Yellow conditions of oral mucosa ppt

MALABAR DENTAL COLLEGE
MALABAR ACADEMIC CITY

1. YELLOW CONDITIONS OF ORAL MUCOSA 1 DR SHABIL MOHAMED MUSTAFA ASSOCIATE PROFESSOR MALABAR DENTAL COLLEGE AND RESEARCH CENTRE

2. INTRODUCTION Many potentially yellow lesions may not appear yellow because the covering mucosa mask their color . Normal fat covered by thin layer of mucosa and salivary gland infiltrated with fat appears yellow. Salivary stones covered by a thin mucosa may impart a yellowish tinge to the mucosa. Yellow lesions , with exception of Fordyce's granule seldom occur in the oral cavity . 2

3. The variety of yellow lesions is limited to the following: Fordyce's granules Fibrin clot Superficial abscess Superficial nodules of tonsillar tissue Yellow hairy tongue Acute lymphonodular pharyngitis 3

4. 7. Lipoma 8.Lymphoepithelial cyst 9.Epidermoid and dermoid cyst 10.Pyostomatitis vegetans 11.Jaundice 12.Lipoid protienosis 13.Carotenemia 14.Rarities: Amyloidosis Cola nitida chewing Lesions of sebaceous gland Pseudoxanthoma elasticum Psoriasis 4

5. FORDYCES GRANULES Occur in oral mucosa as multiple , small , slightly raised granule that vary from whitish yellow to distinct yellow Occur in clusters or plaque like areas . Considered as normal variation of collection of sebacious glands covered with intact muccosa. the lobules of these glands may be quite distinct 5

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7. FEATURES Fordyce's granules increase in number rapidly at puberty and continue to increase during adult life. No established hereditary pattern Male : Female ratio = 1:1 Most common site : buccal mucosa bilaterally and symmetrical 7

8. Other sites includes retromolar pad area , labial mucosa , gingiva , frenum and palate. They are sharply delineated with surfaces that are smooth and not ulcerated and the nodules gives the involved area a slightly cheesy feeling 8

9. The histologic features are the same as those of normal sebaceous gland in skin. The gland have ducts that may be plugged with keratin and frequently extrusions of the sebum into the oral cavity are found. 9

10. DIFFERENTIAL DIAGNOSIS The differential diagnosis should include the possibility that the granules might be the focal collection of Candida organism that the speckled plaque like area associated possibly be leukoplakia. MANAGEMENT As the involved gland are normal , and unless significant pathology occurs , no treatment is indicated. 10

11. FIBRIN CLOTS Many ulcers of oral cavity such as aphthous lesions and traumatic ulcers form fibrin clot. The RBC are leached out of the clot by saliva , with the clot remaining as a yellowish coating on the ulcer. The ulcer is further stained by food and microorganism that may enhance the yellow color 11

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13. SUPERFICIAL ABSCESS Mycotic abscess May appear as yellow lesion The yellow color is imparted by pus pooling below the thinned mucosa that is stretched over the enlarging abscess 13

14. If a fistula forms and allows pus to discharge , however the lesion may no longer be yellow . The superficial swelling of odontogenic abscesses is the visual part of an infection that has its deeper origin at the periapex , the periodontal ligament or below the gingiva The lay term gum boil has been applied to some of this superficial lesions 14

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16. FEATURES Chief complaint will be pain Single or multiple Occur at all ages in either gender and primarily in tooth baring area. Single abscess is nodular or dome-shaped swelling with a smooth , frequently reddened mucosa over the yellow pus. 16

17. On palpation the abscess is fluctuant and on aspiration yields pus. The surface may ulcerate and produce a sinus opening with a resultant draining lesion. Teeth that are badly broken down by caries or that have large restorations producing pulpal disease are most often the precipitating cause of this condition. 17

18. The offending tooth may have a deep periodontal pocket in which A lateral periodontal pocket has developed. MANAGEMENT Management of these lesion is the treatment of underlying cause of infection. 18

19. SUPRFICIAL NODULES OF TONSILLAR TISSUE It is common to find discrete yellowish-pink nodules distributed over the posterior wall of the oropharynx and occasionally on the oral mucosa. These are nodes of lymphatic tissue that supplement the major tonsils composing Waldeyers ring. 19

20. These are situated in the areas that are visible during a routine examination of oropharynx. A total of 1 to 10 may be apparent . They vary in size , usually 3 to 5mm in diameter. 20

