ENT SIDNEY LEE DUANE UY, MD, DPBO – HNS
DISEASES OF THE ORAL CAVITY AND PHARYNX
THE ORAL VESTIBULE AND ORAL CAVITY
 Oral vestibule bounded externally by lips and cheeks and internally by
alveolar processes and teeth
 When teeth are in occlusion, it communicates with oral cavity via a space
behind last molar
 Key role in food ingestion and speech production
 Oral cavity opens into pharynx at the faucial isthmus
ORAL CAVITY
 Bounded anteriorly and laterally by alveolar ridge and teeth, superiorly by
hard and soft palate, and posteriorly by faucial isthmus
 Faucial isthmus is narrow opening between oral cavity and pharynx,
bordered by soft palate with uvula and by dorsum of tongue at its
junction with tongue base
THE CHEEK
 Lateral boundary of vestibule
 Buccinator forms muscular framework
 Buccal fat pad smoothes cheek contour; between buccinator and
masseter
 Excretory duct of parotid gland runs through buccinator and opens
into mucosa of cheek opposite upper second molar
THE TEETH
 Dentition consists of two sets of teeth: deciduous teeth replaced by
permanent teeth, eight occupy each half of the maxilla and
mandible
“ACCEPT WHAT IS, LET GO OF WHAT WAS, HAVE FAITH IN WHAT WILL BE”
 Alveolar processes of maxilla also form floor of maxillary
sinuses
THE PALATE
 Hard palate formed by palatine processes of maxilla anteriorly,
incisive bone, and horizontal plates of palatine bones posteriorly.
Oral cavity is sealed posteriorly by soft palate with its pendulant
process (uvula)
 Palatal muscles form framework of soft palate, innervated by
pharyngeal plexus (CN IX and CN X)
TONGUE
 A muscular structure with apex, body, and base/root.
 Body separated from base by the terminal sulcus
 Papillae: filiform, fungiform, vallate, and foliate
TORUS
 Mucosally covered bony outgrowths
 Pedunculated or multilobulated, broad based, smooth bony mass
 Appears on the second decade of life
 Usually appears at the soft and hard palate and floor of the mouth
TORUS PALATINUS
 The tori of the palate are found only in the midline of the hard
palate
 Tx: surgical
 Hindi namAn laging treated surgical, but for those patiestnts that
are bothersome to them, it is treated surgically. Open the mucosal
covering and drill yung bone to smooth out.
TORUS MANDIBULARIS
 mandibular tori are found to involve only the lingual surface of the
anterior mandible, primarily in the premolar region
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MICROGNATHIA  90% of all ectopic thyroid tissue is associated with the dorsum of the
 Diminution in size of jaw tongue
 congenital or acquired ( more common congenital)  Thyroid hindi pumunta sa neck nsa likod lang ng tongue base so
 failure at the growth center in the condyle nagkakaroon ng obstruction sa pagkain, problem in thyroid
 Tx: Surgical : maxillary mandibular advancement = magdurogtung hormones and it may cause infection and prone to thyroiditis.
then maglalagay ng metak plate  Tx: thyroidectomy
PROGNATHISM CLEFT LIP AND CLEFT PALATE
 Enlargement or anterior placement of the lower jaw  most common congenital anomalies of the head and neck
 may be absolute or relative  CL = 1:1000; CP = 1:2000
 multifactorial hereditary trait.  1 child w/ cleft: 4.4% CL & CP, 2.5% CP
 Tx: surgical: maxillary mandibular advancement: magbabawas then  1 parent w/ cleft: 3.2% CL & CP, 6.8% CP
maglalagay ng metal plate  1 parent and 1 child w/ cleft: 15% CL & CP
MACROGLOSSIA
 Enlargement of the tongue (either congenital or acquired)
 Most congenital cases are due to lymphangioma or
hemangiolymphangioma.

