Soft Tissue Presentation Flashcards
(258 cards)
1
Q
Define Incisional biopsy
A
Removal of only a part of the lesion
2
Q
Define Excisional Biopsy
A
Removal of the entire lesion
3
Q
Define Surgical Excision
A
Removal of the entire lesion +/- border of non-lesional tissue
4
Q
What does a surgical excision not specify?
A
If only the lesion itself is removed or the lesion and a border of normal/non-lesional tissue is removed
5
Q
What is typically removed with malignant lesions or locally invasive lesions?
A
Border of non-lesional tissue
6
Q
Define marginal excision
A
A margin of non-lesional tissue
7
Q
Define wide excision
A
A large circumference (as compared to marginal excision) of normal-appearing tissue removed circumferentially around a lesion.
8
Q
Benign Reactive Lesions AKA _____ ____
A
Non-neoplastic
9
Q
Define Benign Reactive Lesions
A
A lesion that occurs from local trauma or other irritant
10
Q
What are the types of benign reactive lesions?
A
Fibroma 3 P's Verruciform xanthoma Epulis Fissuratum Inflammatory Papillary hyperplasia Amalgam Tattoo
11
Q
What are the 3 P’s?
A
Pyogenic Granuloma
Peripheral Ossifying FIbroma
Peripheral Giant Cell Granuloma
12
Q
Fibroma: Etiology
A
Reactive hyperplasia of fibrous connective tissue as a result of chronic irritation
13
Q
Fibroma: Clinical Features
A
- Asymptomatic, soft, tan/pink, smooth-surfaced nodule
- Sessile or pedunculated
- Usually small (<1 cm) but may increase in size overtime if continually traumatized
14
Q
Fibroma: Site
A
Buccal Mucosa» labial mucosa, tongue, gingiva
15
Q
Fibroma: Histology
A
Nodular mass of dense fibrous connective tissue
16
Q
Fibroma: Treatment
A
Excisional Biopsy
17
Q
Why do we lump the 3 P’s together?
A
Each lesion has some unique features however we usually consider all of these on our DDX for a “bump on the gingiva” as they share many of the same clinical characteristics
18
Q
Two other names for Pyogenic Granuloma
A
- Granuloma Gravidarum
- Epulis Granulomatosa
19
Q
When is granuloma gravidarum used?
A
In pregnant patients
20
Q
When is Epulis Granulomatosa used?
A
When occurring in an extraction site
21
Q
Pyogenic Granuloma: Etiology
A
Reactive Proliferation from chronic irritation/trauma
22
Q
Pyogenic Granoluma: Population Presented In
A
Predominantly children and young adults, but can occur at any age
23
Q
Pyogenic Granulomas are common in _____
A
Pregnancy
24
Q
Pyogenic Granuloma: Clinical Features
A
-Bright red, frequenly ulcreated, bleeds easily on manipulation, friable
25
Pyogenic Granuloma Site
Gingiva >> buccal mucosa, tongue, labial mucosa
26
Pyogenic Granuloma Histology
Resembles granulation tissue
27
Define Granulation Tissue
Tissue formed in ulcers and in early wound healing and repair, composed largely of newly growing capillaries
28
Pyogenic Granuloma Treatment
Excisional Biopsy
29
Pyogenic Granuloma Treatment for Pregnant Women
Wait until after the patient gives birth and monitor for potential self-resolution
30
Peripheral Ossifying FIbroma: Etiology
Reactive proliferation from chronic irritation/trauma
31
Peripheral Ossifying Fibroma: Site
Gingiva Only
32
Peripheral Ossifying Fibroma: Clinical Features
- Raised, smooth-surfaced (unless traumatized and secondarily ulcerated) pink/tan nodule
- More firm and less friable compared to PG
33
Peripheral Ossifying Fibroma: Population
Predominantly teens and young adults
34
Peripheral Giant Cell Granuloma: Etiology
Reactive proliferation from chronic irritation/trauma
35
Peripheral Giant Cell Granuloma: Clinical Features
- On palpation, lesion is somewhere between PG and POF in firmness
- Frequenly bluish in color
36
Peripheral Giant Cell Granuloma: Population
Slightly older patient population
37
Peripheral Giant Cell Granuloma Site
Gingiva or edentulous ridge only
38
Peripheral Giant Cell Granuloma Histology
Multinucleated giant cells
39
Peripheral Giant Cell Granuloma Treatment
Excisional Biopsy
40
Verruciform Xanthoma: Etiology
Reactive proliferation thought to be a response to local inflammation
41
Verruciform Xanthoma Clinical Features
-Well-demarcated, soft, painless, raised lesion with papillary surface architecture
42
Verruciform Xanthoma Color
Range in color from white to orange to yellow to red
43
Verruciform Xanthoma Site
Most common on gingiva and hard palate
44
Verruciform Xanthoma can look similar to what?
