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    LAPORAN TUTORIAL

    SKENARIO 4

    LESI PRAGANAS RONGGA MULUT

    BLOK PENYAKIT DENTOMAKSILOFASIAL II

    Tutor :drg. Agustin u!"n S.D.# M.K$s

    Dr. drg. B"nun Kusu%"&"rd"ni# M.K$s

     K$tu" : Nu'si Egi P (NIM : )4)*)+)+)+,-

    S$/r$t"ris : K"!0in 1uni"&"n (M$2" (NIM : )4)*)+)+)+,,

      N"/3it" Lint"ng S (P""n (NIM : )4)*)+)+)+5-

    Anggot" : Aro'"3 Noor B (NIM : )4)*)+)+)+,6

      Ad$ A7u D&i R (NIM : )4)*)+)+)+58

      Ni9o N"t"n"$! (NIM : )4)*)+)+)+,8

      Si!0it"ni" Putri (NIM : )4)*)+)+)+5-

      D"ni$! B$nn7 S (NIM : )))*)+)+)+,*

    FAKULTAS KEDOKTERAN GIGI

    UNIVERSITAS JEMBER 

    2015

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    DAFTAR ISI

    D"'t"r Isi;;;;;;;;;;;;;;;;;;;;;;;;;; )

    S/$n"rio;;;;;;;;;;;;;;;;;;;;;;;;;;. <

    St$ );;;;;;;;;;;;;;;;;;;;;;;;;;;. -

    St$

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    SKENARIO 4

    LESI PRAGANAS RONGGA MULUT

    Dr. Ati/ Kurni"&"ti# drg.#M.K$s

    S$or"ng !"/i!"/i =$rusi" 46 t"3un d"ting /$ do/t$r gigi d$ng"n /$!u3"n

    !id"3 t$r"s" tid"/ n7"%"n /$ti/" di"/"i %"/"n. P"d" "n"%n$sis di/$t"3ui "si$n

    t$!"3 %$n"%="!/"n gigi ="&"3 =$!"/"ng 7"ng d$/"t !id"3 /$ tu/"ng gigi# s$!"in

    itu "i$n %$%un7"i /$=i"s""n %$ro/o/ s$2"/ r"t" -+ ="t"ng

    s$ti" 3"ri. P"si$n s$ring %$r"s"/"n %u!ut n7" /$ring. P"d" $%$ri/s""n intr"

    or"! dit$%u/"n !"/ uti3 tid"/ d""t di/$ro/# tid"/ t$r"tur# $r%u/""n /"s"r#

     ="t"s tid"/ 2$!"s# dis$rt"i d"s"r /$%$r"3"n "d" !"t$r"! !id"3 "d" r$gion r$%o!"r 

    /"n"n# "!"si s"/it d"n tid"/ %ud"3 =$rd"r"3. Gigi g$!igi "d" ost$rior r"3"ng

     ="&"3 ="n7"/ t$rd""t /"ri$s d"n tu%"t"n !og"% d$ng"n $r%u/""n 7"ng /"s"r.

    "si! $%$ri/s""n PA "d" ="gi"n ost$rior !$si did""t/"n %od$r"t$ d7s!"si"

    d$ng"n 3i$/$r"tosis.

    2

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    STEP I

    ). Mod$r"t$ D7s!"si"

    D7s!"si" s$d"ng# $n$="!"n !"is"n Eit$! B"s"! /$ Str"tu% Sinosu%

    g$2"!" "to!ogis

    -. i$r/$r"tosis

    P$%=$ntu/"n !"is"n /$r"tin 7"ng A=nor%"! =$ru" $nu%u/"n /$r"tin

    7"ng =$r!$=i3"n

    4. P!"/ Puti3

    B$r9"/>=$r9"/ uti3 7"ng =i"s"n7" t$rd""t "d" !id"3 d"n %u/os" rongg"

    %u!ut6. L$si Pr"g"n"s

    L$si 7"ng s$9"r" /!inis tid"/ t$r!i3"t g"n"s n"%un s$9"r" "to!ogis "/"n

    g"n"s# %u!"i =$rsi'"t K"rsinog$ni/ (M$nu2u =$ntu/ K"rsino%"# d"n %u!"i

    %$rus"/ L"is"n B"s"!is.

    STEP II

    ). A"/"3 $n7$="= P!"/ Puti3 tid"/ d""t di/$ro/?

    2$nis L$si Pr"g"n"s rongg" %u!ut?

    8. K""n L$si Pr"g"n"s d""t =$ru="3 %$n2"di L$si G"n"s?

    )+. A"/"3 '"/tor>'"/tor $n7$="= t$r=$ntu/n7" L$si Pr"g"n"s?)). A"/"3 L$si Pr"g"n"s di"&"!i d$ng"n L$si 1in"/ "t"u s$9"r" !"ngsung?

    )

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    !"is"n /$r"tin t$rs$=ut t$!"3 %$n2"di s"tu /$s"tu"n d$ng"n !"is"n>!"is"n

    $it$!.

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    ,. G$2"!" 7"ng %$nun2u/"n !$si t$rs$=ut =$rsi'"t Pr"g"n"s "d"!"3:

    ". Ad"n7" D7s!"si" "d" !"is"n $it$! s$9"r" PA

     =. Inti d"ri S$! B"s"! t$r!i3"t !$=i3 =$s"r d"n g$!" s$9"r" PA

    di/"r$n"/"n "d"n7" $%=$!"3"n inti s$! n"%un sito!"s%" tid"/ 

    %$%=$!"3

    9. P"d" /"sus s/$n"rio "d"n7" P!"/ Puti3 7"ng tid"/ d""t di/$ro/.

    5. 1$nis>2$nis L$si Pr"g"n"s !"inn7" s$rt" 9irin7" "d" %u/os":

    ". L$u/o!"/i" : B$r9"/ uti3 "d" %u/os" RM

     =. Er7t3ro!"/i" : B$r9"/ %$r"3 "d" %u/os" RM

    9. Li93$n P!"nus : B$ntu/"n tid"/ r"t"# =$r&"rn" ungu# d"n /"s"r 

    d. Dis/$r"tosis : T$rd""t $ni%=un"n /$r"tin "d" !"is"n 7"ng

    Kong$nit"! tid"/ s$3"rusn7"$. Or"! Su=%u9ous: Ad"n7" =$ntu/"n s$$rti it" "d" RM

    Fi=rosis

    '. Pi$ S%o/$r : K$r"tosis "d" d"$r"3 %u/os" t$rt$ntu d"n !$=i3

    K$r"tosis t$="!

    g. @"r9ino%" In : Ad"n7" 9"%ur"n =$r9"/ %$r"3 uti3

    Situ

    8. Didug" L$si Pr"g"n"s d""t %$n2"di L$si G"n"s =i!" '"/tor>'"/tor d"ri

    $tio!ogin7" tid"/ di3i!"ng/"n d"!"% 2"ng/" &"/tu 7"ng !"%".

    )+. K$=i"s""n =uru/ s$$rti %$ro/o/# d"n %inu% %inu%"n /$r"s (A!/o3o!#

    D$'isi$nsi Nutrisi# Irit"si Kronis# Tr"u%"# Antio/sid"n D$'isi$nsi (R"di/"!

    B$="s# s$rt" g$n$ti9 /"r$n" ="3"n K"rsinog$ni/ d""t %$n2"di '"/tor>

    '"/tor $n7$="= t$r2"din7" L$si Pr"g"n"s.

    )). L$si Pr"g"n"s d""t tu%=u3 d"ri L$si 1in"/ /"r$n" $ng"ru3 d"ri '"/tor>

    '"/tor $tio!ogi. L$si Pr"g"n"s 2ug" d""t tu%=u3 s$9"r" !"ngsung =i!"

    "d"n7" '"/tor>'"/tor "d$/u"t untu/ %$n2"di Pr"g"n"s.)< !"is"n di"t"s !"is"n

      B"s"!is.

     =. Mod$r"t$ D7s!"si" : T$r2"di 3ingg" L"is"n Sinosu% d"n %$n7$="r 

      s"%"i /$ Pri9/!$ @$!! d"ri str"tu% t$rs$=ut

    9. S$0$r$ D7s!"si" : T$r2"di "d" L"is"n B"s"!is s"%"i d$ng"n

      L"is"n Korn$u%

    5

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    STEP I

    6

    ETIOLOGI

    Merokok Faktor

    PERUBAHAN SEL

    LESI

    KERATOSDYSPLAS

    Mild DysplasiaMd!"a#!

    Dysplasia

    S!$!"!

    Dysplasia

    HPA

    Pemeriksaan

    KLINIS

    PRAGAN   GANAS JINAK 

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    STEP ). M"%u %$%"3"%i d"n %$n2$!"s/"n Etio!ogi L$si Pr"g"n"s RM 3ingg"

    %$n7$="=/"n D7s!"si"

    +#*,

    "!/"!oid# s"!"3 s"tu 2$nis "!/"!oid "d"!"3 "r$9o!in 7"ng %$ng"ndung ->

    (%$ti!nitros"%ino roionitri!. Ar$9o!on 2$nis ini ""=i!" =$r9"%ur 

    d$ng"n /"ur (/"!siu% 3idro/sid" d"!"% ros$s %$ngin"ng "/"n

    %$ng3"si!/"n o/sig$n r$"/ti' (r"di/"! =$="s 7"ng %$ru"/"n $%i9u

     $rtu%=u3"n s$! 7"ng /"rsiog$ni/. Ar$9o!in$ "/"n %$n"i//"n %RNA

    d"n $/sr$si ro7$in 97st"tin @# nong!i9osi!"t$d rot$in d"s"r 7"ng

    %$ng"tur 0"ri"si $/sr$si 'i=ro=!"st d$ng"n 9"r" %$ng"tur r$gu!"sin7".

