Transcript Pathogenesis

GROUP4
REG NO:
10/06/GS/3002
10/06/GS/2993
10/06/GS/2994
10/06/GS/2988
10/06/PS/3186
10/06/GS/ 3088
Cellulitis
Presented by 10/06/GS/2993
Cellulitis is an infection of the deeper layers of the skin and the underlying
tissue
Etiology
• It is caused by a bacterial skin infection of Streptococci
throught the:
•cut
•graze
•burn
•animal, human or insect bite
•puncture wound
•skin ulcer
Risk factors
• obesity and Weak immunity
• diabetes and circulation problems
• chickenpox and shingles
•intravenous drug use
•having previous episodes of cellulitis
• Clinical presentation
• It begins as a small area of
– tenderness
– Swelling
– redness tend to spread to adjacent skin.
• The affected person may develop a
– fever
– chills
– sweats
– swollen lymph nodes
– swollen glands near the area of infected skin.
pathogenesis
• Invasion of S. aureus and S. pyogenes by using
1. M-protein to inhibit phagocytosis
2. Protein F to bind the M protein to fibronectin
3. lipoteichoic acid for adherence
4. hyaluronic acid capsule to inhibit phagocytosis
5. invasins ( as streptokinase,streptodornase and hyaluronidase
Then,there is
 Overcomes of the defensive cells in our body,which includes mast
cells, eosinophils,basophils, and neutrophils as immuno
response.
• Diagnosis
Assessing the symptoms and examining the skin.
Management
• Antibiotics to control Infection
• Analgesic for temperature or vomiting
• Self-care
• Drink plenty of water to prevent dehydration.
• If your leg is affected by cellulitis, keep it raised.
• Pain relief
• Paracetamol and ibuprofen.
Ludwig’s angina
Connective tissue infection, of the floor of the mouth, usually
occurring in adults with concomitant dental infections.
Aetiology
• It is caused by
• bacteria factors include staphylococcus spp,streptococcus spp
and enterobacter
• Mandibular fracture
• penetrating injury
Pathogenesis
• The anaerobic and aerobic bacteria produce the endotoxin
like
• protease,hyalironidase,collagenase that cause synergic effect
and allow th rapid spread of cellulitis
Clinical features
• Bilateral infection of sublingual,submandibular
spaces
• Brawnly oedema with elevation of the
tongue,airway abstruction and very little pus.
Diagnosis
• We find
• Redness,swelling of the upper neck,chin,floor
of the mouth.
• the tongue may be swollen or out of place.
• Culture of fluid from the tissue may show
bacteria
Managment
• Maintainance of airway
• High dose antibiotic such as:
• Penicillin or penicillin-like
• Removal of saurce infection(tooth extraction)
• Parenteral hydration,early surgical,drainage.
• Referance: wikpedia.com
• Altavista.com
Gingival hyperplasia
presented by10/0,6/GS/3002
•
refers to excessive growth of the gums,
Etiology:
Imflammatory enlargment:
•
Chronic imflammation caused by prolonged exposure to bacterial plaque.
Drug -induced enlargment
•
Anticonvulsants, such as phenytoin, valproate, phenobarbital, vigabatrin, topiramate and primidone.
•
Calcium channel blockers, such as verapamil and nifedipine
•
Immunosuppresants such as cyclosporine
Enlargment associated with systemic factors such as:
•
Pregnancy
•
Puberty
•
Vitamin C deficiency.
Systemic disease :
•
Leukemia
•
Granulomatous disease
•
Neoplasm:
– Begnin and malignant
Pathogenesis
The pathogenesis of drug –induced hyperplasia is uncertain.
the interaction between drug and/or metabolite, with the gingival
fibroblasts begin the action.
Factors like age, genetic predisposition, pharmacokinetic variables,
plaque-induced inflammatory and immunological changes and
activation of growth factors intervien in protection or damaging.
these genetic factors which give rise to fibroblast heterogeneity, gingival
inflammation, and pharmacokinetic variables appear to be significant
in the expression of gingival overgrowth.
Diagnosis
It is based on IFN –gamma stimulated Gene expression using
oligonucleotide microorganism.
This determine difference between benign and malgnant gingival
hyperplasia based on evolution by IFN-gamma complex
Clinical presentation
• firm, benign and painless swelling in the gums
• The doctor sees for bleeding in the gums.
• He also notes the level of mouth discomfort due to the enlargement. He
notices if there are any slowly enlarging mass or masses along the gingival
margin.
