Melonie A. Nance and Christine G. Gourin

The surface of the upper aerodigestive tract is lined with smooth, pink, moist mucosa containing minor salivary glands and lymphoid tissue. Interruptions in this smooth surface layer may result from an ulcer or a lesion of the oropharynx, pharynx, larynx, or trachea. An ulcer (or ulcerative lesion) is a concave area of tissue erosion. Natural progression can lead to a variety of outcomes from spontaneous healing to spreading tissue necrosis. Ulcers found on the laryngeal/pharyngeal mucosal surface are often painful and may be described by the patient as a “raw” area. Lesion is a general term that describes a circumscribed area of tissue irregularity, which may represent an area of discoloration, rough texture convexity, or raised tissue. Lesions may have areas of ulceration from concurrent trauma or necrosis, further confounding the distinction between the two terms.

Duration, location, and size, along with history, often provide definitive clues to etiology. It is important to determine whether the ulcer or lesion exists alone or if it is a sign of systemic pathology such as an inflammatory or infectious disorder, or extends beyond the surface epithelium as in the case of an ulcerative mass. Associated symptoms such as pain, increased sensitivity, rapid growth, exudative drainage, or bleeding are important clinical indicators in determining the pathological cause. These causes can be divided into three categories: inflammatory, traumatic, and neoplastic. Although supportive care can alleviate mild general symptoms, definitive treatment is ultimately determined by the specific etiology.

All lesions/ulcers in this area should be followed carefully by a physician. Without clear signs of spontaneous healing or clinical resolution, a biopsy should be considered early in the course of disease. Once the histopathologic diagnosis is established, definitive medical or surgical therapy can be selected with confidence.

Inflammatory Causes

Inflammatory ulcers can be caused by local or systemic infection of bacteria, fungi, or viruses. They often present with erythema and can be covered with exudate. They are usually painful and have a short onset of symptoms. Knowledge of the patient’s medical history can help to elucidate the patient’s degree of immunocompromise. Social history, including sexual history, can point to important factors in terms of behavioral risk of orally transmitted sexually transmitted diseases (STDs), as well as immunocompromise from human immunodeficiency virus (HIV).

Systemic granulomatous fungal infections

— Histoplasmosis

— Blastoplasmosis

— Coccidioidomycosis

— Cryptococcosis

— Candidiasis is more frequently found in the oral cavity and oro pharynx; however, it can also be found in the pharynx and esophagus.

Syphilis: Primary disease presents as a painless ulcer, whereas secondary disease presents with multiple gray mucous membrane ulcerations.

Herpes

Respiratory papillomatosis

Leprosy

Inflammatory noninfectious