Scully Oral and Maxillofacial Diseases Oral and Flint Fourth Edition Bagan About the book Porter Maxillofacial An established bestseller through its previous editions, this is the definitive visual resource for manifestations of oral and Moos maxillofacial diseases, with a comprehensive collection of over 1300 exemplary illustrations. This new edition has a new organization both by disease group and by anatomical region (including new material on the neck): it is also a practical guide to diagnosis and management, with guides to the drugs used in management and to possible oral and maxillofacial adverse effects of drugs used in treatment. The use of colour illustration and tables and lists throughout enables the best presentation Diseases of key information. O This is an essential aid to diagnosis for those working in Oral Medicine, Oral Pathology, Oral Surgery, Oral and Maxillofacial r a Surgery, Head and Neck Surgery, Otolaryngology, Infectious Diseases, Dermatology and Dental specialties. l a n About the editors Fourth Edition d CrISPIAN SCULLY CBE, MD, PhD, MDS, JOSE V BAGAN, MD, DDS, PhD, is President MrCS, FDSrCPS, FFDrCSI, FDSrCS, FrCPath, of the European Association of Oral Medicine, M FMedSci, FHEA, FUCL, DSc, DChD, DMed and Professor, Valencia University and a (HC), Dr HC, is President-elect of the Hospital General Universitario de Valencia, x An illustrated guide to the diagnosis and management of diseases of International Academy of Oral Oncology; Spain Professor of Oral Medicine, Pathology and i the oral mucosa, gingivae, teeth, salivary glands, jaw bones and joints l Microbiology, University of London; Professor l o of Special Care Dentistry, University College STEPHEN r POrTEr, MD, PhD, FDSrCS, f London Eastman Dental Institute; Visiting FDSrCSE, FHEA, is Institute Director and a Professor, Universities of Bristol, Edinburgh, Professor of Oral Medicine, University College c Granada, and Helsinki; and Honorary London Eastman Dental Institute and i Consultant, University College London a Honorary Consultant, University College Hospitals, and Great Ormond Street Hospital l London Hospitals, UK for Children, London, UK D i STEPHEN r FLINT, MA, PhD, MBBS, FFDrCSI, KHUrSHEED F MOOS, OBE, MB, BS, BDS, s FDSrCS, FICD, FTCD, is Professor and FrCS, FDSrCS, FDSrCSE, FDSrCPS, is Emeritus e Consultant in Oral Medicine, Dublin Dental Professor and Honorary Consultant, Glasgow a School and Hospital, Trinity College, Dublin, Hospitals, University of Glasgow, UK s Ireland e s F o u r t h E d i t i o n Edited by Crispian Scully, Stephen R Flint, Jose V Bagan, Stephen R Porter Khursheed F Moos and Telephone House, 69-77 Paul Street, London EC2A 4LQ, UK 52 Vanderbilt Avenue, New York, NY 10017, USA www.informahealthcare.com ORAL AND MAXILLOFACIAL DISEASES ORAL AND MAXILLOFACIAL DISEASES An illustrated guide to the diagnosis and management of diseases of the oral mucosa, gingivae, teeth, salivary glands, jaw bones and joints Fourth Edition Crispian Scully CBE, MD, PhD, MDS, MRCS, FDSRCPS, FFDRCSI, FDSRCS, FRCPath, FMedSci, FHEA, FUCL, DSc, DChD, DMed (HC), Dr HC Professor of Oral Medicine, Pathology and Microbiology University of London Professor of Special Care Dentistry, Eastman Dental Institute University College London Visiting Professor Universities of Bristol, Edinburgh, Granada and Helsinki Honorary Consultant University College London Hospitals, and Great Ormond Street Hospital for Children London, UK Stephen R Flint MA, PhD, MBBS, FFDRCSI, FDSRCS, FICD, FTCD Professor and Consultant in Oral Medicine Dublin Dental School and Hospital, Trinity College, Dublin, Ireland Jose V Bagan MD, DDS, PhD Professor Valencia University and Hospital General Universitario de Valencia, Valencia, Spain Stephen R Porter MD, PhD, FDSRCS, FDSRCSE, FHEA Professsor of Oral Medicine Eastman Dental Institute, University College London Honorary Consultant University College London Hospitals, UK Khursheed F Moos