oral leukoplakia
Introduction
Introduction to oral leukoplakia This plaque on the oral mucosa cannot be rubbed off. It can not be included in other disease classifications in clinical and histopathology. It is a common non-infectious chronic disease, which can occur in various mucous membranes of the oral cavity. However, with the most cheeks and tongues, the prevalence rate of the domestic census in 1980 was 10.47% (including smoke spots). White plaques that have occurred on the oral mucosa have long been referred to as "white spots", confusing many white lesions with white spots, resulting in inappropriate results in epidemiology and treatment. The color of white spots, besides white, can also be manifested as red and white damage. It should be clear that white spots are clinical terms seen by the naked eye. The changes in histopathology should be consistent with the characteristics of precancerous lesions - abnormal epithelial hyperplasia. Not simply epithelial hyperplasia. basic knowledge The proportion of illness: 0.001%-0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: oral cancer
Cause
Causes of oral leukoplakia
Local irritation (60%):
Local stimulating factors play an important role in the pathogenesis of leukoplakia. Smoking is a common cause. People with leukoplakia have a smoking habit of 80% to 90%, and the affected part is more consistent with the stimulating part of the smoke. Others such as chewing betel nut and wine , vinegar, spicy, hot, poor prosthesis, residual crown, residual roots and other stimuli can also cause white spots.
Systemic disease (40%):
Among systemic factors, Candida albicans infection, iron deficiency anemia, vitamin B12 and folic acid deficiency, syphilis and radiation, dry mouth and so on are closely related to white spots, patients are more middle-aged and older, more male than female (male: Female = 13.5:1).
Prevention
Oral leukoplakia prevention
1, relaxed mood, happy and cheerful, at least should avoid trauma, overwork, excessive thinking, worry.
2, non-smoking alcohol, to avoid continuing to harm the body's immune function or damage to the skin.
3, usually eat less pepper, raw garlic, hard or rough irritating food, to avoid irritating or damage the oral leukoplakia, reduce the chance of oral leukoplakia cancer.
4, active treatment of the disease is also a effective way to prevent cancer, and the pathogenesis of oral mucosal leukoplakia is not clear, there is no specific medicine for treatment, generally taking vitamin A, vitamin B12, or rubbing the affected part with cod liver oil to help relieve symptoms, Freezing or laser treatment is a common method.
Complication
Oral leukoplakia complications Complications, oral cancer
It is a kind of precancerous lesion of oral cancer. The leukoplakia is a precancerous lesion. It shows typical epithelial dysplasia under the microscope, deep nuclear staining, increased mitosis, loss of polarity, altered nucleoplasmic ratio, and ischemic, so it is necessary to prevent complications of oral leukoplakia and prevent canceration. occur.
A good group of men is more likely than a woman, especially in men with middle-aged men and women. Symptoms of oral leukoplakia can occur in any part of the oral mucosa, with buccal and tongue mucosa more common. A white plaque lesion that manifests as one or more locations. Patients generally have no obvious symptoms, and may have discomfort, roughness, sensation, loss of taste, and local stiffness. Spontaneous pain and irritation can occur with ulcers. The white spot color is milky white or grayish white. The leukoplakia is tightly textured with clear boundaries, slightly above the mucosal surface, and is more elastic and less elastic than normal mucosa. Disease Hazards Oral leukoplakia is a precancerous lesion. Heterogeneous leukoplakia is more dangerous than homogenous leukoplakia.
Symptom
Symptoms of oral leukoplakia Common symptoms Candida albicans infection Oral mucosa leukoplakia Oral ulcers White flaky oral mucosa Fibrosis oral mucosa on white... Biting lip or tongue
The predilection sites of leukoplakia are the oral mucosa of the cheeks, the back of the tongue, the abdomen of the tongue, the lips, the palate, the bottom of the mouth, and the gums, but sometimes they can occur in other parts. Some types have specific parts: granules and white spots. Seen in the buccal mucosa of the mouth area; wrinkled paper-like white spots are more common in the mouth and the lower abdomen; white spots are more common in the gums, the site of white spots is different from the area of white keratosis, and there is no common in morphology and texture. In addition to microabscess and epithelial dysplasia, Candida albicans leukoplakia can also be used to identify pathogens in tissues by means of periodic acid staining or culture, and distinguish white spots from white spots from the location of the lesion and the texture of the lesion and the boundary of the lesion. Disease, histological examination is more clear.
The leukoplakia is precancerous lesions, showing typical epithelial dysplasia under the microscope, deep nuclear staining, increased mitosis, loss of polarity, changes in nucleoplasmic ratio, and keratinization. The morphology of the epithelial surface is wrinkled, braided, etc. Although it does not symbolize pre-cancer changes, it should be highly vigilant.
1. Plaque: white or grayish white homogeneous hard plaque on the oral mucosa, tight texture, varying shape and area, mild elevation or unevenness, it is worth noting that the damage is the same as cancerous There is no parallel relationship between the possibilities. Sometimes, even if only the size of the rice grain has been cancerous, it is often difficult to distinguish it from the white spot of the white plaque, but the former is harder.