Papilloma
45
Verruciform Xanthoma Histology
Papillary Surface, parakeratin plugging
| -Xanthoma cells (foamy histocytes) in superficial connective tissue papillae
46
Verruciform Xanthoma Treatment
Excisional Biopsy (unless large lesin and then may consider incisional for diagnosis, followed by excision)
47
Epulis Fissuratum: Etiology
- Tumor-like hyperplasia of fibrous CT resulting from an ill-fitting denture
- Folds of tissue complement the denture
48
Epulis Fissuratum Clinical Features
- Single or multiple folds of hyperplastic tissue in the alveolar vestibule
- Most often there are two folds of tissue and the denture flange will fit between them
49
Epulis Fissuratum Population
More common in females; older patients; denture wearers
50
Epulis Fissuratum Treatment
Excisional Biopsy
| Reline of current denture of fabrication of a new denture
51
Leaflike Denture Fibroma Cause and Histology
Identical to Epulis Fissuratum -> ill fitting denture
52
Leaflike Denture Fibroma Treatment
Excisional Biopsy
53
Inflammatory Papillary Hyperplasia: Cause
- Ill fitting denture, poor denture hygiene, wearing the denture 24/7
- Can occur in a non-denture wearer that habitually mouth breathes or has a high palatal vault
54
Inflammatory Papillary Hyperplasia: Clinical Features
Erythematous, pebbly appearance of the palatal vault
55
Inflammatory Papillary Hyperplasia: Treatment
- Improved denture hygiene and fabrication of new well-fitted prosthesis
- Can consider excision of hyperplastic tissue before new prosthesis if does not self resolve
56
Inflammatory Papillary Hyperplasia: Treatment for Superimposed candidia infection
Topical and systemic antifungal
57
Amalgam Tattoo: Etiology
Implantation of amalgam filling particles into the soft tissue
58
Amalgam Tattoo: Clinical Features
Blue-black macule which varies in size
- Should be adjacent to or in the place where there used to be a metal restoration
- Can be visualized on radiology
59
Amalgam Tattoo: Treatment
- Classic examples can be monitored
| - Biopsy may be indicated in cases where the etiology is less clear
60
Basic soft tissue tumor naming: Myo-
Muscle
61
Basic soft tissue tumor naming: neur/schwann-
Neural
62
Basic soft tissue tumor naming: Lipo-
Fat
63
Basic soft tissue tumor naming: Fib-
Fibrous tissue
64
Basic soft tissue tumor naming: Leiomyo-
Smooth muscle
65
Basic soft tissue tumor naming: rhabdomyo-
Striated muscle
66
Basic soft tissue tumor naming: hemangio-
Blood vessel
67
Basic soft tissue tumor naming: -oma
Benign
68
Basic soft tissue tumor naming: -carcinoma; -sarcoma
Malignant
69
-carcinoma etiology
Epithelial
70
-sarcoma etiology
Connective tissue/non-epithelial origin
71
Define Neoplasia
The formation or presence of a new, abnormal growth of tissue
72
Schwannoma: Etiology
benign tumor (-oma) of schwann cell origin
73
Schwannoma: Clinical Features
-Painless, slow-growing, submucosal nodule, ranging from 1 mm- 3 cm in size
74
Schwannoma: Population
Young to middle-aged adults
75
Schwannoma: Site
- Almost anywhere
- Tongue is most common soft tissue site
- Intrabony: Radiolucency, most common in posterior mandible
76
Schwannoma Cause
Can occur sporadically or as part of a syndrome
77
Schwannoma: Associated Syndromes
- Neurofibromatosis type 2
| - Schwannomatosis
78
Schwannoma Treatment
Sometimes excisional biopsy, sometimes incisional biopsy due to size
79
Schwannoma Histology Buzz terms: Antoni A
Hypercellular areas
80
Schwannoma Histology Buzz terms: Antoni B
Hypocellular, aka less cellular areas
81
Schwannoma Histology Buzz Terms: Verocay Bodies
Areas within Antoni A composed of basement membrane and neuronal proesses
82
Neurofibromatosis Type 2: Inheritance Pattern
Autosomal dominant inheritance
83
Neurofibromatosis Type 2: Cause
NF2 Gene
84
Neurofibroma: Etiology
Benign tumor (-oma) with a mixture of cell types (schwann cells, fibroblasts)
85
Neurofibroma: Clinical Features
- Painless, slow-growing, soft lesion
| - Range in size from a small nodule to large masses
86
Neurofibroma: Population
Most common in young adults
87
Neurofibroma: Site
Tongue and buccal mucosa
| Rarely can arise within bone
88
Neurofibroma: Associated Syndromes
Neurofibromatosis type 1
89
Neurofibroma Treatment
Sometimes excisional biopsy, sometimes incisional biopsy due to size
90
Neurofibromatosis Type 1: Inheritance Pattern
Autosomal Dominant; mutation of NF1 gene
91
Neurofibromatosis Type 1: Clinical Features
Enlargement of the fungiform papillae
92
What is the most common oral leasion of NF1?