Managment
•
•
•
•
•
brushing and flossing
.chlorhexidine
Ultrasonic treatments
Erythromycin
Discontinuation of cousative drug
• Referance
•
Wikipedia.com
Granuloma pyogenicum
•
is a primarily oral disease which appears as an overgrowth of tissue due to irritation physical
trauma or hormonal factors
Etiology
Irritation caused by
• poor oral hygiene
• Chronic oral irritants
• Bacterial infection
• Traumatic injury
• Hormonal factors
• Pathogenesis
• inflammatory cytokines have been implied to play the major
roles .
• their links to female steroid hormones still remain to be
elucidated.
Clinical presentation
• color ranging from red/pink to purple, and can be smooth or
lobulated
Management
• surgical excision. For gingival lesions,
• scaling adjacent teeth to remove any calculus and plaque that
may be a source of continuing irritation is recommended
Chondroma
by 10/06/GS/3088
• A chondroma is a benign tumor formed in cartilage.
• Etiology:
Unknown cause
Pathogenesis:
This tumor is thought to arise from primitive element
of the bone marrow or mesenchymal cells.
Most are also associated with a translocation of
chromosome 11and 22.
Clinical features
• swelling or the sensation of a lump which is
fixed to the underlying bone.
• Pain may appear as the tumor grows and
impinges on the surrounding structures.
• The tumor may remain symptomless and may
go undetected
Diagnosis:
X rays shows the tumor as an area of decreased
density within the involved bone. The
remaining bone may be thinned out and
expanded.
Managment:
• Surgery
• Incidentally discovered tumors that have no
symptoms require no treatment except for
regular observation.
Osteoma
• Etiology:
The cause is unknown,But trauma ,Infections
and developmental defect have been suggested as possible
causes.
Clinical presentation:
Clinically,soft tissue osteoma appears as a well
defined,assymptomatic,hard tumor covered by a thin and smooth
normal epithelium.
• Pathogenesis
• Is a benign tumor consisting of mature compact or cancellous
bone.osteomas may be classified either periosteal occuring on
the surface of bone or endosteal,occuring in the bone.
Althought,the osteoma may also occur in the facial bone,such
as the sinus areas.the osteoma is slow growing but may
eventuallly reach larger sizes causing expasion and deformity.
Diagnosis
• histopathology examination.
Management
surgial excision.
• Reference:general and oral pathology for dental hygienist by Leslie De
Long,NancyW.Burkhart.
Lipoma
by:10/06/GS/2988
is a benign tumor of adipose tissue that occurs more
commonly between 40-60years of ages. The buccal
mucosa and tongue are commonly the predominant
sites in adults
AETIOLOGY
As with many tumours the aetiology of lipomas
remains obscure. The repeated mild trauma may
trigger the proliferation of fatty tissue and finally
causes a lipoma
PATHOGENESIS
The pathogenesis of lipoma is still unclear
despite its close similary to normal adipose
tissue.
It is presumed to occur in obese individuals
• Clinical Features
• slowly enlarging, soft, smooth-surfaced mass of
the submucosal tissues
• yellow or pink surface discoloration for
superficial
• Painless
• Well defined tumor
• Varying in size from a few millimeters to several
centimeters(a mucosal oral lipoma may increase
to 5-6 cm)
Diagnosis
• Histopathological examination
• MANAGEMENT
• Conservative surgical removal(excision) is
the treatment of choice for oral lipoma.
• REFERENCES
• Wikepedia.com
• Color atlas of oral diseases
Lipoma pictures
• NEUROFIBROMA
• Neurofibroma is a benign overgrow of nerve
tissue origin.
• CLINICAL FEATURES
• Painless well-defined
• Firm tumors
• Covered by normal epithelium
• Size changes from several millimeters to several
centimeters
• PATHOGENESIS
• The solitary neurofibroma may be found on
any nerve where it presents as a slow growing.
• DIAGNOSIS
• Is based on a series of clinical criteria.
