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By: S. Taklar, M.B.A., M.B.B.S., M.H.S.

Associate Professor, Center for Allied Health Nursing Education


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However impotence may be caused from quizlet silagra 50 mg with mastercard, no study Recommendation 14 has focused on the gingiva or the hard palate erectile dysfunction causes mayo purchase generic silagra. Nevertheless erectile dysfunction from smoking purchase silagra 50 mg with mastercard, the (A) Mucosal/periosteal resection is recommended primarily effects of 5-mm margins were similar across all oral cavity sub for lesions without bone invasion (strong recommenda sites in many studies [125]. Mandibular gingival cancer primarily for lesions with bone invasion (strong recom C4-1. What is the adequate resection margin for mandibular gingival mendation, low-quality evidence). Many studies have revealed the importance of margin status as Recommendation 15 an outcome predictor in oral cancer. Such studies have suggest (A) Mucosal/periosteal resection is recommended primarily ed that a margin of ≥5 mm on final pathology was adequate for lesions without bone invasion (strong recommenda [125]. However, cancers in the maxillary gingiva and hard palate tion, low-quality evidence). Superficial erosion of the bone or tooth socket in gingival cancer is not sufficient to classify the tumor as T4, but gingival In case of the mandibular gingival cancer, selection of the surgi cancer that invades the underlying bone is designated as T4. Re to invade bone early, so it should be classified as T4 in the pre cent trends in treatment focus on preservation of mandibular sentation. As a result, most operations for gingival cancer in function due to its critical involvement in maintaining aesthetic volve removal of bone structures [127]. There are several ic review suggested that small lesions without bone invasion are resection approaches available. Similar to the maxillary gingiva, rare, but can be treated with only mucosal or periosteal resec mandibular gingival cancer without bone invasion is rare, but tion [128]. Attachment of the hard palate mucosa to the underlying peri Studies of mandibular gingiva are mainly either retrospective or osteum is different from that of the gingival mucosa. The hard case reports, and the mandibular gingiva is often studied togeth palate is a unique anatomic site because it has an abundance of er with the other oral cancer subsites; thus mandibular gingival minor salivary glands. In the future, studies focused to invade the bone later than does gingival cancer. Surgery of on gingival cancer will help provide a better basis for conclusions hard palate cancer frequently does not include removal of the of treatment and outcomes. However, management guidelines spe er oral cancer population, gingival subsite analysis is needed to cifically pertaining to hard palate cancer are based on expert better understand this separate disease entity. Enucleation is avoided Although more than 5 mm of histopathologically uninvolved for hard palate cancer because it is associated with a high risk of tissue margin from the resected tumor is usually regarded as a recurrence whether enucleation is safe for hard palate cancer re negative margin in oral cancer, most studies of “margin tissue” mains unknown [131]. Soft tissues includ the extent of maxillary gingival and hard palate surgery is ing mucosa shrink to varying extents once removed from the dependent on the size and growth of the tumor. There are vari original sites; however, due to the hardness of this tissue type, ous types of partial resection modes used for the maxillary planning the placement of 5-mm resection margins in bone is bone, i. Among them, infrastructure maxillectomy involves the mor in the bone may be unclear and lead to ambiguity in the resection of the maxillary floor below the level of the infraorbit application of bone margin. However, maxillectomy may induce functional dis 5 to 10 mm of uninvolved bone around the tumor, and other comfort. Due to the proximity of the maxillary sinuses, the sur researchers have suggested removal of at least 10 mm of unaf gery of upper gingival cancer often leads to oroantral fistulas, fected bone in the case of macroscopic tumors with suspected which may require subsequent surgical or nonsurgical recon bone involvement [135-137]. Intraoperative histologic evalua 118 Clinical and Experimental Otorhinolaryngology Vol. Some authors have suggested intraoperative cytologic scrap surgery and the plan to include safety margins are important for ings of the mandibular bone marrow to estimate the bone mar oncological safety during mandibulectomy. Finally, reconstruc gin, and have demonstrated excellent correlations with the actu tion considering both aesthetic and functional aspects is critical al pathologic status of the bone margin [135,138]. For this reason, choice of graft In principle, a positive bone margin involved by cancer in materials should be made with caution, and preoperative simu creases risk of morbidity; this may influence postoperative addi lation of reconstruction should be performed using computer tional treatment plans, and lead to an unfavorable prognosis. This section addresses However, as previously discussed, low impact of the pathologic recommendations about resection and reconstruction of the status of a bone margin on local disease control and survival mandible in oral cancer. A subsequent question pertaining sion of the spreading pattern and invasion routes is essential to to safety margins in mandibulectomy concerns the extent to determine the optimal level and extent of mandibulectomy in which the buttress of the remnant mandible should be preserved oral cancer. Clinical evaluation of mandibular invasion is per in the case of marginal mandibulectomy. Barttelbort and Ariyan formed by bimanual assessment of the cortical thickening or [139] compared the amount of residual bone necessary to with fixity of the tumor mass in relation to the mandible.