Neurofibromatosis type 1
93
Neurofibromatosis Type 1 Complications
Greater risk for development of malignant peripheral nerve sheath tumor
94
Multiple Endocrine Neoplasia Type 2B (MEN 2B): Why do we only focus on Type 2?
Only type with oral manifestations
95
Multiple Endocrine Neoplasia Type 2B (MEN2B): Etiology
Rare, autosomal dominant inherited condition
96
Multiple Endocrine Neoplasia Type 2B: Clinical Features
- Multiple Endocrine Neoplasms
- Mucosal Neuromas
- Marfanoid Body Habitus
97
Granular Cell Tumor: Etiology
Benign tumor of schwann cell differentiation
98
Granular Cell Tumor: Clinical Features
Non-tender, rubbery-firm, slow-growing, sessile submucosal nodule
Color varies from normal mucosal coloring to a white-yellowish hue
99
Granular Cell Tumor Site
Tongue, buccal mucosa
100
Granular Cell Tumor Treatment
Biopsy for diagnosis followed by conservative excision or just excisional biopy (depending on the size of the lesion)
101
Granular Cell Tumor Reoccurence
Rare
102
Granular Cell Tumor Histology
Pseudoepitheliomatous hyperplasia
| Granular cells in the CT that are positive for neural markers
103
Define Pseudoepitheliomatous hyperplasia
Benign proliferation of the epithelium in reaction to certain stimuli
104
What can Pseudoepitheliomatous Hyperplasia mimic?
Squamous cell carcinoma
105
Congenital (granular cell) Epulis: Define
Benign tumor almost exclusive to the alveolar ridges of newborns
106
Congenital Granular Cell Epulis is not what origin
Neural origin
107
Congenital Granular Cell Epulis: Clinical Features
- Smooth surfaced, pink to red, polypoid mass
| - Maxillary alveolar ridge> mandibular ridge
108
Congential Granular Cell Epulis
Strong female predilection (nearly 90%)
109
Congenital Granular Cell Epulis Treatment
Conservative surgical excision (aka excisional biopsy).
| Can spontaneously regress in some patients, but often poses difficulty for feeding and requires removal
110
Congenital Epulis: Histology
Flat epithelial connective tissue interface
| Similar appearing granular cells in the connective tissue as a granular cell tumor
111
Lipoma, Leiomyoma, Myofibroma, Rhabdomyoma: What characteristics do they share?
Asymptomatic, firm, painless, slow-growing nodules
112
Lipoma: Define
Benign tumor of adipose tissue
113
Lipoma: Color
Yellow-gold huge
114
Lipoma: Location
Buccal, buccal vestibule
115
Leiomyoma: Define
Benign tumor of smooth muscle
116
Leiomyoma: Location
Lips, tongue, palate and cheeck
117
Leiomyoma: Color
Vascular variant has a bluish hue
118
Myofibroma: Define
Benign tumor of myofibroblasts (cells with both smooth muscle and fibroblastic features)
119
Myofibroma: Population
Average age 22
120
What is the most common fibrous tumor of infancy?