OBE, MB, BS, BDS, FRCS, FDSRCS, FDSRCSE, FDSRCPS Emeritus Professor and Honorary Consultant Glasgow Hospitals, University of Glasgow, UK First published in 1989 as An Atlas of Stomatology by Martin Dunitz Ltd, London, UK This edition published in 2010 by Informa Healthcare, Telephone House, 69-77 Paul Street, London EC2A 4LQ, UK. Simultaneously published in the USA by Informa Healthcare, 52 Vanderbilt Avenue, 7th fl oor, New York, NY 10017, USA. © 2010 Informa UK Ltd, except as otherwise indicated. No claim to original U.S. Government works. Reprinted material is quoted with permission. Although every effort has been made to ensure that all owners of copyright material have been acknowledged in this publication, we would be glad to acknowledge in subsequent reprints or editions any omissions brought to our attention. All rights reserved. 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This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as appropriately to advise and treat patients. Save for death or personal injury caused by the publisher’s negligence and to the fullest extent otherwise permitted by law, neither the publisher nor any person engaged or employed by the publisher shall be responsible or liable for any loss, injury or damage caused to any person or property arising in any way from the use of this book. A CIP record for this book is available from the British Library. ISBN-13: 9780415414944 Orders may be sent to: Informa Healthcare, Sh eepen Place, Colchester, Essex CO3 3LP, UK Telephone: +44 (0)20 7017 5540 Email: [email protected] Website: http://informahealthcarebooks.com/ For corporate sales please contact: [email protected] For foreign rights please contact: [email protected] For reprint permissions please contact: [email protected] Typeset by Exeter Premedia Services Printed and bound in the United Kingdom CONTENTS PREFACE TO THE FOURTH EDITION IX 1.4 HAEMATOLOGICAL DISEASE 24 Agranulocytosis 24 Aplastic anaemia 24 1 MAXILLOFACIAL COMPLICATIONS Bleeding tendencies 24 IN SYSTEMIC CONDITIONS 1 Fanconi anaemia 24 Haematinic deficiency 24 1.1 CARDIOVASCULAR DISEASE 3 Haematopoietic stem cell transplantation 24 Angina pectoris 3 Haemoglobinopathies 26 Angiomas 3 Haemolytic disease of newborn 26 Anticoagulants 3 Haemophilia 27 Congenital heart disease 3 Hypereosinophilic syndrome (HES) 27 Drugs 3 Hypoplasminogenaemia 27 Giant cell arteritis 4 Leukaemias 27 Hereditary haemorrhagic telangiectasia (HHT) 4 Leukocyte defects 29 Hypertension 4 Lymphomas 29 Polyarteritis nodosa 4 Multiple myeloma 32 Transplantation 5 Plasmacytosis 33 Wegener granulomatosis 5 Plummer–Vinson syndrome 33 Williams syndrome 5 Polycythaemia 35 Further reading 6 Thrombocytopenia 35 1.2 ENDOCRINOLOGICAL AND METABOLIC Von Willebrand disease 36 CONDITIONS 7 Further reading 36 Addison disease 7 1.5 HEPATOLOGICAL DISEASE 38 Congenital hypoparathyroidism 7 Cirrhosis 38 Congenital hypothyroidism 7 Hepatitis 39 Cushing syndrome 7 Jaundice 40 Diabetes insipidus 7 Primary biliary cirrhosis 40 Diabetes mellitus 7 Transplantation 40 Gigantism/acromegaly 8 Further reading 40 Hyperparathyroidism 8 Hyperthyroidism 10 1.6 IATROGENIC CONDITIONS 41 Hypothyroidism 10 Haematopoietic stem cell transplantation 41 Multiple endocrine neoplasia (adenoma) Graft-versus-host disease 41 (MEN or MEA) syndromes 10 Organ transplantation 41 Pituitary dwarfism 11 Pharmacotherapy 46 Precocious puberty 11 Chemotherapy 46 Pregnancy 11 Immunosuppressive agents 46 Preterm children 12 Tetracyclines 46 Metabolic disorders 14 Other drugs 46 Further reading 14 Osteonecrosis of the jaws (ONJ; osteochemonecrosis) 47 Radiotherapy 52 1.3 GASTROINTESTINAL AND Osteoradionecrosis 56 PANCREATIC DISORDERS 16 Surgery 56 Chronic pancreatitis 16 Dry socket (alveolar osteitis) 56 Coeliac disease 16 Oroantral fistula 59 Crohn disease 16 Oronasal fistula 59 Cystic fibrosis 16 Dental materials 60 Familial adenomatous polyposis (FAP) 16 Further reading 60 