THROAT - Leukoplakia

What is leucoplakia?

White patch or plaque of squamous epithelium that cannot be characterized clinically or pathologically as any other disease.

Which are the most common sites for leucoplakia?

  • Buccal mucosa
  • Oral commissure
  • Ventral surface of tongue
  • Floor of mouth
  • Rarely, larynx.

What are the common causes and incidence rate of leucoplakia?

  1. Predisposing factors:
    • Sharp tooth
    • Smoking
    • Sepsis
    • Spirits(Alcohol)
    • Spices
    • Syphilis
    • Ill fitting dentures
    • Plummer Vinson syndrome
    • Oral submucous fibrosis
    • Chronic hyperplastic candidiasis
  2. Age: Can occur in any age but middle aged or elderly are more commonly affected.
  3. Sex: Males more frequently affected than females due to smoking and alcohol habits.

What are the different types of leucoplakia?

  • Homogenous leukoplakia: Characterized by white patch – surface may be smooth or wrinkled
  • Speckled or nodular leukoplakia: White patches or nodules or nodules on erythematous base

Pathology of leucoplakia:

  • Macroscopic: Affected area of mucous membrane appears as a thickened grey-white plaque with cracks or fissures.
  • Microscopically: Hyperplasia of superficial layer of squamous epithelium with hyperkeratosis, swelling, vacuolation of cells of middle layer with hyperplasia and hyperchromasia of basal layers of cells. Dyskeratosis is a serious complication associated with malignancy.

What are the signs of neoplastic changes in the leukoplakia?

Signs of neoplastic changes in the leukoplakia:

  • Usually within tissue
  • Suspected if there is thickening, bleeding, area of erythema and pain

Clinical Stages of Leucoplakia:

Stage I: Appearance of thin grey transparent patch on the tongue which may be localized or wide spread
Stage II: Thin patch gradually turns white and opaque. This is leucoplakia
Stage III: Gradually hyperplasia leads to small nodule or warty desquamation leaving areas of smooth red and shiny patches
Stage IV: Stage of appearance of carcinoma. All characteristic features of carcinoma seen. The carcinomatous change usually occurs within the fissures and should be suspected if there is local thickening, pain or bleeding.

What is the treatment for leucoplakia?

Treatment of leucoplakia:

  • Removal of predisposing cause
  • Oral antioxidants are said to be useful
  • Excision Biopsy of the suspicious white patch
  • Small superficial patches of leucoplakia may be satisfactorily treated by excision by CO2 laser or cryosurgery
  • Patients should be examined at regular three monthly intervals to note appearance of warty excrescence. Any doubtful lesions if present must be removed and examined histologically
  • Jaw strecther for inability to open the mouth Trismus)

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