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Question 1

Inflammation of Lips (………..): cause

Answer 1

Inflammation of Lips (Cheilitis)

Herpes simplex virus infection (HSV) type 1 → multiple small vesicles - Site: occur mostly on lips or about the nasal orifices → known as Fever blisters.

Question 2

Inflammation Of Tongue (Glossitis): It may be:

Complications:

Answer 2

1- Acute Glossitis:
due to hot or spicy food, smoking, infection of tongue wounds
2- Chronic Glossitis: may be:
a) Nonspecific Glossitis: due to chronic infection, ragged teeth,
heavy smoking, iron or vitamin B deficiency.
b) Specific (Granulomatous) Glossitis: as tuberculosis, syphilis,
as
Complications: chronic glossitis may be complicated by → leukoplakia

Question 3

Leukoplakia Of Tongue:

Causes, Gross, Microscopic, Effects

Answer 3

Causes: Chronic irritation e.g. smoking, ragged tooth
Gross picture: Thick irregular white patches on tongue mucosa.
Microscopic picture:
1- Hyperplastic stratified squamous epithelium with hyperkeratosis.
2- The underlying submucosa shows chronic inflammation.
Effects:
Leukoplakia is precancerous: 5-25% → Squamous cell carcinoma

Question 4

Inflammation Of Oral Mucosa (…………..):

Answer 4

Inflammation Of Oral Mucosa (Stomatitis):

Question 5

Inflammation Of Oral Mucosa (Stomatitis):

Answer 5

1- Catarrhal stomatitis: due to hot or spicy food, smoking or infections.
2- Herpes simplex virus infection (Herpetic stomatitis) →
- multiple small vesicles containing clear fluid → rupture → shallow, painful ulcers
- caused by herpes simplex virus (HSV) type 1.
- The primary infection is asymptomatic, but the virus persists in a dormant state within ganglia about the mouth (e.g., trigeminal ganglia). - With reactivation of the virus (caused by fever, cold exposure, respiratory tract infection)
3- Moniliasis (Oral Candidiasis):
- caused by Candida albicans
- White pseudomembrane anywhere within the oral cavity.
4- Aphthous stomatitis & glossitis

Question 6

Ulcers Of The Tongue: include:

Answer 6

1- Dental Ulcer
2- Aphthous Ulcers: (Canker sores) multiple, small superficial painful ulcers (< 5 mm), with erythematous rim often covered with a gray-white exudate
- Site: Oral mucosa, particularly buccolabial mucosa, floor of the mouth, lateral borders of the tongue.
- often triggered by stress, fever, inflammatory bowel disease, viral infection
- The etiology is unknown but possible to be immunological; - are self-limited
3-Tuberculous Ulcer:
- commonly at tip of tongue in cases of opened pulmonary tuberculosis
4- Syphilitic Ulcers: occur in all stages of syphilis (primary, secondary, tertiary stage)
5- Malignant Ulcer: most common in anterior two thirds of tongue.

Question 7

Tumors Of The Oral Cavity :Benign and malignant tumors of lips , tongue & mouth are almost similar
A) Benign Tumors:

Answer 7

1- Squamous cell papilloma
2- Capillary hemangioma
3- Cavernous hemangioma & lymphangioma:
May cause macrochelia or macroglossia
4- Adenomas of minor salivarv glands.

Question 8

Squamous Cell Carcinoma of The Tongue & Oral Cavity
Risk factors:

Answer 8

Leukoplakia, Tobacco use, Human papilloma virus infection (16, 18)

Question 9

Squamous Cell Carcinoma of The Tongue & Oral Cavity

Sites

Answer 9

more common in lateral margins of lower lip, floor of mouth, lining of cheeks, gums
- The anterior 2/3 of tongue (Lateral border) is more common than the posterior 1/3.

Question 10

Squamous Cell Carcinoma of The Tongue & Oral Cavity

Gross, micro

Answer 10

• Fungating polypoid pattern,
• Fungating papillary growth (Verrucal),
• Ulcerative pattern (the most common)

Micro:
usually moderately to well-differentiated keratinizing squamous cell carcinoma

Question 11

The Salivary Glands Inflammations called …………

obstruction of salivary ducts by stones called ………..

