University Textbook of Oral Mucosal Diseases

8/12/2019 University Textbook of Oral Mucosal Diseases

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Authors:MUDr. Lydie Izakoviov !o"" # $%D.# I'*(i(/(e o0 $a(%o"o1i&a" $%y*io"o1y# Fa&/"(y o0 Medi&i'e# Br'oDo&. MUDr. A'(o')' Fa**+a''# CS&.# De2ar(+e'( o0 S(o+a(o"o1y# Fa&/"(y o0 Medi&i'e# Br'o

R !" # r:MUDr. V3ra Saz+ov

Lydie I4AKOVI5OV6 !OLL6# A'(o')' FASSMANN# Ma*aryk U'iver*i(y Br'o ,--ISBN

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$ NOTES ON THE MORPHOLO%Y OF THE ORAL MUCOSA&&&''&&&&&&&'''''''''

PATHOLO%ICAL PROCESSES IN THE ORAL MUCOSA&&&&&'''''''''''''' '''''''' ''''&&$* ,.: $ri'&i2"e* o0 2a(ie'( e;a+i'a(io'777..777777777777777777.7..:: ,.:.: $a(ie'( %i*(ory77.7777777777777777777777777..77777.::

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- TON%UE PATHOLO%IES&&&&&&&&&&&'&&&&&&&'''''''&&&&&&&'' .

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/ DISORDERS OF SALIVA SECRETION&&&&&&&&&&&&&&&&&&&&'''+- 8.: F/'&(io'* o0 *a"iva77777777777777777.777777777. >


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8. .,.: ero*(o+ia7777777777777777777777777777777. 9. HALITOSIS (FOETOR EX ORE0 BAD BREATH)&&&&&&&&&&&&&&&&&''+

MUCOSAL LESIONS IN THE ORAL CAVITY 1ITH CHARACTERISTIC FINDIN%S''''+2 .: $i1+e'(a(io' J di00ere'(ia" dia1'o*(i& re+ark*777777..777777777777 @ .:.: Addi*o' * di*ea*e77777777777777777777777777..7777... @ .:., Bro'&%o1e'i& "/'1 &ar&i'o+a a'd *o+e o(%er 0or+* o0 +a"i1'a'( (/+o/r* 7777777. @ .:. $e/(zG e1%er* *y'dro+e777777777777777777777777777... @

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UNIVERSITY TEXTBOOK OF ORAL MUCOSAL DISEASES

T%e di*ea*e* o0 (%e ora" +/&o*a re2re*e'( a very varied 1ro/2 o0 di*ea*e* o0 di00ere'( e(io"o1y a'd

*erio/*'e**. T%e &o'di(io'* o0 (%e oro0a&ia" re1io' &a''o(


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THE LIST OF ACRONYMS

ACT! Adre'o&or(i&o(ro2i& %or+o'eACV A&y&"ovir AIDS A&H/ired i++/'ode0i&ie'&y *y'dro+eA$C A'(i1e'G2re*e'(i'1 &e""ARC AIDSGre"a(ed &o+2"e;ATB A'(ia Co+2"e+e'( &o+2o'e'(*C! C%"or%e;idi'eCMV Cy(o+e1a"ovir/*Di0. d1. Di00ere'(ia" dia1'o*i*DLE Di*&oid "/2/* ery(%e+a(o*/*EBA E2ider+o"y*i*


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T%e (%oro/1% k'o "ed1e o0


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Ma=or di00ere'&e*


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Fig. : *he illustration of the keratini ing epithelium (taken from Oral +edicine% *#ldesle# ,-%

1&'1!

)esk# Anglick#

S(ra(/+ &or'e/+ S(ra(/+ &or'e/+

Kera(i'izova'


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)esk# Anglick#

Baz "')


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PATHOLO%ICAL PROCESSES IN THE ORAL MUCOSA

T%e ora" +/&o*a rea&(* (o %ar+0/" e00e&(*


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Fig. : *he schematic view of "asic histopathological changes (taken from 2ermatovenerologie(2ermatovenerolog#!% 34ru"a et al.% 1&& !