Myofibroma
121
Rhabdomyoma: Define
Benign tumor of skeletal muscle
122
Rhabdomyoma: Special Characteristic
Spider cell
123
Choristoma: Define
Benign tumor-like growth of microscopically normal tissue in an abnormal location.
124
Choristoma: Clinical Features
- Firm, smooth surfaced nodule
- 0.5-2 cm
- Osseous and cartilaginous types
125
Choristoma: Histology
Destermine whether it is osseous or cartilaginous
126
Choristoma Treatment
Excisional Biopsy
127
What is the most common tumor of infancy?
Hemangioma
128
Hemangioma: Population
Female predilection
129
Hemangioma: Clinical Characteristics
FIrm, rubbery to palpation, do not blanch
130
Hemangioma: Growth Pattern
Rapid Development during first few months of life -> Stabilize -> Up to 90% spontaneously resolve by age 9
131
Hemangioma Treatment
Observe for resolution if not of functional concern.
First line treatment: beta blocker (propranolol).
Some lesions may be surgically excised.
132
In cases of large cevicofacial hemangioma, what treatment is indicated?
Clinical workup to rule out well-recognized hemangioma syndrome: Phaces
133
P in Phaces
Posterior Fossa Brain Anomalies; also called dandy-walker malformation
134
H in Phaces
Hemangioma
135
A in Phaces
Arterial Anomalies
136
C in Phaces
Cardiac Defects
137
E in Phaces
Eye anomalies
138
S in Phaces
Sternal Cleft; supraumbilical raphae
139
Define Borderline/Intermediate Malignant Potential
Locally aggressive & Destructive, do not metastasize.
140
Example of Borderline/Intermediate Malignant Potential
Soft Tissue Fibromatosis
141
Soft Tissue Fibromatosis is also known as
Juvenille Aggressive Fibromatosis
142
Soft Tissue FIbromatosis: Define
Fibrous proliferation with biologic behavior intermediate between a benign fibrous proliferation and fibrosarcoma
143
Soft Tissue Fibromatosis: Clinical Features
-Firm, painless mass
-Growth potential: Slow and rapid
-
144
Soft Tissue Fibromatosis: Population
Any age, but typically young patients
145
Branchial Cleft Cyst Clinical Features
- Upper lateral neck mass anterior or deep to the SCM (2nd branchial arch origin)
- Cyst itself is soft, fluctuant mass ranging from 1-10 cm
146
Branchial Cleft Cyst Population
Typically develops in children and young adults (ages 10-40)
147
Branchial Cleft Cyst Treatment
Surgical Excision
148
Oral Lymphoepithelial Cyst: Define
Uncommon benign cyst that may form in areas of lymphoid tissue
149
Oral Lymphoepithelial Cyst: What is this histologically identical to?
Branchial cystic lesion
150
Oral Lymphoepithelial Cyst: Clinical Features
- Well circumscribed yellow-white cystic lesion usually less than 1 cm
- Asymptomatic unless traumatized
151
Oral Lymphoepitelial Cyst: Sites
Floor of mouth, ventral tongue, posterior lateral border of tongue, palatine tonsil and soft palate
152
Oral Lympepithelial Cyst Treatment
Excisional biopsy or clinical monitoring if asymptomatic and characteristic enough for clinical diagnosis
153
Thyroglossal Duct Cyst: Etiology
Developmental cyst arising from remnants of the thyroglossal tract (A structure that normally atrophies after thyroid gland descends to the neck in development)
154
Thyroglossal Duct Cyst: Clinical Features
Midline neck mass that can occur anywhere from the foramen cecum area of the tongue to the suprasternal notch (anywhere along the descending tract).
Painless, fluctuant, moveabel swelling
Cysts attached to the hyoid bone or tongue will move vertically with swallowing
155
Thyroglossal Duct Cyst: Population
1-2nd decade of life
156
Thyroglossal Duct Cyst Treatment
Referral to head and neck surgeon or ENT -> Sistrunk procedure
157
Thyroglossal Duct Cyst Treatment
Referral to head and neck surgeon or ENT -> Sistrunk procedure
158
Define Sistrunk Procedure
Specific type of excision that removed some adjacent tissue and structures to lessen recurrence rate
159
Epidermoid & Dermoid Cysts: Etiology/Background
Benign, epithelial-lined, keratin filled, developmental cysts
160
Epidermoid & Dermoid Cysts: Clinical Features
-Midline, yellow-white, soft, compressible, doughy submucosal mass
Rare intraoral lesions
161
Epidermoid & Dermoid Cysts: Site
Rare intraoral lesions. More common on the skin.
