Week 11: Mouth Disorders

What are common mechanisms causing mandible fractures?

Assaults, motor vehicle collisions (MVCs), and falls.

What is vocal cord paralysis?

Can result from damage to the vagus or recurrent laryngeal nerve, leading to breathy dysphonia and aspiration.

What is the difference between cleft lip and cleft palate?

Cleft lip is a split in the upper lip, while cleft palate is a split in the roof of the mouth.

What is sialadenitis?

Commonly affecting the parotid or submandibular gland, presenting with swelling, pain during meals, and tenderness.

What are thyroglossal duct cysts?

Cysts along the embryonic course of the thyroid's descent from the tuberculum impar of the tongue base

What are the associations with glossodynia with glossitis?

DM, diuretics, tobacoo, xerostomia, candidiasis

How is geographic tongue diagnosed?

Diagnosis is made by visual inspection and history of the lesion.

What is the treatment for foreign body aspiration in adults?

Foreign body removal under general anesthesia with rigid or flexible bronchoscopy.

What is glossodynia?

Glossodynia refers to burning and pain of the tongue, which may occur with or without glossitis.

How should an avulsed tooth be handled?

Handle the tooth only by the enamel (crown) to prevent damage to root structures.

What should be done to stop bleeding after a dental injury?

Having a patient bite down on gauze or cloth will stop bleeding.

What is the initial treatment for acute suppurative parotitis?

Hospital admission, IV hydration, and antibiotics (Ampicillin-sulbactam or cefuroxime + metronidazole).

What are the drug treatment options for sialadenitis?

IV antibiotics (Nafcillin) and transition to oral abx

What indicates that an avulsed tooth requires extraction?

If the tooth changes color or signs of an abscess develop.

What is the treatment for a fractured tooth?

Immediate care to reduce pain, and possible extraction if signs of abscess develop.

What are the characteristics of geographic tongue?

It is a chronic, benign inflammatory disorder with circinate, irregular erythematous patches bordered by a white keratotic band.

What is the most common demographic affected by burning mouth syndrome?

It is most common in postmenopausal women.

What is the significance of facial nerve involvement in salivary gland tumors?

It strongly correlates with malignancy.

What are the symptoms of bilateral vocal fold paralysis?

It usually causes inspiratory stridor and may lead to rapid airway compromise.

What imaging studies are indicated for salivary gland tumors?

MRI and CT scans to define the extent of the tumor.

What imaging is recommended if cranial nerve deficits are noted?

MRI of brain/brainstem

What are the clinical findings of a mandible fracture?

Malocclusion, pain with movement, trismus, and tenderness on palpation.

What is the second most common facial fracture?

Mandible fracture.

What are common characteristics of salivary gland tumors?

Most present as asymptomatic masses for months/years in the superficial part of gland

What is the classic cause of acute nonsuppurative parotitis?

Mumps virus.

What causes snoring during sleep?

Narrowing of the upper aerodigestive tract due to changes in position, muscle tone, and soft tissue laxity.

What are common causes of glossitis?

Nutritional deficiencies, drug reactions, dehydration, irritants, and autoimmune reactions (psoriasis).

What should you do prior to salivary gland tumor Tx?

Obtain an FNA biopsy prior to excision

What are the treatment options for snoring?

Options include position changes during sleep, medical/surgical correction of nasal obstruction, and mandibular advancement appliances.

What is the typical presentation of a fractured tooth?

Pain, bleeding, and potential changes in tooth color.

What imaging study is used for low suspicion of mandible injury?

Panorex.

What symptoms might indicate sialolithiasis?

Postprandial pain and local swelling, often with a history of recurrent sialadenitis.

What complications can arise from a root fracture?

Pulpitis and potential for a dead tooth.

What is the treatment for a tooth avulsion?

Reimplantation whole tooth ASAP and splinting of the tooth.

What are brachial cleft cysts?

Soft cystic mass along anterior border of SCM muscle

What is the most common organism involved in sialadenitis?

Staphylococcus aureus.

How are stones in the Wharton duct treated?

Stones close to the duct orifice can be manually palpated & removed intraorally by dilating or incision distal duct

What is the recommended treatment for thyroglossal duct cysts?

Surgical excision is recommended to prevent recurrent infection and rare malignancy.

What are the clinical findings of acute suppurative parotitis?

