Otolaryngology Book

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Oral Mucositis

Aka: Oral Mucositis, Stomatitis
  1. See Also
    1. Oral Ulcers
    2. Pharyngitis
  2. Definitions
    1. Stomatitis
      1. Inflammation of the mouth and lips
      2. Broader term that includes Oral Mucositis
    2. Mucositis
      1. Painful inflammation and ulceration of the gastrointestinal tract
      2. Typically caused by Chemotherapy or Radiation Therapy
  3. Causes: Stomatitis
    1. Vitamin Deficiency (typically associated with recurrent Aphthous Ulcers)
      1. Iron Deficiency Anemia
      2. Vitamin B1 Deficiency (Thiamine deficiency)
      3. Vitamin B2 Deficiency (Riboflavin deficiency)
      4. Vitamin B6 Deficiency (Pyridoxine deficiency)
      5. Vitamin B9 Deficiency (Folic Acid Deficiency)
      6. Vitamin B12 Deficiency (Cobalamin Deficiency)
    2. Specific lesions
      1. Angular Stomatitis
      2. Aphthous Stomatitis
      3. Herpes Gingivostomatitis
        1. Involves Tongue and Hard Palate
      4. Nicotinic Stomatitis
      5. Acute Necrotizing Ulcerative Gingivitis (Vincent's Stomatitis)
      6. Local Trauma or reaction (e.g. ill-fitting dentures, Contact Dermatitis)
      7. Oral Mucositis associated with high dose Chemotherapy or head/neck Radiation Therapy
        1. Often involves Buccal mucosa
        2. May be complicated by Oral Candidiasis (Thrush) or Herpes Gingivostomatitis
  4. Management
    1. See Oral Ulcer
    2. See Pharyngitis Symptomatic Treatment
    3. Evaluate for complications of mucositis and poor oral intake (esp. Chemotherapy and Radiation Therapy related)
      1. Severe dehydration
      2. Electrolyte abnormalities (e.g. Hyponatremia, Hypokalemia)
      3. Failure to Thrive
      4. Secondary Oral Infections
        1. Antifungal rinses may be used prophylactically
      5. Bleeding lesions
        1. Keep Platelet Count >20,000
        2. Apply local pressure
        3. Topical Tranexamic Acid (TXA)
    4. Treat specific causes
      1. Angular Stomatitis
      2. Aphthous Stomatitis
      3. Herpes Gingivostomatitis
    5. Symptomatic management
      1. General measures
        1. Consider debriding with soft ToothBrush
      2. Saline rinses
        1. Prepare one teaspoon salt in 32 ounces water
        2. Some recipes recommend adding bicarbonate
      3. Topical over-the-counter agents
        1. Amphojel (coats lesions)
        2. Zilactin (forms film over the lesion)
      4. Topical prescription agents (expensive)
        1. Episil (viscous gel)
        2. Mugard (oral rinse)
        3. Gelclair (viscous gel)
      5. Consider topical combination agents
        1. Viscous Lidocaine
          1. Exercise caution in dosing and toxicity
        2. Magic Mouthwash
          1. Typically compounded (e.g. Lidocaine, Benadryl, maalox, with or without a Corticosteroid and/or antibiotic)
        3. First Mouthwash BLM (commercially prepared)
          1. Diphenhydramine, Lidocaine, Maalox, and Simethicone
      6. Avoid unhelpful or harmful agents
        1. Avoid sucralfate (ineffective)
        2. Avoid chlorhexidine (ineffective)
        3. Avoid Alcohol-based rinses (may exacerbate pain)
        4. Avoid hydrogen peroxide (may delay healing)
      7. Other agents used in Chemotherapy and Radiation Therapy induced mucositis
        1. Doxepin 0.5% solution
        2. Morphine 2% mouthwash preparation
        3. Keratinocyte growth factor preparation
        4. Systemic Analgesics
  5. References
    1. Negrin in Drews (2014) Oral Toxicity Associated with Chemotherapy, UpToDate, accessed online 11/05/2014
    2. Swaminathan and Dibbs in Herbert (2020) EM:Rap 20(8): 2
    3. (2014) Presc Lett 21(11): 64
    4. Nolan (1991) J Oral Pathol Med 20(8):389-91 [PubMed]
    5. Sun (2014) J Oral Pathol Med [PubMed]
    6. Thongprasom (2001) Southeast Asian J Trop Med Public Health 32(3):643-7 [PubMed]

Stomatitis (C0038362)

Definition (CHV) inflammation of the mucous tissue of the mouth
Definition (CHV) inflammation of the mucous tissue of the mouth
Definition (NCI_NCI-GLOSS) Inflammation or irritation of the mucous membranes in the mouth.
Definition (NCI) Inflammation of the oral mucosa due to local or systemic factors.
Definition (NCI_CTCAE) A disorder characterized by inflammation of the oral mucosal.
Definition (CSP) inflammation of the oral mucosa due to local or systemic factors.
Definition (MSH) INFLAMMATION of the soft tissues of the MOUTH, such as MUCOSA; PALATE; GINGIVA; and LIP.
Concepts Disease or Syndrome (T047)
MSH D013280
ICD10 K12.1
SnomedCT 95361005, 61170000, 155660009, 196527002
English Stomatitides, STOMATITIS, Stomatitis, stomatitis, stomatitis (diagnosis), Mucositis oral, Oral Mucositis, Stomatitis NOS, Stomatitis [Disease/Finding], Oral mucositis, oral mucositis, Stomatitis NOS (disorder), Inflammation of oral mucosa, Inflammatory condition of oral mucous membrane, Stomatitis (disorder), Stomatitis, NOS
French STOMATITE, Mucite orale, Stomatite
Portuguese ESTOMATITE, Mucosite oral, Estomatite
Spanish ESTOMATITIS, Mucositis oral, mucositis bucal, afección inflamatoria de la membrana mucosa bucal, Stomatitis NOS, estomatitis, SAI, estomatitis, SAI (trastorno), estomatitis (trastorno), estomatitis, Estomatitis
German STOMATITIS, Mukositis oral, Stomatitis
Dutch mucositis oraal, stomatitis, Stomatitis
Italian Mucosite orale, Stomatite
Japanese 口腔粘膜炎, コウクウネンマクエン, コウコウネンマクエン, コウナイエン, 口腔炎, 口内炎
Swedish Muninflammation
Czech stomatitida, Stomatitida, Zánět ústní sliznice, zánět sliznice dutiny ústní
Finnish Suutulehdus
Russian STOMATIT, СТОМАТИТ
Croatian Not Translated[Stomatitis]
Polish Zapalenie jamy ustnej, Zapalenie błony śluzowej jamy ustnej
Hungarian Oralis mucositis, Stomatitis
Norwegian Munnhulebetennelse, Stomatitt
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Pharyngeal mucositis (C1699324)

Definition (NCI) An inflammatory process affecting the mucous membrane of the pharynx.
Definition (NCI_CTCAE) A disorder characterized by an inflammation involving the mucous membrane of the pharynx.
Concepts Disease or Syndrome (T047)
Dutch mucositis van keelholte
French Inflammation de la muqueuse pharyngée
German Mukositis des Pharynx
Italian Mucosite faringea
Portuguese Mucosite faríngea
Spanish Mucositis faríngea
Japanese 咽頭粘膜炎, イントウネンマクエン
Czech Mukozitida hltanu
English Pharyngeal Mucositis, Pharyngeal mucositis
Hungarian Pharyngealis mucositis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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