Swellings & Ulcerations

Question 1

Define a congenital abnormality

Answer 1

• Abnormalities (disease, defects, deformities) dating FROM BIRTH
• Not necessarily hereditary
• DEVELOPMENTAL

Question 2

What is the acronym used in assessing ACQUIRED swellings

Answer 2

VIITAMIIN

• Vascular
• Infective
• Inflammation
• Trauma
• Autoimmune
• Metabolic
• Iatrogenic
• Idiopathic
• Neoplastic

Question 3

What are the indigenous layers of connective tissue?

Answer 3

• Fibrous
• Vascular
• Nerve
• Fat
• Blood vessels
• Muscle
• Lymphatic/ glandular

Question 4

What should be included when describing a clinical presentation?

Answer 4

• SSSS, CC, (BB)

Site, Shape, Size, Surface, Colour, Consistency, (Base, Bleeding)

Question 5

What are the types of fibrous overgrowth (hyperplasia) of gingivae? And what causes them?

Answer 5

• Fibrous epulis = localised ginigval hyperplasia, caused by subgingival calculus
• Vascular epulis = granulation tissue response to trauma (aka pyogenic granuloma if not on gingivae, pregnancy epulis), lots of bleeding
• Pregnancy gingivitis = hormonal (raised progesterone levels) and poor OH
• Drug-induced + poor OH = antihypertensives (ca-channel blocker- nifedipine), anticonvulsants (not all- phenytoin), immunosuppressants (ciclosporin)
• Denture-induced = frictional trauma

Question 6

What are giant cells?

Answer 6

Mass formed by the union of several separate cells (often macrophages) in attempt to destroy unphagocytosable material, resulting in a granuloma

Response to infection (HIV, TB, herpes etc.) or foreign body

Question 7

What is Brown’s tumour of hyperparathyroidism?

Answer 7

Giant cell lesions in the the lower jaw (not cancerous)

Question 8

What are some neoplasms that may cause swellings?

Answer 8

• Benign
• Malignant
• Epithelial
• Mesenchymal (CT- fat, nerve, muscle, vascular, bone)

Question 9

What is the difference between tori and osteomas?

Answer 9

• Tori = (usually) symmetrical bony growth on maxilla/ mandible; found on specific places
  
  • -> Midline of palate (torus palatinus)
  • -> Lingual premolar are (torus mandibularis)
• Osteoma = bony growth, usually not following tori growth pattern

Question 10

What is the difference between granulomatous inflammation and granulation tissue?

Answer 10

• Granulomatous INFLAMMATION is characterised by 3 things:
  
  1. Lymphoedema
  2. Chronic inflammatory infiltrate
  3. Giant cell granulomas
• Granulation TISSUE = fibro-vascular, ‘healing’ tissue

Question 11

What type of hypersensitivity is associated with orofacial granulomatosis?

Answer 11

Type IV

Question 12

Describe the triggering events of a reaction in OFG

Answer 12

• (Type IV) Immune reaction stimulated in response to triggering agent
• Giant cell formation –> lymphatic obstruction –> lymphoedema –> granulomas

Question 13

What condition is closely associated to OFG?

Answer 13

Crohn’s

Question 14

What are the signs of OFG?

Answer 14

• Localised to face and mouth ONLY
• Lip and tissue swelling (-> angular cheilitis)
• Skin changes = rashes, redness, rubbery appearance
• Buccal cobble stoning (fissuring)
• Mucosal tags
• Fistula formation
• Ulceration (apthous ulcerations, strong link to Crohn’s)
• Full thickness gingivitis
• Positive to skin patch testing (dietary allergens = benzoates, cinnamonaldehyde, sorbic acid, chocolate)

Question 15

List some granulomatous inflammatory conditions

Answer 15

• Orofacial granulomatosis
• Crohn’s Disease
• Tuberculosis
• Sarcoidosis

Question 16

What is the management of OFG?

Answer 16

• Dietary avoidance
• Antibiotics
• Tacrolimus ointment to lips
• Steroid injections (–> lesions)
• Oral steroids +/- azathioprine
• Biologics e.g. Adalinumab
• NOT surgery!!!!!!