Oral cancer, tumour and cysts

Question 1

List three common cysts of the upper jaw

Answer 1

Odontogenic: Radicular cyst, dentigerous cyst, eruption cyst

Non-odontogenic: nasopalatine duct cyst

Question 2

List 4 etiological factors for oral cancer (2)

Answer 2

Tobacco, alcohol, betel quid and areca nut, diet low in vegetables and fruit, poor oral health etc

Question 3

List 4 benign swelling on the midline neck region that are 1cm in size (2)

Answer 3

Lipomas, epidermal inclusion cysts (EICs), Schwannoma, thyroid nodules

Question 4

Biopsy was done to confirm the diagnosis. What is the likely pathology? (1)

Answer 4

Noncancerous + features of it (??)

Question 5

On examination, the cervical lymph node is firm and mobile. What are the 2 likely causes in his condition? (2)

Answer 5

• Malignant disease: Tumour cells detached from primary tumour grows in the metastatic lymph node
• Infection (e.g. pericoronitis) with systemic involvement

Question 6

How to diagnose what’s wrong with the lymph node? (1)

Answer 6

Fine needle aspiration cytology

Question 7

Patient is scheduled to have surgery and radiotherapy on the mouth lesion and lymph node. Why a thorough dental assessment must be done before the procedure? (2)

Answer 7

• To exclude infection origin (e.g. odontogenic cyst/ tumours) of the lesion/ lymphadenopathy which will require an alternative treatment
• To assess the tooth & periodontal status before radiotherapy, which could be compared to that after radiotherapy for determination of influence of such therapy on dental health, & modify treatment plan accordingly
• To exam for any opportunistic infection (severe periodontal disease or caries) & provide treatment accordingly to minimize the risk of infection spread, causing further complications

Question 8

What is the most likely pathology of the lesion, if it’s cancer?

Answer 8

Definition is “invasion of epithelial cells through the basement membrane into the superficial connective tissues”.

Invasion may start as small breaches by a few cells or small epithelial islands, and progress to gross infiltration of the underlying submucosa or bone by sheets and islands of malignant cells.

This process of invasion gives rise to the two most classical clinical signs of cancer – the lesion is hard (induration) and is fixed to the underlying tissues (fixation)

Question 9

Question Statement 2:
>4cm extending to the midline
______ margin with induration base

a. What further investigation will you do? (3)

Answer 9

Laboratory blood test (blood cell count, autoantibodies)

Biopsy

Question 10

Question Statement 2:
>4cm extending to the midline
______ margin with induration base

b. Management of the condition? (2)

Answer 10

Surgically eliminate it, then maybe radiotherapy.

Reconstruction may be needed to repair structures in the mouth and jaw or to help with speech and swallowing.

Question 11

List 3 pathologies which will show radiolucency at the basal of lower jaw (3marks)

Answer 11

(well-defined border) Radicular cyst, keratocysts, ameloblastoma,
(ill-defined border) osteomyelitis, Bisphosphonate osteonecrosis

Question 12

What is the differential diagnosis for the right mandibular swelling?

Answer 12

• Dentigerous cysts
• Keratocystic odontogenic tumor
• Ameloblastoma
• Pericoronitis, with spreading to fascial spaces (less possible as no painhere)

Question 13

The pt comes for right submandibular swelling

C/O: Discomfort after extraction of 15, salty discharge from the extracted socket, bleeding during brushing. Smoke 1 pack a day for many years.

Given: A pan, 3 CT scan photos (Axial, sagital and coronal viewprovided, “aiming” at a radiopaque object in sinus.

CT scan shows right maxillary sinus filled with fluid, radiopaque mass resembling root fragment of 15, perforated sinus floor)

a. Regarding to this patient’s condition, what will you check when performing the clinical examination?(5)

Answer 13

• Leakage of fluids from the mouth to the nose
• Presence of fistula visually or probing (not enlarging)
• Healing of extraction socket
• Presence of infection, abscess discharge from the suspected area
• Presence of diffused facial pain on affected side
• Related or surrounding teeth are tender to percussion
• **Mirror fogging test

• Ask patient blow out air while keep the nose obstructed, mouth keep open and mirror can be placed near the suspected air

• Air condensation on mirror indicate OAC/OAF (Oroantral communication: abnormal connection between the oral and antral cavities)
(Oroantral fistula: OAC left open, epithelial tissue develops in its track)

• **Valsalva’s test
  Similar to mirror test, but just observe bubbles, liquid come out from the suspected fistula

Or air can be heard hissing out the fistula
(rmb for all tests, be gentle, as you don’t want to enlarge the communication)

Question 14

b. Describe the radiographic findings. What is the provisional diagnosis? What are the possible causes? (4)

Answer 14

• Radiopaque mass located inside right maxillary sinus
• Fluid is filled in right maxillary sinus
• Oroantral fistula
• Iatrogenic

Root fracture during extraction, failure to retrieve while damage the membrane lining, allowing upward displacement into maxillary sinus
- Infection

Pre-extraction existing apical pathology already disrupt the membrane lining

Question 15

c. What are your treatment plans for this px? List any 2 surgical techniques involved (6)

The answer is complicated with lots of bullet points, suggest go to page 26 on the document.

Answer 15

Long answer, no point to show here (Pg 24-25)

Question 16

d. Patient seemed to be quite anxious about the surgical procedure. What can you do to reduce the anxiety of the pt during surgical treatment? (2)

Answer 16

• Explain procedures simply
• Ask patient to raise their hand if they feel pain during surgery
• Assure patient
• Ask patient to breathe in and out slowly