)esk# Anglick#

S2o'1i\za S2o'1io*i*

!y2erkera(\za !y2erkera(o*i*

$arakera(\za $arakera(o*i*

Aka'(\za a 2a2i"o+a(\za A&a'(%o*i* a'd 2a2i""o+a(o*i*

Hyperkeratosis: T%e *o"e e'"ar1e+e'( o0 (%e &or'ea" "ayer (%e *(ra(/+ &or'e/+ . O(%er "ayer* o0 (%ee2i(%e"i/+ &a'


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Epithelial atrophy: I( i* +a'i0e*(ed ++ (o *evera" &+ i* &a""ed"ulla.T%e &o'(e'(* o0 (%e


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)esk# Anglick#

Ma&/"a G *kvr'a Ma&/"e G *2o(

$a2/"a G 2/2e' $a2/"e G


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lcus (ulcer): U'"ike ero*io'# i( i* a dee2er "o** o0 (i**/e J (%e


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+e+


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T%e &o+2"e(e i++/'o"o1i&a" e;a+i'a(io' i* 2er0or+ed i' 2a(ie'(* i(% ora" +/&o*a" di*ea*e* */&%a* &%ro'i& 0or+* o0 ora" &a'didia*i* a'd re&/rre'( i'0e&(io'* &a/*ed


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a T%e &o""e&(io' o0 (%e *2e&i+e' +/*(


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T%e


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di00i&/"( (o de(er+i'e or &"a**i0y. T%e *2e&ia"i*( &o'*/"(a(io' &o+2o'e'( i'&"/de* (%e e;a+i'a(io'


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So+e 2a(%o1e'i& +i&roor1a'i*+* &a' &a/*e "o&a" i'0e&(io' i' very rare &a*e* 0or e;a+2"eMy&o


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i'vo"ved i' (%e 2reve'(io' */22re**io' o0 a/(oi++/'e re*2o'*e i'&"/de (%e i'a&(iva(io' or de"e(io' o0 a/(orea&(ive T a'd B &e""* (%e 0or


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Me"a'i' i* a 2i1+e'( 2rod/&ed


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,'$'+ Dou6? ?"< T%i* a


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1ra'/"o+a(o/* &%ei"i(i* &%ei"i(i* 1ra'/"o+a(o*a a( (%e Me"ker*o'GRo*e'(%a" *y'dro+e J "i2 ede+a G a( *a"ivary 1"a'd %e(ero(o2iaX &%ei"i(i* 1"a'd/"ari* *i+2"e; $/e'( &%ei"i(i* 1"a'd/"ari* a2o*(%e+a(o*a Vo"k+a''

&%ei"i(i* 1"a'd/"ari* */22/ra(iva Bae"z

,'+' P AINFUL MOUTH CORNERS (AN%ULI INFECTIOSI0 AN%ULAR STOMATITIS (STOMATITISAN%ULARIS)0 PERL CHE) T%i* i* a re"a(ive"y &o++o' di*ea*e /*/a""y &a/*ed


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(i**/e*# or a( (%e "o** o0 */22or(i'1 zo'e*. e'era" 0a&(or* */&% a* dia


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& Re&/rre'( oede+a o0 "i2* a*y++e(ri&a" ede+a o0


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&%a'1e* ro/1% &o'(o/r*# (%e e'"ar1e+e'( o0 (er+i'a" 2ar(* . T%e e'"ar1e+e'( o0 (%e (o'1/e i* /*/a""ya**o&ia(ed i(% (%e 0i'di'1 o0 0i**/red (o'1/e "i'1/a 2"i&a(a .

A"yloidosis I' 2ri+ary a+y"oido*i* AL # a+y"oid &a'


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'i1%( are 2re*e'(. I' *o+e &o'di(io'*# (%e &oa(i'1 i* 2a(%o"o1i&a" G ei(%er 2a(%o"o1i&a""y e'"ar1ed o 2a(%o"o1i&a""y red/&ed.

-'+' P3tho?o;"83??5 4?3r; to4;u 8o3t"4; I( re*/"(* 0ro+ (%e %y2er(ro2%y a'd e;(e'*io' o0 0i"i0or+ 2a2i""ae a'd (%e e'%a'&ed kera(i'iza(io' o0 (%eir e2i(%e"ia" 2ro+i'e'&e*. A&/(e &oa(i'1 i* 0or+ed H/i&k"y# /*/a""y i' ,? %o/r* a0(er (%e o'*e( o0 adi*ea*e. I( i* /*/a""y o'e o0 (%e *y+2(o+* o0 *evere a&/(e di*ea*e* J *evere i'0e&(io'* 2'e/+o'ia#+e'i'1i(i*# *e2*i*# *&ar"e( 0ever or di*ea*e* a**o&ia(ed i(% *%o&k a&/(e a


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*%o&k &o'di(io'* . I0 (%e di*ea*e de(eriora(e*# (%e (o'1/e &oa(i'1 i""


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I( i* a (y2i&a" *y+2(o+ o' (%e (o'1/e i' S(a1e III *y2%i"i*. I( %a* ( o 0or+* G */2er0i&ia" a'd dee2 G%ere 1"o**i(i* i'(er*(i(ia"i* "/e(i&a */2er0i&ia"i* i* +a'i0e*(ed -.

