Oral leukoplakia

Introduction Oral mucosal leukoplakia refers to a white keratotic disease that occurs in the mucous membranes of the mouth, lips, and the like. Oral mucosal leukoplakia is more common in men than middle-aged men. It is characterized by punctate, flaky or strip-like gray or white keratotic patches in the lesions. Most of them are benign lesions, and a few tend to have malignant transformation. It is estimated that the malignant rate is about 2%. The location of white spots is related to the degree of malignant transformation. The possibility of leukoplakia at the mouth and tongue is greater than that of other parts. It is advisable to use a combination of local and systemic treatments, and patients with cancer should be removed early.

Cause

Causes

(1) Vitamin A deficiency.

(2) Smoking.

(3) Chronic stimuli such as residual roots, residual crowns, long-term stimulation of inappropriate dentures, alcoholism, and long-term consumption of hot foods. White spots occur in the cheeks, lips, and tongue, followed by sputum, gums, and mouth. Often expressed as irregular shape, different sizes, gray or milky white, slightly higher than the plaque on the mucosal surface. Some surfaces are needle-like or fused into a villus, or they can be irregularly distributed in the form of granules, higher than the mucosa. Most people have no discomfort early on, such as eros or ulcers, which can cause pain. Medically divided into homogeneous, sputum, granular and ulcerative white leukoplakia. The signs of leukoplakia mellitus are: sudden rapid increase and thickening, peripheral congestion and redness, hemorrhage, pain, basal formation of induration or formation of crater-like (crater-like) ulcers.

Pathogenesis

In recent years, it has been suggested that oral leukoplakia is associated with Candida albicans infection, and these lesions should be referred to as chronic proliferative candidiasis or Candida leukoplakia. Hyperkeratosis is a prerequisite for Candida infection, and the oral horn is a predilection site for Candida leukoplakia. A study in the United Kingdom showed that all of the patients with Candida leukoplakia who were investigated had smoked and had dentures day and night. About half of Candida leukoplakia has nodular changes. This may be the cause of up to 45% of epidermal lesions dysplasia. The treatment of Candida leukoplakia with antibiotics lasted for an average of 45 days, and the nodular and partially significant lesions of the lesion disappeared.

Systemic factors include diabetes, endocrine disorders, and vitamin deficiency. It is speculated that leukoplakia is a defensive reaction of the body to chronic stimuli, causing the mucosal stratum corneum to thicken and dense, thereby protecting the submucosal tissue from chronic stimuli.

an examination

Related inspection

Oral endoscopic oral X-ray examination

Long-term unhealed leukoplakia should be biopsied to rule out cancer, and histopathological examination is the main basis.

TCM pathogenesis and syndrome differentiation: The oral mucosa has localized white keratinized plaques, the surface is rough and not easy to peel off, the tongue is slightly red, the fur is white, and the pulse string is slow. Syndrome differentiation belongs to the stomach and lung heat, relapsed poisonous evil, caused by stagnation.

1. More common in men over 40 years old. The predilection sites of mucosal leukoplakia are: buccal mucosa, oral mucosa, toothless alveolar, tongue, lip mucosa, hard palate, sublingual area and gingiva. Buccal mucosa and oral horny mucosal lesions often occur symmetrically. Oral leukoplakia is often associated with Candida infection. This area of simple mucosal leukoplakia is rare, often covering the ecdysis. When it occurs in the high-risk part of oral squamous cell carcinoma (bottom of the mouth, outside of the tongue, soft palate), it should be highly valued.

2. The range of mucosal leukoplakia varies in size and is pleomorphic, single or multiple. The damage is light red at the early stage, and the skin lesions may be waxy spots with clear boundaries. It may also have a wide range of skin lesions. The white lesions may have a villus-like or papillary-like membrane, and the lesions may also have irregular thickening and knotting. Section; sometimes the performance is net, and the adhesion is very tight with the following. Forcibly stripping causes bleeding, the boundary is clear, the quality is hard, it is difficult to push, and the thickness is thick. Repeated trauma can cause ulcers.

3. Usually asymptomatic, but some patients complain of burning or irritation.

4. Although clinical manifestations are not necessarily related to histopathology, the white, punctiform, and hypertrophic nodules on the basis of atrophy are characteristic of epithelial dysplasia of the lesions, indicating a highly malignant tendency. Many mucosal leukoplakia can recover if exogenous stimuli are eliminated. Some long-term skin lesions may not resolve, and late leukoplakia thickening may produce shallow ruptures and small ulcers. Usually no symptoms, or acupuncture or mild pain. Recent studies have shown that 4% to 6% of mucosal leukoplakia are converted to malignant tumors.

Differential diagnosis

Differential diagnosis of oral leukoplakia:

The disease should be differentiated from lichen planus, white spongy sputum, congenital keratosis, congenital thick nail disease.

1. Oral lichen planus leukoplakia is more common in the upper and lower lip and cheek tooth occlusion, often in a network or pattern, with scattered purple-red polygonal papules around, while mucosal leukoplakia is absent, in addition, the body There is a common lichen planus lesion. Histologically, epithelial cells have no atypical hyperplasia, basal cells are liquefied and degenerated, and there is a dense band-like infiltration of lymphocytes in the upper part of the dermis.

2. Mucosal white sponge is a hereditary disease, rare. Occurs in babies, a few occur in adolescence, and reach a peak in puberty. The lesion involved the entire oral mucosa, white or grayish white lesions, spongy. In patients who are under 40 years of age, the lesion is limited to only part of the oral mucosa.

3. The syphilitic mucosa is white and white, surrounded by dark red infiltration, and the smear of the white spot surface can be found in the syphilis spirochete. The body may have other symptoms of syphilis elsewhere, and the syphilis seropositive.

4. White candidiasis occurs mostly in children. There is inflammation around the tunica albuginea. False hyphae and spores can be found by microscopy.

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