Gastro-oesophageal reflux disease (GORD) 18 Malabsorption 18 1.7 IMMUNODEFICIENCIES 62 Neoplasms 18 Acatalasia 62 Pernicious anaemia 19 Ataxia telangiectasia 62 Peutz–Jegher syndrome 19 Chronic mucocutaneous candidosis 62 Short bowel syndrome 22 Autoimmune polyendocrinopathy– Ulcerative colitis 22 candidosis–ectodermal dystrophy 62 Further reading 23 Common variable immunodeficiency 62 VI CONTENTS Di George syndrome 62 Munchausen syndrome 97 Hereditary angioedema 62 Obsessive compulsive disorder 98 Human immunodeficiency virus disease and Schizophrenia 98 acquired immune deficiency syndrome 64 Substance abuse 98 Hyper-IgM syndromes 73 Further reading 99 Leukocyte defects 73 1.10 MUCOSAL, CUTANEOUS AND Myeloperoxidase deficiency 73 MUCOCUTANEOUS DISEASE 100 Neutropenias 74 Papillon–Lefevre syndrome 74 Acanthosis nigricans 100 Selective IgA deficiency 74 Allergies 100 Severe combined immunodeficiency 74 Behçet syndrome (BS) 100 Sex-linked agammaglobulinaemia 74 Darier disease 101 T-cell immune defects 74 Dermatitis herpetiformis 102 Wiskott–Aldrich syndrome 75 Dermatomyositis 102 Further reading 75 Dyskeratosis congenita 102 Ectodermal dysplasia 103 1.8 INFECTIONS 76 Eosinophilic ulcer (EU) 103 Aspergillosis 76 Epidermolysis bullosa 103 Blastomycosis 76 Erythema multiforme 104 Candidosis 76 Gorlin syndrome 109 Cat scratch disease 76 Lichen sclerosis 111 Coxsackie and echo 76 Lichen planus (LP) 111 Cytomegalovirus (CMV) 76 Linear IgA disease (LAD) 121 Epstein–Barr Virus (EBV) 76 Pachyonychia congenita 121 Gonorrhoea 78 Pemphigoid 121 Herpes Simplex Virus (HSV) 78 Pemphigus 124 Herpes varicella zoster 83 Psoriasis 129 Histoplasmosis 86 White sponge naevus 129 HIV 86 Further reading 131 Human herpesvirus 6 (HHV-6) 87 Human papillomavirus (HPV) 87 1.11 NEOPLASTIC DISEASE 133 Impetigo 87 Bone neoplasms 133 Kaposi Sarcoma Herpesvirus (KSHV) 87 Langerhans histiocytosis 133 Kawasaki disease 88 Leukaemia 133 Leishmaniasis 88 Lipoma 133 Leprosy 88 Lymphoma 133 Lyme disease 89 Melanoma 133 Measles 89 Metastases 133 Mucormycosis 90 Myxoma 133 Mumps 90 Neuroblastoma 133 Paracoccidioidomycosis 90 Neurofibroma 133 Rubella 91 Neuroma 133 Syphilis 91 Odontogenic neoplasms 135 Toxoplasmosis 91 Oral carcinoma 135 Tuberculosis 91 Osteoma 135 Further reading 93 Paraneoplastic syndromes 136 Salivary neoplasms 136 1.9 MENTAL DISEASE 94 Sarcomas 139 Anorexia nervosa 94 Further reading 140 Anxiety states 94 Attention deficit hyperactivity 1.12 NEPHROLOGICAL DISEASE 142 disorders 94 Chronic renal failure 142 Autism 96 Nephrotic syndrome 142 Bulimia 96 Oculocerebrorenal syndrome 142 Depression 96 Renal rickets 142 Down syndrome 97 Renal transplantation 142 Learning impairment 97 Further reading 143 CONTENTS VII 1.13 NEUROLOGICAL DISEASE 145 Reactive arthritis 163 Abducens (sixth cranial) nerve palsy 145 Rheumatoid arthritis 163 Alzheimer disease 145 Scleroderma 164 Bulbar palsy 145 Sjögren syndrome 165 Cerebral palsy (CP) 145 Further reading 175 Cerebrovascular accident 145 Choreoathetosis 147 2 COMMON AND IMPORTANT Cranial neuropathies 147 DISORDERS AFFECTING Down syndrome 147 MAXILLOFACIAL REGION: Encephalopathies 147 Epilepsy 148 DIFFERENTIAL DIAGNOSIS BY SITE 177 Facial palsy 149 Diagnosis 177 Horner syndrome 149 Investigations 177 Hypoglossal nerve palsy 149 2.1 LIPS 179 Multiple sclerosis 149 Neck–tongue syndrome 149 Aesthetic conditions 179 Neurofibromatosis (NF) 150 Blisters 186 Neurosyphilis 150 Pigmented, red, purple or blue lesions 189 Oculomotor nerve palsy 151 Soreness, ulceration and pain 193 Parkinson disease 151 Swellings and lumps 202 Sturge–Weber syndrome 151 White lesions 204 Trigeminal neuralgia 151 Further reading 208 Trigeminal sensory loss 151 2.2 ORAL MUCOSA 210 Trochlear nerve palsy 152 Aesthetic conditions 210 Tuberous sclerosis 152 Blisters 210 Further reading 153 Pigmented, red, purple or blue lesions 210 1.14 RESPIRATORY DISEASE 155 Soreness, ulceration and pain 215 Swellings and lumps 222 Antral