The mouth, tongue and lips
Kevin G Burnand, John Black, Steven A Corbett, William EG Thomas, Norman L Browse in Browse’s Introduction to the Symptoms & Signs of Surgical Disease, 2014
Always inspect the mouth with a good light and a spatula, and most importantly palpate the tissues. More can be revealed in the soft tissues with a finger than an eye. Inspect the external appearance of the lips.Retract the lips to see the buccal mucosa.Push the cheek outwards to see the buccal side of the gum.Push the tongue away from the inside of the gum and the floor of the mouth.Push the tongue to one side to see the lateral aspect of its posterior third.Depress the tongue to look at the fauces, tonsils and pharynx.
Pemphigus vulgaris and foliaceus
Biju Vasudevan, Rajesh Verma in Dermatological Emergencies, 2019
Lesions in PV classically start in the oral mucosa and might then extend to the skin. Oral mucosa involvement consists of flaccid blisters that easily rupture, leaving behind painful erosions (Figure 9.1). This might potentially lead to weight loss and malnutrition. Though the buccal mucosa is commonly affected, lesions may also involve the gingiva, palate, and even oropharynx. Other mucosal surfaces, such as the larynx, esophagus, conjunctiva, nose, genitalia, and anus, might be less frequently affected. Cutaneous involvement usually occurs after a latent period of a few days to months; it is characterized by flaccid blisters (Figure 9.2) and partly crusted erosions (Figure 9.3) on healthy-appearing or erythematous skin, which show a tendency for peripheral extension (Figure 9.4). Areas of predilection include the head, upper trunk, and groin (Figure 9.5). Erosions of the intertriginous areas such as axillae and the groin might develop into vegetative plaques (pemphigus vegetans, Figure 9.6). Nikolsky sign (shearing pressure over the bony prominence at a distant site from the lesion results in appearance of blister or erosion) is often used to assess the clinical activity of the disease. A substantial number of patients with PV can relapse with a PF clinical and histological phenotype, especially when the relapses occur after a long remission [3,12].
Paper 1
Aalia Khan, Ramsey Jabbour, Almas Rehman in nMRCGP Applied Knowledge Test Study Guide, 2021
A 75-year-old asthmatic lady presents with a sore tongue and mouth. On examination there are white creamy patches adherent to her buccal mucosa. What would be your further management? Oral co-amoxiclavFerrous sulphate supplementationHIV testingAmphotericinAciclovir
Oral mucosa grafting in periorbital reconstruction
Published in Orbit, 2018
Andre Grixti, Raman Malhotra
Buccal mucosa is delimited by the outer commissure of the lips anteriorly, the anterior tonsillar pillar posteriorly, the maxillary vestibular fold superiorly, and the mandibular vestibular fold inferiorly. Vascular supply is derived predominantly from branches of the maxillary artery. These include the buccal artery, the middle and posterior superior alveolar arteries, and the anterior superior alveolar branch of the infraorbital artery. The transverse facial artery, a branch of the superficial temporal artery provides additional blood supply. Buccal mucosa is innervated by the long buccal nerve, a branch of the third division of the trigeminal nerve (CNV3) and the anterior, middle, and posterior superior alveolar branches of the second division of the trigeminal nerve (CNV2). The facial nerve also contributes sensory innervation to the buccal mucosa.74,75
Surgical repair for transverse facial cleft: two flaps with a superiorly rotated single Z-plasty lateral to the commissure
Published in Journal of Plastic Surgery and Hand Surgery, 2019
Pan Zhou, Lin Qiu, Yan Liu, Tianwu Li, Xionghui Ding
In our research, we performed modified surgical techniques. The precise position of the new commissure is important. The anthropometric method before endotracheal intubation is necessary. Points A1 and A2 should be symmetrical to the non-cleft side commissure individually in theory, but we found that the labial length of the cleft side would be longer than the non-cleft side owing to complete contraction. Especially in hemifacial microsomia, the reconstructed commissure should be positioned slightly medially to provide balance to lesser facial tissue on the cleft side and the reconstructed commissural position [14]. Thus, we positioned A1 and A2 2 or 3 mm medial to the theoretical point individually. With vermillion-mucosal flaps, placement of the incisions in continuity with the commissures can be avoided and their positions can be stabilized [5]. We designed the triangular mucosa flap based on the inferior lip to hide the commissural scar in the superior moist lip and attain optimal cosmetic results. The rectangular vermilion-mucosa flap in the superior lip formed the oral mucosa of the buccal fissure. Thereby, the suture line could be made opposite the commissural triangular flap transfer direction. This geometric design increased the tensile strength when opening the mouth and can effectively prevent a postoperative acuminate commissure.
Oromucosal films: from patient centricity to production by printing techniques
Published in Expert Opinion on Drug Delivery, 2019
Yu Tian, Mine Orlu, Herman J. Woerdenbag, Mariagiovanna Scarpa, Olga Kiefer, Dina Kottke, Erica Sjöholm, Heidi Öblom, Niklas Sandler, Wouter L. J. Hinrichs, Henderik W. Frijlink, Jörg Breitkreutz, J. Carolina Visser
The buccal mucosa acts as a natural barrier. Therefore, one of the essential tools for the evaluation of MBFs intended for systemic drug administration is permeation testing. In literature, various animal tissues have been used, which are supposed to mimic the human buccal mucosa. Mostly used are esophageal [40,85] and buccal porcine membranes [86] as well as buccal membranes from chicken [87], sheep [61], rabbit [88] and goat [76]. Investigations with cell cultures are gaining popularity, as shown by experiments by Castro et al. with cell TR146 lines [68] and Morales et al. with tridimensional human buccal tissue (EpiOral) [78]. When performing permeation tests, Franz diffusion cells are conventionally used, which are modified sometimes according to the specific use [87]. The permeation rate is analyzed based on the flux determination by calculating the slope of the resulting plot. A further evaluation method is the determination of the apparent permeability which requires the flux (J) over the concentration (co) [68].
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