162
Epidermoid & Dermoid Cysts: Treatment
Surgical excision
163
Malignant Soft Tissue Neoplasms in Children
Rhabdomyosarcoma
164
Malignant Soft Tissue neoplasms in Teens/Young Adults (4)
1. Malignant peripheral nerve sheath tumor
2. Fibrosarcoma
3. Synovial sarcoma
4. Alvolar Soft Part Sarcoma
165
Malignant Soft Tissue neoplasms in Middle Aged Adults
1. Liposarcoma
2. Olfactory neuroblastoma
3. Leiomyosarcoma
4. Undifferentiated pleomorphic sarcoma
166
Malignant Soft Tissue Neoplasms in Older Adults
Angiosarcoma
167
Key Features of Rhabdomyosarcoma
Most common soft tissue sarcoma in children
168
Key Features of MPNST
1. 50% of cases occur in patients with NF1
| 2. Patients with NF1 develops MPNST's in first decade earlier than non-NF1 patients
169
Key Features of Synovidal Sarcoma
Translocation X; 18
170
Key Features of Alveolar Soft Part Sarcoma
Translocation X; 17
171
Kaposi Sarcoma Etiology
Human herpesvirus 8
172
Kaposi Sarcoma Clinical Features
Blue/brown macules that do not blanch
Macules develop into blue/purple plaques or nodules
Can become a diffuse, exophytic mass
173
Kaposi Sarcoma: Four different clinical presentations
Classic, endemic, iatrogenic and epidemic
174
What is usually associated with Kaposi Sarcoma?
Aids
175
Treatment of Kaposi Sarcoma (HIV Associated)
Initiation of cART therapy
| Chemotherapy, immunotherapy
176
Metastatic Disease of Oral Soft Tissue: Etiology
Hematogenous spread of malignancy via the Batson plexus
177
Metastatic Disease to Oral Soft Tissue: Clinical Features
Nodular mass resembling pyogenic granuloma
| Nodular mass with non-ulcerated smooth surface
178
Metastatic Disease to Oral Soft Tissue: Site
Metastases can occur to the jaws or soft tissue
| Soft Tissue: Gingiva > tongue
179
Metastatic Disease to Oral Soft Tissue: Treatment
- Metastatic disease always constitutes stage IV cancer
- Chemo/radiation
- Surgical management in some cases
180
malformations and anomalies (non-neoplastic)
```
Lymphangioma
Variscosity
Caliber persistent artery
Vascular malformations
Sturge-Weber Syndrome
```
181
Lymphangioma/Lymphatic Malformation: Etiology
Developmental Anomaly
182
Lymphangioma/Lymphatic Malformation: Clinical Features
Cystic hygroma
Oral Cavity lymphatic malformation
Pebbly "Vessicle-like" appearance "Frog Eggs" on anterior 2/3 of tongue
183
When do lesions occur in lymphangioma?
Around age 2
184
Define Cystic hygroma
Macrocystic lymphatic malformation that often occurs in the neck
185
Lymphangioma Histology
Dilated lymphatic vessels beneath the epithelium
186
Lymphangioma Treatment
Small Lesion -> Observation only or biopsied if unsure
| Larger lesions or lesions of cosmetic concern -> surgical excision and sclerotherapy
187
Variscosity Etiology
Abnormally dilated veins
188
Variscosity Clinical Features
Blue-purple, painless nodule
Diascopy positive
May become thrombosed and feel firm to palpation
189
Variscosity Population
Older adults
190
Variscosity Treatment
Excisional biopsy for small lesions if uncertain of diagnosis or desired by patient for esthetics.
Large and clinically characteristic lesions not of esthetic concern: Monitor
191
Caliber Persistent Artery: Etiology
Vascular anomaly
| Main arterial branch extends up into superficial submucosa
192
Caliber Persistent Artery location
Almost exclusively on lip
193
Caliber Persistent Artery Population
Older adults
194
Caliber Persistent Artery Clinical Features
Linear or popular elevation ranging from typical mucosal coloration to blueish in color.