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22. YELLOW HAIRY TONGUE Hairy tongue is a condition occurs on the dorsal surface of tongue. It is more common in men. May cover whole dorsal surface or just a patch ; occasionally lateral margin may be involved. The hypertrophied filiform papillae of hairy tongue may be stained yellow by food, tobacco, medicines , or chromogenic microorganisms 22

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24. ACUTE LYMPHONODULAR PHARYNGITIS It is manifested by whitish to yellowish papular lesions on the soft palate and oropharynx. Have widespread occurrence Cause: coxsackie A10 virus 24

25. FEATURES Incubation period : 5 days after exposure . The patients , primarily children and young adult, complain of a sore throat . There will be fever (38-41 degree Celsius) , headache and loss of appetite. The oral lesions resolve in 6-14 days after the onset of the symptoms. M:f=1:1 25

26. The lesion are raised , discrete papule 3-6mm in dm. The whitish to yellowish papules are surrounded by a narrow , well defined zones of erythema. Their surface are not vesicular and do not ulcerate . 26

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28. The nodules are extremely tender completely superficial and bilateral; they generally occur as multiple lesions on the ovula , soft palate , anterior tonsillar pillars , and posterior oropharynx The histopathology of these lesions consist of densely packed nodules of lymphocytes . There may be some inclusion bodies in the overlying epithelium. 28

29. DIFFERENTIAL DIAGNOSIS Herpangina MANGEMENT Since it is self limiting , no treatment other than supportive therapy is recommended. 29

30. LIPOMA Most common benign neoplasm but seldom occur in the oral cavity. It is a tumor of mature fat cell found in the subcutaneous tissue. No significant mechanical , dental , familial , or social history is consistent with the occurrence of lipoma 30

31. FEATURE The oral lipoma has been reported in individuals from 6 weeks age to 75 years , with an average age of 50. M:f=1:1 Most common site: buccal mucosa , mucobuccal fold Other site : tongue , floor of mouth , lip , Because pain is not a feature , patient may not be aware of the lesions, but those who are aware report a slow –growing mass that may have been present from 1 month to 30 years. 31

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33. The lipoma usually occurs as a solitary lesion that may be sessile , pedunculated , or submerged. It ranges in size from a small lesion approximately 1cm in dm to a massive tumor 5x3x2cm. Deeper lesions vary in contour and shape ranging from a well- contoured , well-defined round swelling to rare ill-defined , lobulated mass. 33

34. The color , Which often is yellow , depends on the thickness of the overlying mucosa. The surface is smooth and non-ulcerated except when traumatized. On palpation , the lesion is nontender , soft and almost cheesy in consistency , but it may be fluctuant. 34

35. It is usually relatively superficial , but it any infiltrate muscle and become fixed to the surrounding tissue and therefore not be freely movable. Deeply occurring lesions may produce only a slight surface elevation and may be well encapsulated and more diffuse. There is no tooth involvement with these lesion. 35

36. On microscopic examination , the lipoma is mature and fat and may be enclosed within a connective tissue capsule . A thin fibrous stroma divides the fat into lobules. Various combinations of histologic features have been reported : cartilage , angiolipoma , myxoid lipoma , fibrolipoma and spindle lipoma. 36

37. DIFFERENTIAL DIAGNOSIS: Epidermoid cyst Dermoid cyst Lymphoepithelial cyst M ANAGEMENT Surgical excision 37

38. LYMPHOEPITHELIAL CYST The lymphoepithelial cyst is relatively uncommon in the oral cavity. It is apparently the result of cyclic degeneration of epithelial inclusions in lymphoid aggregates in the oral cavity. 38

39. Chaudhry , Yamane , Sharlock et al propose that lymphoepithelial cysts arise in excretory duct of the sublingual gland or occasionally from the duct of the minor salivary glands and that lymphoid components are a localized inflammatory response , perhaps of an autoimmune type. 39

40. FEATURES asymptomatic and nontender , so the patient is not frequently aware of how long they have been present. There is no related social or family history. Occurs predominantly among men Age 14 to 81 yrs Most common site :floor of mouth. 40

41. On clinical examination the lesion is solitary and appears as a raised , yellowish-white or white nodule with a smooth surface . It is usually small, with a diameter of only a few millimetre but it may be as large as 2cm in dm. It is fairly mobile, usually superficial , soft in consistency , variably fluctuant and sharply delineated 41

