PANCE Blueprint EENT (7%)

Other oropharyngeal disorders (Pearls)

NCCPA™ PANCE EENT Content Blueprint  Oropharyngeal disorders  other oropharyngeal disorders

Patient will present as → a 42-year-old male with symptoms of the flu. On social history, the patient describes drinking 2-3 beers per day as well as smoking 1 pack of cigarettes per day. He is noted on physical exam to have a white plaque-like lesion on the side of the tongue, which could not be scraped off with a tongue depressor.

Oral leukoplakia is an oral potentially malignant disorder that presents as white patches of the oral mucosa that cannot be wiped off with gauze. (compare this to oral candidiasis)

  • Tobacco use (smoked and especially smokeless), alcohol abuse, HPV infections
  • Leukoplakia is in itself a benign and asymptomatic condition. However, some patients will eventually develop squamous cell carcinoma (SCC)

DX: The diagnosis of leukoplakia is suspected in patients presenting with a white lesion of the oral mucosa that cannot be wiped off with gauze and that persists after eliminating potential etiologic factors, such as mechanical friction, for a six-week period

  • Biopsy is indicated for any undiagnosed leukoplakia

TX: For 2–3 circumscribed lesions, surgical excision

  • Destructive therapies (e.g., laser ablation, cryosurgery), medical therapies (e.g., retinoids, vitamin A, carotenoids, NSAIDs), and watchful waiting with close clinical and histologic follow-up
Patient will present as → a 42-year-old patient with AIDS presents with a grayish-white “corduroy-like” plaque on the lateral borders of her tongue that does not scrape off.

Oral hairy leukoplakia is a separate disorder that is not premalignant. It is an Epstein-Barr virus-induced lesion that occurs almost entirely in HIV-infected patients

  • Generally affects the lateral portions of the tongue, although the floor of the mouth, the palate, or the buccal mucosa may also be involved

TX: Unlikely to progress to squamous cell carcinoma

  • Treatment with zidovudine, acyclovir, ganciclovir, foscarnet, and topical podophyllin or isotretinoin
  • Therapy is usually not indicated
"Thrush can be scraped off with a tongue depressor revealing inflamed mucosa underneath. Leukoplakia will remain intact when attempting to remove with a tongue depressor."

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