Foaia de observatie.

Mucoasa orală.

 Evaluarea pacientului
de medicina orală
• Patologie general
• medicatie, alergi
• leziunea este inițială
sau recurent
• Momentul apariției
simptomelor oral
• Prezenta leziunilor
tegumentar
• Tratamente urmate si
e cienta lor.
fi
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Foaia de observatie

Date pacien
Motivele prezentări
Istoric afecțiun
Antec pers si heredo-colateral
Ex.clinic extra si intr
Topogra a muc. oral
Dg. prezumti
Ex.complementare in patologia oral
Dg. certitudin
Dg. diferentia
Prognosti
Tratamen
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 Motivele prezentarii
Durer
Prezenta unor leziuni muco-
tegumentar
Alte motiv
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Istoricul afectiunii
• Momentul apariției
leziunilo
• Corelarea
simptomatologie
Antecedente personale si h.c.
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 Examen clini
Extraoral

• Inspecția vizuala: eritem, leziuni pigmentare, asimetrii, edem,

tumefacti
• Palpare: zona, forma, dimensiune, textura, consistent

Intraoral: examinarea cavității orale cu ajutorul oglinzilor dentare, aer, apa de

gura -bicarbonat sodiu
• Țesuturi mo
:

 Topogra a cavității orale

Mucoasa nekeratinizata ( groasa)
• Mucoasa vestibular
• Mucoasa labial

Mucoasa nekeratinizata (intermediar)

• Gingie neatasata/ mucoasa alveolar

Mucoasa nekeratinizata (subtire)

• Planseul lingua
• Fata ventrala a limbi
• Palat moal

Mucoasa keratinizata
• Mucoasa palatului du
• Gingie atașat

Mucoasa keratinizata, specializată

• Fata dorsala a limbi
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Anatomia cavității orale

 Mandibular labial vestibule. Note frenulu
Left maxillary buccal vestibule ( long solid arrow ) and secretions from minor salivar
glands in the lower lip ( short solid arrows ).

Maxillary labial vestibule showing health

Maxillary labial vestibule showing frenulu
appearing soft tissues. ( broken arrow ).
m

 Mandibular labial vestibule. Note frenulu

Left maxillary buccal vestibule ( long solid arrow ) and secretions from minor salivar
glands in the lower lip ( short solid arrows ).

Maxillary labial vestibule showing health

Maxillary labial vestibule showing frenulu
appearing soft tissues. ( broken arrow ).
m

 Tongue dorsum Foliate papillae ( long solid arrow ). Also note prominent submucosal veins (
broken arrow ) and frictional hyperkeratosis ( short solid arrow )

Palate. Junction of hard and soft palate ( dotted line ), maxillary tuberosities
( thick solid arrows ), palatine fovea ( thin solid arrows ), rugae ( broken arrows ),
Floor of mouth. and incisive papilla ( asterisk ).
 Trigeminal nerve showing the three
divisions: V1 ( orange ), V
( green ), and V3 ( lavender )
2

 Diagnostic prezumtiv
Examene complementare in patologie orală:

Cultura virușilor, bacteriilor si fungilo

Teste de sâng
Examen citologi
Biopsi
Coloratia intravitala cu albastru de toluidin

Diagnostic de certitudin
Diagnostic diferenția
Prognosti
Tratament
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 Histopatologi
Epithelial dysplasia represents a disruption of the normal orderly growth and maturation process of oral
mucosa, which may then progress to carcinom
in situ or invasive carcinoma . Normally, cell division occurs in the deep basal layer of the epithelium, which
is separated from the underlying connective tissue by a basement membrane . New cells migrate upward
through the layers of epithelium to replace those that are shed regularly from the surface. Cell maturation and
differentiation take place in the process, with mature cells ultimately acquiring their attened ( squamoid )
shape and ability to make keratin
Keratin production and deposition occurs only in the super cial layers of keratinized tissues. The entire
process of epithelial regeneration and turnove
is well organized and regulated, with distinct maturational layers ( strati cation ) visible histologicall
Cell alteration and atypia are seen in dysplastic epithelium, with evidence of abnormal cell division,
hyperplasia of the basal cell layer, cell crowding, and loss of the usual strati cation pattern. Cell maturation
is disordered, with appearance of keratin producing cells or clumps of keratin ( keratin pearls ) in the deepe
layers and immature cells more super cially. Dysplasia is a histological diagnosis, and the severity is
determined according to the proportion of epithelium that exhibits these abnormal features. Mild dysplasia
involves the deeper layers only, generally estimated at no more than 1/3 of the total thickness of the
epithelium. Severe dysplasia involves the entire thickness of epithelium without disruption of the basement
membrane, and is considered equivalent to carcinoma in situ . Once the barrier basement membrane between
epithelium and connective tissue has been breached by abnormal cells, the lesion is labeled invasive
carcinoma and possesses the potential for spread ( metastasis ) through the lymphatic or vascular systems.
Not all dysplastic lesions will progress to invasive carcinoma, and in some cases they may actually regress;
however the underlying mechanisms for this remain poorly understood.
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