    S$!"in itu "r$9o!in$ 2ug" %$ning/"t/"n $/r$si d"ri /$r"tinosit gro&t3

    '"9tor>)# insu!in$ gro&t3 '"9tor>)# $/sr$si int$r!$u/in * 7"ng t$r!i="t

    d"!"% $%=$ntu/"n 2"ring"n 'i=rous s$3ingg" 2"ring" 'i=rous 7"ng

    t$r=$ntu/ s$%"/in ="n7"/. F!"0"noid# 9"t$93in# "nd t"nnin

    %$n7$="=/"n /o!"g$n %$ng"!"%i 9ross !in/ s$3ingg" s$!>s$!n7" "/"n

    su!it untu/ t$rd$gr"d"si.

    7

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    d"!"% s"!i0"# 7"ng =$rgun" untu/ %$n$tr"!isir ="/t$ri d"!"% rongg"

    %u!ut d"n %$n7$="=/"n g"nggu"n 'ungsi s$!. P$nurun"n 'ungsi s$! ini

    dis$rt"i d$ng"n %$ning/"tn7" 2u%!"3 ="/t$ri "$ro= s$3ingg" rongg"

    %u!ut r$nt"n t$r/$n" in'$/si.

    Ro/o/ d""t %$n7$="=/"n 3i$r/$r"tosis di/"r$n"/"n "d"n7" $'$/ 

    "/i="t irit"si /ronis "s" ro/o/. Irit"si /ronis ini dis$="=/"n /"r$n"

    "d"n7" ="3"n /"rsinog$n 7"ng t$r/"ndung d"!"% ro/o/ 7"itu t"r#

    ni/otin d"n ="3"n /i%i" !"inn7" 7"ng d""t %$n7$="=/"n $ru="3"n

    "&"! stru/tur d"s"r $it$! %u/os" %u!ut s$$rti d$s/u"%"si $it$!#

    "troi ="3/"n d""t %$n7$="=/"n dis!"si" $it$! 7"ng %$ng"!"%i

    /$g"n"s"n. Ro/o/ %$nsti%u!"si %$!"nosit %u/os" %u!ut s$3ingg"

     rodu/si %$!"nosit %u/os" %u!ut =$r!$=i3"n d"n %$ng$nd" "d"

    !"is"n ="s"! %u/os" s$3ingg" t$r2"di ig%$nt"si "d" %u/os"

    t$rs$=ut.

    Pros$s $%="/"r"n ro/o/ %$ng3"si!/"n ="3"n>="3"n o/sid"n d"!"%

     2u%!"3 7"ng =$s"r# /ondisi ini %$n7$="=/"n /$tid"/s$i%="ng"n "nt"r"

    o/sid"n d"n "ntio/sid"n 7"ng dis$=ut str$s o/sid"ti'. Tinggin7" 2u%!"3

    /"ndung"n o/sid"n d"n r"di/"! =$="s 7"ng t$rd""t d"!"% ro/o/ d""t

     =$r$"/si d$ng"n gugus su!'idri! 7"ng %$n7$="=/"n $ru="3"n stru/tur 

    d"n 'ungsi %o!$/u!# t$r%"su/ s"!i0" 7"ng %$ru"/"n ="ri$r t$r3"d"

    s$r"ng"n s$n7"&">s$n7"&" o/sid"n d"n r"di/"! =$="s. P$nurun"n

    sist$% "ntio/sid"n d""t =$r"/i="t "d" /$rus"/"n /o%on$n>

    /o%on$n s$!u!$r 7"ng $nting s$$rti %$%=r"n !iid# rot$in d"n

    DNA.

    S$!"in %$ng"ndung ="3"n o/sid"n ro/o/ 2ug" %$ng"ndung ="3"n>

     ="3"n /"rsinog$n. B"3"n>="3"n /"rsinog$n "nt"r" !"in =$nCo7r$n$

    d"n "/ro!$in. B"3"n ="3"n /"rsinog$n d""t =$ri/"t"n d$ng"n ="s"

    DNA d"n %$n7$="=/"n /$s"!"3"n $%="9""n in'or%"si g$n$ti/ "d"

    9

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    s""t DNA dir$!i/si s$3ingg" %$n7$="=/"n t$r2"din7" %ut"si DNA

    d"n d""t %$ni%=u!/"n /"n/$r# t$r%"su/ /"n/$r "d" rongg" %u!ut.

    d. Sin"r M"t"3"ri

    T$r!"!u ="n7"/ sin"r %"t"3"ri tid"/ ="i/ untu/ tu=u3. En$rgi d"ri

    %"t"3"ri s$=$n"rn7" r"di"si t"/ t$r!i3"t 7"ng s$3"t d"n =$r="3"7" "d"

    &"/tu 7"ng s"%". Ad" du" 2$nis ut"%" d"ri u!tr"0io!$t (U sin"r 7"ng

    %$n9""i =u%i# UA d"n UB. Sin"r UA %$ning/"t/"n $'$/ d"ri

    sin"r UB. M$r$/" %$n7$="=/"n n$o!"s%" /u!it# /"t"r"/# $nu""n#

    /$riut d"n 3i!"ngn7" $!"stisit"s /u!it. Sin"r UB %$n7$="=/"n risi/o

    !$=i3 =$s"r t$r/$n" /"n/$r /u!it d"ri sin"r UA.

    $. irus: P

     Human papillomavirus "t"u P %$ru"/"n 0irus 7"ng d""t

    %$n7$="=/"n /uti! di =$r="g"i ="gi"n tu=u3. In'$/si P d""t t$r2"di

     2i/" s$s$or"ng =$rs$ntu3"n !"ngsung d$ng"n /u!it $ngid" "t"u =$nd"

    7"ng t$r/ont"%in"si 0irus P. u=ung"n s$/su"! 2ug" d""t %$n2"di

    s"r"n" $nu!"r"n 0irus P "d" /$!"%in. Mis"!n7" /ont"/ !"ngsung

    d$ng"n /u!it /$!"%in# %$%=r"n %u/os" "t"u $rtu/"r"n 9"ir"n tu=u3#

    d"n s$/s or"! "t"u "n"!.

    F"/tor Ut"%" t$rs$=ut d""t %$n7$="=/"n o0$r $/sr$si d"ri $it3$!i"!

    gro&t3 '"9tor r$9$tor (EGFR 7"itu g!i/orot$in ),+ /D" d$ng"n

    "/ti0"si tirosin d"!"% i/"t"n $it3$!i"! gro&t3 '"9tor (EGF. EGFR 

    dit$%u/"n untu/ %$ng"tur $rtu%=u3"n# ro!i'$r"si# d"n di'$r$nsi"si

    $it3$!iu% nor%"!. EGFR %$ru"/"n rot$in 7"ng =$r"d" di$r%u/""ns$! 7"ng 'ungsin7" s$="g"i r$s$tor $ngi/"t EGF d"n %$ru"/"n r"%=u

     ="gi s$! untu/ %$!"/u/"n ro!i'$r"si. EGF dit"ng/" o!$3 EGFR d"n s$!

    "/"n t$r="ngun s$rt" =$rsi" untu/ %$!"/u/"n $r="n7"/"n. P"d" !$si

     r"g"n"s d"n g"n"s# EGFR "/ti' oto%"tis d"n tid"/ !"gi t$rg"ntung "d"

    EGF s$3ingg" t$r2"di $ning/"t"nro!i'$r"si s$! 7"ng %$ng"r"3 %$nu2u

    d7s!"si" $it$! (R$$9$#

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    D$'isi$nsi d"ri =$=$r"" %i/ronutrisi s$$rti 0it"%in A# @# E# d"n F$ d""t

    %$%$ng"ru3i t$r2"din7" tu%or ="i/ 2in"/# r"g"n"s %"uun g"n"s. P"d"

    0it"%in A t$rd""t < go!ong"n 7"itu r$tino! (r$'or%$d 0it"%in A d"n

    9"rot$noids (ro0it"%in A 7"ng %"n" 9"rot$noids ""=i!" di=utu3/"n

    o!$3 tu=u3 "/"n diu="3 %$n2"di r$tino!. P$rtu%=u3"n d"n di'$r$nsi"si d"ri

    s$! nor%"! "t"u s$! tu%or d""t di%odu!"si o!$3 r$tinoid 7"ng

    %$%$ng"ru3i "d" $/sr$si g$n. R$tinoid %$ngindu/si "otosis #

    %$ng"r"3/"n %"tur"si $%=$!"3"n s$! 7"ng nor%"! d"n %$n$/"n

    /"rsinog$n$sis. R$tinoid %$%i!i/i /$%"%u"n untu/ %$n2"g"

    /$s$i%="ng"n 7"ng %$%"d"i "nt"r" $rtu%=u3"n# di'$r$nsi"si# d"n

    /$3i!"ng"n s$!. K$s$i%="ng"n 3o%$ost"tis 7"ng t$rg"nggu "d" $n7"/it

    g"n"s d""t diu!i3/"n d$ng"n %$nd""t/"n /$s$i%="ng"n "nt"r"

     ro!i'$r"si d"n /$%"ti"n s$!.

    it"%in E d"n @ di d"!"% tu=u3 %$%un7"i $'$/ s$="g"i "ntio/sid"n.

