ENT oral cavity

1. PREMALIGNANT CONDITIONS
OF ORAL CAVITY
Presentation By
Devasuriya.K
Roll Number 31

2. ANATOMY OF ORAL CAVITY
• Extension of Oral Cavity
From the skin-Vermilion border of lips ANTERIORLY to the junction of
hard and soft palate SUPERIORLY and the line of the Circumvallate
papillae POSTERIORLY.
Most common site for oral cavity cancer :
1) Floor of the mouth
2) Lateral Border of Anterior Tongue
3) Buccal Sulcus
4) Retromolar Trigone

3. LIST OF PREMALIGNANT CONDITIONS OF ORAL CAVITY
• LEUKOPLAKIA
• ERYTHROPLAKIA
• MELANOSIS AND MUCOSAL HYPERPIGMENTATION
• CHRONIC HYPERPLASTIC CANDIDIASIS
• ORAL SUBMUCOSAL FIBROSIS
• SYPHILITIC GLOSSITIS
• SIDEROPENIC DYSPHAGIA
• ORAL LICHEN PLANUS
• DISCOID LUPUS ERYTHEMATOSUS
• DYSKERATOSIS CONGENITA

4. CONDITIONS ASSOCIATED WITH MALIGNANT TRANSFORMATION
• HIGH RISK LESIONS
Erythroplakia ( Homogenous/Speckled)
Proliferative Verrucous Leukoplakia
Chronic Hyperplastic Candidiasis
• MEDIUM RISK LESIONS
Oral Submucous Fibrosis
Syphilitic glossitis
• LOW RISK LESIONS
Oral Lichen planus
Discoid LUPUS Erythematosus
Discoid Keratosis Congenita

5. LEUKOPLAKIA
• DEFINITION : It is a clinical term used to describe any white patch or
plaque that cannot be rubbed off or characterized clinically or
pathologically as another disease.
• Most Common Sites involved:
1. BUCCAL MUCOSA
2. ORAL COMMISURES
Other sites involved are Tongue,Gingivobuccal Sulcus,Mucosal Surface
of Lip,Floor of Mouth.

6. LEUKOPLAKIA CHEEK AND SPECKLED LEUKOPLAKIA ON
LATERAL BORDER OF TONGUE

7. ETIOLOGY
• SMOKING
• TOBACCO CHEWING
• BOTH ALCOHOL AND SMOKING
Other White lesion of Oral Mucosa like LICHEN PLANUS,DISCOID LUPUS
ERYTHEMATOSUS,CANDIDIASIS should be excluded before confirming a
condition of Leukoplakia.
Leukoplakia is a hyperkeratotic,irreversible patch which is most common premalignant
lesion of Oral cavity.
Leukoplakia is a persistent and adherent patch

8. TYPES OF LEUKOPLAKIA
• HOMOGENOUS VARIETY
They are uniform white patches with less malignant potential.
This is the MOST COMMON TYPE and prevalent in BUCCAL MUCOSA.

9. • NODULAR (SPECKLED)
This is a variation of Leukoplakia arising on ERYTHEMATOUS BASE and
has the highest rate of malignant transformation.

10. • EROSIVE (ERYTHROLEUKOPLAKIA)
Leukoplakia is interspersed with Erythroplakia and has Erosions and
Fissures.
Leukoplakia can be associated with
1) Submucous Fibrosis 2) Hyperplastic Candidiasis 3)Plummer Vinson
Syndrome.
Most commonly seen around 40years of age.
Male : Female = 3 : 1
PAINLESS AND NON TENDER.

11. HISTOLOGY OF LEUKOPLAKIA
• 25% of Leukoplakia show some form of Epithelial Dysplasia.
• Higher the grade of dysplasia more are the chances of its going into
malignant change.

12. • Leukoplakia presents as spectrum of epithelial changes ranging from
hyperkeratosis overlying a thickened,acanthotic but orderly mucosal
Epithelium to lesions with markedly dysplastic changes sometimes
merging into carcinoma in situ (PARAKERATOSIS WITH WIDENING OF
RETE PEGS)
• Histology picture shows SEVRERE DYSPLASIA with NUCLEAR AND
CELLULAR PLEOMORPHISM,NUMEROUS MITOTIC FIGURES AND LOSS
OF NORMAL MATURATION.

13. HAIRY LEUKOPLAKIA
• Hairy leukoplakia is a distinctive oral lesion on the lateral border of
the tongue that is usually seen in IMMUNOCOMPROMISED PATIENTS
and is Caused by EPSTEIN BARR VIRUS (EBV).
• Seen in patients infected with HIV and may portend the development
of AIDS.
• Hairy leukoplakia takes the form of WHITE,CONFLUENT PATCHES OF
FLUFFY (HAIRY) HYPERKERATOTIC THICKENINGS,ALMOST ALWAYS
SITUATED ON LATERAL BORDER OF TONGUE.
• Microscopic appearance : HYPERKERATOSIS and ACANTHOSIS with
“BALLOON CELLS” in the UPPER SPINOUS LAYER.