9


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0linical picture: e'era" *y+2(o+* are d/e (o (%e a'e+i& *y'dro+e &%ara&(erized


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/ DISORDERS OF SALIVA SECRETION

/'$ F UNCTIONS OF THE SALIVA Red/&ed *a"iva *e&re(io' i* (%e +o*( &o++o' di*order o0 *a"iva *e&re(io' %erea* i'&rea*ed *a"iva*e&re(io' o&&/r* "e** o0(e'. I' order (o 1ai' dee2 i'*i1%( i'(o (%e &o'*eH/e'&e* o0 i'*/00i&ie'( *a"iva(io'#"e( /* +ake a


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Sa"iva *e&re(io' a( 2%y*io"o1i&a" &o'di(io'* de2e'd* o' a de1ree o0 (%e a&(ivi(y o0 ve1e(a(ive 'ervo/**y*(e+ %erea* (%i* a&(ivi(y "ar1e"y de2e'd* o' a de1ree o0 +a*(i&a(ory a&(io'. Sa"iva *e&re(io' 0ro+ (%e 2aro(i& 1"a'd i* *ero/* %erea* */


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1a*(roi'(e*(i'a" (ra&(# a'd i' 2a(ie'(* i' %o+ (%e +/&o*a" di*ea*e &oi'&ide* i(% dr/1Gi'd/&ed%y2o*ia"ia 2*y&%o2%ar+a&e/(i&a"*# 2ara*y+2a(%o"y(i&*# 'o'G*e"e&(ive a'(i%i*(a+i'e*# e(&. . I( o


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I( i* a &%ro'i& a/(oi++/'e di*ea*e %o*e 2a(%o1e'e*i* i* 2ro


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Na*o2%ary';X a'1i'a# 2%ary'1i(i* 2ar(i&/"ar"y &%ro'i& a(ro2%i& 0or+* E*o2%a1/*X diver(i&"e*# *(ri&(/re*# de&ayed (/+o/r* L/'1*X


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(ra&( /*/a""y a00e&(i'1 (%e "ar1e i'(e*(i'e #


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(%e a1e o0 -G?- year*. T%ey do 'o( vary i' a "o'1G(i+e 2er*2e&(ive a'd &a' di00er s8r"6 > ?34os"s (M ?34os"s 8"r8u>s8r" ?34os"srare"y o&&/r* o' (%e "i2* a'd ora" +/&o*a a'd a" ay*(ra'*0or+* i'(o a +a"i1'a'( +e"a'o+a. I( i* (y2i&a""y +a'i0e*(ed ?34o>3 I( o&&/r* i' (%e ora" &avi(y very rare"y :b o0 a"" +a"i1'a'( (/+o/r* i' (%i* area . I( /*/a""y o&&/r*o' (%e 2a"a(e or i' (%e a"veo"ar 2ro&e** o0 (%e /22er =a # i' a"" a1e &a(e1orie*# i(% a %i1%er i'&ide'ra(e i' +e'. I( ori1i'a(e* 0ro+ a 2reGe;i*(i'1 2i1+e'(ed "e*io' (%a(


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0old o"d a&&/+/"a(e* i' (i**/e* /2o' (%e "o'1G(i+e a22"i&a(io' o0 i'=e&(io'* &o'(ai'i'1 &o""oida" 1o"d*o"/(io'* (%a( are /*ed i' (%e (rea(+e'( o0 r%e/+a(oid ar(%ri(i*. I( &a/*e* a (y2i&a"


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%i1%e*( i'&ide'&e ra(e i* a+o'1 +e' a( (%e a1e o0 ?-G8- year*. Ma"i1'a'( (ra'*0or+a(io' o0 "e/ko2"akiavarie* i' a ra'1e o0 G8b. T%e deve"o2+e'( o0 +a"i1'a'&y de2e'd* o' a &o+o4"?"3s"s0 soor0 thrush) I( i* a' i'0"a++a(ory 0/'1a" &o'di(io'. T%e 2redi"e&(io' *i(e i* (%e ora" +/&o*a 0ro+ %i&% i( +ay*2read (o (%e +/&o/* +e+