    R$"/si r"di/"! =$="s d""t %$n7$="=/"n $ru="3"n $nCi%"ti/ 'ungsi d"n

    %ut"si DNA d"n %$ning/"t/"n risi/o %$ng$%="ng/"n 2"!ur s$! g"n"s .

    M$ngur"ngi r"di/"! =$="s %$nggun"/"n "ntio/sid"n # s$$rti 0it"%in E

    d"n @ %ung/in d""t %$n9$g"3 $ru="3"n s$!. it"%in @ =$/$r2" s$9"r"

    sin$rgis d$ng"n 0it"%in E. it"%in E 7"ng t$ro/sid"si r"di/"! =$="s d""t

     =$r$"/si d$ng"n 0it"%in @ /$%udi"n "/"n =$ru="3 %$n2"di to/o'$ro!

    s$t$!"3 %$nd""t ion 3idrog$n d"ri 0it"%in @. M$/"nis%$ /$r2"

    "ntio/sid"n s$!u!$r "d"!"3 s$="g"i =$ri/ut:

    ". B$rint$r"/si !"ngsung d$ng"n o/sid"n# r"di/"! =$="s "t"u

    o/sig$n tungg"!

     =. M$n9$g"3 $%=$ntu/"n 2$nis o/sig$n r$"/ti' 

    9. M$ngu="3 2$nis o/sig$n r$"/ti' %$n2"di /ur"ng to/si/ 

    d. M$n9$g"3 /$%"%u"n o/sig$n r$"/ti' 

    $. M$%$r="i/i /$rus"/"n 7"ng ti%=u!.

    11

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    D$'isi$nsi C"t =$si "/"n %$n7$="=/"n "n$%i". P!u%%$r>inson S7ndro%$

    "d"!"3 su"tu $n7"/it 7"ng =$r3u=ung"n $r"t d$ng"n "n$%i". S7ndro%$

    ini %$ru"/"n '"/tor $n9$tus =$r/$%="ngn7" /"n/$r %u!ut# /"rsino$ s$!

    s/u"%ous.

    2% 'IRI LESI PRAGANAS BERDASARKAN

    PEMEIKSAAN KLINIS DAN (PAKLINIS&

    G"%="r"n /!inis 7"ng $nting "d"!"3 K$%$r"3"n# Nodu!"r (P$non2o!"n#

    d"n U!s$r"si. Tid"/ "d"n7" r"s" s"/it# "d"n7" /o%on$n %$r"3

    (Eritro!"si" "d" su"tu L$si Puti3 %"/in %$ning/"t/"n /$%ung/in"n

    %un9u!n7" D7s!"si" "t"u /"n/$r. Ad"n7" $non2o!"n (Nodu! 7"ng !un"/ 

     "d" s""t di"!"si didug" =$r"d" di ="&"3 $r%u/""n /"r$n" "d"n7"

    D7s!"si" d"ri"d" 3"n7" su"tu K$r"tosis. S"%" 3"!n7" d$ng"n t$rs$=ut#

    u!s$r"si "d" su"tu !$si uti3 7"ng %$nun2u//"n ros$s D$stru/ti' Lo/"!#

    "t"u N$/rosis "d"!"3 indi/"si "d"n7" $rus"/"n o!$3 /"n/$r "t"u in'$/si.

    (PA&

    S$9"r" PA# t"nd">t"nd" t$r2"din7" L$si Pr"g"n"s 7"itu "d"n7" D7!"si"

    7"ng %$ru"/"n su"tu g$2"!" d$g$n$r"ti0$ d"ri su"tu s$!.

    D7s!"si" %$ru"/"n /$"d""n di%"n" s$!>s$! n$o!"sti/ t$rd""t "d"

    s$!uru3 !"is"n $it$!. P$ru="3"n r" /"n/$r !"in 7"ng tid"/ s"%"i

    %$!ig"t/"n s$!uru3 !"is"n $it$! s$r0i/s dis$=ut dis!"si" 7"ng di="gi

    %$n2"di ring"n# s$d"ng d"n =$r"t. Dis!"si" "d"!"3 n$o!"si" s$r0i/"!

    intr"$it$!i"! (@IN# ting/"t"nn7" "d"!"3 @IN ) (dis!"si" ring"n @IN <

    (dis!"si" s$d"ng d"n @IN - (dis!"si" =$r"t d"n /"rsino%" in situ.

    O %$ng/!"ssi'i/"si/"n $it3$!i"! d7s!"si" %$nurut ting/"t

    /$""3"nn7" %$n2"di:

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    ). Mi!d d7s!"si"# 7"itu g"nggu"n $rtu%=u3"n s$! d$ng"n ting/"t ring"n

    d$ngn $%=$ntu/"n ) "t"u du" !"is"n ="s"!oid s$! di "t"s %$%=r"n$

     ="s"!is t"n" dit"nd"i "d"n7" "tii" s$!.

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    $am%ar (# 'apisan epitel gepeng %erlapis normal ()# *+splasia pada

    lapisan %asal 

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    )% PAT(OGENESIS TERBENTUKN*A LESI PRAGANAS

    RONGGA MULUTLESI PUTI( DAN MERA(

    P"d" !$si uti3 &"rn" uti3 di s$="=/"n /"r$n" "d"n7" 37$r/$r"tosis#

    s$d"ng/"n# untu/ !$si 7"ng =$r&"rn" %$r"3# &"rn" %$r"3 di s$="=/"n /"r$n"

    3i!"ngn7" "t"u %$niisn7" !"is"n /$r"tin 7"ng di"/i="t/"n o!$3 g"nggu"n

    di''$r$nsi"si s$! ="s"!oid 7"ng "r"3 s$3ingg" tid"/ %$ng3"si!/"n /$r"tin.

    Ad" tid"/n7" /$r"tin 7"ng di3"si!/"n %$%$ng"ru3i $n"%"/"n /!inis !$si#

    7"ng s$di/it /$r"tin "t"u tid"/ =$r/$r"tin %$%=u"t $it$! t$%=us 9"3"7" d"n

    %$n"%="3 0isi=i!it"s "d" $%=u!u3 d"r"3 /$9i! di="&"3n7" s$3ingg"

    %$n7$="=/"n "d"n7" &"rn" /$%$r"3"n. K$%ung/in"n t$r=$ntu/n7" !$si

    %$r"3 di/"r$n"/"n "d"n7" g"nggu"n "d" ros$s /$r"tinis"si. Pros$s

    /$r"tinis"si s$2"tin7" %$ru"/"n ros$s 'isio!ogis 7"ng nor%"!. N"%un# "d"

     $%=$ntu/"n !$si r"g"n"s ini# t$r2"di $n$="!"n !"is"n /$r"tin s$3ingg" !$si

     =$r&"rn" uti3# "t"u %ung/in $%=$ntu/"n /$r"tin 7"ng !$=i3 s$di/it

    s$3ingg" !$si t$r!i3"t !$=i3 %$r"3. P"d" "tog$n$sis !$si r"g"n"s# "/ti0it"s

    %itoti/ s$!>s$! ="s"! %$ning/"t. P$%=$ntu/"n s$! ="ru ini %$ng"/i="t/"n

    !"is"n ="s"! %$n2"di !$=i3 t$="!. A"=i!" $%=$ntu/"n s$! ="ru t$rs$=ut

    dii%="ngi d$ng"n ros$s di''$r$nsi"si 7"ng ="i/ (,ell-differentiate %"/"

    "/"n t$r=$ntu/ !"is"n /$r"tin 7"ng 2ug" !$=i3 t$="!. N"%un# ""=i!"

     $%=$ntu/"n s$! ="ru t$rs$=ut tid"/ dis$rt"i d$ng"n ros$s di''$r$nsi"si 7"ng

     ="i/ ( poorl+ differentiate# %"/" t$r=$ntu/!"3 !"is"n /$r"tin 7"ng !$=i3 tiis

    "t"u ="3/"n tid"/ t$r2"di $%=$ntu/"n /$r"tin. L"is"n /$r"tin 7"ng tiis

    ini!"3 7"ng %$%=u"t !$si t$r!i3"t !$=i3 %$r"3.

    +% MA'AM,MA'AM LESI PRAGANAS RONGGA MULUT

    BESERTA PATOGENESISN*AL!si P-#i.

    1% L!-/pla/ia

    L$u/o!"/i" %$ru"/"n s"!"3 s"tu /$!"in"n 7"ng t$r2"di di %u/os" rongg"

    %u!ut. M$s/iun !$u/o!"/i" tid"/ t$r%"su/ d"!"% 2$nis tu%or# !$si ini

    s$ring %$!u"s s$3ingg" %$n2"di su"tu !$si r$>9"n9$r. L$u/o!"/i"

    %$ru"/"n su"tu isti!"3 !"%" 7"ng digun"/"n untu/ %$nun2u//"n "d"n7"

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    su"tu =$r9"/ uti3 "t"u !"/ 7"ng tid"/ nor%"! 7"ng t$rd""t "d"

    %$%=r"n %u/os". P$nd""t !"in %$ng"t"/"n ="3&" !$u/o!"/i" 3"n7"

    %$ru"/"n su"tu =$r9"/ uti3 7"ng t$rd""t "d" %$%=r"n %u/os" d"n

    su/"r untu/ di3i!"ng/"n "t"u t$r/$!u"s.

