Diseases of Oral Cavity & Esophagus

Diseases of Oral Cavity & Esophagus

• Diseases of the oral cavity and esophagus are discussed.

Oral Cavity Infections

• Herpes simplex infections are common.
• Most orofacial herpes are caused by HSV-1.
• These infections result in common, but mild cold sores.
• Acute herpetic gingivostomatitis presents with vesicles and ulcerations.
• Recurrent herpetic stomatitis describes the recurring nature.

Oral Cavity Apthous Ulcers

• These are common superficial ulcerations of the oral mucosa.
• The lesions appear as single or multiple, shallow ulcerations.
• They usually heal spontaneously, often recurrently.
• They are more painful than serious.
• Glossitis: A beefy-red tongue is seen in deficiency states.
• Atrophy of papillae and thin mucosa is noted.
• Vitamin B12 and iron deficiencies are common causes.

Oral Candidiasis (Thrush)

• Superficial white patches or a fluffy membrane cover the oral cavity.
• The membrane consists of matted organisms, within a fibrinosuppurative exudate.
• It is easily detached, revealing a reddened underlying surface.
• Candida is part of normal oral flora.
• This condition is found in diabetic, neutropenic, and immunocompromised individuals (like those with HIV).
• It is the most common fungal infection in the oral cavity.

Oral Manifestations of Systemic Disease

• Hairy leukoplakia is seen in immunocompromised patients, especially those with HIV.
• Manifestations include white, fluffy thickenings on the lateral parts of the tongue.
• Epstein-Barr virus is often present in these cases.
• Infections like measles (Koplik spots), infectious mononucleosis, and diphtheria can appear in the oral cavity.
• Dermatologic conditions such as lichen planus, pemphigus, erythema multiforme (including Stevens-Johnson syndrome) can manifest orally.
• Haematologic disorders like pancytopenia (agranulocytosis, aplastic anemia) and leukemia, can affect the mouth.
• Monocytic leukemia can cause infiltration and expansion of the gingivae.

Oral Precancerous Lesions

• Leukoplakia is a clinical term for white plaques.
• It cannot be removed by scraping.
• It's considered precancerous until proven otherwise via examination.
• Erythroplakia presents as red, velvety erosions.
• Tobacco use (cigarettes, pipes, cigars, chewing tobacco) is a major risk factor for these conditions.

Tumors and Precancerous Lesions

• Many oral tumors, like papillomas, hemangiomas, and lymphomas also appear elsewhere in the body.
• Only squamous cell carcinoma and its precancerous lesions are exclusively oral.

Leukoplakia Definition

• Leukoplakia is defined by the World Health Organization as a white patch or plaque that is not removable by scraping and cannot be classified as any other disease.
• Lichen planus and candidiasis are not considered leukoplakia.

Leukoplakia Risk Factors

• Approximately 3% of the global population has leukoplakic lesions.
• About 5–25% of these lesions show premalignant potential, therefore until proven otherwise, all leukoplakias are considered precancerous.

Erythroplakia Description

• Related to leukoplakia but much less common.
• Erythroplakia represents a red, velvety, possibly eroded area within the oral cavity.
• It usually remains level with or slightly depressed compared to surrounding mucosa.

Oral Cavity Squamous Cell Carcinoma

• Smoked tobacco, alcohol, betel quid chewing, sirih, paan, sunlight, and pipe smoking are associated.
• The cancer can appear on the floor of the mouth, tongue, hard palate, and base of the tongue.
• Lesions are often ulcerating with raised rolled borders.
• Histology typically shows well-differentiated squamous cells.
• Cancer spreads to cervical, mediastinal nodes, lungs, and liver.

Odontogenic Tumors

• Odontogenic tumors are derived from odontogenic epithelium, ectomesenchyme, or both.
• Two common types are ameloblastoma and odontoma.
• Ameloblastoma arises from odontogenic epithelium.
• Odontomas are formed from epithelium but contain enamel and dentin deposits.

Salivary Glands

• Three major salivary glands- parotid, submandibular, and sublingual glands exist.
• Also, minor salivary glands are found.
• Inflammations (siadenitis) common.
• Mucoceles are most common inflammatory lesions.
• They result from the blockage or rupture of salivary gland ducts, and present as a swelling of the lower lip.
• Viral (Mumps), autoimmune (Sjogren's syndrome), and bacterial (sialolithiasis) are other factors involved.
• Viral causes of sialadenitis include mumps.
• Autoimmune disorders, such as Sjögren's syndrome are associated.
• Bacterial causes affect salivary glands secondary to ductal obstruction (sialolithiasis).

Salivary Gland Tumors- Benign

• Pleomorphic adenoma is the most common benign salivary gland tumor.
• It's primarily found in the parotid.
• It appears as a painless, slow-growing mass, often with recurrence after removal.
• Warthin tumor (adenolymphoma) is the second most common benign salivary gland malignancy.
• It is characterized by a rounded mass with cleft-like spaces.

Salivary Gland Tumors- Malignant

• Mucoepidermoid tumor is the most common malignant tumor in salivary glands.
• It can occur following radiation therapy
• It contains squamous and mucus cells.

Esophagus

• Dysphagia, heartburn, pain, and haematemesis are common symptoms associated with esophageal diseases.
• Congenital anomalies, such as esophageal atresia/fistula, can cause feeding problems and often require surgical intervention.
• Some conditions like achalasia, hiatal hernias, and diverticular development present as motor function disorders.

Esophagitis

• Reflux esophagitis (GERD).
• Gastroesophageal reflux disease (GERD) results in reflux of gastric contents into the esophagus and mucosal injury.
• Increased inflammatory cells, basal zone hyperplasia, bleeding, ulceration, and stricture are possible complications.
• Barrett's esophagus is a complication of long-standing GERD.
• It includes squamous mucosal replacement by metaplastic columnar epithelium.

Esophageal Varices

• Portal hypertension can lead to esophageal varices, dilated submucosal veins.
• Rupture can cause upper GI bleeding (hematemesis).
• Esophageal varices are common in cirrhotic patients.

Esophageal Squamous Cell Carcinoma

• Worldwide, dietary and environmental factors influence squamous cell carcinoma incidence.
• Genetic factors affect the reaction to the associated external factors.
• Alcohol and tobacco use contribute to the development of esophageal squamous cell carcinoma in several regions.
• Different regions of the world may have distinctive rates and factors influencing this form of esophageal cancer.
• Squamous cell carcinoma typically presents with a polypoid, diffuse infiltrating, or ulcerated appearance.
• Spread, including lymph node involvement, is often early.
• Key regions for lymph node involvement are cervical, mediastinal, and coeliac nodes.

Esophageal Adenocarcinoma

• Adenocarcinoma arises in people with Barrett's esophagus.
• It follows a multistep process, beginning with dysplasia.
• The cancer often arises in the lower third of the esophagus.
• It commonly involves intestinal type cells.
• Clinical characteristics resemble those of squamous cell carcinoma.