Anatomy of Oral Cavity and Common Disorders

Anatomy of Oral Cavity
Dr. Sudhir Gopal Parajuli

3rd Year Resident Department of Otolaryngology
Oral Cavity
The Oral Cavity extends from the lips to the
oropharyngeal isthmus up to the level of
anterior pillar of tonsils.

Oral Vestibule
Lies Between Gums and teeth


Oral Cavity Proper
Lies behind and within the arch of teeth
Oral Vestibule
1. Anteriorly by the lips,
2. Laterally by the cheeks,
3. Superiorly by the mucolabial and
mucobuccal folds, and
4. Posteriorly and medially by the
teeth and gums.
Oral Cavity
1. Anteriorly and laterally by the teeth and
gums,
2. Superiorly by the palate (hard and soft),
3. Inferiorly by the tongue and the floor of
the mouth, and
4. Posteriorly by the opening into the
pharynx.
Blood Supply
 Facial Artery
 Inferior Alveolar Artery
 Maxillary Artery
 Infraorbital Artery
 Postero superior alveolar

arteries
Lymphatics
Common Disorder of Oral Cavity
• Ulcers of Oral Cavity
– Infection
Viral, Bacterial, Fungal
– Immune Disorders
Apthous ulcer, Behcet’s syndrome
– Trauma
Cheek bite, jagged tooth, ill fitting denture, chemical burns, thermal burns
– Neoplasms
Erythema multiforme, lichen planus, lupus erythematosus
Ulcers caused by Infection
Herpangina Caused by coxsackie virus, affects
children
Multiple small vesicles on faucial pillars, tonsils,
soft plate and uvula, rupture to form ulcers 2-
4mm in size have yellow base and red areola
around them.
Usually Asymptomatic might present with fever
and sore throat
Supportive treatment, self limiting diseases lasts
about 7-10 days
Herpetic gingivostomatitis Caused by Herpes
simplex virus, two types
Primary infection affects children, presents as
multiple pin-head vesicles which rupture to form
painful irregular ulcers covered by yellow grey
membrane
present with fever, malaise, headache and sore
throat with or without lymphadenopathy, halitosis.
Supportive treatment inc fluid intake, oral hygeine,
self limiting diseases lasts about 7-14 days without
scarring
Herpetic gingivostomatitis
Secondary infection affects adult, presents as milder
form as adults have some immunity to this virus.
Commonly involves vermillion border of the
lip(herpes labialis) less often intraorally on hard
palate and gingiva.
• In Recurrent herpes, virus lies dormant in
trigeminal ganglion and when reactivated affects
oropharynx, precipitated by emotional stress,
fatigue, fever, pregnancy or immune deficiency
states.
• Acyclovir 200mg 5 times a day and supportive care.
Vincent’s Infection (Acute Necrotising Ulcerative
gingivitis) Caused by Fusiform bacillus and a
spirochaete Borrelia vincenti smilar to vincent angina
Starts at the interdental papillae and then spreads to free
margins of gingivae which get covered with necrotic
slough, gingivae become red and odematous.
Painful bleeding gums and ulceration, halitosis, metallic
taste
Diagnosis by smear from affected area fusospirochaetal
bacteria and leukocyts
Systemic antibiotics (Pencillin or erythromycin and
metronidazole), oral hygiene (mouth washes)
• Candidiasis(Moniliasis) Caused by Candida albicans,
occurs in two forms
Thrush: white grey patches on oral mucosa and tongue
when wiped off leave an erythematous mucosa. Common
in infants and childerns, adults are also affected if they
are suffering from systemic malignancy and DM or taking
broad specturm antibiotics.
Chronic Hypertrophic Candidiasis (leukoplakia): white
patch which cannot be wiped off
Antifungals: clotrimazole, fluconazole, amphotericin B
Hypertorphic form usually requires surgery
Ulcers caused by Immune Disorders
• Apthous Ulcer unknown aetiolgy ( Vit B12, folic acid
and iron Def)
• Superficial ulcer involving mucosa inner surface of lips,
buccal mucosa, tongue, floor of mouth and soft palate
while sparing mucosa of hard palate and gingivae
• Minor Form 2-10mm in size heals without leaving scar
about 2 weeks
• Major Form 2-4cm in size heals with scar and soon
followed by ulcer
• Lignocaine jelly, steroids and cauterization with silver
nitrate(10%) in server cases tetracycline
Ulcers caused by Immune Disorders
• Bechcet’s Syndrome (Oculo-oro-genital Syndrome)
rare autoimmune mediated small vessel vasculitis
• It is a triad of apthous like ulcers in oral cavity,
genital ulcerations, uveitis. Edge of the ulcer is
characteristically punched out. May be lesions of the
skin joints and CNS
• Treatment aim to control symptoms, reduce
inflammation and controlling immune system.
• Coticosteroids, imunospurresents interferon alpha
Ulcers caused by Trauma
Traumatic Ulcer
• Ulcer on the lateral border of tongue may be due to
jagged tooth or ill fitting denture, on palate by
forgein objects like pencil or tooth brush.
• Accidental ingestion of acids or alkalies or hot fluids
Other lesions of tongue and Oral Cavity
Geographical Tongue
Erhthematous areas, devoid of papillae,
surrounded by an irregular keratotic white outline.
Lesions keep changing their shape and size so also
called migratory glossitis.
Asymptomatic
does not require any treatment
Median rhomboid glossitis(Central Papillary
atrophy)
Characterized by an area of redness and loss of
lingual papillae, situated in dorsum of the tongue in
the midline immediately in front of the circumvallate
papillae. Recent studies suggest might be caused by
chronic candida infection.
Asymptomatic and does not require any treatment
Ankyloglossia(Tongue tie)
If tongue can be protruded beyond the lower
incisors, it is unlikely to cause speech defects. A
Mobile tongue is imp to maintain oral hygiene .
Asymptomatic and does not require any