14. Extensive Leukoplakia on Dorsum of Tongue
with carcinoma on lateral margin

15. DIAGNOSIS AND TREATMENT
• BIOPSY confirms the diagnosis as well as rules out CARCINOMA.
• Elimination of associated ETIOLOGICAL FACTORS (PAN CHEWING AND
ALCOHOL) is the initial basis of management.
• All erythroplakia and Speckled Leucoplakia should undergo incisional
biopsy.
• Severe epithelial dysplasia and Carcinoma in situ should be Ablated
by surgical excision.
• REGULAR FOLLOW UP IS MANDATORY.
• LASER VAPORISATION can be done.

16. Severe Dysplasia on Lateral border of tongue
and Laser Vaporisation.

17. PROLIFERATIVE VERRUCOUS LEUKOPLAKIA
• It is a rare progressive exophytic variant of leukoplakia which is
frequently multifocal and carries higher risk of malignant
transformation.
• Arises in the absence of traditional risk factors for oral
premalignancy.
• Common in elderly women not associated with tobacco use.

18. KEY POINTS ON LEUKOPLAKIA

19. ERYTHROPLAKIA
• Definition: It is defined as the lesion of Oral Mucosa that presents as a
Bright red velvety plaque that cannot be characterized clinically or
pathologically as any other recognizable condition.
Red colour is due to decreased keratin causing shining and prominence
Of Submucosal Red vascularised Connective tissue.
Most Common Sites involved: 1)LOWER ALVEOLAR MUCOSA
2)GINGIVOBUCCAL SULCUS 3) FLOOR OF MOUTH

20. Features of Erythroplakia
• Males and Females equally affected (No sex predilection)
• 3 varieties are
1. HOMOGENOUS
2. SPECKLED/GRANULAR
3. ERYTHROPLAKIA INTERSPERSED WITH LEUKOPLAKIA
• Malignant potential is 17 times higher than Leukoplakia.
• Histological Feature : PARAKERATOSIS WITH SEVERE EPITHELIAL
DYSPLASIA is the typical feature.

21. Lesion of Maxillary Gingiva and Mandibular
Alveolar Ridge

22. Diagnosis and Treatment
• For diagnosis, BIOPSY is done
• For treatment, SURGICAL ABLATION is necessary
Lesions of Erythroplakia shows Severe Dysplasia,Carcinoma In situ
So BIOPSY is must to rule out CARCINOMA.
ERYTHROPLAKIA OF CHEEK

23. MELANOSIS AND MUCOSAL
HYPERPIGMENTATION
• Benign pigmented lesions of Oral Mucosa may transform into
malignant melanomas.
Incidence of conversion from benign to malignant is UNKNOWN.
But,Biopsy is Mandatory.
25% of mucosal melanomas resemble benign lesion.

25. CHRONIC HYPERPLASTIC CANDIDIASIS
• It produces dense plaques of leukoplakia particularly around the
commisures of mouth.
• Higher incidence of Malignant transformation and is associated with
Candida albicans
• Management includes Prolonged Topical Antifungal Treatment for 6
weeks or Systemic Antifungal Treatment for 2 weeks.
• If medical management fails,consider Surgical Excision.

26. Chronic Hyperplastic Candidiasis involving
LEFT BUCCAL MUCOSA

27. ORAL SUBMUCOSAL FIBROSIS
• It is a progressive fibrosis deep to the Mucosa of Oral Cavity which causes
Trismus and Ankyloglossia.
• ETIOLOGY: Beetlenut,Tobacco and Vitamin Deficiency.
• 5-8% of them can convert into malignancy
• Management includes Avoiding precipitating factors and maintaining oral
hygiene.
• Local injection of Dexamethasone with hyalase biweekly with vitamin and
iron supplements
• Surgical excision of lesion with coverage of raw area using skin graft or
tongue flap.

28. Oral submucosal fibrosis of right buccal
Mucosa and soft palate

30. Risk of premalignant condition to malignant
condition

31. LICHEN PLANUS
• 6P’s : PRURITIC,PURPLE,POLYGONAL,PLANAR,PAPULES,PLAQUES.
• Papules are highlighted by white dots called WICKHAM STRIAE.
Lichen planus is characterized histologically by dense,Continous
infiltrate of lymphocytes along dermoepidermal junction (example of
interface dermatitis)
Anucleate ,necrotic basal cells gets incorporated into inflammed
papillary dermis called as COLLOID or CIVATTE BODIES

32. THANK YOU 😀