Search

A 68-year-old female patient presented at the emergency room with episodes of epistaxis, dysphagia and malaise. The patient had acute prerenal renal failure, probably in association with previous infection of the airways and treatment with NSAID's. Laboratory values revealed greatly decreased leukocyte and platelet counts as well as anemia. The patient had a diagnosis of a seronegative arthritis since 9 months and, therefore, was treated with low dose methotrexate (MTX) 10 mg/week. After exclusion of other causes, myelosupression was considered to be associated with low-dose MTX. After stopping MTX and treatment with folic acid leucocyte and platelet counts returned to normal and stomatitis recovered as well within nine days. We discuss the pharmacology of low-dose MTX and in particular the risk factors and prophylaxis of its toxicity. Renal function needs special attention in patients treated with low-dose MTX.

The best known clinical picture of a one-sided necrotisising, infectious tonsillitis is the by Plaut and Vincent (1894) described angina Plaut-Vincent. In addition to this fusospirochetosis it is in case of necrotisising inflammations in the oropharynx differential-diagnostically important to consider also the anaerobic type Prevotella, especially Prevotella disiens as a potential trigger .Because the clinical course forms of a necrotisising oropharyngeal inflammations can be very different and complicate so a suitable diagnosis, it is very important to get a complete and perfect cause proof. For getting this proof a correct test production, transport and cultivation are of extreme importance .The type Prevotella consists of different species gram-negative, obligate anaerobic strains. They are regarded as a cause of suppurating inflammations and abscesses of the genital tract and are components of the aerobic anaerobic mixed flora in case of gingival infections. The sole proof in the microbiological culture as a smear test result of a one-sided necrotisising tonsillitis has to be seen as a first description by reason of missing literature .As triggers for one-sided necrotisising tonsillitis are considered different causes. Next a carcinoma of the tonsil, Lues, Angina Plaut-Vincent have to be excluded. An infection with Prevotella disiens is an extremely rare variation in contrast. However, the transmission is possible by insufficient hygiene, lack phenomena and sexual intercourse and to consider therefore as an exclusion diagnosis.

Many systemic diseases have oral and/or pharyngeal manifestations. Mucosal lesions in the upper aerodigestive tract may be caused by granulomatous inflammations, and infectious, autoimmune and neoplastic diseases before they appear systemically or otherwise. ENT specialists can play a decisive role in identifying patients with pathological mucosal changes and transfer them to dermatology, hematology, gastroenterology or maxillofacial surgery in order to assure the best possible treatment. This article presents the case of an elderly female patient with a history of necrotising severe stomatitis that turned out to be a rare B-cell lymphoma. In the second part of the article, we present a number of common and rare diseases that may be encountered in ENT practice with an overview of clinical manifestations and current diagnostic modalities.

Necrotizing ulcerative gingivitis (NUG) and necrotizing ulcerative Periodontitis (NUP) share many clinical and etiologic characteristics. Both forms are characterized by necrotic gingival tissues, bleeding and pain. Malodor and malaise may be also present. NUG is an infection limited to the gingiva whereas NUP also involves the attachment apparatus. Predisposing factors may include immune dysfunction, poor oral hygiene, cigarette smoking and emotional stress. NUG and NUP might possibly be different stages of the same infection. This case report shows the successful treatment of a patient suffering from NUP.

An unusual case of nonhealing necrotizing gingivostomatitis in a 66-year-old man is described. Microscopic examination of biopsy material showed an infiltrate of Langerhans cells. Merely oral lesions of Langerhans cell granulomatosis--especially in an old person--occur very seldom.

Vincent's angina (Plaut-Vincent) is the most prominent disease caused by coinciding infections from fusibacteria and spirochaeta both belonging to obligate anaerobic bacteria. A possible symbiotic infection of both anaerobics may become manifest on the mucous membranes of the oral cavity and the oropharynx beside the tonsillas. The clinical outcome may be different and pose difficulties in the differential diagnosis. We report the case of a 29 year old female patient with necrotizing ulcera of the soft palate suspicious for stomatitis ulceromembranacea. In case necrotizing inflammations of the oral cavity area were to be found infections due to anaerobic bacteria should be considered mostly occurring as mixed infections. The correct identification by cultivation turns out to be difficult in that it requires special conditions. Furthermore, reliable detection of these bacteria necessitates careful collection and transport of patients specimens. In case of Fusospirochaetosis (Fusotreponematose) a specimen should be prepared for microscopic examination beside setting up a special culture. This is because the staining is the most suitable procedure for bacteril identification to support the clinical diagnosis of stomatitis ulceromembranacea.

The development of an acute necrotizing ulcerative gingivitis (ANUG) is connected with preexisting gingivitis and factors of disposition which are able to influence the host resistance. Typical clinical signs of ANUG are necrosis of interdental gingiva, bleeding and pain. Concerning to clinical sign there is a differentiation between the acute and the chronic necrotizing gingivitis. The treatment of ANUG follows the general rules of gingivitis-therapy and will be modified concerning to the clinical signs. It will propose a regular follow-up for prevention of recidivation.