• Histopathological examination
• MANAGEMENT
• Total or partial resection of neurofibromatous
lesions (Surgical excision)
• REFERENCE
• Wikepedia.com
• Color atlas of oral diseases
Fig 1. A: intraoral view showing a protruding lesion from tooth
2.4 to the ipsilateral tuberosity
Lymphangioma
presented by 10/06/Ps/3186
Lymphangiomas are malformations of the lymphatic
system, which is the network of vessels responsiblefor
returning to the venous ystem excess fluid from tissues
Etiology
The direct cause of lymphangioma is a blockage of the lymphatic
system as a fetus develops, although symptoms may not become
visible until after the baby is born. This blockage is thought to be
caused by a number of factors, including maternal alcohol use and
viral infections during pregnancy.
classification
• Lymphangiomas have traditionally been classified into three subtypes:
capillary and cavernous lymphangiomas and cystic hygromas. This
classification is based on their microscopic characteristics. A fourth
subtype, the hemangiolymphangioma is also recognized.
1. Capillary lymphangiomas : Capillary lymphangiomas are composed of
small, capillary-sized lymphatic vessels and are characteristically located in
the epidermis
2.Cavernous lymphangiomas: Composed of dilated lymphatic channels,
cavernous lymphangiomas characteristically invade surrounding tissues.
3.Cystic hygromas :Cystic hygromas are large, macrocystic lymphangioma.
4.Hemangiolymphangioma As suggested by their name,
hemangiolymphangiomas are lymphangiomas with a vascular component.
• Lymphangiomas may be also classified based on the size of their
cyst:
• 1.macrocystic
• 2. microcystic
• 3.mixed
• CLINICAL FEATURE
• They resembles to the clusters of small blisters
ranging in color from pink to dark red.They are
benign and do not require medical treatment,
although some patients may choose to have
them surgically removed for cosmetic reasons
Common site relevent in dentistry
•
typically on the neck, tongue and lips, and vary widely in size, ranging
from as small as several wide.
• Diagnosis
• Cases of lymphangioma are diagnosed by histopathology inspection. In
prenatal cases, cystic lymphangioma is diagnosed using an ultrasound
Pathogenesis
• lymphatic cisterns in the deep subcutaneous plane are
separated from the normal network of lymph vessels.
• They communicate with the superficial lymph vesicles
through vertical dilated lymph channels.
• The typical history of Lymphangioma shows a small number of
vesicles on the skin at birth or shortly after.
• In subsequent years, they tend to increase in number, and the
area of skin involved continues to expand.
• Vesicles or other skin abnormalities may not be noticed until
several years after birth.
Treatment and prognosis
• Drainage
• Lymphangioma can be healed when treated with a flashlamp
• Treatment for cystic lymphangioma involves the removal of
the abnormal tissue;
• Surgical removal of the tumor is the typical treatment
provided, with the understanding that additional removal
procedures will most likely be required as the lymphangioma
grows.
• References:Wikipedia,the free Encyclopedia
• Hemangioma
• It is the abnormal buildup of blood vessels in
the skin or internal organ.
• It is benign
Etiolgy:
• Vascular malformation
The pathogenesis
• is still not understood.
• But there are factors :
• hormonal and mechanical influences that
affect the abnormal proliferation of
endothelial cells
• the primary, causative defect in
hemangiogenesis remains unknown and no
genetic alteration has been implicated
ClInical features
The common site :the are seen on the tongue,lips and buccal
mucosa. They are lesion with blue discoloration.
Diagnosis
• The use of aglass slide(diascopy)
 Management
• Non symptomatic:non reaction
• symptomatic: surgecal excision, cryotherapy, sclerosing and
embolisation
Burkett's lymphoma by 10/06/Gs/2994
• High grade malignant B-cell lymphoma arising
from germinal cell or lymph node.or or MALT
• Aetiology:the cause is unknown but epstein Barr
virus can take place.
• Associated wieh maralia
• Clinical presentation:
• Because of rapid growth of Burkett's
tumour,patient may quickly manifest
significant metabolic derangement and renal
function supairment.
It can present also skin nodules, acute
lymphocytic leukemia with fever,anaemia
bleeding and adenopathy.
• Pathogenesis
• In immunosuppressed individuals, such as
 patients with AIDS
 patients treated with immunosuppressive agents in the
setting of organ transplantation,
 suppressed by normal T-cell immunity.
 With diminished T-cell function,
• Then, there is an infection of EBV which may progress to
malignant lymphoma.
• And as EBV infection correlates with CNS tropism of
lymphoma.
• The tumor displayed diffuse and strong immunoreactivity for
smooth muscle actin, H-caldesmon; focal positivity for
desmin; and strong and diffuse positivity for Epstein-Barr virus
RNA on in situ hybridization.
Diagnosis
• biopsy of the tumor mass for histopathology,
immunochemistry and flow cytometry.