    B"t"s"n !$u/o!"/i" t$!"3 di"/"i di %"s" !"!u o!$3 "3!i /u!it d"n "3!i

    /$=id"n"n untu/ %$nun2u//"n su"tu $n$="!"n uti3 "d" %u/os" %u!ut

    "t"u 0u!0" 7"ng %$nun2u//"n $ru="3"n dini# in situ d"n "n"!"sti/.

    B$rd"s"r/"n /ons$ 7"ng dit$ri%" o!$3 .orld Health /rgani0ation %"/"

     ="t"s"n !$u/o!"/i" "d"!"3 !$si 7"ng tid"/ "d" /onot"si 3isto!ogin7" d"n

    di"/"i 3"n7" s$="g"i d$s/risi /!inis. 1"di d$'inisin7" "d"!"3 su"tu

     $n$="!"n uti3 7"ng tid"/ d""t digoso/ s"%"i 3i!"ng d"n tid"/ d""t

    digo!ong/"n s$9"r" /!inis "t"u 3isto!ogi s$="g"i $n7"/it>$n7"/it s$si'i/ 

    !"inn7" (9onto3: s$$rti !i/3$n !"nus# !uus $rit$%"tosus# /"ndidi"sis#

    ,hite sponge naevus.

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    Stadium 'eukoplakia

    L$u/o!"/i" d""t di="gi %$n2"di - st"diu%# 7"itu:

    ). o%og$nous !$u/o!"/i"

    M$ru"/"n =$r9"/ uti3 7"ng /"d"ng>/"d"ng =$r&"rn" /$=iru"n#

     $r%u/""nn7" !i9in# r"t"# d"n =$r="t"s 2$!"s. P"d" t"3" ini# tid"/ 

    di2u%"i "d"n7" indur"si. M$ng"9u "d" su"tu !$si s$t$%"t "t"u =$r9"/ uti3 7"ng !u"s# 7"ng %$%$r!i3"t/"n su"tu o!" 7"ng r$!"ti0$

    /onsist$n# s$/"!iun $r%u/""n !$si t$rs$=ut %ung/in dig"%="r/"n

     =$r%"9"%>%"9"% s$$rti %is"!n7"# =$ro%="/>o%="/ (!i/$ " =$"93 "t

    $==ing tid$# d$ng"n o!" g"ris>g"ris 3"!us (9rist"$# /$riut (!i/$

    dr7# 9r"9/$d %ud# "t"u "i!o%"tous.

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    %u!"i t$r"s" /"s"r d"n di2u%"i 2ug" $r%u/""n !$si 7"ng $rosi0$.

    M$ng"9u "d" su"tu !$si 9"%ur"n %$r"3 d"n uti3# di%"n" nodu!>

    nodu! /$r"toti/ 7"ng /$9i! t$rs$="r "d" =$r9"/>=$r9"/ "tro'i/ ("t"u

    $rito!"/i/ d"ri %u/os".

    -. S$9/!$d "t"u $ro9uos !$u/o!"/i"

    P$r%u/""n !$si t"%"/ sud"3 %$non2o!# =$r&"rn" uti3# t$t"i tid"/ 

    %$ng/i!"t. Ti%=u!n7" indur"si %$n7$="=/"n $r%u/""n %$n2"di /"s"r 

    d"n =$r!$/u/>!$/u/. S""t ini# !$si t$!"3 di"ngg" =$ru="3 %$n2"di

    g"n"s. K"r$n" =i"s"n7" d"!"% &"/tu 7"ng r$!"ti' sing/"t "/"n =$ru="3

    %$n2"di tu%or g"n"s s$$rti su"%us s$! /"rsino%"# t$rut"%" =i!" !$siini t$rd""t di !id"3 d"n d"s"r %u!ut.

    $am%aran H

    P$%$ri/s""n %i/ros/ois "/"n %$%="ntu %$n$ntu/"n $n$g"/"n

    di"gnosis !$u/o!"/i". Bi!" dii/uti d$ng"n $%$ri/s""n 3isto"to!ogi d"n

    sito!ogi# "/"n t"%"/ "d"n7" $ru="3"n /$r"tinis"si s$! $it$!iu%#

    t$rut"%" "d" ="gi"n su$r'isi"!.

    S$9"r" %i/ros/ois# $ru="3"n ini d""t di=$d"/"n %$n2"di 6 ="gi"n#

    7"itu:

    2% S-li-al K!"a#sis

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    Isti!"3 ini digun"/"n untu/ !$si uti3 7"ng t$rd""t di d"s"r %u!ut d"n

    0$ntr"! d"ri !id"3. L$si ini %$%un7"i /$%"%u"n 7"ng tinggi untu/ 

    %$n2"di g"n"s (-+.

    G$2"!" /!inis 7"ng ditun2u//"n i"!"3 =$r&"rn" uti3# t$rd""t !"/ 7"ng

    3"!us# tid"/ t$r"tur n"%un =$r="t"s 2$!"s. Bi"s"n7" !$si ini tid"/ dii/uti

    d$ng"n in'i!tr"si s$!>s$! r"d"ng.

    $am%aran histologi  untu/ su=!ingu"! /$r"tosis s"%" d$ng"n g"%="r"n

    3isto!ogi "d" !$u/o!"/i" !"inn7"# 7"/ni "d"n7" "r"/$r"tosis "t"u

    ort3o/$r"tosis "t"u /$du"n7" d"!"% "r$" 7"ng =$r=$d". K$r"tin t$rs$=ut

    %$ni%=u!/"n &"rn" uti3 "d" !$si t$rs$=ut. Eit$!iu%n7" t"%"/ "tro'i

    (%$ng$9i! d"n =i"s"n7" dis$rt"i d$ng"n "/"ntosis. K$="n7"/"n

    !$u/o!"/i" tid"/ %$nun2u//"n "d"n7" d7s!"si"# &"!"uun s$="gi"n /$9i!

    %$nun2u//"n "d"n7" $ru="3"n d7s!"si" d"ri %i!d d7s!"si" %$nu2u

    s$0$r$ d7s!"si". Untu/ s$!>s$! 7"ng %$ng"!"%i d7s!"si" =i"s"n7" dii/uti

    d$ng"n r$"/si r"d"ng d"ri !i%'osit d"n s$! !"s%".

    )% Li3.! Pla-s$am%aran klinis

    Li93$n !"nus # s$9"r" /!inis 2ug" %$ru"/"n su"tu !$si uti3. Di%"n"

    s$9"r" /!inis %$nn2u//"n su"tu !"is"n uti3 7"ng =$ru" "n7"%"n

    3o%og$n "t"u tid"/ 3o%og$n 7"ng tid"/ d""t t$r/$!u"s. L$si ini s$9"r"

    /!inis %$%un7"i ti$ $rosi d"n non $rosi. D""t t$r2"di "d s$!uru3

     $r%u/""n rongg" %u!ut d"n $r"t 3u=ung"nn7" d$ng"n in'$/si 2"%ur "t"u

    0irus.

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     atogenesis

    Or"! Li93$n P!"nus (OLP t$r2"di "/i="t t$r2"din7" in'!"%"si 7"ng /ronis

    7"ng di%$di"si o!$3 s$! T (s$! T @D5H . B$!u% di/$t"3ui "g$n "sti

     $n7$="= t$r2"din7" OLP# t$t"i =$=$r"" =$r"ngg""n ="3&" s$! $it$!

    7"ng rus"/ %$ru"/"n $%i9u t$r2"din7" OLP.

    S$! %ononu9!$"r# s$$rti %"/ro'"g d"n s$! T "/"n %$ngin'i!tr"si 3ingg" /$

    !"is"n roi" ="gi"n "t"s# =$rd$/"t"n d$ng"n %$%=r"n ="s"!is. P"d"

    "&"!n7" s$! T @D5H "/"n %$ng$n"!i /$r"tinosit s$="g"i "ntig$n d$ng"n

     ="ntu"n M"2or isto99o%"ti=i!it7 @o%!$ /$!"s I (M@ I. S$t$!"3

     $ng$n"!" d"n "/ti0"si# s$! T @D5H "/"n %$ngindu/si "otosis

    /$r"tinosit d"n %$%$di"si d"t"ngn7" =$=$r"" sito/in# s$$rti TNF 7"ng

    "/"n %$ni%=u!/"n in'!"%"si 7"ng !$=i3 !"n2ut.

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    Pros$s t$rs$=ut %$ng"/i="t/"n t$r2"din7" g"%="r"n "to!ogis /3"s "d"

    OLP# 7"itu t$r2"di $nd"t"r"n %$%=r"n ="s"!is# dit$%u/"n int$r9$!!u!"r 

    s"9$s# d"n t$ris"3n7" $it$! d$ng"n %$%=r"n ="s"!is 7"ng di/$n"!

    d$ng"n !iu$'"9tion %$%=r"n ="s"!is. Bi"s" dit$%u/"n 2ug" 9o!!oid =odi$s

    (@i0"tt$ =odi$s 7"ng dis$="=/"n o!$3 /$r"tinosit 7"ng %$ng"!"%i

    /$%"ti"n >r$%"tur$.