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43. On aspiration of the cyst , an amorphous coagulum composed predominantly of keratin is obtained. Microscopic examination illustrates that the nodules is a cyst lined with a thin ,stratified squamous epithelium containing nucleated, partially keratinized cells and keratin Circumferential lymphoid follicles are embedded in the walls. 43

44. DIFFERENTIAL DIAGNOSIS Lymph node Mucocele Sialolith Dermoid cyst Neuroma Lipoma MANAGEMENT Treated by conservative excision Recurrence is impropable 44

45. EPIDERMOID AND DERMOID CYST Developmental anomalies They are basically cystic teratomas , resulting primarily from trapped germinal epithelium. They occur in all areas of the body but rare in oral cavity. Usually patients complains of swelling in the floor of mouth. 45

46. FEATURES Site :floor of mouth , submaxillary and submental area May lie above or below the mylohyoid muscle If they are above , the tongue is displaced superiorly and if they are below , soft tissue in the submental region is distended. 46

47. The cyst may be in the midline or placed laterally. May occur at any age from birth to 72 yrs : average age of occurrence is 15 – 35 years. They may be slow growing or sudden onset and not fixed to the surrounding tissue. Both are nontender and ranges from a relatively small lesion to 10x5x5 cm mass. 47

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49. Its color varies depending on its position and thickness of overlying tissue. If the cyst is relatively superficial , it is yellow to white , and its surface is smooth and nonulcerated unless traumatized. On palpation: soft to firm , fluctuant and frequently rubbery or cheesy . 49

50. On aspiration produces a variety of material with typical straw colored cyst fluid. The histology of this entity ranges from a simple cyst , usually lined with stratified squamous epithelium and showing some keratinisation , to a cyst composed of the other germ layers and various types of epithelium. 50

51. The lumen of the simple cyst is filled with cyst fluid or karatin and no other specialized structure: such a cyst is defined as epidermoid cyst. The lumen may contain other elements depending upon the germinating epithelium; consequently in the case of these more complex cyst , the lumen may be filled with sebum , hair and even teeth. 51

52. If the lumen consist of sebaceous material as well as keratin, the lesion is called dermoid cyst. If the lumen contains elements such as bone , muscle , or teeth from various germinal layers , the entity is called a teratoma 52

53. DIFFERENTIAL DIAGNOSIS Ranula Thyroglossal duct cyst Cystic hygroma Brachial cleft cyst cellulitis Tumors Lipoma MANAGEMANT Enucleation , some curettage may be necessary. Usually does not recur 53

54. PYOSTOMATITIS VEGETANS It was first described as a rare inflammatory disease of the oral mucosa Cause : unknown; but consistently associated with inflammatory bowel disease. Chief complaint: “eruptions in the mouth”. The lesion may be present for months before the patient seeks professional attention. it may form a part of syndrome that includes ulcerative colitis 54

55. FEATURES Oral lesions are composed of large numbers of small, closely set Papillary projections with a broad base , usually on an intensely erythematous mucosa Although the small projections red to reddish pink, they may show tiny yellow pustules beneath the epithelium. the lesions are painless, and there is little if there is lymphadenitis. Buccomucosal and labiomucosal lesions have many folds and papillary projections develops on these folds. 55

56. No gender predilection Average age of occurrence : 15-47 yrs. Yellow vesicles that develop on the Papillary projections are pustules , and if opened , these vesicle discharge small amount of oral purulent material. On histologic examination , the involved mucosal tissue is characterized by a chronic inflammatory infiltration , occasionally with localized accumulation of polymorpho nuclear leukocyte. 56

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58. DIFFERENTIALN DIAGNOSIS Generalized papillomatosis Crohn`s disease Pemphigus vegetans Viral and fugal infections Systemic drug reactions erythema multiforme 58

59. MANAGEMENT In most of the lesions are completely resistant to any kind of therapy , including antibiotics. Those lesions that are concomitant with ulcerative colitis frequently improve when the colitis is controlled and an exacerbation of the colitis is followed by the similar change in the oral lesions Topical and systemic steroids are used to control the oral lesions 59

60. JAUNDICE OR ICTERUS It is the yellowish discoloration of the skin , mucous membranes and sclera of the eyes that is produced by an increase in the blood level of bilirubin and the deposition of this bile pigment in the tissues The jaundice appears when the serum concentration exceeds 2 to 3 3 mg/100 ml. 60