Answer 11

Sialadenitis

sialolithiasis

Question 12

Example of Salivary Glands Inflammations (Sialadenitis

infection

Answer 12

Mumps: (Acute Viral Parotitis , Epidemic Parotitis) Etiology: Mumps virus, transmitted by droplet infections. Incubation period: 2-4 W Gross: Bilateral diffuse parotid enlargement Prognosis & Complications: a) Childhood mumps is self-limited and rarely leads to complications· b) Mumps in adults may be accompanied by:- Orchitis. This may lead to sterility. - Others: Pancreatitis, Oophoritis, meningoencephalitis

2-Acute Suppurative Parotitis (Parotid abscess)
→ Swollen gland containing pus ( staphylococcal infection)

3- Chronic obstructive (calcular) sialadenitis:
gland
- Bacterial sialadenitis often occurs secondary to obstruction of salivary ducts by stones (sialolithiasis).

Question 13

Sjögren Syndrome (Autoimmune sialadenitis)

Etiology ,Presentation

Answer 13

Autoimmune disease: immune-mediated destruction of the lacrimal & salivary glands

Presentation: - Characterized by
1) Keratoconjunctivitis sicca (Dry eyes)
- burning or itching, sandy feeling, (described as “sand in my eyes”)
- injury to the cornea (inflammation or ulcer)
2) Xer ostomia (Dry mouth)
- Chalky –like, difficulty in swallowing, speaking or tasting, - Increased dental (tooth) decay,
3) May be associated with manifestations of Rheumatoid arthritis

Question 14

Laboratory findings of Sjögren Syndrome

Answer 14

a. Positive serum ANA (Antinuclear antibodies) in most cases
b. Positive serum RF (rheumatoid factor), (in ~90% of cases)
c. Anti–SS-A antibodies (anti-Ro) ; in ~70%–95% of cases
d. Anti–SS-B antibodies (anti-La) ; in ~60%–90% of cases

Question 15

The combination of salivary and lacrimal gland inflammatory enlargement, and inflammatory
xerostomia, whatever the cause, is referred to as ………….. disease or syndrome.

Answer 15

Mikulicz

The causes include sarcoidosis, leukemia, lymphoma

Question 16

TUMORS OF SALIVARY GLANDS

Answer 16

Benign:
1- Benign pleomorphic adenoma (Mixed tumor of salivary gland):commonest.
2- Warthin tumor (Papillary cystadenoma lymphomatosum)
Malignant:
1- Malignant mixed salivary gland tumor is the commonest. 2- Mucoepidermoid carcinoma.
The most malignanttumor of the salivary gland occurs mainly in the parotids.
Mixture of neoplastic squamous and mucus-secreting cells

Question 17

Pleomorphic Adenoma
(Benign mixed salivary gland tumor)
C/P, Gross

Answer 17

C/P: slow-growing painless swelling at the angle of the jaw
Gross: firm apparently encapsulated mass. Cut section → mucinous & solid areas

Question 18

Pleomorphic Adenoma

Microscopy, Behavior, True malignant transformation may occur and is evidenced by

Answer 18

Microscopy: composed of Mixed elements:
1- Proliferating epithelial cells forming acini, cords, or sheets of tumor cells
2- myxoid stroma, fibrous strands with areas resembling cartilage (pseudocartilage)
Behavior: - Tiny extensions of tumor tissue commonly penetrates the capsule - Therefore recurrence is common after surgical excision.Adequate margins of resection are thus necessary to prevent recurrences.

• True malignant transformation may occur and is evidenced by
• Rapid increase in size, with induration and fixation - Facial nerve paralysis (due to invasion)
• Cervical lymph node enlargement (due to spread)

Question 19

Warthin Tumor (……….. )

Answer 19

(Papillary Cystadenoma Lymphomatosum, Cystadenolymphoma)

Question 20

Warthin Tumor (Papillary Cystadenoma Lymphomatosum, Cystadenolymphoma)

benign tumor (5-10% of total) occurs mostly in ……..,

Micro

Answer 20

tail of the parotid gland near the angle of the mandible.
primarily affects older individuals (age 60–70 years).

Micro:
cystic spaces lined by double cell layer epithelial cells,
Forming papillary projections that protrude into lumen
lymphoid stroma ± lymphoid follicles with germinal center formation

Question 21

Aphthous Ulcers: (……….)

Answer 21

Canker sores