oral leukoplakia
Introduction
Introduction to oral mucosal leukoplakia Oral mucosal leukoplakia refers to a white keratotic disease that occurs in the mucous membranes of the mouth, lips, and the like. Oral mucosal leukoplakia is more common in men than middle-aged men. It is characterized by punctate, flaky or strip-like gray or white keratotic patches in the lesions. Most of them are benign lesions, and a few tend to have malignant transformation. It is estimated that the malignant rate is about 2%. basic knowledge The proportion of sickness: 0.0001% - 0.0002% Susceptible people: good for men Mode of infection: non-infectious Complications: oral ulcers
Cause
Oral mucosal leukoplakia
Smoking (30%):
Smoking is the most important external stimuli, but snuff can induce special forms of leukoplakia. Brushing and mechanical stimulation with toothless alveolar chewing can also cause white spots, called rubbing keratosis, not mucocele, syphilis. Can cause leukoplakia of the tongue and can be complicated by atrophic glossitis. In the so-called pathogenesis of spontaneous mucosal leukoplakia, there is no obvious local factor, and mucosal atrophy is an important pathogenic factor.
Infection factor (20%):
In recent years, it has been suggested that oral leukoplakia is associated with Candida albicans infection. These lesions should be referred to as chronic proliferative candidiasis or candida leukoplakia. Hyperkeratosis is a prerequisite for Candida infection, and the oral horn is Candida leukoplakia. The predilection site, a study in the United Kingdom showed that in the patients with Candida leukoplakia investigated, all smoked and dentured day and night, about half of Candida leukoplakia had nodular changes, which may be as high as 45% The cause of dysplasia of the epidermis was treated with antibiotics for the treatment of Candida leukoplakia. The average duration of treatment was about 45 days, and the nodular and partially significant lesions of the lesion disappeared.
Systemic factors (12%):
Systemic factors include diabetes, endocrine disorders and vitamin deficiency. It is speculated that leukoplakia is a defensive reaction of the body to chronic stimuli, causing the mucosal stratum corneum to thicken and dense, thereby protecting the submucosal tissue from chronic stimuli.
Prevention
Oral mucosal leukoplakia prevention
Prevention of leukoplakia should pay attention to the following aspects:
(1) Remove all possible irritants in the mouth, such as residual roots, residual crowns, inappropriate dentures, etc.
(2) Topically available vitamin film.
(3) quit smoking, alcohol, and eat less hot and irritating food.
(4) Oral administration of vitamin A and retinoic acid under the guidance of a doctor.
(5) Regularly go to the dental department for examination, and those who have a tendency to become malignant will be surgically removed immediately.
Complication
Oral mucosal leukoplakia complications Complications, oral ulcers
Recent studies have shown that 4% to 6% of mucosal leukoplakia are converted to malignant tumors.
Symptom
Oral mucosal leukoplakia common symptoms Oral mucosa Candida infection nodules
1. More common in men over 40 years old, mucosal leukoplakia are: buccal mucosa, oral mucosa, toothless alveolar, tongue, lip mucosa, hard palate, sublingual area and gums, buccal mucosa and oral horn mucosal lesions are often Symmetry occurs, oral leukoplakia is often accompanied by Candida infection, this part of the simple mucosal leukoplakia is rare, often covering the molting, when it occurs in the high-risk part of oral squamous cell carcinoma (bottom, lingual, soft palate) Should be highly valued.
2. The range of mucosal leukoplakia varies in size, and the performance is pleomorphic, single or multiple, and the damage is light red at the early stage. Later, the skin lesions are clear wax-like spots with small boundaries, and can also have extensive skin lesions and white color; The skin lesions may have a villus-like or papillary-like membrane. The skin lesions may also have irregular thickening and nodules; sometimes the appearance is reticulated, and the adhesion is tight with the underside. Forcibly peeling causes bleeding, and the boundary is clear and the quality is hard. It is not easy to push, thickening, and repeated trauma can cause ulcers.
3. Usually asymptomatic, but some patients complain of burning or irritation.
4. Although clinical manifestations are not necessarily related to histopathology, white, point-like, hypertrophic nodules on the basis of atrophy are characteristic of lesional epithelial dysplasia, indicating a highly malignant tendency. If exogenous stimuli are eliminated, many mucosa White spots can be recovered, some long-term skin lesions may not retreat, late white spots thickening, can produce shallow cracks and small ulcers, usually no symptoms, or needle stimulation or mild pain, recent studies show: 4% to 6% Mucosal leukoplakia becomes a malignant tumor.
Examine
Oral mucosal leukoplakia examination
Histopathology: early epidermal hyperkeratosis, keratinous plate tight, granulosa cell proliferation, irregular thickening of the spinous layer, irregular epithelial protrusion, basal cell arrangement disorder, individual keratinization, deep nuclear staining, see mitotic figures The basal layer is liquefied and denatured, and the stratified layer has no inflammatory changes. The lamina propria shows less inflammatory changes. If the Candida infection is complicated, the dermis shows polymorphonuclear cell infiltration, in which lymphocytes, plasma cells and histiocytes predominate, and the epithelium is shallow. There are micro-abscesses in the layer. The mitotic activity of excessive abnormal keratosis is 4 times higher than that of excessive keratosis. About 10% to 20% of cases of leukoplakia are epithelial dysplasia, moderate to severe, and even carcinoma in situ (maturation abnormality, mitosis) Increase and cellular pleomorphism).
Diagnosis
Diagnosis and differentiation of oral mucosal leukoplakia
Diagnostic criteria
Long-term unhealed leukoplakia should be biopsied to rule out cancer, and histopathological examination is the main basis.
TCM pathogenesis and syndrome differentiation: the oral mucosa has localized white keratinized plaque, the surface is rough and not easy to peel off, the tongue is slightly red, the fur is thin white, the pulse string is slow, and the syndrome is the stomach and lung heat, the complex poisonous evil, the stagnation caused .
Differential diagnosis
The disease should be differentiated from lichen planus, white spongy sputum, congenital keratosis, congenital thick nail disease.
Oral lichen planus
White spots are more common in the upper and lower lip and cheek teeth. They are often arranged in a mesh or pattern. There are scattered purple-red polygonal papules around them, but mucosal leukoplakia is absent. In addition, lichen planus is common in the body. Loss, histological epithelial cells have no atypical hyperplasia, basal cell liquefaction and degeneration, and the upper part of the dermis has a dense band-like infiltration of lymphocytes.
2. Mucosal white sponge
Is a hereditary disease, rare, occurs in babies, a small number occurs in adolescence, until the puberty reaches the extreme, the lesion affects the entire oral mucosa, white or gray-white lesions, spongy, such as in patients under 40 years old, The lesion is limited to only part of the oral mucosa.
3. Mucosal white sponge
The color is milky white, and there is a dark red infiltration around it. The smear of the white spot surface can be found in the syphilis spirochete. The body may have other syphilis symptoms elsewhere, and the syphilis serum is positive.
4. Candidiasis
It occurs mostly in children, and there is inflammation around the white membrane. False hyphae and spores can be found by microscopic smear microscopy.
