口腔粘膜病診斷和治療措施-課件

NEXT口腔粘膜潰瘍類疾病

OralUlcerativediseasesBACKTOINDEXNEXT口腔粘膜潰瘍類疾病

OralUlcerative1IntroductionBeh?et’sdiseaseTraumaticUlcer&TraumaticBullaRecurrentAphthousUlcerSummary&QuestionsBACKReiter’sSyndromeIntroductionBeh?et’sdiseaseTr2I.IntroductionUlcersareoneofthemostcommontypesoflesionsseeninoralmucosa.

2.Thedifferencebetweenulceranderosion.

NEXTI.IntroductionUlcersareone3ulcererosionNEXTulcererosionNEXT4ulcererosioncontinuityofepitheliumbrokenseveresuperficialbasalcellsinvolvedfreeborderclearuncleardiseasesRAUBehcet’sdiseaseSyphilisPemphigusHerpessimplexBACKComparisonulcererosioncontinuityofepit5RecurrentAphthousUlcer

1.Preface

?NamerecurrentaphthousulcerRAUrecurrentaphthousstomatitisRASrecurrentoralulcerROUNEXTRecurrentAphthousUlcer

1.Pre6?TypingLehner’sclassification

minoraphthousulcer（MiAU）majoraphthousulcer（MjAU）herpetiformulcer（HU）?Characteristic

recidivity

self-healing

periodicityNEXT?TypingLehner’sclassific72.Etiologyunknown

?immunity:cellularimmunity,humoralimmunity,complement,autoantibody

?heritage

?infection：HSV

?environment:psychologyNEXT2.EtiologyunknownNEXT8?denutrition：iron,copper,zinc,folicacid,VitB12?hyperoxidedismutase?microcirculationdisturbance：lip,nail,apexlinguae?systemicfactor：ulcerationofstomach、hepatitis、colonitis、diarrhoeaNEXT?denutrition：iron,copper,z93.Clinicalfeatures

minoraphthousulcermajoraphthousulcerherpetiformulcerNEXT3.ClinicalfeaturesNEXT10NEXTMiAUMjAUHUfeatureyellowredconcavepainfulsmall(2-4mm)big(1-3cm)deepscarmultiplesmallcourse7-10days3-6weeks7-10daysnumber1-51>10positionnonkeratinizedoralmucosasoftpalatetonguelipmouthfloorsystemicsymptom—lymphnodesswelling

feverheadachelymphnodesswellingNEXTMiAUMjAUHUfeatureyellowre11MinoraphthousulcersNEXTMinoraphthousulcersNEXT12NEXTNEXT13NEXTMiAUMjAUHUfeatureyellowredconcavepainfulsmall(2-4mm)big(1-3cm)deepscarmultiplesmallcourse7-10days3-6weeks7-10daysnumber1-51>10positionnonkeratinizedoralmucosasoftpalatetonguelipmouthfloorsystemicsymptom—lymphnodesswelling

feverheadachelymphnodesswellingNEXTMiAUMjAUHUfeatureyellowre14MajoraphthousulcersNEXT

PeriadenitisMucosaNecroticaRecurrensMajoraphthousulcersNEXTPer15NEXTMajoraphthousulcersNEXTMajoraphthousulcers16NEXTMiAUMjAUHUfeatureyellowredconcavepainfulsmall(2-4mm)big(1-3cm)deepscarmultiplesmallcourse7-10days3-6weeks7-10daysnumber1-51>10positionnonkeratinizedoralmucosasoftpalatetonguelipmouthfloorsystemicsymptom—lymphnodesswelling

feverheadachelymphnodesswellingNEXTMiAUMjAUHUfeatureyellowre17Herpetiformulcers

NEXTHerpetiformulcersNEXT18disease-process24h10d-14doutbreakNEXTintermissionhealingprodromalstageulcerativestagedisease-process24h10d-14doutbr195.DiagnosishistoryclinicalfeatureNEXT4.Pathology：nonspecificinflammation5.DiagnosishistoryNEXT4.Pa206.Differentialdiagnosisbenignulcer&malignantulcerNecrotizingsialadenometaplasia,Beh?et’sdisease,herpessimplex,hand-foot-and-mouthdiseaseNEXT6.Differentialdiagnosisbenig21benignulcermalignantulcerageyouththeageddepthdeepDeeporshallowself-healingyesnosystemicconditiongoodcachexypathologychronicinflammationcancerrecurrenceyesnoComparisonNEXTbenignulcermalignantulcerage227.Treatmentprinciple：symptomatictreatmentEvaluationofcurativeeffectNEXT7.Treatmentprinciple：symptoma23Topicalapplicationofasteroidointmentreducesdiscomfortanddecreasesthedurationofthelesions.Topicalanesthetics,antibiotics,mouthwashes,etc.,havebeenused.Inseverecases,intralesionalsteroidinjectionorsystemicsteroidsinalowdose(10-20mgprednisone)for5-10daysreducethepaindramatically.BACKTopicalapplicationofastero24III.Beh?et’sdisease1.PrefaceHulusiBeh?et(1937)Beh?et’sdiseaseisachronicmultisystemicinflammatorydisorderofuncertaincauseandprognosis.