Pulsation of lesion
195
Caliber Persistent Artery Treatment
No treatment indicated
196
Vascular malformation: etiology
Present at birth, persistent throughout life
197
Vascular malformation: Location
Occur in both soft tissue and intrabony
198
Three clinical features of vascular malformation
- Venous malformation
- Arteriovenous malformation
- Intrabony lesions
199
Describe clinical features of venous malformation
- Low flow
- Bluish, easily compressible
- Grow with the patient
200
Describe clinical features of arteriovenous malformation
- High flow, may be able to feel a thrill/pulse
| - Present at birth but often become noticeable later in childhood or adulthood
201
Describe clinical features of intrabony lesions
- Usually miltiocular radiolucency
| - Can cause sunburst periosteal reaction resembling osteosarcoma
202
Vascular malformation Treatment
- Small stable soft tissue lesions do not require treatment.
- Large problematic lesions -> sclerotherapy +/- surgical resection
- Intrabony lesions: need aspiration of any undiagnosed intrabony lesions before biopsy is a wise precaution to rule out the possibility of a vascular malformation. Lesions are typically embolized before surgical resection
203
Port Wine Stain: Etiology
Congenital dermal capillary vascular malformation.
| Caused by specific genetic mutation (GNAQ)
204
Port Wine Stain aka
Nevus flammeus
205
Port Wine Stain Clinical Features
- Pink or purple macular lesions
- Grow commensurately with the patient
- Lesion may darken and become nodular with age
206
Port Wine Stain Treatment
Laser treatment for esthetic purposes with functional difficulty due to the size of the lesion
207
Port Wine Stain can occur independently or as a component of _______
Sturge-Weber Syndrome
208
Sturge-Weber Syndrome Etiology
```
Development Condition (not hereditary)
GNAQ Mutation
```
209
Sturge-Weber Syndrome: Site
Affects skin, brain, and eyes
210
Sturge-Weber Syndrome Treatment
Lasers for port wine stain and potential oral lesions.
| Neurosurgery in some cases for intractable epilepsy with progressive ID
211
Granulomatosis with polyangiitis: Etiology
- Disorder characterized by necrotizing granulomatous inflammation and systemic vasculitis of small arteries and veins
- Thought to be caused by an abnormal immune reaction to an inhaled environmental antigen or infectious agent
212
Granulomatosis with polyangiitis: Age and Sex
40 years old; no sex predilection
213
Granulomatosis with polyangiitis: Initial Clinical Features
- Related to upper and lower respiratory tract involvement
- Chronic sinus pain, nasal discharge, congestion
- Dry cough, hemoptysis, dyspnea
214
Granulomatosis with polyangiitis: What can occur without treatment
Progress to renal involvement
215
Granulomatosis with polyangiitis: Oral clinical characteristics
Strawberry gingivitis
216
Granulomatosis with polyangiitis: Diagnosis
Clinical features + microscopic findings
| Indirect immunofluorescence for serum antibodies against PR3-ANCA
217
Granulomatosis with polyangiitis: Histology
Necrotizing granulomas, leukocytoclastic vasculitis
218
Granulomatosis with polyangiitis: Treatment
Systemic steroids+ cyclophosphamide
219
Granulomatosis with polyangiitis: Prognosis
If untreated and with systemic involvement-> mortality at 2 years is 90%.