    $am%aran Histopatologik 

    Bi"s"n7" "d" tig" g"%="r"n 7"ng di"ngg" s"ng"t $nting untu/ di"gnos"

    3isto"to!ogi/ d"ri !i/$n !"nus 7"ituJ d"$r"3 3i$r"r"/$r"tosis "t"u

    3i$rorto/$r"tosis# s$ring dis$rt"i d$ng"n $n$="!"n !"is"n !"is"n s$!

    g!"nu!"r d"n g"%="r"n gigi g$rg"2i "d" r$t$ $gJ d$g$n$r"si !iu$'"9tion

    "t"u n$/rosis "d" !"is"n s$! ="s"! 7"ng s$ring dig"nti/"n d$ng"n it"

    $osino'i!i/ d"n su"tu it" su=$it3$!i"! 7"ng "d"t d"n !i%'osit. T$r!i3"t

    /$rus"/"n %$%=r"n$ ="s"!is# in'i!tr"si s$! !i%'osit dis$rt"i %$%=$ntu/ 

    unt"i"n# $osino'i!i/ %"t$ri"! d d"$r"3 !"%in" rori"# d"n =$ntu/ r$t$ $g

    s$$rti g$rg"2iG"%="r"n di"gnosti9 7"ng ut"%" d"ri !i/$n !"nus 7"ng %iri d$ng"n

    r$"/si !i/$noid !"inn7" "d"!"3 /$rus"/"n "d" !"is"n s$! ="s"!# t$r%"su/ 

     $ru="3"n 0"9uo!"r d"n /$%"ti"n s$!. P$ru="3"n 0"9uo!"r (d$g$n$r"si

    !iu$'"9tion dit"nd"i d$ng"n 0"/uo!" intr"s$!u!$r# $d$%"# s$"r"si s$!

     ="s"!# d"n t$r!$"sn7" !"%un" rori" d"ri s$!>s$! ="s"!. P$ru="3"n

    0"9uo!"r intr"s$!u!"r# $d$%"# s$"r"si s$! ="s"!# d"n t$r!$"sn7" !"%in"

     rori" d"ri s$!>s$! ="s"!. S$ri3"n>s$ri3"n "rti'"9tu"! di d"$r"/ ini s$ring

    di2u%"i "d" s$9i%$n 7"ng di/iri% untu/ $%$ri/s""n d$ng"n

    %i/ros/o 9"3"7"# d"n %$ni%=u!/"n /$9urig""n t$nt"ng /$%ung/in"nn7"

    s$="g"i su"tu !$si 0$si/o=u!os"# d"n =i!" %$%"ng ti%=u! "d" d"$r"3 ini

    d"!"% !i/$n !"nus =o!us".

    K$%"ti"n s$!>s$! $id$r%"! 7"ng t$r!i3"t d"!"% $n7"/it ini =i"s"n7"

    %$!i="t/"n s"tu s$!>s$! ="s"! 7"ng "/"n %$ng/$rut d$ng"n sito!"s%"

    $osino'i!i/ d"n s"tu "t"u !$=i3 'r"g%$n nu9!$"r i/noti/. S$!>s$! 7"ng %"ti

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    ini dis$=ut s$="g"i @i0"tt$ =odi$s# d"n t$rd""t =u/ti u!tr"stru/tur"! ="3&"

    /$"d""n t$rs$=ut t$r2"di %$!"!ui su"tu ros$s 7"ng uni/ dis$=ut s$="g"i

    "otosis# di%"n" s$!>s$! di/on0$rsi %$n2"di ="d"n 'i!"%$ntous 7"ng

    di'"gosit o!$3 %"/ro'"g "t"u s$! ="s"! di d$/"tn7". Aotosis ini

    %$ni%=u!/"n r$"/si $r"d"ng"n /$9i! =i!" di="nding/"n d$ng"n s$!>s$!

    7"ng %"ti "/i="t n$/rosis# d"n s$!>s$! 7"ng %$ng"!"%i "otosis d"!"%

    !"is"n ="s"! d"ri s$! $it$! !i/$noid di t$%"t !"in s$ring dis$=ut s$!>s$!

    dis/$r"toti/. S$="gi"n d"ri s$!>s$! ="s"! 7"ng %"ti tid"/ d""t di'"gositosis

    d"n %$non2o! /$!u"r# %"su/ /$ d"!"% d$r%is di ="&"3n7" di%"n"

    /$%udi"n "/"n dis$!u=ungi o!$3 i%%unog!o=u!in t$rut"%" IgM d"n

    dis$=ut s$="g"i ="d"n /o!oid.

    +% O"al S-4-/-s Fi"sis

    Or"! su=%u/ous 'i=rosis %$ru"/"n su"tu $n7"/it rogr$si' 7"ng !"%="t

    di%"n" t$r=$ntu/ it" 'i=rosis di d"!"% %u/os" %u!ut# 7"ng "d" "/irn7"

    "/"n %$n7$="=/"n su"tu 3"%="t"n 7"ng 3$="t t$r3"d" $rg$r"/"n %u!ut#

    t$r%"su/ !id"3.

     $n7"/it ini dis$rt"i d$ng"n r$"/si r"d"ng 2u/st" $it3$!i"! 7"ng disusu!

    d$ng"n su"tu $ru="3"n 'i=ro$!"sti/ d"ri !"%in" rori" d"n /$%udi"n

    "troi $it$! s$="g"i "/i="tn7". P$ru="3"n>$ru="3"n ini dis$rt"i d$ng"n

    r"s" "n"s t$r="/"r di %u!ut d"n /"d"ng>/"d"ng d$ng"n 0$si/$! "d"

    %u/os".

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    G"%="r"n /!inis

    P"d" t"3" dini /$!"in"n in su!it did$t$/si# s$d"ng/"n "d" t"3"

    !"n2utdi%"n" s$!uru3 !"%in" rori" t$!"3 dig"nti/"n o!$3 2"ring"n i/"t

    'i=rous "d"t d"n $it$!iu% %$ng"!"%i "troi s$9"r" /!inis %u/os" t$r!i3"t

     u9"t.

    P"d" t"3" !"n2ut# 2"ring"n otot d""t %$ng"!"%i /$rus"/"n 7"ng d""t

    dig"nti/"n o!$3 2"ring"n i/"tt 'i=rous d$ng"n /o!"g$n 7"ng t$="!.

    Bi!"%"n" 3"! ini t$r2"di di d"$r"3 !i"t"n =u/"!. S$9"r" /!inis $nd$rit"

    "/"n %$ng"!"%i /$su!it"n %$%=u/" %u!ut.

    M$ru"/"n $n7"/it 7"ng %$!$%"3/"n rongg" %u!ut 7"ng dit"nd"i

    d$ng"n "d"n7" $r"d"ng"n d"n rogr$si' 'i=rosis d"ri 2"ring"n su=%u/os"

    (!"%in" rori" d"n 2"ring"n i/"t 7"ng !$=i3 d"!"%. Or"! su=%o9ous

    'i=rosis %$n7$="=/"n /$/"/u"n dit"nd"i d$ng"n /$tid"/%"%u"n

    %$%=u/" %u!ut. P"!ing s$ring t$r2"di %u/os" =u/"!. OSF d""t

    dis$="=/"n /"r$n" /$=is""n %$ngin"ng "t"u %$n7usur t$%="/"u#"!/o3o!#d$'isi$nsi nutrisi# g"nggu"n g$n$ti/ d"n i%unit"s tu=u3 s$rt" '"/tor>'"/tor 

    !"inn7".

    G"%="r"n isto"to!ogi/ 

    S$9"r" 3isto!ogis "d" t"3" dini %$nun2u//"n "d"n7" $ning/"t"n

     2"ring"n 'i=rous di !"%in" rori"# /o!"g$n# d"n "tro'i $it$!iu% .

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    Fi=rosis su=%u/os" "d" !i"t"n %u/os" ii# %$nun2u//"n $%=$ntu/"n

    s$r"=ut /o!"g$n 7"ng t$="! "d" d"$r"3 !"%in" rori"# dii/uti "tro'i

    %u/os" $it$!iu% (t"nd" "n"3

    5% S- Dipp!"s K!"a#sis

    Dit"nd"i d$ng"n "d"n7" su"tu d"$r"3 =$r&"rn" /uning =$r/$rut "d"

    !i"t"n %u/os" gusi# ii# "t"u =i=ir. L$si ini t$r2"di "/i="t $nggun""n

    intr" or"! t$%="/"u t"n" di="/"r. T$%="/"u 7"ng tid"/ di="/"r d""t

    digun"/"n d"!"% =$r="g"i =$ntu/ (di3is"# di/un7"3# "t"u disu%="t/"n

    d"n "/"n %$ningg"!/"n t"nd">t"nd" 7"ng /3"s di d"$r"3 7"ng =i"s"

    disisii t$%="/"u. Or"ng 7"ng %$%i!i/i /$=i"s""n %$n7isi/"n t$%="/"u

    di t$%"t 7"ng =$r=$d">=$d" "/"n %$%i!i/i !$si 7"ng ="n7"/ d"n /ur"ng

    %$n9o!o/.

    B$r9"/>=$r9"/ snu''>di$rs "&"!n7" =$r&"rn" %$r"3 %ud" u9"t# d$ng"n

     $r%u/""n 7"ng t"%"/ =$r/$rut dn =$r!i"t>!i"t. P$ru="3"n !$si %$n2"di

    &"rn" uti3# uti3 /$/uning"n# "t"u 9o/!"t /$/uning"n d""t t$r2"di "/i="td"ri "d"n7" 37$r/$r"tosis d"n $&"rn""n $/sog$n.

    L!si M!"a.