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i'0e&(io' i'(o (%e * a""o i'1 ro/(e*. I0 (%e i'0"a++a(io' doe* 'o( %ea" *2o'(a'eo/*"y or a0(er (%era2y #i( +ay 2ro1re** (o (%e &%ro'i& *(a1e or (o (%e di**e+i'a(io' or 1e'era"iza(io' o0 (%e 2ro&e**. Acute erythe"atous candidiasis/*/a""y deve"o2* d/e (o dy*+i&ro


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ora" &a'didia*i* a"*o i'&"/de o(%er# "e** &o++o' di*ea*e* o0 (%e "i'1/a" +/&o*a (%a( are G (o1e(%er i( 2ro*(%e(i& *(o+a(i(i* G re0erred (o a* Ca'didaGa**o&ia(ed "e*io'*[.

;.2.2.1 edian rho"#oid glossitis (0lossitis rho"#ica "ediana /roc'7Pautrier glossitis) I( i* a red# *+oo(%ed 2a(&% o0 ova"# re&(a'1/"ar or r%o+


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2eriodo'(a" (rea(+e'( a'd (%e e;(ra&(io' o0 de*(r/&(ed (ee(% a'd roo(* (%e e"i+i'a(io' o0 *o/r&e* o0 yea*( . I( i* a"*o i+2or(a'( (o (rea( 2redi*2o*i'1 1e'era" di*ea*e*# i0 2o**i


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2if. dg.: T%e 0i'di'1 o0 *2oradi& "i&%e' 2a2/"e* a( (%e ed1e* o0 2a(&%e* dia1'o*i* /*i'1i++/'o%i*(o"o1y i* re"ia3t"t"s 9u>34t"u>0 ? u@o@ r3tos"s 4"8ot"4"83 ,


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I( i* a rare di*ea*e i(% a/(o*o+a" do+i'a'( i'%eri(a'&e. I( o&&/r* +ore 0reH/e'("y i' +e' (%a' i'o+e'. Sy+2(o+* +a'i0e*( (%e+*e"ve* i' &%i"d%ood or ado"e*&e'&e. T%e di*ea*e 2redo+i'a'("y a00e&(*

(%e *ki' a'd 'ai"* (%e +/&o*a ora"# re&(a" a'd 1e'i(a" &a' a"*o


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%ea"(%y (i**/e# i(% *ki' a(ro2%y a'd (e"ea'1ie&(a*ia* i' a +ore adva'&ed 2%a*e o0 (%e di*ea*e (%&"o ' * 0a&e . Ery(%e+a &e'(ri0/1/+[ i* a &%ara&(eri*(i& 0i'di'1 i(% (y2i&a" "o&a"iza(io' a


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*h: Radi&a" */r1i&a" (%era2y. 2if. dg.: Fro+ a di00ere'(ia" dia1'o*i* 2oi'( o0 vie # i( i* *o+e(i+e* di00i&/"( (o di*(i'1/i*% ery(%ro2"akia0ro+ &%ro'i& ery(%e+a(o/* &a'didia*i* %ere (%e ery(%e+a(o/* re1io' o0 (%e a00e&(ed +/&o*a i* /*/a"""o&a(ed o' (%e 2a"a(i'e +/&o*a or o' (%e +/&o*a o0 (%e (o'1/e dor*/+# i' o'e 2"a'e i(% (%e

*/rro/'di'1 +/&o*a. Ery(%ro2"akia i* 'o( &o++o' a( (%e*e *i(e*. I( i* a"*o di00i&/"( (o di*(i'1/i*%ery(%ro2"akia 0ro+ a(ro2%i& "i&%e' r/


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Fig. . 2ifferential diagnosis of diseases with the white patch s#mptom as the ma


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ado"e*&e'&e a'd ad/"(%ood /2 (o (%e a1e o0 > year*. I( i* (ra'*+i((ed


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I( i* a &o""e&(ive (er+ /*ed (o de*&ri


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Cc ema herpeticatum Baposi (pustulosis varioliformis! T%i* *erio/* 0or+ o0 2ri+ary i'0e&(io' &a/*ed b o0 2a(ie'(* %o deve"o2 2ai'0/" ero*io'* i' (%e +o/(% (%a( are +ore*evere (%a' (%o*e a**o&ia(ed i(% %er2e(i& *(o+a(i(i*.*h: T%e 1e'era" a22"i&a(io' o0 viro*(a(i& a1e'(* J a&y&"ovir ACV # *y+2(o+a(i& (%era2y# or 1a++aG1"o


