malignant maxilla, swellings of the jaws are commonest in the young adult males. carcinoma of maxilla is a disease of old age.

2- swelling:- note its duration. ; long history of slow growing large tumor suggests adamantinoma.

.,, inquire about any pain... cysts and benign tumors are painless... pain is present in arthritis,, osteomyelitis and malignant tumours. in affections of maxilla and temporomandibular joint, referred pain in the ear or even deafness may be present.

3- other symptoms :- inquire about any history of loss of teeth, unilateral nasal obstruction, epiphora or nasal discharge

4- past history:- inquire about any history of trauma, irritation, dental sepsis, sinusitis , tooth extraction, poisoning with mercury or phosphorus or general bone and joint disease


examine any swelling present in the routine fashion and then examine the two jaws, the temporomandibular joints and cervical glands

examine other bones and joints for evidence of generalized affection. the jaw is commonly affected in generalized osteitis, fibrosa cystica and tempromandibular joint in rheumatoid and gonococal polyarthritis

نتحدث الان عن اورام الفك السفلى فى الفم
lower jaw :-

1- inspection :- note the site and characters of any swelling and the condition of the overlying skin. ask the patient to open the mouth and inspect the alveolar margin, the gingivolabial folds and the floor of the mouth. note whether the swelling affects one aspect of the bone only or expands both surfaces of the bone


palpation:- the body angle and lower part of the ramus are accessible to the palpating fingers both from without and from within mouth. the upper portion of the ramus and its condyloid and coronoid processes can be palpated manually with one finger inside the mouth and the fingers of the other hand applied externally. examine all aspects of the bone and note the characters of any swellings
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تشخيص اورام الفك فى الفم بوجه عام او انواع الاورام التى تظهر فى الفك فى الفم

diagnosis of jaw swellings:-

search on google about the swellings and tumors that appear in these areas or places

ابحث فى جوجل عن الاورام التى تظهر فى هذه المناطق باللغة الانجليزية

search on website of www.medicalnewstoday.com
ابحث فى موقع
www,medicalnewstoday.com

ابحث فى جوجل عن الاورام التى تظهر فى هذه المناطق باللغة الانجليزية
1- granulomatous epulis
2-fibrous epulis
3-myeloid epulis
4- malignant epulis.
5- dental cyst
6- dentigerous cysr
7- adamantinoma
8-osteoma
9-osteoclastoma
10- sarcoma of the jaw
11- carcinoma of the maxilla
12- osteomyelitis of the jaw
13- leontiasis ossea


temporomandibular joints
inspection :- ask the patient to open and close the mouth. note any deformity, dental malocclusion or limitation of movement. in bilateral dislocation, the prognathus deformity is characteristic ; the mouth is open and fixed with the lower teeth protruding . fixation of the jaw (trismus) commonly complicates any painful condition in the neighbourhood of the joint (reflex spasm) but may be due to tetanus, arthritis or ankylosis. in old standing ankylosis dating from infancy, the lower jaw atrophies and receding chin gives a characteristic " shrewmouse"

2- palpation:- palpate the joint just below and in front of the tragus for tenderness, swelling or hollowing. in dislocation, a distinct hollow will be felt just behind the dislocated condyle. with the fingers over the joint, ask the patient to open and close his mouth and feel for crepitus (osteoarthritis) or clicking ( loose meniscus)


differential diagnosis of jaw swellings
انواع اورام الفك فى الفم التى تظهر فى الاماكن التالية :-

1- granulomatous epulis is a mass of granulation tissue around a carious tooth

2- fibrous epulis is pedunculated firm tumour arising from the mucoperiosteum in relation to a carious tooth. it occurs most often between the incisor teeth of the lower jaw.

3- myeloid epulis forms a sessile lobulated tumour covered by intact mucous membrne which ulcerates only when traumatized by the teeth of the other jaw. it nearly always occurs between the ages of 10 and 25 years and affects the mandible much more frequently than the maxilla

4- malignant epulis is merely an epithelioma of the gum

5- dental cyst occurs in adults in connection with a pulpless tooth, especially an incisor or canine of the upper jaw. it forms a smooth painless swelling causing expansion of the bone, sometimes with egg-shell cracking.

6- dentigerous cyst (follicular odontome) occurs in children and adolescnts and is more common in the lower than in the upper jaw. the cyst is associated with an unerupted permanent tooth and causes a globular expansion of the alveolar margin often with egg-shell cracking x-ray examination confirms the diaggnosis by showing the unerupted tooth with in the cavity of the cyst.