    1% E"i#"pla/ia

    Eritro!"/i" "d"!"3 !"/ %$r"3 7"ng tid"/ d""t didi"gnos" s$="g"i su"tu

     $n7"/it s$si'i/ d$ng"n d"s"r "n"!is" /!inis. Eritro!"/i" 2ug" did$'inisi/"n

    s$="g"i =$r9"/ %$r"3 s$$rti =$!udru# %$n$t"# 7"ng tid"/ d""t

    digo!ong/"n s$9"r" /!inis s$="g"i /$"d""n !"in ""un. Isti!"3 ini s$$rti!$u/o!"/i" tid"/ %$%un7"i "rti 3isto!ogis. T$t"i# s$="gi"n =$s"r d"ri

    $ritro!"/i" didi"gnosis s$9"r" 3isto!ogis s$="g"i dis!"si" $it$! "t"u !$=i3

     2$!$/ !"gi %$%un7"i /$9$nd$rung"n !$=i3 tinggi untu/ %$n2"di /"rsino%".

    S$$rti 3"!n7" !$si uti3# di"gnos$ $ritro!"si" !$=i3 /$"r"3 /!inis d"ri"d"

    s$9"r" 3isto!ogis d"n 3"!i ini di=u"t d$ng"n $ng$9u"!i"n.

    L$si r"/"n/$r d"n /ondisi "=nor%"! d"ri %u/os" %$%i!i/i /$t$r/"it"n

    d$ng"n /"rsinog$n$sis "d" rongg" %u!ut. Er7t3ro!"/i" %$ru"/"n !$si

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     r"/"n/$r 7"ng d""t t$r2"di di %u/os" rongg" %u!ut. P$ru="3"n g$n

    %$n2"di s"!"3 s"tu $n7$="= !$si r"/"n/$r# d"n =$r$r"n d"!"%

    tr"ns'or%"si %"!ign"nt. Erit3ro!"/i" =i"s"n7" %$%i!i/i /"r"/t$r dis!"si"

    $it$! 7"ng =$r"t d"n =$r/$%="ng %$n2"di /"rsino%" 7"ng in0"si'.

     atogenesis :

    Er7t3ro!"/i" d""t %un9u! s$="g"i "/i="t d"ri =$r="g"i /$2"di"n 7"ng

    %$n7$="=/"n /$rus"/"n g$n$ti/ 7"ng %$%$ng"ru3i /ro%oso% d"n g$n#

    7"ng "/3irn7" %$nu2u /$"d" $ru="3"n DNA. A/u%u!"si $ru="3"n>

     $ru="3"n t$rs$=ut %$%i9u t$r2"din7" disr$gu!"si s$! "d" ="t"s di%"n"

    t$r2"din7" $rtu%=u3"n otono% d"n $r/$%="ng"n 7"ng in0"si'. Pros$s

    n$o!"sti/ %u!">%u!" =$r%"ni'$st"si s$9"r" intr"$it$! d$/"t %$%=r"n d"s"r 

    7"ng %$7$="=/"n t$r2"din7" dis!"si" $it$!# 7"itu 7"ng s$9"r" 3isto!ogis

    %$ngg"%="r/"n /o%=in"si g"nggu"n $%"t"ng"n d"n g"nggu"n ro!i'$r"si

    s$!. Pro!i'$r"si s$! ="s"! 7"ng =$r!$=i3"n d$ng"n =$ntu/ 7"ng tid"/ =$r"tur"n

    "t"u 7"ng dis$=ut dis!"si" %$n7$="=/"n s$!>s$! itu %$n2"di i%"tur. "! ini

    %$n7$="=/"n tid"/ t$r=$ntu/n7" /$r"tin d"n "d" /$"d""n $r7t3ro!"/i" ini

     2ug" dis$rt"i d$ng"n "troi s$!>s$! $it$!. K$"d""n>/$"d""n t$rs$=ut

    %$ng"/i="t/"n %$niisn7" !"is"n $it$!. P$niis"n !"is"n $it$!

    %$n7$="=/"n !"is"n su=$it$! di ="&"3n7" 7"ng %$%i!i/i ="n7"/ 

    0"s/u!"ris"si $%=u!u3 d"r"3 !$=i3 t$r!i3"t d"n %$n7$="=/"n &"rn" %$r"3

     "d" g"%="r"n /!inis !$si ini. T$i !$si =i"s"n7" =$r="t"s 2$!"s. Tid"/ "d"

     r$di!$/si 2$nis /$!"%in d"n "!ing s$ring %$ng$n"i "si$n =$rusi" di "t"s

    *+ t"3un.

    Eritro!"/i" d""t t$r2"di di s$ti" t$%"t di d"!"% %u!ut# t$t"i "!ing

    s$ring d"!"% !i"t"n %u/o=u/"! %"ndi=u!"# oro'"ring# i!"r tonsi!# "!"tu%

    !un"/# $r%u/""n !"t$r"! d"n 0$ntr"! !id"3# d"n d"s"r %u!ut. Eritro!"/i"

     "!ing u%u% di2u%"i "d" "si$n>"si$n $ro/o/ =$r"t d"n "!/"3o!i/.

    S$2u%!"3 $n$!iti t$!"3 %$%=u/ti/"n ="3&" %"7orit"s d"ri !$si %u!ut

    s$2$nis ini# %$nun2u//"n 'r$/u$nsi tinggi d"ri "tii" s$!u!$r d"n $ru="3"n

     r$%"!ign" s$rt" $ru="3"n %"!ign".

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    S$$rti 3"!n7" !$si uti3 %u/os"# ="n7"/ /$"d""n 7"ng %ung/in di

    di"gnos$ "t"u didug" /u"t s$="g"i d"s"r id$nti'i/"si =$rs"%""n# s$3u=ung"n

    d$ng"n 7"ng dit$%u/"n. "!"uun "n"!is" /!inis d$ng"n 9$r%"t t$!"3

    di!"/u"/"n# "d" s$di/it /"sus t"n" s7%to%# %$r"3# !"/ s$$rti /"in

     =$!udru 7"ng tid"/ d""t di id$nti'i/"si. Erito!"si" =i"s"n7" t"n" /$!u3"n#

    &"!"uun "d" /$!u3"n s$$rti s"/it tid"/ =$r"rti =$rt$nt"ng"n d$ng"n

    di"gnos$.

    Eritro!"/i" d""t t$r2"di di s$ti" t$%"t di d"!"% %u!ut# t$t"i "!ing

    s$ring d"!"% !i"t"n %u/o=u/"! %"ndi=u!"# oro'"ring d"n d"s"r %u!ut.

    T$!"3 di/$n"! - 0"ri"n /!inis d"ri $ritro!"/i":

    ). B$ntu/ 3o%og$n7# 7"ng t"%"/n7" %$r"3 r"t".

    =$r9"/ titi/# tid"/ %$ni%=u!# =u!"t d"n %$r"3. P"!"tu%

    !un"/ "d"!"3 !o/"si 7"ng "!ing u%u% untu/ $t$93i"$ %u!ti'o9"!. Su"tu

    d"$r"3 $/str"0"s"si 7"ng di"%$t$rn7" =i"s"n7" !$=i3 =$s"r d"ri ) 9%

    dis$=ut $/i%osis. $%"to%" "d"!"3 g$n"ng"n !u"s d"ri d"r"3 $/str"0"s"si"/i="t d"ri t$rutusn7" $%=u!u3 d"r"3 /"r$n" tr"u%". T$r2"di "!ing

    u%u% d"!"% rongg" %u!ut s$="g"i "/i="t d"ri =n$tur"n "d" &"2"3#

    $rusi gigi# ro=$/n7" 0$n" "!0$o!"r su$rior ost$rior s$!"%" $n7unti/"n

    "n"st$si !o/"!.

    )% Va"i/si#as

    Ad"!"3 su"tu $%=$ng/"/"n =$r'!u/tu"si 7"ng =$r&"rn" %$r"3>ungu d"n

    s$ring /"!i di2u%"i "d" or"ng !"n2ut usi". P$%=$ng/"/"n t$rs$=ut

    %$nun2u/"n su"tu di!"t"si $%=u!u3 d"r"3 s$="g"i "/i="t d"ri %$nu" "t"u

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    o!$3 su"tu rint"ng"n int$rn"! "d" 0$n"n7". P$r%u/""n 0$ntr"! d"ri d"$r"3 u%u% 7"ng !"in.

    +% T"4-s

    Su"tu s$ri 7"ng %$!iuti tr"u%"# $ng"/ti'"n urut"n $%=$/u"n d"n

     $%=$ntu/"n =$/u d"r"3 7"ng s$9"r" /3"s %$ng"/i="t/"n t$r3$ntin7"

     $rd"r"3n. B$=$r"" /$%udi"n $ng3"n9ur"n =$/u d"r3 t$r2"di d"n "!ir"n

    d"r3 nor%"! %u!"i /$%="!i . Tro%=us t"%"/ s$="gi nodu!">nodu!" %$r"3

    # =ui!t # %$ni%=u!# /3"s "d" %u/os" =i=ir. K$"r"s "d" "!"si d"n d""t

    s$di/it n7$ri. Su%="t"n>su%="t"n 0"s/u!$r d""t %$%=$s"r s$9"r"/ons$ntris d"n %$nutu s$!uru3 !u%$n $%=u!u3n7" "t"u %"s"/ d"n

     =$r/"ur untu/ %$%=$ntu/ su"tu !$=o!it. P!$=o!it "d"!"3 t$%u"n or"!

    7"ng 2"r"ng d"n t$rd""t d!% i# =i=ir# "t"u !id"3. S$9"r" r"diogr"'ig

    t"%"/ s$$rti don"t# %$!ing/"r# 'o9us>'o/us r"dio"/ d$ng"n t$ng"3 7"ng

    r"dio!us$n.