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a&/(e *(o+a(i(i* i(% 2%ary'1i(i*# /*/a""y i(% i'di*(i'&( &"i'i&a" 2ro


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2if. dg: S(re2(o&o&&a" a'1i'a a'1i'a "a&/'ari* i"" re*o"ve d/ri'1 ATB (%era2y i' ,G day* e'"ar1ed"y+2% 'ode* are 2ai'0/". !er2e(i& 1i'1ivo*(o+a(i(i* %a* a (y2i&a" ( oG2%a*e[ 2ro1re**io' 1e'era"*y+2(o+* di*a22ear i(% (%e deve"o2+e'( o0 (%e i'(raora" di*ea*e a'd 2*e/do+e+


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I'%eri(a'&e J (%e ro"e o0 1e'e(i& 0a&(or* i* */22or(ed 37or 3


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h r< t"9or> (y2e J "e** &o++o' /2 (o :-b . C"i'i&a" 0i'di'1 i* *i+i"ar (o (%a( o0 %er2e(i&1i'1ivo*(o+a(i(i*. !o ever# (%e a00"i&(io' o0 (%e 1i'1iva a'd 1e'era" *y+2(o+* are a


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So"&o*ery" de'(a" ad%e*ive 2a*(e . $rior (o 2re*&ri


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;. .2.1 Erythe"a "ulti!or"e (erythe"a e-sudativu" "ulti!or"e He#rae) A&&ordi'1 (o &/rre'( &o'&e2(*# (%i* (er+ i* o'"y de*&ri2(ive# a* i( doe* 'o( *2e&i0y (%e ori1i' a'd'a(/re o0 (%e di*ea*e. T%e a""er1i& &o+2o'e'( 2"ay* a ro"e i' (%e e(io"o1y o0 (%e di*ea*e#


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addi(io'# *y+2(o+* &a' a"*o o&&/r i' (%e eye* a'd (%e CNS. T%i* i* a 1e'era"ized di*ea*e a00e&(i'1+/"(i2"e or1a'*# (%era2y i* o'"y *y+2(o+a(i&.

'+'+ To="8 3?? r;"8 =34th >3

To e*(a


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o&&/r* i' i'divid/a"* a( (%e a1e o0 >-G8- year*# i(% (%e *a+e i'&ide'&e ra(e i'


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I( i* a */2er0i&ia"# "e** *erio/* 0or+ i(% a 2ro"o'1ed 2ro1re**io'. I( o&&/r* rare"y. I( i* &%ara&(erize


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Ctiopathogenesis:I( i* a' a/(oi++/'e di*ea*e i(% (%e 2re*e'&e o0 &ir&/"a(i'1 a'(i


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)esk#: Cnglish:Fyzik "'3 &%e+i&k v"ivy $%y*i&o&%e+i&a" 0a&(or*M/"(i0or+') ery( + Ery(%e+a +/"(i0or+e$e+2%i1/* $e+2%i1/*Be'i1') 2e+2%i1/* de*va+a(iv') 1i'1ivi(i* Be'i1' 2e+2%i1/* de*H/a+a(ive 1i'1i(ivi*Li&%e' r/3r"?5 399 8t"4; th ;"4;"!3 T%e 0ir*( 1ro/2 &o'(ai'* di*ea*e* (%a( 2ri+ari"y a00e&( (%e 1i'1iva a'd o&&/r i' o(%er re1io'* o0 (%eora" +/&o*a o'"y very rare"y# /*/a""y a( (%e *i+/"(a'eo/* a00"i&(io' o0 (%e 1i'1iva . Di*ea*e* */&% a*

9,


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2if. dg: A&/(e vira" *(o+a(i(i* /*/a""y


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T%e (y2i&a" 0ea(/re o0 (%e *e&o'd 1ro/2 o0 di*ea*e* i* (%a( /"&er* do 'o( a00e&( (%e 1i'1iva 2ri+aria'd are /*/a""y "o&a"ized i' o(%er re1io'* o0 (%e ora" &avi(y. T%i* 1ro/2 o0 di*ea*e* i'&"/de* de&/


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re1io'a" "y+2% 'ode* */


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I( ari*e* d/e (o &%e+i&a"


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ear"y "a(e'&y# 0o""o ed


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T%etraumatic ulcer o0 (%e ora" +/&o*a i* de(e&(ed i' (%e 0ir*( *(a1e o0 (%e di*ea*e. I( di00er* 0ro+ 2ri+ary i'0e&(io'


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Fig. 11: 2ifferential diagnosis of the disease with an ulcer as the "asic skin manifestation(taken from Onemocnn sli nice dutin# ustn (Oral mucosal diseases!% $kach et al.% 1& 5!.

