Diploma of the Faculty of Dental Surgery (MFDS) Oral Surgery, Oral Medicine and Pathology Flashcards

24 sample cards from the Oral Surgery, Oral Medicine and Pathology deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. List the most common malignant tumour of the jaws and the most common site of intra-oral squamous cell carcinoma.

   Oral squamous cell carcinoma (OSCC) is the most common oral malignancy. Intra-orally the most common sites are the lateral border/ventral surface of the tongue and the floor of mouth. The jaws may also be affected by osteosarcoma and metastatic deposits.

2. Name the major and minor salivary glands.

   Major (paired): parotid, submandibular, and sublingual glands. Minor salivary glands (hundreds) are distributed throughout the oral mucosa, especially the lips, palate, buccal mucosa and floor of mouth.

3. Differentiate a mucocele from a ranula.

   A mucocele is a mucus extravasation/retention cyst of minor salivary glands, commonly on the lower lip, presenting as a bluish fluctuant swelling. A ranula is a mucocele of the sublingual (or submandibular duct) gland in the floor of mouth; a 'plunging' ranula extends through mylohyoid into the neck.

4. What is sialolithiasis, which gland is most affected, and how does it present?

   Sialolithiasis is salivary calculus (stone) formation. It most commonly affects the submandibular gland/Wharton's duct (mucinous secretion, upward duct course). It presents with mealtime pain and swelling of the gland, which may resolve between meals; managed by sialogogues, stone removal or sialendoscopy.

5. Name the most common benign and most common malignant salivary gland tumours.

   Most common benign tumour is the pleomorphic adenoma (most often in the parotid). The most common malignant salivary gland tumour overall is mucoepidermoid carcinoma; adenoid cystic carcinoma is notable for perineural spread.

6. List the main types of biopsy used in oral pathology.

   Incisional biopsy (a representative portion of a larger/suspicious lesion), excisional biopsy (removal of the whole lesion, for small benign lesions), punch biopsy, fine-needle aspiration (FNA) for swellings/lymph nodes, and brush biopsy/cytology as an adjunct.

7. What principles govern taking an incisional biopsy of a suspected malignancy?

   Include a representative area at the edge of the lesion incorporating some adjacent normal tissue, avoid grossly necrotic centres, take an adequate depth, avoid crushing the specimen, orient and place immediately in 10% formalin, and provide a full clinical history and lesion details on the histopathology request form. Suspected malignancy is best biopsied by the treating specialist.

8. What information must accompany a histopathology request form?

   Patient identifiers, relevant medical/social history (e.g. smoking, alcohol), clinical description and site of the lesion (ideally with a diagram), duration, provisional/differential diagnosis, type of biopsy, fixative used, and any previous related pathology.

9. Describe the clinical appearance and types of oral lichen planus.

   A chronic T-cell mediated mucosal condition presenting as bilateral, often symmetrical lesions. Types: reticular (lacy white Wickham's striae, usually asymptomatic), atrophic/erythematous, erosive/ulcerative (painful), plaque-like, papular and bullous. The erosive form is most symptomatic and carries a small malignant transformation risk.

10. Define leukoplakia and erythroplakia and their malignant potential.

    Leukoplakia is a white patch that cannot be rubbed off or attributed to any other definable lesion (a clinical diagnosis of exclusion) with malignant potential. Erythroplakia is a red velvety patch that cannot be attributed to another condition; it has a much higher risk of dysplasia/malignancy than leukoplakia and warrants urgent biopsy.

11. What is the classification and significance of epithelial dysplasia in oral mucosa?

    Dysplasia is graded histologically as mild, moderate or severe (with carcinoma in situ as full-thickness change). Increasing grade correlates with increasing risk of progression to invasive squamous cell carcinoma; it guides the need for excision and surveillance.

12. Give examples of oral manifestations of systemic disease.

    Crohn's disease (cobblestoning, mucosal tags, linear ulcers, lip swelling); coeliac disease (recurrent aphthae, glossitis); pernicious/iron-deficiency anaemia (glossitis, angular cheilitis, aphthae); leukaemia (gingival enlargement, bleeding, ulceration); HIV (candidiasis, hairy leukoplakia, Kaposi sarcoma); and lichenoid reactions in graft-versus-host disease.

13. List common causes of orofacial pain by category.

    Odontogenic (pulpitis, periapical, cracked tooth, dry socket); musculoskeletal (temporomandibular disorders, myofascial pain); neuropathic (trigeminal neuralgia, post-herpetic neuralgia, atypical odontalgia); neurovascular (migraine, cluster headache); and referred (sinusitis, cardiac, salivary, malignancy). Psychogenic factors may contribute.