7- adamantinoma ( multilocular cyst ) occurs in adults, particularly females and affects the mandible much more often than the maxilla. it forms a painless lobulated swelling most often in the region of the angle and usually more obvious from the cheek than from the mouth. it grows very slowly, expanding the jaw and causing loss of neighbouring teeth. the tumour is benign but tends to recur after incomplete removal. in advanced cases, it may fungate into the mouth and become infected ...X-RAY examination shows an expanding transulucent shadow traversed by numerous small thick trabeculae

8- osteoma :- ivory osteoma forms a smooth hard domeshaped swelling of the alveolar process of the mandible , the outer surface of the maxilla, the palate orbit or antrum

b- cancellous osteoma arises most often from the maxilla and grows chiefly into the mouth or cheek. the whole bone is usually involved causing obliteration of the canine fossa, enlargement of the alveolus and bulging of the lip and cheek


9- osteoclastoma is commonest in adolescents and affects the mandible more often than the maxilla. it forms a painless globular swelling which expands the jaw, loosens the related teeth and may exhibit egg-shell cracking......X-ray examination shows an expanding translucent central shadow with wide thin scanty trabeculation ( soap-bubble appearance )


10- sarcoma of the jaw arises usually under the periosteum as a round or spindle-celled sarcoma, osteogenic sarcoma or fibrosarcoma. it occurs at any age and in either sex and is much commoner in the maxilla than the mandible. the tumour forms a deforming hard swelling. it encroaches on the buccal cavity, loosens the teeth and causes profuse salivation and foetor of the mouth. blockage of the nose, epistaxis, epiphora and proptosis may occur in the late stages of the disease.


11- carcinoma of the maxilla :- is usually a columnar -cell carcinoma arising from the maxillary antrum or nasal cavity and rarely a squamous-celled carcinoma derived from the palate, tooth sockets or gums. pain is any early symptom due to blockage and infection of the antrum and later to involvement of the branches of the trigeminal nerve. other symptoms include swelling of the face, unilateral nasal obstruction, bulging of the palate, proptosis, diplopia and eiphora. rarley , the tumour is occult and cervical secondaries attract attention before the primary growth.


12- osteomyelitis of the jaw usually starts as an alveolar abcess or may follow infection of a compound fracture, phosphorus or mercurial poisoning or radium necrosis. in the early stages, there is severe pain increased by heat and relieved by cold (gases in the cavity) with considerable swelling of the cheek and redness and odema of the gum. the regional glands are often enlarged and tender and a marked constitutional disturbance is present. Trismus superveness if the molar region is involved from infiltration and spasm of the muscles of the maxillary region or towards the mouth and pharynx, causing dysphagia. in the upper jaw, a swelling may develop in the cheek, nose or palate and infection may spread to the orbit, ethmoids or even the cavernous sinus.


13- leontiasis ossea probably arises as a creeping osteitis from the nasal sinuses. a number of adjacent facial and cranial bones are thickened and replaces by nodular masses of spongy bone. the teeth are carious and secondary infection is common with sinuses and sequestra. as the disease progresses, the new bone encroaches on the antrum, the orbit or even the cranial cavity







upper jaw

the maxilla has five surfaces which must be examined systematically:-

1- the anterolateral surface is accessible for direct inspection and careful palpation. note the condition of the skin and look for overflow of tears (epiphora) on the affected side. palpate the bone through the skin for thickening, swelling, irregularity, egg-shell cracking or tenderness. Evert the lip and cheek to examine the lower part of the surface. with the thumb outside and the finger inside. palpate the zygomatic process.

2- the upper surface forms the floor of the orbit. compare the inferior orbital margin on the two sides and note any thickening or elevation. look at each profile of the patient to compare the relative protuberance of the eyeballs. extreme upward bulging of the floor of the orbit causes proptosis and diplopia

3- the lower surface is examined through the mouth :
a) look for any swelling of the gum or alveolar margin (epulides and odontomes) and note its colour, surface, edge, consistency and mucosal covering. b) examine the teeth and inquire about the cause of any missing teeth. dental cyst occurs in relation to a carious tooth whereas a dentigerous cyst is always associated with unerupted permanent tooth. c) look for any swelling or depression of the hard palate and note whether the swelling occupies one half of the palate or extends beyond the midline.

4- the medial surface forms the lateral wall of the nostril. look for any discharge of blood or pus from the affected nostril. examine for unilateral nasal obstruction by occluding the other nostril and asking the patient to blow through the nose with the mouth closed. inspect the interior of the nostril for any visible bulging of the lateral wall. for more thorough inspection, a nasal speculum is necessary.

5- the posterior surface forms the anterior boundary of the inaccessible pterygopalatine fossa. However, palpation of the temporal region may reveal evidence of tumour extension into infratemporal fossa