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Jemds.com Original Research Article ORAL ULCERS- A CLINICOPATHOLOGICAL PROFILE... Manjunath K1, Smitha V. Manjunath2 1Assistant Professor, Department of ENT, Basaveshwara Medical College and Hospital & Research Centre, Chitradurga. 2Postgraduate Student, Department of Oral Pathology & Microbiology, Bapuji Dental College and Hospital, Davangere. ABSTRACT BACKGROUND Oral ulcers have been an everyday problem and routinely patients with oral ulcers are treated symptomatically without even coming to a definitive conclusion of their own disease. The objectives of this study are to identify various aetiological factors in ulcers of oral cavity and to study the benign and malignant nature of these lesions and outcome of its management. MATERIALS AND METHODS Study included patients attending ENT Outpatient Department for 12 months at our Hospital, wherein 68 cases were studied. RESULTS Out of 68 cases, 55 cases (80.8%) were non-malignant ulcers and 13 cases (19.1%) were malignant (including 3 cases of Leukoplakia). There were proper 10 cases of malignant ulcers (14.7%), M: F : 4: 6, commonest age group between 3rd to 4th decade. Histopathologically, all the malignant ulcers were Squamous Cell Carcinoma. CONCLUSION Oral ulcers are common disease for which patient seeks medical advice. Clinical examination and histopathological examinations are mandatory investigations done for early diagnosis and treatment. KEYWORDS Histopathological Examination, Tobacco Chewers, Smoking, Betel Quid Chewers, Oral Cavity Lesions, Pre-Malignant Lesions (Leukoplakia), Malignant Lesions, Wedge Biopsy, Cancer Screening. HOW TO CITE THIS ARTICLE: Manjunath K, Manjunath SV. Oral ulcers- a clinicopathological profile... J. Evolution Med. Dent. Sci. 2017;6(69):4938-4941, DOI: 10.14260/Jemds/2017/1071 BACKGROUND and erythroplakia. Furthermore, lichen planus and oral Oral ulcers have been an everyday clinical condition to many submucous fibrosis are on rise. It was only in 1967 when an otolaryngologists, physicians and dental surgeons. Many a international reference centre for the study of oral pre- times, patients with oral ulcers are treated symptomatically cancerous lesion was established by the WHO. The incidence without even coming to a definitive conclusion of their of oral cancer among patients who had tobacco smoking was malady. Among them many lesions are benign, pre-malignant 8.4-fold higher than that among patients who did not. and malignant with various aetiological factors. Membranous patch is an inflammatory condition, in Most of the oral cavity lesions are asymptomatic. The which the cells of mucous membrane surface are eroded, an association between ill-fitting dentures and tobacco chewing, exudate is laid down on the surface and the whole necrotic where most of them are inflammatory like aphthous ulcers, layer is bound by fibrosis to the underlying tissue to form a oral candidiasis, oral submucous fibrosis, mucoceles and false membrane classically seen in diphtheritic membrane. nevus. No significant advancement in the treatment of oral Oral cavity ulcer may be an early sign of drug reaction or lesions was found in recent years. malignant transformation due to nutritional disorder and World Health Organisation (WHO) workshop end in 2005, immunocompromised state. So, early diagnosis may help in terminology, definitions and classification of oral lesions with better treatment and reduction of morbidity and mortality. predisposing factors of malignant transformation has been discussed. The conditions considered as pre-malignant are Objectives of the Study leukoplakia, lichen planus, oral submucous fibrosis and To identify clinical behaviour and various aetiological erythroplakia. The pre-malignant conditions of the oral cavity factors associated with ulcerative and membranous are those which have potentiality to turn malignant in its due conditions in oral cavity and oropharynx. course if left untreated. In these treaties, tension was given to To know the significance in clinical morbidity and to leukoplakia determine the malignant potential in these lesions. Financial or Other, Competing Interest: None. Submission 08-07-2017, Peer Review 03-08-2017, MATERIALS AND METHODS Acceptance 08-08-2017, Published 28-08-2017. • This study is a descriptive study from March 2016 Corresponding Author: Dr. Smitha V. Manjunath, to February 2017 for 12 months. The data was Postgraduate Student, collected from the patients after taking history, Bapuji Dental College and Hospital, Davangere. detailed clinical examination and relevant E-mail: [email protected] investigations. DOI: 10.14260/jemds/2017/1071 J. Evolution Med. Dent. Sci./eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 6/ Issue 69/ Aug. 28, 2017 Page 4938 Jemds.com Original Research Article • Clinical diagnosis was confirmed by throat swabs fibrosis, 6 had abusive history of smoking and gutka chewing for culture, blood tests and