14. Describe the classic features and first-line drug treatment of trigeminal neuralgia.

    Severe, brief, paroxysmal, electric-shock-like unilateral pain in a trigeminal division (often V2/V3), triggered by light touch, washing, eating or wind, with refractory periods between attacks. First-line treatment is carbamazepine; microvascular decompression is a surgical option for refractory cases.

15. Define xerostomia and list common causes of dry mouth/salivary dysfunction.

    Xerostomia is the subjective sensation of dry mouth. Causes: medications (anticholinergics, antidepressants, antihistamines, diuretics), Sjögren's syndrome, head and neck radiotherapy, dehydration, diabetes, anxiety, and mouth-breathing. Consequences include caries, candidiasis, dysphagia and altered taste.

16. What is Sjögren's syndrome and how is it characterised?

    A chronic autoimmune exocrinopathy causing lymphocytic destruction of salivary and lacrimal glands, producing dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca). Primary occurs alone; secondary occurs with another connective tissue disease (e.g. rheumatoid arthritis). It carries an increased risk of MALT lymphoma; anti-Ro/SS-A and anti-La/SS-B antibodies are markers.

17. Describe burning mouth syndrome (BMS) and its management.

    BMS is a chronic burning sensation of the oral mucosa (often the tongue) with clinically normal mucosa and no identifiable local or systemic cause. It is more common in peri/post-menopausal women. Management involves excluding causes (candida, deficiencies, diabetes, dry mouth, parafunction), reassurance, cognitive behavioural therapy, and low-dose neuromodulators (e.g. clonazepam, gabapentin or tricyclics).

18. What are the major risk factors for oral squamous cell carcinoma?

    Tobacco (smoked and smokeless/chewed), areca/betel nut and paan, heavy alcohol (synergistic with tobacco), HPV (especially type 16, more for oropharyngeal SCC), sunlight (lip cancer), increasing age, immunosuppression, chronic trauma, and pre-existing potentially malignant disorders. Diets low in fruit/vegetables also contribute.

19. List the oral potentially malignant disorders (OPMDs).

    Leukoplakia, erythroplakia, erythroleukoplakia (speckled), oral submucous fibrosis, oral lichen planus (erosive), actinic cheilitis, oral lupus erythematosus, and dyskeratosis congenita. These carry an increased risk of transformation to squamous cell carcinoma and need monitoring.

20. What clinical features of an oral lesion should raise suspicion of malignancy and prompt urgent referral?

    A non-healing ulcer persisting more than 3 weeks, an indurated/rolled margin, a fixed or hard lesion, exophytic or speckled red-white patch, bleeding, tooth mobility without cause, persistent neck lymphadenopathy, dysphagia, numbness, or referred otalgia. Any unexplained red or red-white patch should be referred.

21. What is the '2-week wait' urgent cancer referral pathway and when is it used?

    It is the UK NHS urgent suspected-cancer referral that ensures the patient is seen by a specialist within two weeks. For oral cancer it is used for any unexplained ulceration/red or red-white patch persisting more than 3 weeks, persistent unexplained neck lump, or other suspicious features, referred to oral/maxillofacial or head-and-neck services.

22. Outline the TNM staging system as applied to oral cancer.

    T = primary tumour size/local extent (T1 ≤2 cm, T2 >2-4 cm, T3 >4 cm, T4 invading adjacent structures, with depth of invasion now incorporated), N = regional lymph node involvement (N0-N3 by number, size, laterality and extranodal extension), and M = distant metastasis (M0/M1). These combine into overall stage I-IV.

23. What is the role of the multidisciplinary team (MDT) in head and neck cancer management?

    The MDT (surgeons, oncologists, radiologists, pathologists, restorative dentists, clinical nurse specialists, dietitians, speech and language therapists, etc.) reviews diagnosis, imaging and histology to plan and coordinate treatment (surgery, radiotherapy, chemotherapy), rehabilitation and supportive/palliative care, ensuring patient-centred decisions.

24. How can dental practitioners contribute to prevention and early detection of oral cancer?

    Provide tobacco and alcohol cessation/brief intervention advice, perform thorough soft-tissue (mucosal) examinations at every routine recall, recognise and urgently refer suspicious lesions, document and review white/red patches, promote HPV awareness and a healthy diet, and educate patients on self-examination and risk factors.

What this deck covers

Oral Surgery, Oral Medicine and Pathology flashcards FAQ