carcinoma 155 White lesions 226 Asthma 155 Further reading 236 Cystic fibrosis (CF) 155 Lung cancer 155 2.3 TONGUE 239 Sarcoidosis 155 Aesthetic conditions 239 Sinusitis 155 Congenital conditions 239 Tonsillitis 157 Pigmented, red, purple or blue lesions 243 Transplantation 158 Soreness, ulceration and pain 247 Tuberculosis 158 Swellings and lumps 250 Wegener granulomatosis 159 White lesions 256 Further reading 159 Further reading 260 1.15 RHEUMATOLOGICAL AND 2.4 PALATE AND FAUCES 262 MUSCULOSKELETAL DISEASE 160 Aesthetics 262 Cherubism 160 Blisters 262 Cleidocranial dysostosis 160 Red, purple or blue lesions 262 Craniofacial dysostosis 160 Soreness, ulceration and pain 268 Connective tissue diseases 160 Swellings and lumps 271 Ehlers–Danlos syndrome 160 White lesions 272 Ellis–van Creveld syndrome 160 Further reading 278 Fibrous dysplasia 160 2.5 GINGIVAE AND PERIODONTAL Lupus erythematosus 160 Mandibulofacial dysostosis 160 TISSUES 279 Myasthenia gravis 160 Aesthetic conditions 279 Mixed connective tissue disease 160 Bleeding 279 Osteogenesis imperfecta 160 Blisters 281 Osteopetrosis 160 Gingival attachment loss 281 Paget disease of bone 161 Pigmented, red, purple or blue lesions 283 VIII CONTENTS Soreness, ulceration and pain 287 2.10 TEETH 347 Swellings and lumps 289 History related to dental problems 347 White lesions 293 Dental examination 347 Further reading 297 Diagnosis 348 Aesthetics 348 2.6 NECK 300 Early tooth loss 356 Skin and fascia 300 Eruption disorders 356 Lymph nodes 300 Tooth number variations 359 Lymph node swelling 302 Tooth size, shape and structural anomalies 361 Other lesions in the neck 306 Tooth surface loss 367 Further reading 307 Further reading 372 2.7 SALIVARY GLANDS 308 2.11 MAXILLOFACIAL NEUROLOGICAL History related to salivary problems 308 DISORDERS AND PAIN 374 Diagnosis 308 History related to pain and neurological Investigations 308 problems 374 Drooling 309 General features 374 Dry mouth 309 Sensory system 374 Sjögren syndrome 311 Motor system 374 Swellings and lumps 311 Cranial nerve examination 375 Sarcoidosis 315 Diagnosis 376 Sialosis (sialadenosis) 322 Investigations 376 Sjögren syndrome 323 Involuntary movements 377 Further reading 323 Pain 379 Paralysis in the maxillofacial region 382 2.8 JAWS 324 Sensory loss in the maxillofacial region 385 History related to jaw problems 324 Further reading 389 Diagnosis 324 Jaw anatomical and morphological defects and non-odontogenic cystic lesions 325 3 DIFFERENTIAL DIAGNOSES AND Jaw pain 326 MANAGEMENT 391 Jaw swellings 329 3.1 Differential diagnoses by symptoms or signs 393 Further reading 342 3.2 Differential diagnoses by site 405 3.3 Guide to the diagnosis and management 2.9 TEMPOROMANDIBULAR JOINT of orofacial diseases 412 DISORDERS 344 3.4 Guide to drugs used in the management Mandibular pain-dysfunction of orofacial diseases 428 syndrome [temporomandibular joint (TMJ) 3.5 Guide to the orofacial adverse effects dysfunction syndrome] 344 of drug treatment 443 Temporomandibular ankylosis 345 Temporomandibular joint subluxation 345 Further reading 346 INDEX 451 PREFACE TO THE FOURTH EDITION This atlas of oral and maxillofacial pathology differs from can always argue as to which disease is best placed in other atlases by the inclusion of clinical detail on diseases which particular section but we trust readers will find of the oral mucosa, gingivae, teeth, salivary glands, jaw the condition in which they are interested, somewhere. bones and joints, and of a wide range of the more obvious The specific section on diagnosis and management has extraoral manifestations. It is intended primarily as a also been updated and continues to be presented in the pictorial diagnostic aid, both for dental healthcare profes- clear and easy-to-use format and covers differential sionals, surgeons and physicians, with text that provides diagnoses by symptoms, signs and site, investigations a concise synopsis of stomatology. and