Recording of Swelling FINAL omr bds.pptx

oral medicine and radiology

1. RECORDING OF SWELLING NEHA GANGA P S 3 RD YEAR

2. CONTENTS INTRODUCTION QUESTIONAIRE CONCLUSION REFERENCES

3. INTRODUCTION Swelling is an abnormal enlargement or protruberance of a part of the body caused by increase in volume of tissues It may result from inflammation , neoplasia , trauma , infection , cyst formation or other pathological process Swelling is a common presenting symptom in oral medicine and can rise from variety of causes Proper history taking is essential to identify the nature , origin , and possible diagnosis of swelling . Recording of swelling involves a systemic approach considering a following set of questionaire

4. 1. Site Where was the swelling noticed? Site gives the idea regarding common site of occurrence for that lesion, e.g., a swelling below ear lobe might originate from parotid gland. Sometimes lesion also may originate in the uncommon site of occurrence.

5. Site of swelling - Facial Unilateral swelling: – Sequelae of periapical lesions like abscess, cellulitis – Osteomyelitis – Developmental anomalies – Post traumatic swellings – Fracture – Tumours of muscles, bones, soft tissue, etc – Parotid gland disorders Bilateral swelling: – Mumps – Sialadenosis – Sjögren’s syndrome – Ludwig angina – Allergic reaction like angioedema – Puffiness of face in hypothyroidism

6. Site of swelling - Lip Localized swelling: – Irritational /traumatic fibroma/focal fibrous hyperplasia – Mucocele (mainly lower lip) – Minor salivary gland tumour mainly upper lip – Sialolith in minor salivary glands – Haemangioma – Arterio -venous malformation – Lymphangioma – Varix – Benign neoplasms of smooth muscle origin (leiomyoma, angioleiomyoma ) – Malignant melanoma – Neurofibroma – Neurilemmoma Diffuse swelling: – Arterio -venous malformation – Lymphangioma – Cheilitis granulomatosa – Angioneurotic edema – Traumatic

7. Site of swelling - Floor of mouth & Palate Floor of mouth: – Ranula – Minor salivary gland neoplasms – Torus mandibularis – Sialolithiasis – Haemangioma – Arterio -venous malformation – Lymphangioma Palate: – Palatal abscess – Radicular cyst – Minor salivary gland tumour (benign and malignant) – Torus palatinus – Maxillary sinus pathologies like maxillary cyst – Hyperparathyroidism (brown tumour )

8. Site of swelling - Tongue Localized swelling: – Irritational /traumatic fibroma/focal fibrous hyperplasia – Mucocele (ventral) – Minor salivary gland tumour – Granular cell tumour Diffuse swelling: – Neurofibroma – Neurilemmoma – Lingual thyroid – Haemangioma – Arterio -venous malformation – Lymphangioma – Macroglossia – Ludwig angina – Traumatic

9. Chin, Submandibular region Chin region: – Submental /submandibular space infection – Submandibular lymphadenopathy Submandibular region: – Submandibular space infection – Submandibular lymphadenopathy – Submandibular salivary gland neoplasm – Lymphoma – Metastatic lymphadenopathy

10. Angle of mandible Angle of mandible: – Pericoronal abscess – Periapical abscess (for 2nd or 3rd molar) – Submandibular space infection – Odontogenic cyst like dentigerous cyst, KCOT, etc – Odontogenic tumour like ameloblastoma , etc – Osteomyelitis – Ossifying fibroma – Cherubism – Fracture of angle – Osteogenic sarcoma – Ewing sarcoma – Sialadenosis – Sialadenitis – Mumps – Benign tumour like parotid gland tumour , etc – Malignant tumour like mucoepidermoid carcinoma, etc – Submandibular lymphadenopathy due to infection/malignancy, etc – Lymphoma (Hodgkin/ Burkitt ) – Masseteric hypertrophy – Tumour of masseter muscle, e.g., myoblastoma , etc

11. 3. Mode of onset How did the swelling start? Whether swelling is sudden in onset or may have gradually – Developed just after a trauma? (post-extraction swelling, haematoma , etc ) – Developed suddenly and grows rapidly with severe pain? (inflammatory/infection/malignancy) – Developed suddenly and grows rapidly with no pain? (Allergies like angioedema) – Noticed casually and gradually increased in size? (Neoplasm) – May occur from pre-existing conditions.

12. 2. Duration How long is the swelling present there? When did you first notice the swelling? – If congenital swelling (Brachial cyst, Dermoid cyst, etc ). – Swelling with short duration (with pain) – Mostly inflammatory cause. – Swelling from long duration (without pain) – Benign neoplasia , mandibular or maxillary tori. – Swelling from long duration (with pain) – Chronic inflammatory. – Swelling from short duration (without pain) – Neoplastic/Mostly malignant.

13. 4. Painful Is the swelling painful? The swelling may be painful or painless. Most inflammatory swellings or benign converting to malignancy are painful. Benign neoplasms are usually painless .

14. 5. Progression of swelling Has the swelling changed since it was first noticed. Whether the swelling has grown bigger or smaller in size and/or changed its shape and consistency. Slow growth suggests an expanding lesion. Rapid growth indicates an inflammatory swelling due to a traumatic or infectious cause. Benign swellings – Grow very slowly/remain static for a long time . Malignant swellings –grow very rapidly Malignant transformation of benign growths-suddenly increases in size after remaining static for longer time Mucocele shows increase or decrease in size after or before meals Glandulkar swelling due to sialolith increases during meals Some developmental lesions presenting as swelling may regress with the passage of time ( e.g,hamartomas;hemangioma )

15. 6. Pus discharge Whether there is any history of pus discharge from extraorally or intraorally from the site of tooth infection.

16. 7. Recurrences of swelling Sometimes the swelling under consideration may have a connection with a swelling that had occurred in the past. Examples of recurrent swelling are: – Phoenix abscess – Incomplete removal of lesion during excision, e.g., odontogenic keratocyst . – Lesions that are not treated by the aetiology , e.g., pyogenic granuloma. – Benign lesion changing to malignancy. – Swelling arising from vascular origin e.g., lymphangioma , AV malformations.

17. 8. Interfering with functions If a swelling is disfiguring or interfering with functions, seek the history of each symptom carefully. For example, swelling of the face can interfere with mouth opening, speech, swallowing or breathing.

18. 9. Associated symptoms Swellings due to infection may be associated with fever, malaise. Sometimes findings such as joint pains, painful sinus, headache, etc may also be associated with oral swellings. Altered sensation/ paraesthesia – Swelling may causes altered sensation by compressing the nerve underneath it, e.g.: – Altered sensation in the lower lip due to compression of inferior alveolar nerve canal in case of mandibular tumour (like ameloblastoma , osteosarcoma, chronic osteomyelitis, etc ). – Altered sensation on tongue in case of tongue tumour .

19. 10. Swelling elsewhere in the body Multiple swellings, which can be present in other body parts are: – Metastasis – Neurofibromatosis – Gardener’s syndrome (multiple osteomas )

20. CONCLUSION Accurate and systemic recording of swelling is vial for formulating a differential diagnosis Key factors such as site , duration , onset , progression , associated symptoms and functional interference help narrow down the cause Correlating clinical history with examination finding ensure early diagnosis , targeted investigations and effective management

21. REFERENCE Textbookof oral medicine and oral radiology- P eeyush Shivhare

22. THANK YOU