treatment. Surgical release of thin mucosal
folds.(frenuloplasty)
Submucous Fibrosis(Oral submucous Fibrosis)
Chronic insidous process charactersied by juxta-
epthielial deposition of fibrosis tissue in oral
cavity and pharynx.
Aetiology:
Socio-economic status
Tobacco chewing
Areca nuts
Alcohol
Nutritional Esp. Vit A, Zinc
Pathology of OSMF
• Basic change is fibroelastotic transformation of connective tissues in lamina
propria associated with epithelial atrophy, sometimes preceded by vesicle
formation, later on when fibrosis is marked there is progressive trismus and
diffculty to protrude tongue.
• Premalignant condition and malignant transformation has been seen in 3-
7.6% of cases
Areca Nut Chewing
Collection of Act. T-lymphotcytes and

macrophages in subepithelial layers of oral
mucosa
Macrophages
Act. T- Lymphocytes
↓ production of ↑ production of
antifibrotic cytokines fibrinogenic
cytokines
Act On
Mesenchymal cells
↓ Collagenase
↑ of fibroblasts
↑ production of collagen
Clinical Features of OSMF
Affects mainly age group 20-40
Patient often present with
• Intolerance and chills to spicy food
• Soreness of mouth with constant burning sensation
• Vesicular eruptions on palate and pillars
• Difficulty to open mouth
• Difficulty to protrude tongue
Treatment of OSMF
Medical
1. Steroids: Dexamethasone 4mg combined with hylase 1500 IU injection in
affected area biweekly for 8-10 weeks
2. Avoid irritant factors: areca nuts, pan, tobacco,
3. Treatment of Anemia or vitamin deficiencies
4. Jaw Opening Exercises
Treatment of OSMF
Surgical
1. Simple release of fibrosis and skin grafting
2. Bilateral tongue flaps
3. Nasolabial flaps
4. Island palatal mucoperiosteal flap
5. Bilateral radial forearm free flap
6. Excision and buccal fat pad graft
7. Superficial temporal fasica flap and split skin graft
8. Coronoidectomy and temporal muscle myotomy

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Anatomy of Oral Cavity

Dr. Sudhir Gopal Parajuli

Lies Between Gums and teeth

 Inferior Alveolar Artery

 Postero superior alveolar

Asymptomatic and does not require any

Collection of Act. T-lymphotcytes and

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