Unilateral complete cleft lip (left) unilateral cleft secondary palate

HEMANGIOMA OF THE TONGUE

 Pag ganito kaliit hindi namn kailangan na surgical
 Just give steroids only to prevent inflammation kasi lumalaki then
nawawala but if it is infected give antibiotics.
 You can embolize the hemangioma because it is a defect of a blood vessel Complete bilateral cleft palate

How to diagnosis?
 It can be cleft lip only or cleft palate only
 Complete or incomplete
 Unilateral or bilateral
CAVERNOUS LYMPHANGIOMA
TX:
 Pag ganito na kalaki we do Glossectomy usually Hemi Glossectomy not
 Cleft lip = Rhinoplasty
necessasrily Total glossectomy.
 Cleft palate = Palatoplasty
 Babawasan yung tongue, medyo madugo so we usually refer the patient
Karaniwan by stage naman hindi gagawin na sabay. For example complete
to interventional radiology for embolization then after 48 hrs after
bilateral cleft palate hindi kaya ng isang surgery lang para masara yung cleft
embolization then we can have the surgery to lessen the bleeding
palate nya.
Prolem associated with cleft
 Cleft lip = cosmetic
 Cleft palate = speech problem (nasal), prone to middle ear infection,
baby tends to aspirate whenever they feed milk
ANKYLOGLOSSIA Rule of tens= minimum requirement for surgery
 Common congenital anomaly  Atleast 10 weeks old
 Secondary to a congenitally short lingual frenulum. ( patients have speech  10 pounds
problem)  10 hemoglobin
 Frenulum could be clipped in infancy or Z-plasty could be performed to ODONTOGENIC CYSTS
lengthen frenulum and produce more tongue mobility.  Common
 Surgical correction must be done before speaking age kasi pag hindi 2 types
mabubulol yung patient at kailngan na ng speech therapy para maging  Radicular cyst
normal na yung speech nila. So how do you know na sapat na yung bawas o Periapical
na ginawa mo sa frenulum nya? Dapat yung anterior portion of the o Lateral
tounge can reach the soft palate effortlessly pag hindi mabubulol pa yung o Residual
patient kaya bawas ka pa.  Dentigerous cyst

LINGUAL THYROID
 Very rare RADICULAR CYST
 failure of the thyroid gland to descend from the foramen cecum to  The periapical cyst must be associated with a nonvital tooth. The tooth
the anterior neck may be rendered nonvital by trauma, caries, or periodontal space
extension.

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“ACCEPT WHAT IS, LET GO OF WHAT WAS, HAVE FAITH IN WHAT WILL BE”
 Lateral radicular cyst - a variant of the periapical cyst. It is associated with
a nonvital tooth, but instead of being at the apex of the tooth the cyst is
located lateral to the tooth root(s).
 Residual cysts - majority of these cysts will be the result of leaving a
periapical cyst “behind” following tooth extraction.
 All of these cysts are inflammatory cysts.
LIP MUCOCELE
 Tx: if infected= antibiotics then remove the cyst removing the nonvital
 Mucous cysts are pseudocysts, because no true lining is present; they are
tooth done by oromaxillofacial surgeon, dentist and ENT
also called mucous retention cysts ( minsan lumalaki minsan lumiliit)
 These lesions are usually located on the mucous surface of the lower lip
and are asymptomatic.
 They appear to be the result of traumatic rupture of the ducts of minor
salivary glands. With leakage of the contents into the tissue, an
inflammatory process ensues, with the resultant formation of granulation
DENTIGEROUS CYST
tissues surrounding the cystic space.
 The dentigerous cyst by definition must be associated with the
 TX: Surgery, but you can do aspiration but it can reoccur. You can do
crown of an unerupted tooth, developing tooth, or odontoma.
Marsupialization where in you don’t excise all the cyst just suture at the
 Dentigerous cysts form when fluid accumulates between reduced
surface because there are cyst that are difficult to excise and difficult to
enamel epithelium and tooth crown.
differentiate the cyst from the normal tissue especially mucocele
 As alluded to earlier, the accumulation of fluid may be partially or
largely surrounded by connective tissue and epithelium.
 Because the third molars and maxillary canines are the teeth most
frequently impacted, they are also the most likely to be associated
with dentigerous cysts. However, any impacted tooth has an
increased risk.
 Tx: Surgical = remve the unerrupted tooth pag sa bata under general
anesthesia. We pen it and tanggalin any cyst pati epithelium tapos
tanggaling ang unerrupted tooth some drill around the mandible but RANULA = mucus retention cyst in the floor of the mouth at the salivary lands,
this makes the mandible thin and prone to fracture. Pag bluish in color and frog like
napabayaan it can lead to odontogenic tumor. Tx: Surgery = remove it including the salivary gland causing it or you can do
Marsupialization