2.Etiology

Unknown

NEXTIII.Beh?et’sdisease1.Prefac253.Clinicalfeatures

1)oralmucosa:minoraphthousulcer

2)genitallesion:ulcer

3)skinlesions:erythemanodosum,epifolliculitis,pustuleafterneedling

4)ocularlesions:conjunctivitis,recurrentiritis

5)otherssystems:joint,digestive,cardiovascular,nervous,respiratory,urinaryNEXT3.ClinicalfeaturesNEXT26Beh?et’sdiseaseNEXTBeh?et’sdiseaseNEXT274.Pathology：Histopathologicchangesconsistofaperivascularmononuclearcellularinfiltrate,endothelialcellswellingornecrosis,partialluminalobliterationandoccasionalfibrinoidnecrosisofthevessels.NEXT4.Pathology：NEXT285.Diagnosis1)recurrentoralulceration2)recurrentgenitalulceration3)eyelesions4)skinlesions5)positivepathergytestToestablishthediagnosisofBeh?et’sDisease,recurrentoralulcerationplusanytwooftheotherfourmajorclinicalcriteriamustbepresent.NEXT5.DiagnosisNEXT296.DifferentialdiagnosisNEXTRAUHerpeticatomatitisCrohn’sdiseaseReiter’ssyndromeStevens-Johnsonsyndrome6.DifferentialdiagnosisNEXTR307.TreatmentSymptomaticinmildcases.Systemicsteroids,immunosuppressivedrugs,colchicines,thalidomide,anddapsoneareadministeredinseverecases.BACK7.TreatmentBACK31IV.TraumaticUlcer

TraumaticBulla1.PrefaceBecauseoftheconstantmotionofthemasticatorymucosaovertheteethandtheintroductionofhardobjectsintotheoralcavity,traumaticulcersarefrequent.NEXTIV.TraumaticUlcer

Tr322.EtiologyMechanicalfactors:asharporbrokentooth,roughfillings,clumsyuseofcuttingdentalinstruments,hardfoodstuffs,sharpforeignbodies,bitingofthemucosa,anddentureirritationetc.Physicalfactors:thermalburnsChemicalfactors:strongacid,strongbase,As2O3,Ag(NO)3,iodophenolNEXT2.EtiologyMechanicalfactor333.Clinicalfeature1)DecubitalulcermechanicalirritatingfactorstheulcerconformsinareaandlinearitytothesourceoftheirritatingfactorsNEXT3.Clinicalfeature1)Decubita34NEXTtraumaticulcerNEXTtraumaticulcer35traumaticulcerNEXTtraumaticulcerNEXT36infants,hardpalateimproperfeedingNEXT2)Bednarulcerinfants,hardpalateNEXT2)Be373)Rida-FedeulcerinfantslingualfrenumulcersecondarytoinferiordeciduousincisorNEXT3)Rida-FedeulcerinfantsNEX384)Factitiousulcermentallyhandicappedpatientsorthosewithserousemotionalproblemsoralself-inflictedtraumabybiting,fingernails,orbytheuseofasharpobjecttongue,lowerlip,gingivaslowtohealduetoperpetuationoftheinjurybythepatientlocalmeasuresandpsychiatrictherapyNEXT4)Factitiousulcermentally395)Chemicalburnthetypeofchemicalutilized,itsconcentration,andthedurationwhitishsurfacedesquamatingpainfulerosionorulcerbonedamage

