Diseases of the Oral Cavity, Diseases of the Oral Cavity, Oropharynx, and NasopharynxOropharynx, and Nasopharynx

Josefino G. Hernandez, MDJosefino G. Hernandez, MDAssociate Professor and Vice Chairman, Dept of ORL,Associate Professor and Vice Chairman, Dept of ORL,

UP-PGHUP-PGHAssociate Professor, Fatima College of MedicineAssociate Professor, Fatima College of Medicine

Chairman, Dept of ENT,Chairman, Dept of ENT,Asian Hospital and Medical CenterAsian Hospital and Medical Center

Chairman, Philippine Academy of RhinologyChairman, Philippine Academy of Rhinology

Oral CavityOral Cavity

Floor of the MouthFloor of the Mouth

2. Pharynx

a. Nasopharynx: the free border of the soft palate divides the nasopharynx from the oropharynx

b. Oropharynx: a horizontal line at the level of the epiglottis separates the oropharynx from the hypopharynx

c. Hypopharynx

The posterior pharyngeal wall is continuous in all 3 divisions and consists of the fascia, muscle and mucosa overlying the base of the skull and the first 6 cervical vertebra.

Developmental Anomalies of the Developmental Anomalies of the Face, Jaws and MouthFace, Jaws and Mouth

Oral Tori

1. Torus palatinus

nodular or lobular bony growth in the midline of the hard palate.

manifest beginning puberty, 25% of females and 15% of males.

Torus PalatinusTorus Palatinus

2. Torus mandibularis

single or multiple, unilateral or bilateral bony growths on the lingual aspect of the mandible in the region of the premolars.

become evident at puberty or later.

develops in 10% of the population.

Torus MandibularisTorus Mandibularis

MicrognathiaDiminution in size of jaw. May be congenital or acquired. Due to a failure at the growth center in the condyle. Mandibular micrognathia is usually an isolated polygenic trait but has been noted in association with craniofacial dysostosis, in acrocephalosyndactyly and in trisomy 21 (mongolism).

PrognathismEnlargement or anterior placement of the lower jaw may be absolute or relative and is a multifactorial hereditary trait.

MacroglossiaMacroglossia

Most congenital cases are due to lymphangioma or hemangiolymphangioma. Cystic hygroma

may also be present.

MacroglossiaMacroglossia

HemangiomaHemangioma

Cavernous LymphangiomaCavernous Lymphangioma

Median Rhomboid GlossitisMedian Rhomboid Glossitis

• It has been considered to be caused by embryonal failure of the tuberculum impar to submerge, that is, to be covered by the lateral lingual tubercles. It is characterized by a smooth to nodular, elevated or depressed area void of papillae,located just anterior to the circumvalate papillae.

Median Rhomboid GlossitisMedian Rhomboid Glossitis

AnkyloglossiaAnkyloglossia

• Secondary to a congenitally short lingual frenulum. Frenulum could be clipped in infancy or Z-plasty could be performed to lengthen frenulum and produce more tongue mobility.

AnkyloglossiaAnkyloglossia

Lingual ThyroidLingual Thyroid

• Embryonal failure of the thyroid gland to descend from the foramen cecum to the anterior neck.

Lingual ThyroidLingual Thyroid

Cleft Lip and Cleft PalateCleft Lip and Cleft Palate

• Combination of cleft lip and cleft palate comprises about 50% of the cases

• Isolated cleft lip and cleft palate accounts for 25% each

• Isolated cleft lip is bilateral in 20%

• If unilateral, cleft is more common on the left side(70%)

Bifid UvulaBifid Uvula

TreatmentTreatment• Cleft lip:

Cheiloplasty: Rule of 10

Millard’s technique• Cleft Palate:

Palatoplasty: Before child learns to speak Von Langenbeck technique (bilateral relaxing incision)

V to Y technique

Cysts of the Jaws and Oral Floor Cysts of the Jaws and Oral Floor

• Odontogenic cysts

• Nonodontogenic cysts and fissural cysts

Odontogenic CystsOdontogenic Cysts

Radicular Cyst ClassificationRadicular Cyst Classification

Radicular Cyst with Oro-Cutaneous Radicular Cyst with Oro-Cutaneous FistulaFistula

