Thursday, September 8, 2011

Lip lesions, Oral medicine OSCE aid.......

Common & rare lip lesions
Herpes labialis


Herpes simplex virus, usually type 1.
HSV latent in trigeminal ganglion reactivated as herpes labialis(‘cold sore’).
Percipitated by sun, trauma, menstruation, fever, immunosuppression.

 Impetigo contagiosa

Srptococci are main pathogens.
Papules change into vesicles surrounded by erythema then multiple pustules with golden crust.

Primary syphilis

Primary infection with Treponema pallidum.
Small papule develops into large painless indurated ulcer.
Heals spontaneously in 1-2 months.

Pyogenic granuloma

Exaggerated inflammatory and reparative response to minor trauma.
Red painless mass that bleeds easily, ulcerates and grows rapidly.

Carcinoma


Thickening, induration, crusting or ulceration, usually at vermilion border of lower lip.

Erethema multiforme

May affect mouth alone, or skin and/or other mucosa.

Leukaemia

Recurrent labial and intraoral herpes virus infections.
Purpura with bleeding into lesions.

Discoid lupus erythematosus

Mainly affects buccal mucosa, gingival and lips.
Lesions on vermilion boarder scaly and crusting.
Intraoral lesions have central atrophic often indurated red area with border of radiating white striae.

Lichen planus

White striae, rarely popular lesions or plaque like or atrophic or erosive lesions on lips.

Angular cheilitis(angular stomatitis)

Usually Candida albicans. Staph. aureus and/or streptococci may also cultured from lesions.
Common mainly in elderly edentulous pts.

Cracked lip

Chronic self induced trauma and maceration, mouth breathing. Also found in Crohn’s disease, Down’s syndrome.
Usually single persistent painful ulcer.

Actinic burns

Erythema, oedema, vesiculation and occasionally hemorrhage.

Allergic angioedema

Rapid development of oedematous swelling of lips.Oedema may involve neck and hazaed the airway.    

Naevi

Congenital lesions derived from melanoblasts.
Usually asymptomatic smooth pigmented macule < 1cm in diameter

                                                               Peutz Jegher syndrome

Mucocele

Usually extravasation of mucous from damaged salivary gland duct.
Mostly in lower lip and in young.

Sturge-Weber syndrome

Haemangioma in trigeminal region involving face, oral mucosa and underlying bone.


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