healingwithin1-2weeksNEXT5)Chemicalburnthetypeofc40NEXTchemicalburnNEXTchemicalburn416)Thermalburnveryhotfoods,liquid,orhotmetalobjectspalate,lips,floorofthemouth,tonguepainful,red,undergoingdesquamation,leavingerosionssupportivetreatment;self-healinginaboutaweekNEXT6)Thermalburnveryhotfood42NEXTthermalburnNEXTthermalburn437)Traumaticbulla&traumatichematomacausedbybitingorprostheticappliancesbuccalmucosa,softpalate,lips,tongueself-healingin4-6daysNEXT7)Traumaticbulla&traumatic44traumaticbullaNEXTtraumaticbullaNEXT454.DiagnosishistoryclinicalfeaturesNEXTcarcinoma,syphilis,tubercularulcer,majoraphthousulcerthrombocytopenia,thrombastheniapemphigus,cicatricialpemphigoid5.Differentialdiagnosis4.DiagnosishistoryNEXTcarcin46malignantulcerNEXTmalignantulcerNEXT47TraumaticulcerMjAUmalignantulcertubercularulceretiologyfeatureofulcermorphologyofulcerpathology5.DifferentialdiagnosisBACKTraumaticulcerMjAUmalignantu486.TreatmentRemovalofthetraumaticfactorsTopicalmeasuresNEXT6.TreatmentRemovalofthetr49V.Reiter’sSyndrome1.PrefaceReiter’ssyndromeisadiseaseofunknowncausethatpredominantlyaffectsyoungmen,20-30yearsofage.NEXT2.EtiologyunknownV.Reiter’sSyndrome1.Preface503.ClinicalfeatureMajorsymptoms:nongonococcalurethritis,conjunctivitis,arthritisOthersymptoms:oralulcer,circinatebalanitis,keratodermablennorrhagicumNEXT3.ClinicalfeatureMajorsymp51NEXTorallesionNEXTorallesion524.DiagnosishistoryclinicalcriteriaNEXT4.DiagnosishistoryNEXT535.DifferentialdiagnosisThedifferentialdiagnosistheorallesionsincludeserythemamultiforme,Stevens-Johnsonsyndrome,psoriasis,Beh?et’sDisease,geographictongue,andstomatitis.NEXT5.DifferentialdiagnosisThe546.TreatmentItisnonspecificandsymptomatic.Non-steroidalanti-inflammatorydrugs,salicylates,andtetracyclinesmaybehelpful,cyclosporin,azathioprine,methotrexate,andsystemicsteroidinseverecase.BACK6.TreatmentItisnonspecifi55SummaryTocomparethecharacteristicsofmajorAphthousulcer,traumaticulcer,carcinomaandtuberculousulcer.(etiology,pathology,clinicalfeature,treatment,prognosis).TomasterthetreatmentprincipleofulcerativediseasesbytakingRAUforexample.NEXTSummaryTocomparethecharact56Tomastertheeffect,usage,contraindicationandside-effectofcorticosteroidintreatingulcerativediseases.ToestablishtheconceptionoforalmucosalsyndromebymeansoflearningBeh?et’sdisease.NEXTTomastertheeffect,usage,c57QuestionsWhichisthemostcommonformofRecurrentAphthousUlcer?What’sthecharacteristicofitslesion?What’stheeffectofcorticosteroidintreatingoralulcerativediseases?What’stheprimarytreatmenttotraumaticulcer?NEXTQuestionsWhichisthemostcom58TakingmajorAphthousulcerandcarcinomaforexample,trytotellthedifferencebetweenbenignulcerandmalignantulcer.WhataretheorallesionsofBeh?et’sDiseaseandReiter’sSyndrome?Whataretheirclinicalsystemicfeatures?BACKTakingmajorAphthousulceran59NEXT口腔粘膜潰瘍類疾病

OralUlcerativediseasesBACKTOINDEXNEXT口腔粘膜潰瘍類疾病

OralUlcerative60IntroductionBeh?et’sdiseaseTraumaticUlcer&TraumaticBullaRecurrentAphthousUlcerSummary&QuestionsBACKReiter’sSyndromeIntroductionBeh?et’sdiseaseTr61I.IntroductionUlcersareoneofthemostcommontypesoflesionsseeninoralmucosa.

2.Thedifferencebetweenulceranderosion.