Dentigerous Cyst, MaxillaDentigerous Cyst, Maxilla

Dentigerous Cyst X-rayDentigerous Cyst X-ray

Nonodontogenic CystsNonodontogenic Cysts

• Fissural cysts

Nasoalveolar cyst

Nasopalatine cyst

Globulomaxillary cyst

Nasoalveolar cyst (Klestadt’s cyst)Nasoalveolar cyst (Klestadt’s cyst)

• Arises from the epithelial rests located at the junction of the globular, lateral nasal and maxillary processes.

Nasoalveolar CystNasoalveolar Cyst

Nasoalveolar CystNasoalveolar Cyst

Nasopalatine Cyst X-rayNasopalatine Cyst X-ray

Coronal View

Axial View

Lateral

Nasopalatine CystNasopalatine Cyst

Dermoid Cyst, Upper LipDermoid Cyst, Upper Lip

Lip MucoceleLip Mucocele

RanulaRanula

Disorders of the Oral MucosaDisorders of the Oral Mucosa

Black Hairy TongueBlack Hairy Tongue

Elongation of the filiform papillae with overgrowth of pigment producing bacteria or fungi

Atrophic Glossitis (Smooth Atrophic Glossitis (Smooth Tongue)Tongue)

Scrotal TongueScrotal Tongue

StomatitisStomatitis

LeukoplakiaLeukoplakia

ErythroplakiaErythroplakia

Oral CandidiasisOral Candidiasis

Oral Candidiasis (Thrush)Oral Candidiasis (Thrush)

Oral TumorsOral Tumors

Ameloblastoma, MentumAmeloblastoma, Mentum

Ameloblastoma, MandibleAmeloblastoma, Mandible

Incision lines

Tumor Defect

Clavicular Grafting Closure w/drains

SPECIMEN

Post-opPost-op

1 month 3 months 3 years

Cementifying FibromaCementifying Fibroma

Incision Lines Tumor Defect w/cheek flap

THIN SPLIT-THICKNESS SKIN GRAFT IS HARVESTED TO LINE THE INNER CHEEK FLAP

SPECIMEN CLOSURE

Palatal Defect 1 Week Post-op

Granuloma PyogenicumGranuloma Pyogenicum

FibromyxomaFibromyxoma

Squamous cell Ca, Buccal Squamous cell Ca, Buccal Mucosa Ulcerative TypeMucosa Ulcerative Type

Leukoplakia

Around the Ulcer

Squamous cell Ca, Tongue Squamous cell Ca, Tongue Exophytic TypeExophytic Type

Palatal CarcinomaPalatal Carcinoma

NasopharynxNasopharynx

Enlarged AdenoidsEnlarged Adenoids

Juvenile Nasopharyngeal Juvenile Nasopharyngeal AngiofibromaAngiofibroma

Axial View Coronal View

Juvenile Nasopharyngeal Juvenile Nasopharyngeal AngiofibromaAngiofibroma

SPECIMEN

OropharynxOropharynx

Acute & Chronic TonsillitisAcute & Chronic Tonsillitis

ACUTE

CHRONIC

Peritonsillar AbscessPeritonsillar Abscess

Unilateral Tonsillar EnlargementUnilateral Tonsillar Enlargement

Indications for TonsillectomyIndications for Tonsillectomy

• Absolute

Hypertrophy resulting in cor pulmonale

Hypertrophy resulting in sleep apnea

Hypertrophy resulting in dysphagia with associated weight loss

Consideration of malignancy

Recurrent peritonsillar abscess or abscess extending into adjacent tissue spaces

• Relative indicationDocumented recurrent bouts of

tonsillitisTonsil and adenoid hypertrophy

associated with orofacial or dental abnormalities that narrow the upper airway

Rheumatic fever history with heart damage associated with chronic recurrent tonsillitis

Thank You