management of the various conditions covered in the The previous editions over the past 20 years have been book, the drugs used in the management of oral diseases extremely successful and the Atlas has become increas- and the oral and perioral adverse effects of drug treat- ingly popular because of the very wide coverage of oral ment. The further reading has been fully updated. and maxillofacial diseases and the depth of information We are grateful to our colleagues who have kindly contained. Versions have also been published in French, provided some illustrations; particular thanks in addition German and Portuguese. to those acknowledged in the previous editions are to This fourth edition welcomes a new author and provides Antonio Azul (Lisbon), Drore Eisen (Cincinnatti), Catherine one of the most comprehensively illustrated coverage of Flaitz (Houston), Florencio Monje Gil (Valencia), Rodney oral and maxillofacial diseases of which we are aware Grahame (London), Navdeep Kumar (London), Jane worldwide. The Atlas had also, however, become rather Luker (Bristol), Nick Rogers (Rochester), Richard Welbury large and heavy and, therefore, it has been revised, (Glasgow) and Donald Winstock (London); to the pub- updated and re-organized, and some new conditions lishers and our co-authors of Dermatology of the Lips (Scully included. It has been further improved to include better C, Bagan JV, Eisen D, Porter S, Rogers RS) Isis Medical examples of many conditions, particularly additional Media, Oxford, 2000; A Colour Atlas of Orofacial Health and examples of the more common orofacial conditions or Disease in Children and Adolescents (Scully C, Welbury R, where clinical diagnosis can be difficult because of varied Flaitz C, Almedia ODP) Martin Dunitz, London, 2001; presentations. Orofacial Disease; an Update for the Dental Team (Scully C, A major challenge with all books is how best to persuade Porter SR), Elsevier Harcourt, London & Edinburgh, 2002; publishers to afford enough pages without an excessively Oral and Maxillofacial Medicine (Scully C) Elsevier, London high price, and how best to organize and present the and Edinburgh, 2007; Oral and Maxillofacial Medicine and material. Our first edition presented conditions according Pathology (Scully C, Almeida ODP, Bagan JS, Diz Dios P, to the International Classification of Diseases but this is Mosqueda A), Blackwell, Oxford, 2010; The oral cavity incomplete and not always helpful in clinical diagnosis. and lips (Scully C, Hegarty A) In Rook’s Textbook of Derma- We have here attempted to highlight the more common tology. 8th edition. Eds: Burns DA, Breathnach SM, Cox N, and/or important conditions by includ ing more text Griffiths C, Blackwell Science, Oxford, 2010, and to the and/or illustrations of these. publishers of British Dental Journal, British Journal of Chapter 1 summarizes the systemic disorders seen Dermatology, International Journal of Oral and Maxillofacial mainly in hospital practice, with some detail about the Surgery, Journal of Oral Pathology and Medicine, Medicina more important conditions but only a less detailed out- Oral, Oral Diseases, Oral Oncology and Oral Surgery, Oral line of the less common or less relevant disorders: further Medicine and Oral Pathology. background can be found in Medical Problems in Dentistry All typing and image preparation was carried out by (Scully C), Elsevier, London, 2010. Clearly, systemic Crispian Scully. Our thanks are to Paul Darkins and John factors may also influence conditions discussed in other Evans for assistance with the image scanning. chapters. Chapters 2–11 cover the conditions which are more Crispian Scully common and/or important in day-to-day primary care Jose-Vicente Bagan practice, and largely of local aetiology. Much more detail Stephen R Flint on aetiopathogenesis, clinical features, diagnosis and Stephen R Porter management of these conditions has been included. One Khursheed F Moos