NEXTI.IntroductionUlcersareone62ulcererosionNEXTulcererosionNEXT63ulcererosioncontinuityofepitheliumbrokenseveresuperficialbasalcellsinvolvedfreeborderclearuncleardiseasesRAUBehcet’sdiseaseSyphilisPemphigusHerpessimplexBACKComparisonulcererosioncontinuityofepit64RecurrentAphthousUlcer

1.Preface

?NamerecurrentaphthousulcerRAUrecurrentaphthousstomatitisRASrecurrentoralulcerROUNEXTRecurrentAphthousUlcer

1.Pre65?TypingLehner’sclassification

minoraphthousulcer（MiAU）majoraphthousulcer（MjAU）herpetiformulcer（HU）?Characteristic

recidivity

self-healing

periodicityNEXT?TypingLehner’sclassific662.Etiologyunknown

?immunity:cellularimmunity,humoralimmunity,complement,autoantibody

?heritage

?infection：HSV

?environment:psychologyNEXT2.EtiologyunknownNEXT67?denutrition：iron,copper,zinc,folicacid,VitB12?hyperoxidedismutase?microcirculationdisturbance：lip,nail,apexlinguae?systemicfactor：ulcerationofstomach、hepatitis、colonitis、diarrhoeaNEXT?denutrition：iron,copper,z683.Clinicalfeatures

minoraphthousulcermajoraphthousulcerherpetiformulcerNEXT3.ClinicalfeaturesNEXT69NEXTMiAUMjAUHUfeatureyellowredconcavepainfulsmall(2-4mm)big(1-3cm)deepscarmultiplesmallcourse7-10days3-6weeks7-10daysnumber1-51>10positionnonkeratinizedoralmucosasoftpalatetonguelipmouthfloorsystemicsymptom—lymphnodesswelling

feverheadachelymphnodesswellingNEXTMiAUMjAUHUfeatureyellowre70MinoraphthousulcersNEXTMinoraphthousulcersNEXT71NEXTNEXT72NEXTMiAUMjAUHUfeatureyellowredconcavepainfulsmall(2-4mm)big(1-3cm)deepscarmultiplesmallcourse7-10days3-6weeks7-10daysnumber1-51>10positionnonkeratinizedoralmucosasoftpalatetonguelipmouthfloorsystemicsymptom—lymphnodesswelling

feverheadachelymphnodesswellingNEXTMiAUMjAUHUfeatureyellowre73MajoraphthousulcersNEXT

PeriadenitisMucosaNecroticaRecurrensMajoraphthousulcersNEXTPer74NEXTMajoraphthousulcersNEXTMajoraphthousulcers75NEXTMiAUMjAUHUfeatureyellowredconcavepainfulsmall(2-4mm)big(1-3cm)deepscarmultiplesmallcourse7-10days3-6weeks7-10daysnumber1-51>10positionnonkeratinizedoralmucosasoftpalatetonguelipmouthfloorsystemicsymptom—lymphnodesswelling

feverheadachelymphnodesswellingNEXTMiAUMjAUHUfeatureyellowre76Herpetiformulcers

NEXTHerpetiformulcersNEXT77disease-process24h10d-14doutbreakNEXTintermissionhealingprodromalstageulcerativestagedisease-process24h10d-14doutbr785.DiagnosishistoryclinicalfeatureNEXT4.Pathology：nonspecificinflammation5.DiagnosishistoryNEXT4.Pa796.Differentialdiagnosisbenignulcer&malignantulcerNecrotizingsialadenometaplasia,Beh?et’sdisease,herpessimplex,hand-foot-and-mouthdiseaseNEXT6.Differentialdiagnosisbenig80benignulcermalignantulcerageyouththeageddepthdeepDeeporshallowself-healingyesnosystemicconditiongoodcachexypathologychronicinflammationcancerrecurrenceyesnoComparisonNEXTbenignulcermalignantulcerage817.Treatmentprinciple：symptomatictreatmentEvaluationofcurativeeffectNEXT7.Treatmentprinciple：symptoma82Topicalapplicationofasteroidointmentreducesdiscomfortanddecreasesthedurationofthelesions.Topicalanesthetics,antibiotics,mouthwashes,etc.,havebeenused.Inseverecases,intralesionalsteroidinjectionorsystemicsteroidsinalowdose(10-20mgprednisone)for5-10daysreducethepaindramatically.BACKTopicalapplicationofastero83III.Beh?et’sdisease1.PrefaceHulusiBeh?et(1937)Beh?et’sdiseaseisachronicmultisystemicinflammatorydisorderofuncertaincauseandprognosis.