NASOALVEOLAR CYST
 Nasoalveolar cysts are thought to originate from trapped nasal epithelium
between the developing lateral and medial maxillary nasal processes.
 The manifestations of nasoalveolar cysts usually occur in adulthood as the STOMATITIS = singaw; medical treatment only
cyst increases in size. ( karaniwan incidental finding lang sya, hindi
maxadong nakikita kasi nakatago naman sa nose unless nakapa nila.)
 Patients typically present with swelling in the nasolabial area, which
causes unilateral elevation of the nasal ala.
 Intraorally, a smooth, mucosal, covered mass in the gingival labial sulcus
is seen.
 TX: If aspirated it will reoccur so it needs SURGERY dapat matanggal yung
pinaksupot nun. If not bothersome to patient di naman tintanggal.

LEUKOPLAKIA
 Oral leukoplakia can be defined as a white patch or plaque that
cannot be otherwise characterized clinically as representing any
other disease entity. (Importance: most leukoplakia are
premalignant lesion usually needs BIOPSY. Difference nito with
candida is kahit anung kuskos mo hindi natatanggal)
DERMOID CYST, Upper Lip ( lower, upper lip and sometimes sa face)
 Although the cause of oral leukoplakia is unknown, several
 Dermoid cysts are cystic masses found along embryonic fusion lines
associated habits or behaviors are associated with the presence of
and form from epithelial rests.
this clinical lesion.
 Histologically, dermoid cysts are lined by squamous epithelium of
 Most closely associated with leukoplakia is the use of tobacco in its
the keratinizing variety. They contain elements of epidermal
many forms including smoking and several forms of smokeless
appendages including hair follicles, sweat glands, and connective
tobacco use.
tissue.
 In general the appearance can range from a thin grayish surface
 Tx: Surgical, depends on the age of the patient: child= under general
alteration demonstrating a white translucent quality with ill-defined
anesthesia. Adult = local anesthesia
margins and generally smooth surface qualities to discrete, sharply

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“ACCEPT WHAT IS, LET GO OF WHAT WAS, HAVE FAITH IN WHAT WILL BE”
 marginated, thick and opaque plaques.
 In general terms such lesions may be homogeneous and smooth,
focal or diffuse, or heterogeneous and multifocal with variable
textures.
 Surface textural alterations can range from a fine granularity to a
slightly papillary outline.

AMELOBLASTOMA, MENTUM
 Ameloblastoma is the most common neoplasm of odontogenic
origin.
 Ameloblastomas are thought to arise from rests of primitive dental
lamina related to the enamel organ in alveolar bone.
ORAL CANDIDIASIS
 Patients are typically seen in the third decade of life with a painless
 Candidiasis is a common opportunistic infection of the oral cavity,
mass involving the maxilla or mandible.
oropharynx, and corners of the mouth.
 Cortical bone expansion can be seen. Histologically, ameloblastomas
 Candida albicans represents the most common candidal species.
are solid infiltrating tumors with a follicular or plexiform pattern,
The finding of atrophic red patches or white curdlike surface
which exhibit an element of cystic change.
colonies with or without angular cheilitis in relation to discomfort in
 To differentiate it from dentigerous cyst request for PANORAMIC
the more acute forms of the disease is usually compelling.
X-RAY
 Coomonly affected are those immunocompromised patients with
o Dentigerous cyst = cyst tlaga makikita mo puro fluid (
diabetes and undergoing chemotherapy.
school children)
 Tx; Antifungal = Nistatin
o Amelobalstoma = cortical boen expansion ( third decade
of life)

AMELOBLASTOMA, MANDIBLE
TX: Depends kung hanggang saan yung extent nya karaniwn sa mandible
nagkakaroon
 Total Mandibulectomy
ORAL CANDIDIASIS (THRUSH)  Segmental Mandibulectomy
 We usually send it for rational resection to check that we are
ORAL CANDIDIASIS: RISK FACTORS negative margin na kami. Kung masyadong malki yung natanggal na
mandible you need to reconstruct it by using fibular graft, harest
bone from fibula through microvascular surgery and use of steel
plates ikakabit mo xa. But now a days we have synthetic bone grafts
but it is more expensive the problem with synthetic is that it depend
on length na natanggal pag maxadong Malaki kailangan m tlga ng
fibular graft but not all are trained to do microvascular surgery.