With treatment and with systemic involvement prolonged remission in 75% and many patients can be cured
220
Palatal perforation: Differential Diagnosis
- Granulomatosis with polyangiitis
- Cocaine abuse
- Extranodal NK-T cell lymphoma
- Gumma
- Tuberculosis
221
Saddle Nose Deformity Differential Diagnosis
Granulomatosis with polyangiitis
Cocaine Snorting
Congenital Syphilis
222
Granulomatous Inflammation: Define
Specific type of inflammatory reaction to antigen
223
Granulomatous Inflammation: histology
Collections of histiocytes (macrophages) trying to wall off the intruder
224
Granulomatous inflammation: Causes
- Immune mediated diseases like sarcoidosis, granulomatosis with polyangiitis, crohn disease
- Some infections: Tuberculosis (and other mycobacteria), cat scratch disease, other fungal infections
- Foreign body reaction
225
Sarcoidosis: Etiology
Multisystem granulomatous disorder
| Thought to be a result of improper degradation of antigenic material
226
Sarcoidosis: Acute Clinical Features
Fever, fatigue, anorexia, weight loss+ respiratory symptoms polyarthritis, vision problems, skin lesions
227
Sarcoidosis: Specific Acute syndromes
Lofgren syndrome and Heerfordt syndrome
228
Sarcoidosis: Chronic Clinical Features
-Dry cough, dyspnea, chest pain
229
Sarcoidosis: Head and Neck Manifestations
Submucosal mass, isolated papule or an area of granularity or ulceration
Intraosseous lesions: ill-defined radiolucency
Salivary glands can be infiltrated by granulomatosis inflammation
230
Sarcoidosis: Characteristic skin manifestation:
Lupus pernio
231
Sarcoidosis: Diagnosis
- Combination: clinical features+ radiology+ biopsy of lung lesions or of the parotid gland showing granulomas
- Elevated serum ACE in 60% of patients
232
Sarcoidosis: Histology
Non-necrotizing granulomas, asteroid bodies and shaumann bodies
233
Sarcoidosis: Treatment
- 60% of cases resolve spontaneously
| - If progressive -> corticosteroids
234
Sarcoidosis: Prognosis
4-10% mortality
235
Oral Lesions associated with cosmetic fillers: Etiology
Oral lesion as a result of a foreign body type reaction to cosmetic filler
236
Biodegradable filler materials
Collagen, fat transfer, dextran, hyaluronic acid, poly-Llactic acid
237
Permanent/non-degrading fillers
Liquid silicone, polyacrylamid, hydroxyapatite
238
Oral Lesions associated with cosmetic fillers: Acute Mild Characteristics
Brusing, erythema, pain, localized infection
239
Oral Lesions associated with cosmetic fillers: Acute Severe Characteristics
Local allergic response (anaphylaxis), arthralgia, myalgia, facial paralysis, retinal artery thrombosis
240
Oral Lesions associated with cosmetic fillers: Chronic Clinical Characteristics
Latent tumor-like nodules in the soft tissue within vestibules and lips
If hydroxyapatite is used you may see radiopaque material on PAN or cone beam
241
Oral Lesions associated with cosmetic fillers: Diagnosis
Biopsy; intralesional or systemic steroids
242
Cervicofacial Emphysema: Etiology
Introduction of air into subcutaneous or fascial spaces of the face and neck
243
What puts a patient at higher risk for cervicofacial emphysema?
Surgical extractions, endodontic procedures, osteotomies, significant traumas
244
Cervicofacial Emphysema Other Causes
Use of compressed air, difficult or prolonged extractions, increased intraoral pressure after extraction
245
When do 90% of cervicofacial emphysema cases occur?
During surgery or within 1 hour post-op
246
Initial Signs of cervicofacial emphysema
Soft tissue enlarges, crepitus is detected easily with palpation
247
What helps differentiate between angioedema and cervicofacial emphysema?
Crepitus
248
Why do symptoms progress in cervicofacial emphysema? What are those symptoms?
Due to secondary inflammation and edema.
| Symptoms: Variable pain, facial erythema, dysphagia, dysphonia, visual difficulty, mild fever
249
Cervicofacial Emphysema: What occurs if it spread to mediastinum?
Pneumomediastium
250
Cervicofacial Emphysema: Symptoms of Pneumomediastium
Harsh voice, dyspnea and respiratory distress, hamman's crunch/sign
251
Define Hamman's crunch/sign
A sound hearde on cardiac ausculatation in a patient with pneumomediastinum
252
Treatment of Cervicofacial Emphysema for Mild to Moderate Cases
- Observation for self-resolution (2-5 days)
- Prophylaxis with broad-spectrum antibiotic
- Body gradually removes air over 2-5 day period
253
Treatment for Cervicofacial Emphysema for severe cases
- Immediate emergency medical attention
| - Possibility of airway compromise and other serious complications
254
Pneumoparotid is very similar to what disease
Cervicofacial emphysema
255
Describe Penumoparotid
Air enters parotid duct and causes enlargement of the parotid gland
256
What population is affected by pneumoparotid
Occupation based (trumpet players, or other similar instruments)
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Clinical manifestations of pneumoparotid
Saliva from parotid duct is frothy from mixing with air
| Crepitus over parotid gland region
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Pneumoparotid Treatment
Prophylactic antibiotics, massage, hydration, warm compresses, sialagogues