2.Etiology

Unknown

NEXTIII.Beh?et’sdisease1.Prefac843.Clinicalfeatures

1)oralmucosa:minoraphthousulcer

2)genitallesion:ulcer

3)skinlesions:erythemanodosum,epifolliculitis,pustuleafterneedling

4)ocularlesions:conjunctivitis,recurrentiritis

5)otherssystems:joint,digestive,cardiovascular,nervous,respiratory,urinaryNEXT3.ClinicalfeaturesNEXT85Beh?et’sdiseaseNEXTBeh?et’sdiseaseNEXT864.Pathology：Histopathologicchangesconsistofaperivascularmononuclearcellularinfiltrate,endothelialcellswellingornecrosis,partialluminalobliterationandoccasionalfibrinoidnecrosisofthevessels.NEXT4.Pathology：NEXT875.Diagnosis1)recurrentoralulceration2)recurrentgenitalulceration3)eyelesions4)skinlesions5)positivepathergytestToestablishthediagnosisofBeh?et’sDisease,recurrentoralulcerationplusanytwooftheotherfourmajorclinicalcriteriamustbepresent.NEXT5.DiagnosisNEXT886.DifferentialdiagnosisNEXTRAUHerpeticatomatitisCrohn’sdiseaseReiter’ssyndromeStevens-Johnsonsyndrome6.DifferentialdiagnosisNEXTR897.TreatmentSymptomaticinmildcases.Systemicsteroids,immunosuppressivedrugs,colchicines,thalidomide,anddapsoneareadministeredinseverecases.BACK7.TreatmentBACK90IV.TraumaticUlcer

TraumaticBulla1.PrefaceBecauseoftheconstantmotionofthemasticatorymucosaovertheteethandtheintroductionofhardobjectsintotheoralcavity,traumaticulcersarefrequent.NEXTIV.TraumaticUlcer

Tr912.EtiologyMechanicalfactors:asharporbrokentooth,roughfillings,clumsyuseofcuttingdentalinstruments,hardfoodstuffs,sharpforeignbodies,bitingofthemucosa,anddentureirritationetc.Physicalfactors:thermalburnsChemicalfactors:strongacid,strongbase,As2O3,Ag(NO)3,iodophenolNEXT2.EtiologyMechanicalfactor923.Clinicalfeature1)DecubitalulcermechanicalirritatingfactorstheulcerconformsinareaandlinearitytothesourceoftheirritatingfactorsNEXT3.Clinicalfeature1)Decubita93NEXTtraumaticulcerNEXTtraumaticulcer94traumaticulcerNEXTtraumaticulcerNEXT95infants,hardpalateimproperfeedingNEXT2)Bednarulcerinfants,hardpalateNEXT2)Be963)Rida-FedeulcerinfantslingualfrenumulcersecondarytoinferiordeciduousincisorNEXT3)Rida-FedeulcerinfantsNEX974)Factitiousulcermentallyhandicappedpatientsorthosewithserousemotionalproblemsoralself-inflictedtraumabybiting,fingernails,orbytheuseofasharpobjecttongue,lowerlip,gingivaslowtohealduetoperpetuationoftheinjurybythepatientlocalmeasuresandpsychiatrictherapyNEXT4)Factitiousulcermentally985)Chemicalburnthetypeofchemicalutilized,itsconcentration,andthedurationwhitishsurfacedesquamatingpainfulerosionorulcerbonedamage

healingwithin1-2weeksNEXT5)Chemicalburnthetypeofc99NEXTchemicalburnNEXTchemicalburn1006)Thermalburnveryhotfoods,liquid,orhotmetalobjectspalate,lips,floorofthemouth,tonguepainful,red,undergoingdesquamation,leavingerosionssupportivetreatment;self-healinginaboutaweekNEXT6)Thermalburnveryhotfood101NEXTthermalburnNEXTthermalburn1027)Traumaticbulla&traumatichematomacausedbybitingorprostheticappliancesbuccalmucosa,softpalate,lips,tongueself-healingin4-6daysNEXT7)Traumaticbulla&traumatic103traumaticbullaNEXTtraumaticbullaNEXT1044.DiagnosishistoryclinicalfeaturesNEXTcarcinoma,syphilis,tubercularulcer,majoraphthousulcerthrombocytopenia,thrombastheniapemphigus,cicatricialpemphigoid5.Differentialdiagnosis4.DiagnosishistoryNEXTcarcin105malignantulcerNEXTmalignantulcerNEXT106TraumaticulcerMjAUmalignantulcertubercularulceretiologyfeatureofulcermorphologyofulcerpathology5.DifferentialdiagnosisBACKTraumaticulcerMjAUmalignantu1076.TreatmentRemovalofthetraumaticfactorsTopica