The mucosal protective effect of sucralfate (Ulcogant) was evaluated in a prospective randomised clinical study during radiation therapy. Twenty-four patients received 1 g of a sucralfate suspension 4 times a day orally for 5 min each. This group was compared with a control group of 21 patients receiving standard oral hygiene consisting of frequent tooth cleaning and disinfection of the oral and pharyngeal mucosa. The radiation technique was telecobalt therapy in two opposing fields using the shrinking field technique, with an electron boost to the posterior lymph nodes; the dosage was 60-70 Gy in daily fractions of 2 Gy. Mucosal reactions, pain and difficulty in swallowing were recorded twice a week. We also checked the patient's weight during treatment. The patients showed significant differences in all parameters, and lower weight loss compared with the control group. Minimal or absent mucosal inflammation pain or dysphagia were found in 88%, 79% and 83% respectively, while 43% and 29% and 52% of the controls had such mild radiation side-effects. Local effectivity appeared to be less in the hypopharynx due to shorter time of application compared with mouth and oropharynx. There were no side-effects from the sucralfate. Sucralfate prophylaxis is effective and easy to apply in the protection of mucosa during irradiation therapy.

Natural changes in oral mucosa are influenced by disturbances of metabolism and many local injuries with the result of various appearances in the surface of the oral cavity in the elderly. There are less acute inflammations but more diseases with chronic inflammation and more degenerative and tumorous alterations. A special problem comes from psychosomatic diseases with their difficulties in diagnoses and therapeutic management.

Skin and mucous membranes including the oral mucosa are among the preferential locations of opportunistic infections and secondary neoplasms in patients infected with the human immunodeficiency virus (HIV). Infections of the oral mucosa such as thrush occur in a high percentage of AIDS patients, patients with AIDS-related complex or HIV-seropositive individuals. The clinical appearance of the infections (herpes virus infection, periodontitis) is often marked by aggressive expansion, frequent recurrences or resistance to therapy. Oral "hairy" leukoplakia is considered to be a characteristic lesion in HIV-infected individuals. Tumors like Kaposi's sarcoma, squamous cell carcinoma and non-Hodgkin lymphoma of the oral mucosa may cause marked morbidity in AIDS patients. Such oral lesions are frequently the first indication of an HIV-infection. Dentists should be aware of the oral manifestations of HIV-infection and initiate diagnostic and therapeutic measures in the interest of the patients and for epidemiologic reasons.

Clinically, praecancerosis of the oral mucosa may be classified into the following groups: Whitish, flat changes, reddish changes, papillary changes and ulcers. Combination of the various groups and flowing transition between them is often observed. It can be shown that praecancerosis can be neither clearly distinguished from benign tumors or changes, nor can it be differentiated from already existing malignomas. The same picture of a disease can occur in various clinical aspects. On the other hand, histologically very different changes may often hardly be distinguished clinically. A change in the oral mucosa must therefore be regarded as possibly malignous as long as not proven to the contrary. Also, it is important to check, at regular intervals, changes diagnosed benign, since the possibility of malignous change cannot be ignored.

Acute necrotizing ulcerative gingivitis is a disease in which the bacilli of the flora normally found in the buccal cavity (fusiform bacilli and spirochetae) play a role. This type of gingivitis occurs relatively frequently in young men. The frequency of the disease tends to peak in the winter. We examined 72 young men between the ages of eighteen and twenty-one with acute necrotizing ulcerative gingivitis, fever and swelling of the regional lymph nodes for possible noxas. All of the individuals were smokers: approximately 3/4s of the group smoked more than 60 cigarettes per day. Roughly half of the individuals examined showed extremely poor oral hygiene or underlying psychological or physical stress at the onset of the disease. Dentitio difficilis and alcohol abuse however appeared to be less important factors. Symptomatic measures, such as mouthwash and oral hygiene, proved to be effective therapy. Diseases and disorders of internal structures of the body could not be diagnosed in any of these individuals.

A necrotizing inflammation in the mucosa of the superior maxilla is described in an infant suffering from benign chronic neutrocytopenia. A connection between primary dentition which occurred at the same time and the basic illness is assumed.

The clinical picture and the aetiology of prosthesis-induced alterations of the oral mucosa are presented. In the light of personal gerontological observations, the authors deal with the mechanical irritation produced by the prosthesis as the main aetiological factor and discuss its effects on prophylaxis, diagnosis and therapy.

The different specific and non-specific general effects of ultra-violet rays are discussed. Intro-oral ultra-violet irradiation is indicated in all ulcerous and ulcero-aphthous diseases of the gingiva and the remaining oral mucosa. The author's experience does not plead for other applications, e. g., in case of parodontopathia inflammata and parodontopathia dystrophica, which is sometimes recommedned. The technique of ultra-violet irradiation is described. It is emphasized that a stomatological nurse may give this treatment, which relieves the stomatologist

46 ambulatory patients with chronic lymphocytic leukemia were treated with Prednimustine either continuously (daily or each other day 20 mg) or intermittently (daily 20 mg for 14 days, followed by a pause of 4 weeks). A good response was seen in 28 patients lasting up to 17 + months (mean 4,5 + months) after terminating therapy. Patients without prior chemotherapy have improved earlier and to a smaller amount of the total dose applicated. Signes of bone marrow toxicity (anaemia, thrombocytopenia) were observed in 8 cases, gastrointestinal side effects in 7 cases, cutaneous exanthema in 3 cases, and one patient exhibited a severe stomatitis after treatment. Prednimustine constitutes an effective drug for chronic lymphatic leukemia.