CLINICAL FORMS OF ORAL/OROPHARYNGEAL CANDIDIASIS

PYOGENIC GRANULOMA
 Pyogenic granulomas of the oral cavity and oropharynx can occur on
any mucosal surface subject to acute or chronic trauma or infection
 Pag ganito tinatanggal narin kasi paulit ulit na nagiinfect

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“ACCEPT WHAT IS, LET GO OF WHAT WAS, HAVE FAITH IN WHAT WILL BE”
SQUAMOUS CELL CA, BUCCAL MUCOSA  Bounded posteriorly by first cervical vertebra, with its overlying
prevertebral cervical fascia and prevertebral musculature

Common in buccal mucosa so kailangan na tanggalin lahat.

Tx: Surgical removal of the lesion and reconstruction after pag negative margin
kana then chemoradiotherapy. Reconstruction: Anterolateral thigh flap or
pectoralis major flap?
Amenobalstoma: no need for chemoradiotherapy just surgical

OROPHARYNX
 Extends from lower boundary of velum to upper margin of epiglottis
 Communicates with oral cavity via faucial isthmus
 Boundaries: tongue base (anterior); lingual tonsil and by C2 to C3
vertebrae with prevertebral fascia (posterior); faucial pillars (lateral)
which flank the palatine tonsils
Squamous cell Ca, Tongue
TX: Total Glossectomy and neck dissection and reconstruction of the tongue
15:10

Palatal Carcinoma

HYPOPHARYNX
 Extends from superior border of epiglottis to inferior border of cricoid
cartilage. Posterior wall is C3-C6 vertebrae.
 Anterior wall is larynx, protrudes to form two lateral mucosal pouches
(piriform sinuses), which rejoin at level of esophageal inlet

THE PHARYNX
 A tubular, fibromuscular space from skull base to upper esophageal
sphincter
 Bounded externally by muscle to coordinate the act of swallowing,
immune response to infection, and as a resonator of speech sounds

TONSILLAR RING (WALDEYER’S RING)

NASOPHARYNX
 Extends from skull base (sphenoid sinus) to velum
 Communicates with nasal cavity (choanae) and middle ear (ET)
 Lymphoepithelial “organs”
 Similar to lymph nodes but lacks afferent lymphatic vessels
 Pharyngeal tonsil - ciliated epithelium
 Palatine and lingual tonsils - stratified, nonkeratinized squamous
epithelium

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 PERITONSILLAR ABSCESS

Chronic Adenotonsillar Hypertrophy

UNILATERAL TONSILLAR ENLARGEMENT

Juvenile Nasopharyngeal Angiofibroma

INDICATIONS FOR TONSILLECTOMY
 Angiofibroma usually occurs in adolescent males and is thus commonly
ABSOLUTE INDICATION
called JNA.
 Hypertrophy resulting in cor pulmonale
 It accounts for less than 1% of all head and neck tumors.
 Hypertrophy resulting in sleep apnea
 The tumor mass is locally infiltrative and usually has a wide-based
 Hypertrophy resulting in dysphagia with associated weight loss
attachment to the NP and to its surrounding related anatomy.
 Consideration of malignancy
 Recurrent peritonsillar abscess or abscess extending into adjacent
tissue spaces

RELATIVE INDICATION
 Documented recurrent bouts of tonsillitis
 Tonsil and adenoid hypertrophy associated with orofacial or dental
abnormalities that narrow the upper airway
 Rheumatic fever history with heart damage associated with chronic
Juvenile Nasopharyngeal Angiofibroma
recurrent tonsillitis
 The gross pathology usually shows a sessile, lobulated, rubbery dark red
to tan gray mass that can be large in size.
UNDERLINED – FROM THE LECTURER
 Mucosal ulceration is uncommonly seen and the tumor is unencapsulated
and composed of an admixture of vascular tissue and fibrous stroma.
 The vessel walls lack elastic fibers and have incomplete or absent smooth
muscle that will account for their tendency to bleed

ACUTE TONSILLOPHARYNGITIS

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