biopsy for and 3 had history of alcohol, betel nuts and pan chewing. histopathological examination (HPE) wherever In our study, various investigations have been done for 56 necessary. Patients were treated appropriately and cases (82.3%). Routine haematological tests were done. Out regular followup of the cases was done. of these Random blood sugar 15 cases were elevated, HIV and HBsAg were positive in 3 cases, ESR levels were raised in 2 Data was analysed by using descriptive statistics (mean, cases and 12 cases were anaemic with Hb < 10 gm%. proportions, percentage) and presented in the form of tables, For 30 cases, Wedge biopsy was done and sent for bar diagram, cone diagram and pie diagrams. histopathological examination. Out of these, 10 cases were diagnosed to have squamous cell carcinoma, 3 cases were RESULTS pre-malignant lesions (leukoplakia), 4 cases were oral In our study of aetiopathology of ulcers and membranous submucous fibrosis, 2 cases were lichen planus, 2 cases were lesions of oral cavity and oropharynx of the 68 cases, out of pemphigus vulgaris and 9 cases were aphthous ulcers. which 56 patients were above 40 years of age and 12 were In our study, benign ulcers were 54 cases (79.4%), pre- below that age. P-value was 0.001. Out of 68, males were 46 malignant lesions (leukoplakia) were 4 cases (5.8%) and cases (67.6%) and females were 22 cases (32.3%). The ratio malignant lesions were 10 cases (14.7%). of Male: Female was 2: 1 with male predominance. Among the study group various benign lesions were aphthous ulcers 25 cases (36.7%), oral submucous fibrosis 12 Sex No. of Patients Percentage P value cases (17.6%), oral candidiasis 6 cases (8.8%), dental ulcers 2 Male 46 66% cases (2.9%), pemphigus vulgaris 2 cases (2.9%), traumatic Female 22 34% 0.05 ulcers 2 cases (2.9%), lichen planus 2 cases (2.9%) and Total 68 100% follicular tonsillitis 3 cases (4.4%). Table 1. Sex Distribution The present study shows various lesions presented as ulcers and membranous lesions, among them patients came Among the study group, 52 cases (76.4%) presented as with ulcers were 23 cases of aphthous ulcers, 8 cases of oral ulcer and 16 cases (23.5%) as membrane like lesions. submucous fibrosis, 10 cases of malignant lesions, 2 cases of In the study, the anatomical distribution of various ulcers dental ulcers, pemphigus vulgaris, traumatic ulcers, and membranous lesions were buccal mucosa 41 cases leukoplakia and lichen planus respectively. Cases presented (60.2%), tongue 11 cases (16.1%), lips 6 cases (8.8%), as membrane like lesions were 2 cases of aphthous ulcers, 4 gingiva 3 cases (4.4%), hard palate 3 cases (4.4%), anterior cases of oral submucous fibrosis, 6 cases of oral candidiasis, 3 tonsillar pillar 2 cases (2.9%) and soft palate 2 cases (2.9%). of follicular tonsillitis and 2 of leukoplakia. In our present study, patients having abuse/ habits were In our study, among various types of lesions 35 cases 45 cases (66.1%). Various combined abuse/ habits found in (51%) were acute ulcers (less than 3 weeks), among them 20 these patients were smoking in 20 cases (29.4%), alcohol in were (29.4%) aphthous ulcers (sporadic), 3 were (4.4%) oral 18 cases (26.4%), tobacco chewing in 23 cases (33.8%), betel submucous fibrosis, 4 were (5.8%) oral candidiasis, 2 were nuts in 22 cases (32.3%), pan chewing in 20 cases (29.4%) (2.9%) leukoplakia and traumatic ulcers respectively, 1 was and gutka in 14 cases (20.5%). In the study, duration of (1.4%) dental ulcer, pemphigus vulgaris, lichen planus and abuse/ habits were smoking for 25-30 yrs. of 27 cases follicular tonsillitis respectively. In chronic ulcers (more than (61.3%), alcohol for 12 – 15 yrs. of 8 cases (18.1%), Gutka 3 weeks) there were 33 cases (49%), among them 5 were chewing for 12 – 15 yrs. of 4 cases (9%), tobacco chewing for (7.3%) aphthous ulcers (recurrent), 9 were (13.2%) oral 8 - 10 yrs. of 3 cases (6.8%) and betel nuts and pan chewing submucous fibrosis, 10 were (14.7%) malignant lesions, 2 for 8 – 10 yrs. of 3 cases (6.8%). were (2.9%) oral candidiasis, leukoplakia and follicular Among the study group, 45 cases (66.1%) had habits/ tonsillitis respectively, 1 was (1.4%) dental ulcer, pemphigus abuse and 23 cases (33.8%) did not have any habits. Out of vulgaris and lichen planus respectively. patients who had habits, 29 (42.6%) were males and 16 (23.5%) were females. DISCUSSION • In our study, commonest benign ulcers constituting Habits/ No. of Per- 80.8% (n= 55) of all cases. Majority of them were Sl. No. P-value Abuse Patients centage Aphthous ulcers in buccal mucosa and lateral Patients having border of tongue. Other benign ulcers were oral 1. 45 66.1% habits submucous fibrosis 20.5% (n= 14) and oral 0.008 Patients not candidiasis 8.8% (n= 6). Next commonest benign 2. 23 33.8% ulcers were Dental ulcers 4.4% (n= 3), Pemphigus having habits vulgaris 4.4% (n= 3), Traumatic ulcers 2.9% (n= 2) Table 2.
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