61. The hyperbilirubinemia is caused by excessive pigment production ; reduced hepatic uptake ; or decreased transport , conjugation , and biliary excretion of bilirubin. Hemolysis is the most common cause of excessive production of bilirubin . It is a feature of a number of disease such as thalassemia , sickle cell anemia , pernicious anemia , polycythemia and neonatal jaundice . 61

62. A reduced conjugation of bilirubin in the liver in neonetal jaundice and in some other rare syndrome is caused by the immaturity of the hepato excretory system. Reduced uptake of bilirubin in the liver is usually the result of a defect in the transport of plasma bilirubin to the liver cells Such a defect occurs in Gilbert syndrome , acute viral hepatitis and congestive heart failure and with bilirubin uptake . 62

63. The reduced excretion of conjugated bilirubin is found in case of hepatocellular injuries such as in viral hepatitis or inflammatory granulomatous or neoplastic infiltration of the liver , resulting in an obstruction of the biliary tree or bile duct FEATURES The physical manifestation of jaundice includes a yellow tinge of the eyes , skin , and mucous membranes. The appearance of bilirubin in the urine , however , may precede for some time the development of clinical jaundice . 63

64. the discoloration of the oral mucosa is most often seen first at the junction of the hard of soft palate . This may be caused by the accentuation of the yellow color by the fat in this area 64

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66. Depending on the cause of the jaundice , there may be pruritis , pain and enlarged liver. If there is partial , intermittent or total biliary obstruction , the faeces are light in color and the urine is dark. MANAGEMENT A patient with icterus who is suspected of having liver disease or one of the hemolytic disease should be referred to a physician for consultation and treatment 66

67. LIPOID PROTEINOSIS Rare disease that severely affects the oral cavity , with the formation of characteristic yellowish - white popular plaque on the oral mucosa . The same type of plaque also develops on the skin. 67

68. The disease thought to be a disturbance of mucopolysaccharide metabolism or an alteration in the formation of lipoprotein , is transmitted as an autosomal recessive trait. The chief complaints with lipoid proteinosis are an inability to cry as a baby , a husky voice from birth and scaring mucopapular eruptions on the skin. 68

69. FEATURES Lipoid proteinosis is present from birth , and lesions occur on the lips , oral mucosa , face , neck , hands , axillae , scrotum , perineal areas and intergluteal cleft , eyelids , knees and elbows. Lesion also occur on the epiglottis , the aryepiglottic folds , and the interarytenoid region . The patient may have a recurrent , painful parotitis. 69

70. The yellowish white lesion are multiple and appear to occur in all races. No gender predilection. The lesions are characteristically raised , waxy ,nodules that are whitish to yellow and have a smooth , nonulcerated surfaces. 70

71. Size 2mm to 0.5cm in dm Solid in consistency and firmly fixed to the underlying tissue . Congenital absence of the teeth and enamel hypoplasia have been reported to accompany this disease . 71

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73. Histologic study shows hyalinosis of the connective tissue of the upper layer of the corium in the plaques. Small blood vessels are affected much like those in diabetes mellitus . The hyaline material stains intensely with the periodic acid-Schiff stain. 73

74. MANAGEMENT The treatment of this disease is symptomatic . Corticosteroids have been used , but there is no convincing evidence that they are effective. 74

75. CAROTENEMIA Carotenemia is a somewhat common condition in children in which there is generalised yellowness of the skin and mucosa , It is produced by the excessive deposition of carotenoid (lipochrome ). which is the result of a high intake of foods containing carotene pigments. 75

76. There is usually no other systemic problem , but increased yellowness is seen in hyperlipidemia , diabetes , nephritis, hypothyroidism and conditions in which the conversion of carotene to vitamin A is impaired by an inborn metabolic error or hepatic disease 76

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78. FEATURE Carotenemia is a generalized yellowness of the skin and mucous membrane. No unusual statistical relationship exists between the occurrence of this phenomenon and the gender or age of the individual . The history usually discloses that the patient has an extremely high intake of food containing relatively large amounts of carotene (carrot juice , oranges) 78

79. DIFFERENTIAL DIAGNOSIS The differential diagnosis must include jaundice. There is an early involvement of sclera in jaundice , whereas the eye is not discolored in carotenemia 79

80. RARITIES Various lesions of intraoral sebaceous glands have been reported from time to time and include the following : sebaceous hyperplasia , retention phenomenon, and sebaceous carcinoma 80

81. REFERENCE Wood NK, Goaz PW. Differential diagnosis of oral and maxillofacial lesions (5 th edn) St Louis: Mosby, 1997 81

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