)esk#: Cnglish:V"ivy 0yzik "') dek/


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'o'e o0 (%e+


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8HairyC leukoplakia (condylo"a plana) I( i* &%ara&(erized


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deve"o2. I'i(ia" +i"d 2ai' i"" &%a'1e (o i'(e'*e 2ai'. T%e 2re+o"ar *e&(io'* o0 (%e =a * are +o*("ya00e&(ed. $re*e'( 2eriodo'(i(i* i* a 2redi*2o*i(io'.*h: T%e %y1ie'e o0 (%e ora" &avi(y +e&%a'i&a" a'd &%e+i&a" J &%"or%e;idi'e# (%e "o&a" a22"i&a+e(ro'idazo"e# or 1e'era" a22"i&a(io' o0 a'(i


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2'$'+ Fu4;3? "49 8t"o4s Re&/rre'( &a'didia*i* i* (%e +o*( &o++o' +a'i0e*(a(io' i' (%e ora" &avi(y i' !IVG2o*i(ive 2a(ie'(*.!o ever# (%e ra'1e o0 0/'1a" di*ea*e* i* +/&%


85/93

T%i* ki'd o0 "y+2%o+a i* (%e *e&o'd +o*( &o++o' +a"i1'a'&y i' !IVG2o*i(ive i'divid/a"*. T%e1rea( +a=ori(y o0 "y+2%o+a* ori1i'a(e 0ro+ BG"y+2%o&y(e*# u8os3 o9 4o4s< 8"9"8 t"o?o;5 "4 HIV 4t o9 HIV


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2' MUCOSAL CHAN%ES IN THE ORAL CAVITY ASSOCIATED 1ITH DISEASES OF THEHEMATOPOIETIC SYSTEM T%e 0ir*( *y+2(o+* o0 *o+e o0 (%e .?. .

Aplastic anemia I( o&&/r* %e' %e+o2oie*i* i' (%e


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T%ey &a' o&&/r a0(er


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A (y2i&a" +o/(% odo/r o&&/r* i' (%e (er+i'a" *(a1e o0 &%ro'i& re'a" 0ai"/re# a( /re+ia. O(%er i*e#(%ere are 'o (y2i&a" &%a'1e* o' (%e +/&o*a. T%e (o'1/e &a'


90/93

$re&a'&ero*e* i' (%e re1io' o0 (%e "i2* a'd ora" +/&o*a 2ar(i&/"ar"y i'&"/de "e/ko2"akia a'dery(%ro2"akia# rare"y *e'i"e kera(o+a a'd &or'/ &/(a'e/+. O' (%e


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$*'- OTHER FACULTATIVE PRECANCEROSES T%ere i* a ide ra'1e o0 o(%er 2a(%o"o1i&a" &o'di(io'* G 1e'era" or "o&a" G %i&% +ake (%e o+/&o*a +ore */*&e2(i ) I( 2redo+i'a'("y o&&/r* i' +idd"eGa1ed o+e' i(% iro' de0i&ie'&y i' *er/+ *ee C%a2(er >.?. .T%e %o"e +/&o*a i' (%e ora" &avi(y i* 1"o**y# red a'd a(ro2%i&. Le/ko2"akia* are &o++o' a'd +ay(/r' i'(o &ar&i'o+a i' *o+e &a*e* 2ar(i&/"ar"y i' (%e rear 2ar( o0 (%e ora" &avi(y a'd (%e oro2%ary'; .

$*'-' D"s8o" ?u3tosus (DLE)I( 2re*e'(* i' (%e ora" +/&o*a a* 2*e/doe2i(%e"io+a(o/* %y2er2"a*ia *ee C%a2(er .,. .: . Car&i'o+a

a* re2or(ed (o deve"o2 i' (%e a(ro2%i& e2i(%e"i/+ 2ar(i&/"ar"y o' (%e "o er "i2 .

$*'-'+ X ro r>3


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Bere^ M# j/rovi E# !/1e&ov A# !/1e& $. Vh:G:>?.

o(ke . $a(o"o1ie oro0a&i "') o


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4 r/

Documents

University Textbook of Oral Mucosal Diseases