Swollen, painful, tender gland, induration and pitting edema with high fever and pus discharge from the duct orifice.

What is sialolithiasis?

The formation of calculi (stones) in the salivary glands, more commonly in the Wharton duct (submandibular).

What are common causes of unilateral recurrent laryngeal nerve involvement?

Thyroid surgery, neck surgery, and lung cancer are common causes.

What is the treatment for glossodynia?

alpha-lipoic acid and clonazepam

What is the treatment of mandible fracture?

barton's bandage if stable airway

What are the clinical findings of acute nonsuppurative parotitis?

brawny induration of parotid region, swelling in front of tragus, behind mandibe & earlobe, pushing outward, red duct orifice w occasional discharging pus

Who are foreign body aspirations more common in?

children/older adults with dentures

What is the treatment for brachial cleft cysts?

completely excised with their fistulous tracts to prevent recurrence and possible CA

Extension of salivary gland tumors

deep to the plane of the facial nerve or originate in the parapharyngeal space

What is the treatment for salivary gland tumors?

excision via parotidectomy with facial nerve dissection or submandibular gland excision

What is the presentation of brachial cleft cysts?

high in the neck/below ear; fistulous connection with flood of external auditory canal

What are the measures to increase salivary flow for sialadenitis?

hydration, warm compresses, sialagogues, and massage of the gland.

What is the most common cause of unilateral vocal fold paralysis?

iatrigenic injury

What is the treatment for stones >1.5-2cm?

if they are close to the lingual nerve, they can't be removed

What is glossitis?

inflammation of the tongue due to loss of filiform papillae, leading to a red, smooth-surfaced appearance.

What is tooth subluxation and its complication?

loose tooth -> dead tooth (rare)

What does the central erythematous patch represent?

loss of filiform papillae presented as a migratory pattern

What does palpation of a mandible fracture reveal?

loss of smooth counters of mandible, tenderness, & anesthesia in the distribution of proximal inferior/alveolar & ears

What are the exam findings of mandible fracture?

mandible may appear widened or displaced to one side

What imaging is used for patients suspected with condyle, complex, or multiple facial fractures?

mandible or facial CT with coronal and axial sections *CXR to r/o teeth aspiration

What is the presentation of geographic tongue?

map with pink contents surrounded by whiter oceans "white halos"

What is visible on intraoral exam of salivary gland tumors?

medial deviation of soft palate

What is the presentation of thyroglossal duct cysts?

midline mass, below hyoid bone, which moves with swallowing

What should the clinic exam consist of for OSA?

nasal cavity, nasopharynx, oropharynx, & larynx to r/o other causes of dynamic airway obstruction

Treatment for larger and high-grade cancers of the salivary glands

postop irradiation

What is the goal of management for vocal cord paralysis?

protect airway

Geographic tongue is most associate with what disease?

psoriasis

What are the symptoms of glossitis?

rarely painful

When does sialadenitis occur?

setting of dehydration or in association with chronic illness --> sjogren syndrome or chronic periodontitis

What is the treatment for chronic sialolithiasis?

sialoendoscopy > extracorporeal shockwave lithotripsy & fluoroscopically guided basket removal

What are the symptoms associated with obstructive sleep apnea (OSA)?

snoring, excessive daytime somnolence, daytime headaches, and weight gain.

What can comminuted mandible fractures cause?

upper airway obstruction d/t tongue being unsupported anteriorly

What are the symptoms for acute nonsuppurative parotitis?

warm skin, fever, tenderness, pain with chewing

What is the difference between stones in the wharton duct vs stensen duct?

wharton duct: large & radioplaque stensen duct: smaller & radiolucent

What is a tooth avulsion?

when the WHOLE tooth including root comes out, not a broken tooth

How long does it take for parotid swelling and pain to resolve?

2-3 weeks

What imaging is recommended for suspected vocal cord paralysis?

A CT scan with contrast from the skull base to the aorto-pulmonary window.

What is burning mouth syndrome?

A condition characterized by a burning sensation in the mouth without any clinical findings

What is tooth luxation?

A condition where a tooth is very loose from trauma and may be out of alignment with adjacent teeth.

What is a cleft lip?

A congenital condition that occurs most often on the left side, US can identify the absence of muscle fibers crossing the lip.

What is a cleft palate?

A midline opening in the hard palate resulting from congenital failure of fusion of the maxillary processes.