Inspect the Buccal Mucosa

The patient should be asked to open the mouth widely. The mouth should be illuminated with a light source. The buccal mucosa must be evaluated for any lesions or color changes, and the buccal cavity is inspected for any evidence of asymmetry or areas of injection (dilated vessels, usually indicative of inflammation). The buccal mucosa, teeth, and gingivae are easily evaluated by using a tongue depressor to retract the cheek away from the gums, as shown in Figure 12-14. The examiner should inspect for discolorations, evidence of trauma, and the condition of the parotid duct orifice.

Are there any ulcerations of the buccal mucosa? Are there white lesions on the buccal mucosa? A common painless white lesion in the mouth is lichen planus, which appears as a reticulated, or lacelike, eruption bilaterally on the buccal mucosa. An erosive, painful variant is similar in appearance except for the presence of hemorrhagic and ulcerated lesions. Nonerosive

Figure 12-12 Peutz-Jeghers syndrome. Note the pigmentary Figure 12-13 Mucocele of the lower lip.

changes.

Figure 12-12 Peutz-Jeghers syndrome. Note the pigmentary Figure 12-13 Mucocele of the lower lip.

changes.

Figure 12-17 Leukoplakia of the tongue.

lichen planus is shown in Figure 12-15. Is leukoplakia present? In the mouth, leukoplakia can manifest as a painless, precancerous white plaque on the cheeks, gingivae, and tongue. Leukoplakia of the gingiva is pictured in Figure 12-16. Over 15 years, this lesion developed into verrucous hyperplasia, verrucous carcinoma, and finally squamous cell carcinoma. A resection of the maxilla and palate was required. Figure 12-17 depicts leukoplakia of the tongue in another patient. The thick, white, adherent patches are sharply demarcated and cannot be denuded from the tongue.

Small, pinhead-sized, yellow papules on the buccal mucous membrane are usually Fordyce's spots or granules. Fordyce's spots are normal, prominent, ectopic sebaceous glands commonly seen on the lips or buccal mucosa near the exit of the parotid duct and are probably the most common lesions in the mouth. Figure 12-18 depicts Fordyce's spots on the buccal mucosa. Ectopic sebaceous glands can also be found on the shaft of the penis (see Fig. 18-11) and on the labia (see Fig. 19-13).

Figure 12-19 shows angiokeratomas of the buccal mucosa, or angiokeratoma corporis diffusum, in a patient with Fabry's disease. Figure 18-18 depicts angiokeratomas on the scrotum of the same patient.

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