    5% (!4ai4a

    Ad"!"3 3$%"rto%" 0"s/u!$r# 2in"/# %$%=$s"r 7"ng %ung/in di2u%"i di

    s$ti" !o/"si 2"ring"n !un"/ intr"or"!. T$r2"di "d" 9u/u dini d"n s$di/it

    u%u% "d" &"nit" d"ri"d" ri". Dorsu% !id"3# gusi# d"n %u/os" ii

    "d"!"3 !o/"si u%u%. S$9"r" 3isto!ogist d""t %$ru"/"n ti$ /"i!$r "t"u

    /"0$rnosus.

    $%"ngio%" 2i/" t$r!$t"/ d"!"% 2"ring"n i/"t tid"/ "/"n %$ngu="3 &"rn"

    d"ri $r%u/""n %u/os". S$="!i/n7" 3$%"ngio%" su$r'i9i"! =$r&"rn"

    %$r"3# =iru "t"u ungu# r"t" "t"u s$di/it %$ni%=u!# $r%u/""nn7" !i9in

    ds"n s$di/it /$r"s. B"t"s>="t"sn7" =i"s"n7" di'us d"n $r%u/""nn7" !9in

    7"ng !o=u!$r tid"/ sring t$r!i3"t.

    9% T!lai!/#asia (!4".ai/ (!"!di#!" 6R!d-,Osl!",:!!"8

    T$!"ngi$/t"si" 3$%or3"gi/ 3$r$dit$r "d"!"3 su"tu $n7"/it g$n$ti9 7"ng

    diturun/"n s$="g"i su"tu si'"t do%in"n "utoso%"!. P$n7"/it t$rs$=ut

    dit"nd"i o!$3 t$!"ngi$/t"si" 7"ng %u!ti!$ di%"n" "d" %"9u!">%"/u!"

    ungu>%$r"3 "t"u "u!">"u!" s$di/it %$r"3 7"ng %$nun2u//"n

     $%=$s"r"n s$9"r" $r%"n$n d"ri /"i!$r>/"i!$r t$i d"ri /u!it# %u/os"#

    d"n 2"ring"n>2"ring"n !"in. L$si>!$si t$rs$=ut =i"s"n7" =$ru/ur"n )>- %%#

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    tid"/ "d" d$n7ut $%=u!u3 d"r"3 di t$ng"3n7" d"n %$n2"di u9"t &"/tu

    di"s/oi. S$sud"3 u=$rt"s# u/ur"n d"n ="n7"/n7" !$si 9$nd$rung %"/in

    %$ning/"t d$ng"n =$rt"%="3n7" usi". Pri" d"n &"nit" %$ng"!"%in7"

    d$ng"n r"sio s$i%="ng. P$rd"r"3"n "d"!"3 g"%="r"n 7"ng %$n9o!o/ d"ri

     $n7"/it ini.

    L$si>!$si t$!"ngi$/t"si" 3$%or3"gi/ 3$r$dit$r t$r!$t"/ !"ngsung di ="&"3

    %u/os"n7" d"n %ud"3 t$r/$n" tr"u%"# =$r"/i="t ro=$/# $rd"r"3"n# d"n

     $%=$ntu/"n u!/us. L$si>!$si /u!it tid"/ %ud"3 ro=$/ /"r$n" "d" $it$!

     =$rt"ndu/ 7"ng %$nutuin7". Lo/"si 7"ng "!ing u%u% "d" /u!it "d"!"3

    t$!""/ t"ng"n# 2"ri>2"ri# d"s"r /u/u# &"2"3# d"n !$3$r. L$si %u/os" d""t

    di2u%"i "d" =i=ir# !id"3# s$tu% n"si# d"n /on2ungti0". Gusi d"n "!"tu%

    /$r"s 2"r"ng t$r/$n". Ko%!i/"sin7" %$!iuti $ist"/sis# $rd"r"3"n

    g"stroint$stin"!# %$!$n"# 3$%"turi"# sirosis# 'istu!" "rt$rio0$n" "ru>"ru.

    Di"n2ur/"n 3"ti>3"ti d$ng"n $nggun""n "n"!g$si" in3"!"si# "n"st$si

    u%u%# ros$dur =$d"3 %u!ut# d"n o="t>o="t 3$"toto/si/ s$rt" "nti>

    3$%ost"ti/. Ro=$/n7" t$!"ngi$/t"si" d""t %$n7$="=/"n $rd"r"3"n# 7"ng

     "!ing ="i/ di/ontro! d$ng"n "/ t$/"n. Ri&"7"t# g"%="r"n /!inis d"n

    g"%="r"n /!inis d"n 3isto!og7 "d"!"3 $nting d"!"% %$%=u"t di"gnos$.

    Os!$r>$=$r>R$ndu Dis$"s$ (ORD "t"u T$!"ngi$/t"si" $%org3"i/ 

    $r$dit$r (T "d"!"3 $n7"/it 7"ng dis$="=/"n o!$3 9"9"t "d"

    r$s$tor su$r'"%i!i TGF>. M"ni'$st"si /!inis ORD dis$="=/"n o!$3

     $r/$%="ng"n $%=u!u3 d"r"3 7"ng "=nor%"!# t$r%"su/ t$!"ngi$9t"si"s#

    AMs# d"n "n$uris%". D"$r"3 7"ng tid"/ t$r$ng"ru3 "" !$si

    %$nun2u//"n "rsit$/tur /""! nor%"! "d" "n"!isis u!tr"stru9tur"!. D$ng"n

    d$%i/i"n# $n7"/it ini %$ru"/"n "&"! di/o%=in"si/"n d$ng"n 3"si!

     $r="i/"n "=nor%"! "d" !$si.

    @"9"t "d" $rsi%"ng"n $ndot$! s$!# d$g$n$r"si s$! $ndot$!# d"n

    /$!$%"3"n d"ri 2"ring"n i/"t $ri0"s/u!"r 7"ng didug" %$n7$="=/"n

     $!$="r"n /"i!$r d"n 0$nu!" ost9"i!!"r7# 7"ng =$r%"ni'$st"si s$="g"i

    t$!"ngi$9t"si"s. P"!ing u%u%# t$!"ngi$9t"si"s %$!i="t/"n s$!"ut !$ndir#

    s$rt" /u!it# /on2ungti0"# r$tin"# d"n s"!ur"n $n9$rn""n.

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    T$!"ngi$9t"s$s d"n $rd"r"3"n AM %$nun2u//"n /$!$%"3"n dinding

     $%=u!u3 d"r"3 7"ng t$r!o/"!isir s$="g"i 3"si! r$%od$!!ing 7"ng "=nor%"!

    /"r$n" /$tid"/s$i%="ng"n 'ungsi d"ri TGF>. Int$r"/si d$ng"n TGF>

    sign"!ing %$ng3"si!/"n disorg"nis"si sitos/$!$t"! stru/tur d"n /$"r"3"n

    d"!"% $%=$ntu/"n tu=u!i 0"s9u!"r.

    G$n 7"ng %$gi%!i/"si "d" /"sus T ini "d"!"3 $ndog!in g$n (T

    ti$ ) d"n ALK>) g$n (T ti$ d"n /$du"n7" s"ng"t %$%$ng"ru3i s$!

    $ndot$! $%=u!u3 d"r"3.

    S$9"r" 3isto"to!ogi dit$%u/"n $%=u!u3 d"r"3 %$%=$s"r# ir$gu!$r d"ndinding 7"ng tiis# t$t"i "tog$n$sisn7" =$!u% di/$t"3ui s$9"r" "sti.

    Ko"gu!"si 7"ng "=nor%"! d"n $ning/"t"n "/ti0it"s 'i=rino!iti/ "d" !$si

    ini =$r/ontri=usi /$ /$9$nd$rung"n $rd"r"3"n.

    ;% Sid"4 S#-"!,:!!" 6Es!al#"i!4ial Ai4a#sis8

    Sindro% Sturg$>$=$r "d"!"3 su"tu /$!"in"n 9ong$nit"! 7"ng 2"r"ng

    t$r2"di. M"ni'$st"sin7" "d"!"3 "ngio%" 0$n" d"ri !$to%$ning$" ot"/#

    3$%"ngio%" %"9u!" isi!"t$r"! "d" &"2"3# d$'i9it n$uro%us/u!$r# d"n

    !$si>!$si o/u!o>or"!. $%"ngio%" %"9u!" d"ri /u!it &"2"3 7"ng 2ug"

    dis$=ut ort&in$ st"in "t"u n$0us '!"%%$us "d"!"3 g"%="r"n 7"ng

     "!ing %$n9o!o/ d"ri sindro% t$rs$=ut. Su"tu 3$%"ngio%" &"2"3 =$r="t"s

     2$!"s# r"t" "t"u s$di/it %$ni%=u!# d"n =$r&"2"3 %$r"3 s"%"i ungu.

    $%"ngio%" t$rs$=ut %$n2"di u9"t =i!" dit$/"n# di2u%"i "d" &"/tu

    !"3ir# $n7$="r"nn7" di s$"n2"ng s"r"' trig$%inus d"n s$9"r" /3"s %$!u"s

    /$ g"ris t$ng"3 t"n" %$!int"s /$ sisi !"in. Di0isi ot"!%i/us d"ri s"r"' 

    trig$%inus "!ing s$ring t$rs$r"ng. Tid"/ "d" n7$ri "t"u $r"d"ng"n 7"ng =$r/"it"n d$ng"n 3$%"ngio%" d"n tid"/ %$%=$s"r d$ng"n =$rt"%="3n7"

    usi".