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Physical trauma can be caused during regular washes or oral care products with high alcohol content erectile dysfunction and coronary artery disease in patients with diabetes buy 50mg silagra with visa. Burn injuries from food are small and localized to erectile dysfunction 7 seconds discount silagra online master card the hard palate and The commonly encountered thermal burns occur when ingesting lips and seen in teenagers and adults erectile dysfunction psychogenic causes generic 100 mg silagra. Tese present with tenderness hot food substances or beverages like pizza, cofee or tea or from a and an area of erythema that develop into ulcers which may take heated dental instrument during a dental procedure. The ulcers have Oral mucosal damage can result from unintentional use of a yellowish white necrotic psuedomembrane with borders that are therapeutic agents during dental procedures such as eugenol, raised and erythematous. J Dent & Oral Disord Volume 4 Issue 4 2018 Citation: Sivapathasundharam B, Sundararaman P and Kannan K. Figure 5: a) Vesicles and bulla located in the right maxillary dermatome and Figure 3: Chronic nodular lesion with surface ulceration of Necrotizing b) showing multiple small ulcers in the right half of palate not crossing midline sialometaplasia. The virus then establishes a chronic latent infection in the sensory ganglion such as the trigeminal ganglion by travelling along the sensory nerve axons [4]. The oral manifestations present as erythema and clusters of pin headed vesicles (Figure 4) and/or ulcers appear on the hard and sof palate, attached gingiva, tongue, buccal and labial mucosa within few days afer the prodromal symptoms. The vesicles break down to form ulcers that range from 1 to 5 mm and coalesce to form larger ulcers. Figure 4: a) Showing Clusters of vesicles, b) showing large irregular ulcer The borders are scalloped with erythema. The mouth is painful, red due to the coalescence of multiple pin headed sized ulcers, c) Healing herpes and ofen causes difculty in swallowing and eating. It is important to distinguish traumatic lesions as herpeslabialis/cold sores/fever blisters [11]. Primary herpetic gingivo-stomatitis might show disease of the salivary glands mimicking a malignancy both clinically ulcerations similar to coxsackie virus infections but the latter does and Histopathologically [7]. It is more frequently seen in middle aged not present ulcers on the gingiva and are not clustered. Most common site of involvement is the palate, followed by or a cytology smear diferentiates between the two. The lesion initially starts as a non ulcerated swelling associated with pain A cytological smear or viral culture is necessary to rule out and later the necrotic tissue sloughs leaving a crater like ulcer. The aphthous ulcers, necrotizing ulcerative gingivitis and ulcers secondary ulcer is indurated with well delineated borders (Figure 3). The size of to cytomegalovirus infection from recurrent intraoral herpes in the lesion usually ranges from 1cm to more than 5cm [6]. Usually the age of occurrence is between 6 months The patients undergo a prodromal phase of pain, burning sensation, to 5 years with a peak incidence between 2 and 3 years. Afer few days of the prodromal symptoms, symptoms include fever, nausea, anorexia and irritability [10]. The oral fndings are mostly seen on the lips, buccal mucosa, tongue and labial mucosa. In severe cases when the ulcers are large, there may be difculty in eating, drinking and swallowing [16]. The viral lesions Figure 6: Multiple large shallow irregular ulcers which bleed profusely with bloody crustations in lips in erythema multiforme. Acute necrotizing ulcerative gingivitis is an infammatory Tese ulcers heal by 10 to 14 days [14]. The early symptoms are excessive salivation, a metallic taste and Autoimmune diseases like pemphigus and pemphigoid also present gingival sensitivity and bleeding along with halitosis. Tere is sloughing of the oral mucosa necrotizing ulcerative periodontitis should be considered which can followed by sequestration of the exposed, necrotic bone and teeth. They are classifed as minor ulcers, major ulcers and sulphonamides and antibiotics [15]. The major ulcers are over 1cm and take The age group of 20 to 40 years is most commonly afected with time to heal and ofen scar. Herpetiform ulcers are recurrent crops of a slight male predilection and 20% cases are seen in children too.


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