2. Granular: also known as granule-nodular leukoplakia, the mucosa of the mouth area is more common, the damage is often like a triangle, the bottom edge is at the corner of the mouth; the color of the damage is red and white, the red area is atrophic red spot; the surface of the red spot is " Embellished with nodular or granular leukoplakia, so there are many synonymous names: nodules - granular white spots or granular red spots or heterogeneous red spots, etc., most of this type of white spot can be found Candida albicans infection.
3. Wrinkled paper: more common in the bottom of the mouth and the belly of the tongue, synonymous with leukoplakia, sublingual keratosis, the disease can occur at the mouth and tongue, but also in the mouth or tongue Or the bottom of the mouth and the left and right sides of the tongue, the damage area is not equal, and even the lingual gingival can be involved, the surface is undulating like white crumpled paper, the base is soft, except for the rough discomfort, there is no obvious symptoms at the beginning, more women than men, In order to confirm the diagnosis, it is necessary to carry out a physical examination. Any damage in the areas of the mouth, the abdomen, the soft palate, the alveolar mucosa, etc., often has a crumpled paper-like "peak-like protrusion" seen by the naked eye, and the same is seen under the microscope.
4. Symptoms: damage bulge, uneven surface, accompanied by papillary or burr-like protrusions, palpation micro, except in the gums or upper jaw, the base has no obvious hard knots, the damage area is obvious, usually due to ulcer formation Pain occurs.
All of the above types can be referred to as "ulcer type" in the event of ulceration, and the ulcer is essentially a sign that the precancerous lesion has been further developed. Second, the clinical diagnosis of each type must be verified by pathological examination as a basis for further selection of treatment methods.
Examine
Examination of oral leukoplakia
Pathological examination:
The white crease gingivitis is seen under the microscope: the squamous epithelium is significantly thickened, even up to 40~50 layers without granules, keratinization is incomplete, the spine cells are swollen, the closer the surface is, the more obvious, the cytoplasm is not stained. The connective tissue has a small amount of inflammatory cell infiltration.
Exfoliated cell examination and toluidine blue staining: epithelial hyperkeratosis, cell atypical hyperplasia and epithelial abnormal proliferation.
Histological biopsy: Clinically diagnosed cases of oral leukoplakia should be promptly biopsy, and those with epithelial atypical hyperplasia should be closely followed up.
Diagnosis
Diagnosis and differentiation of oral leukoplakia
The predilection sites of leukoplakia are the oral mucosa of the cheeks, the back of the tongue, the abdomen, the lips, the palate, the bottom of the mouth, the gums, etc., but sometimes they can occur in other parts. Some types have specific parts: granule leukoplakia is more common in the buccal mucosa of the mouth area; wrinkled paper-like leukoplakia is more common in the base of the mouth, and verrucous leukoplakia is more common in the gums. The site of leukoplakia is different from that of white keratosis, and there is no commonality in morphology and texture. It can distinguish white spot and white keratosis from the location of the disease and the texture of the damage and the boundary of the lesion. In addition to microabscess and abnormal epithelial hyperplasia, Candida albicans leukoplakia can also be used to identify pathogens in tissues by means of periodic acid staining or culture, and the histological examination is more clear.
1. white edema (leukoedema)
More than middle-aged men are more common than women, and the fullness of the cheeks is more likely. White edema is less likely to cause symptoms, so it is rarely seen. However, it is easy to find in the clinical clinic that white edema may be normal mucosa. Variation, may also be related to smoke, alcohol, hot food stimulation, bilateral cheek mucosa is translucent pale, like the skin of the fingers in the water after excessive foaming, buccal mucosa, the interline area is often the most uplifted part of edema, The surface of the edema area is smooth and the boundary is blurred. Sometimes it can spread to the mouth area and the upper and lower lips. However, sometimes there are some vertical or irregular wrinkles due to obvious edema. The palpation is soft and no tenderness. White edema generally does not require treatment.
The white edema is seen under the microscope. The main layer of the spinous layer is thickened without horny layer. The spine cells are swollen. The closer to the shallow layer, the more obvious, the nucleus disappears or concentrates, the cytoplasm does not stain, and the deep spine cells and basal cells have no abnormality. The epithelial nails are irregularly elongated, and a small amount of inflammatory cells infiltrate the connective tissue.
2. White fold gingivostomatitis
The disease has existed at birth, but it is not obvious. It begins to develop rapidly during puberty and gradually maintains a stable state, but it does not increase with age. Wrinkle gingivitis is a rare autosomal dominant disease, except for oral mucosa. In addition, it can also occur in the nasal cavity, anus and vulva, the disease is also called white spongy nevus.
The damage is grayish white or milky white, showing wrinkled, spongy, scaly thick soft tissue. Although palpation, these parts still maintain the flexibility and elasticity of the mucosa, but the shape is like sponge, buccal mucosa damage is more common, other The site can also be affected, even affecting the entire oral mucosa, the smaller scaly tissue can be removed, and it is painless and reveals a light pink, smooth, non-hemorrhagic "surface" similar to normal mucosa, oral retinoic acid Significant.