• Management
• Monitor serumchemistries,intravenous
antibiotics
• References:Ali H kambar
• Kaposi's sarcoma
Etiology
• human herpes virus
Clinical features
• nodules and blochetes(that may be red brown
or black),lesion easily damaged by chewing
and bleeding, interference eating and
speaking.
Pathogenesis
• the tumor is high vascular containing
abnormally dense and irregular blood vessels
with leak red blood cells into surrounding
tissue.
• These high vascularity give the dark color,
inflammation around the tumor then swelling
and pain occur.
Diagnosis
• biopsy and microscopic examination to find the spindle cells.
• detection of Kaposi's simplex herpes virus(KSHV protein LANA
in tumor cell)
•
•
•
•
•
Management:
Treat the cause of immune system dysfunction
radiotherapy
cryosurgery
interferon alpha, liposomal.
• References:Ali H kambar
Lymphangioma
Lymphangiomas are malformations of the lymphatic
system, which is the network of vessels responsiblefor
returning to the venous ystem excess fluid from tissues
Etiology
The direct cause of lymphangioma is a blockage of the
lymphatic system as a fetus develops, although symptoms may
not become visible until after the baby is born. This blockage is
thought to be caused by a number of factors, including
maternal alcohol use and viral infections during pregnancy.
• classification
• Lymphangiomas have traditionally been classified into three subtypes:
capillary and cavernous lymphangiomas and cystic hygromas. This
classification is based on their microscopic characteristics. A fourth
subtype, the hemangiolymphangioma is also recognized.
1. Capillary lymphangiomas : Capillary lymphangiomas are composed of
small, capillary-sized lymphatic vessels and are characteristically located in
the epidermis
2.Cavernous lymphangiomas: Composed of dilated lymphatic channels,
cavernous lymphangiomas characteristically invade surrounding tissues.
3.Cystic hygromas :Cystic hygromas are large, macrocystic lymphangioma.
4.Hemangiolymphangioma As suggested by their name,
hemangiolymphangiomas are lymphangiomas with a vascular component.
• Lymphangiomas may be also classified based on the size of their
cyst:
• 1.macrocystic
• 2. microcystic
• 3.mixed
• CLINICAL FEATURE
• They resembles to the clusters of small blisters
ranging in color from pink to dark red.They are
benign and do not require medical treatment,
although some patients may choose to have
them surgically removed for cosmetic reasons
• Common site relevent in dentistry
•
typically on the neck, tongue and lips, and vary widely in size, ranging
from as small as several wide.
• Diagnosis
• Cases of lymphangioma are diagnosed by histopathology inspection. In
prenatal cases, cystic lymphangioma is diagnosed using an ultrasound
• Pathogenesis
• finding lymphatic cisterns(waterproof or water collection) in the
deep subcutaneous plane are separated from the normal network
of lymph vessels. They communicate with the superficial lymph
vesicles through vertical, dilated lymph channels
• Microscopically, the vesicles in lymphangioma are greatly dilated
lymph channels that cause the papillary dermis to expand
• The typical history of Lymphangioma shows a small number of
vesicles on the skin at birth or shortly after. In subsequent years,
they tend to increase in number, and the area of skin involved
continues to expand. Vesicles or other skin abnormalities may not
be noticed until several years after birth
•
•
•
•
Treatment and prognosis
Drainage
Lymphangioma can be healed when treated with a flashlamp
Treatment for cystic lymphangioma involves the removal of the
abnormal tissue;
• Surgical removal of the tumor is the typical treatment provided,
with the understanding that additional removal procedures will
most likely be required as the lymphangioma grows.
• References:Wikipedia,the free Encyclopedia
• Hemangioma
• It is the abnormal buildup of blood vessels in
the skin or internal organ.
• It is benign
Etiolgy:
• Vascular malformation
Clinical features
The common site :the are seen on the tangwe,lips and buccal
mucosa. They are lesion with blue discoloration.
Diagnosis
• The use of aglass slide(diascopy)
 Management
• Non symptomatic:non reaction
• symptomatic: surgecal excision,cryotherapy,sclerosing and
emboliation
•
•
•
•
Pathogenesis
Is still not understood.
but growth factors :
hormonal and mechanical influences affect
the abnormal proliferation of endothelial cells
in hemangioma
• the primary, causative defect in
hemangiogenesis remains unknown and no
genetic alteration has been implicated.
• Referance:Dr Isyagi and wikipedia