    P$ru="3"n "!ir"n d"r"3 0$n" 7"ng dis$="=/"n% o!$3 "ngio%"

    !$to%$ning$" d""t %$ng"/i="t/"n d$g$n$r"si /orti/"! 9$r$=r"!# /$2"ng>

    /$2"ng# /$t$r=$!"/"ng"n %$nt"!# d"n 3$%i!$ngi". P"d" r"diogr"' 

    t$ng/or"/ !"t$r"!# /"!si'i/"si>/"!si'i/"si g7ri'or% s$9"r" /3"s t"%"/ 

    s$="g"i tr"%>!in$s =$r/ontur g"nd". Kir">/ir" -+ d"ri "si$n

    %$ng"!"%i /$!"in"n o/u!$r t$r%"su/ "ngio%"# /o!o=o%"# "t"u g!"u9o%".

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    i$r!"si" 0"s/u!$r 7"ng %$ng$n"i %u/os" ii d"n =i=ir "d"!"3 t$%u"n

    or"! 7"ng "!ing s$ring. P"!"tu%# gusi d"n d"s"r %u!ut 2ug" d""t t$r/$n".

    P$n7$="r"n =$r9"/>=$r9"/ or"! %$r"3 t$r"ng t$rs$=ut "d"!"3 /$ d"$r"3>

    d"$r"3 7"ng di"so/ o!$3 9"="ng>9"="ng s"r"' trig$%inus. S$$rti !$si

    &"2"3# =$r9"/>=$r9"/ ini =$r3$nti di g"ris t$ng"3. K$t$r!i="t"n gusi d""t

    %$%=u"t 2"ring"n %$n2"di $d$%" d"n %$n7$="=/"n /$su!it"n d$ng"n

    3$%ost"sis 2i/" di!"/u/"n ros$dur =$d"3 7"ng %$ng$n"i 2"ring"n>

     2"ring"n ini. Erusi gigi 7"ng "=nor%"!# %"/ro/$i!i"# %"/rodonsi"# d"n

    %"/rog!osi" "d"!"3 "/i="t d"ri $rtu%=u3"n 7"ng s"ng"t =$r!$=i3"n d"ri

     $%=u!u3 d"r"3 =$s"r. P"d" d"$r"3 37$r!"si" 0"s/u!$r# =$d"3 %u!ut

    3"rus di!"/u/"n %$nurut u/ur"n 3$%ost"ti/ 7"ng /$t"t.

    STOMATITIS NIKOTINA

    Sto%"titis ni/otin" %$ru"/"n su"tu !$si s$si'i/ 7"ng t$r2"di "d" "!"tu%

    d"ri $ro/o/ =$r"t ="i/ sig"r$t# i" %"uun 9$rutu. L$si ini %$%i!i/i s"t

    g"%="r"n /3"s 7"ng 2"r"ng t$r!$&"t/"n /"r$n" !o/"sin7" 7"ng %$n9o!o/ "d"

     "!"tu%. L$si d"ri sto%"titis ni/otin" ini t$r="t"s "d" d"$r"3 7"ng t$r$/sos

    d$ng"n s$%=ur"n "s" ro/o/ 7"ng r$!"ti' t$rus"t. L$si ini =i"s"n7" !$=i3

    %$non2o! "d" "!"tu% /$r"s 7"ng =$r/$r"tinis"si.

    D"!"% t"3" "&"! %u/os" "/"n t"%"/ /$%$r"3"n# "/"n t$t"i /$%udi"n "/"n

     =$r"ngsur>"ngsur %$n2"di "=u>"=u /$uti3"n# %$n$="! d"n =$r'isur. Pus"t

     $n$="!"n t$r2"di di s$/$!i!ing ori'isu% d"ri /$!$n2"r s"!i0" %inor di "!"tu%

    7"ng t"%"/ s$$rti nodu! uti3 d$ng"n ="gi"n t$ng"3 =$r&"rn" %$r"3 7"ng

    %ung/in "/"n =$ru="3 %$n2"di 9o/!"t "/i="t d$osit /"!/u!us.

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    $am%ar stomatitis nikotina2 3ukosa dari palatum keras memperlihatkan

    nodul putih4 terlum%rikasi dengan ,arna merah di tengahn+a2

    S$9"r" 3isto!ogis $it$!iu% %$nun2u//"n "/"ntosis d"n 3i$r/$r"tosis. L"is"n

    $it$!iu% du/tus /$!$n2"r s"!i0" s$ring %$nun2u//"n su"tu %$t"!"si"

    s/u"%os" d"n o=stru/si d"ri du/tus.

    KARSINOMA IN SITU

    Kons$ /"rsino%" in>situ ( @IS =$r"s"! d"ri 9$r0i ut$ri#7"itu su"tu

     $ru="3"n dis!"sti/ d"ri $it$! s/u"%os 7"ng tid"/ %$ng"!"%i di'$r$nsi"sis$3ingg" tid"/ %$ng3"si!/"n /$r"tin. Kons$ ini =$r=$d" d$ng"n /"rsino%" in>

    situ 7"ng t$r2"di "d" rongg" %u!ut di%"n" /$r"tinis"si %"si3 t$r2"di. K"r$n"

    tu%or ini 3"n7" t$r2"di s$="t"s intr" $it$!# =$=$r"" "3!i %"si3 %$nggun"/"n

    isti!"3 dis!"si" "r"3 (s$0$r$ d7s!"si"# "t"u n$o!"si" intr" $it$! (Su"%ous

    Intr" N$o!"si"SIN 3ig3 gr"d$.S$d"ng/"n O %$ng/!"si'i/"si/"n

    /"rsino%" in>situ rongg" %u!ut s$="g"i su"tu /!"si'i/"si di!"si" $it$!

    s/u"%os.

    K"rsino%" in>situ "d"!"3 su"tu n$o!"si" 7"ng =$r"d" di"nt"r" di!"si" $it$!

    s/u"%os d"n /"rsino%" s$! s/u"%os in0"si' (S@@#t$t"i ="t"s /rit$ri"

    di"nt"r"n7" =$!u% 2$!"s d"n /"d"ng/"!" %"si3 /ontro0$rsi"!.

    K"rsino%" insitu =u/" su"tu /"n/$r . !$si %$nun2u//"n =$ntu/ /$"r"3"n

     r"g"n"s $it$! d$ng"n g"nggu"n s$!uru3 !"is"n $it$! %"t"ng.

    $am%aran klinis

    G"%="r"n /!inis d"ri /"rsino%" in situ d""t =$ru" !$si>!$si uti3 %"uun !$si

    %$r"3 ($rito!"/i". D$ng"n t$i 7"ng %$non2o! indur"si d"n s$ring/"!i di

    d"3u!ui o!$3 su"tu i!s$r"si 7"ng tid"/ s$%=u3>s$%=u3. D""t dit$%ui "d"

    s$!uru3 $r%u/""n %u/os" rongg" %u!ut. U!s$r 7"ng tid"/ s$%=u3>s$%=u3

    d!"% 2"ng/" &"/tu 7"ng !"%" t$rut"%" "d" d"s"r %u!ut "t"u t$i!"t$r"! !id"3

    3"rus di&"s"d"i s$=g"i !$si>!$si r"g"n"sg"n"s.

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     athogenesis

     $ru="3"n s7st$% /$s$i%="ng"n s$!u!$r d""t t$r2"di o!$3 /"r$n" su"tu irit"si

    /ronis. Irit"si t$rs$=ut %$rus"/ s$! in"ng d$ng"n 9"r" %$rus"/ DNA s$!#

    s$3ingg" r$g$n$r"si 2"ring"n %$n2"di t$rg"nggu "t"uun $rtu%=u3"n 2"ring"n

    %$n2"di tid"/ t$r/ontro!. T$r2"di $r=$d""n o!" $/sr$si rot$in P6- di%"n"

    t$r2"di $ning/"t"n $/sr$si =$r!$=i3 7"ng di2u%"i "d" s$! ="s"!# "r" ="s"!

    3ingg" %$ngg"nti/"n s$!uru3 $it$! 9"r9ino%" in situ.

    $am%aran histopatologis

    S$%u" g"%="r" 3isto!ogis dis!"si" $it$! 7"ng t$!"3 dis$=ut/"n s$=$!u%n7"

    /$%ungin"n di2u%"i "d" /"rsino%" in situ. "!"uun d$r"2"t g"nggu"n

    %"tur"si =$gitu "r"3 t$t"i tid"/ %$ng3"si!/"n /$r"tin. Tid"/ "d"n7" /$r"tin

    s$di/itun %$%=u"t $it$! t$%=us 9"3"7" d"n %$n"%="3 0isi=i!it"s "d"

     $%=u!u3 d"r"3 /$9i! di ="&"3n7". "! ini %$ru"/"n d"s"r "d"n7"

    /$%$r"3"n s$9"r" /!inis 7"ng %$n2"di /"r"/t$risti/ $rito!"/i". M$s/iun

    /"rino%" insitu di"rti/"n s$="g"i g"nggu"n s$!uru3 r"ng/"i"n %"tur"si # t$t"itid"/ %$nun2u//"n in0"si s$! /$ !"is"n su=%u/os". O!$3 /"r$n" itu /"rsino%"

    insitu diis"3/"n d"ri /"rsino%" $it$!oid.

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    DAFTAR PUSTAKA

    i/%"3# Nuru!.

    -6

    Sudiono# 1"nti# d//.