6. Head and Neck p327-333 (Mouth, Thyroid, Parathyroid) Flashcards
Juvenile Nasal Angiofibroma (4)
Male teenager with nosebleeds. Obstruction is a common symptom.
Mass centered on the sphenopalatine foramen.
Expansion of the pterygopalatine fossa.
Very vascular, angiogram will blush.
Primary vascular supply from ascending pharyngeal artery and/or internal maxillary artery
Antrochoanal polyp (6)
Seen in 30-40s, with nasal congestion and obstructive symptoms.
Arises within the maxillary sinuses and passes through and enlarges the sinus ostium (or accessory ostium).
“Widening of the maxillary ostium”.
No associated bony enlargement of the sinus.
Polyp extends into the nasopharynx.
Basically a large inflammatory polyp with a thin stalk arising from the maxillary sinus.
Inverting papilloma (5)
Uncommon tumour with distinctive imaging features.
Classic location is lateral wall of the nasal cavity, most frequently related to the middle nasal turbinate.
Impaired maxillary drainage is expected.
Focal hyperostosis at the tumour origin.
MRI: “cerebriform pattern”, sort of looks like brain on T1 and T2.
10% harbour a squamous cell cancer.
Esthesioneuroblastoma (4)
Neuroblastoma of olfactory cells, starts at cribriform plate.
Classically dubbbell appearance, growth into the skull and down into sinuses, waist at the cribriform plate.
Often cysts in the mass.
Octreotide scan positive, as it’s neural crest origin.
Squamous cell/SNUC (6)
Squamous is the most common head and neck cancer.
Maxillary antrum is most common location.
Highly cellular, and therefore low on T2.
Relatively little enhancement compared to other sinus masses.
SNUC (undifferentiated squamous cell) is more aggressive version of regular squamous cell cancer. Massive and seen more in the ethmoid air cells.
Epistaxis (5)
Usually idiopathic, can be iatrogenic.
Most common location is anterior septal area (Kiesselbach plexus), but because these are anterior they tend to be easier to manually compress.
Posterior ones are less common but tend to be the ones that bleed uncontrollably and need angio.
Most cases are given a trial of nasal packing before IR.
Main supply to the posterior nose is the sphenopalatine artery (terminal internal maxillary artery), tends to be first target.
Variant anastamosis between ECA ad ophthalmic artery is important, don’t want to embolise the eye.
Floor of mouth dermoid/epidermoid (2)
“Sack of marbles” - fluid sac with globules of fat.
Typically midline
Ranula (4)
Mucous retention cyst.
Typically lateral.
Arise from sublingual gland/space.
“plunging” once it’s under the myelohyoid muscle.
Torus palatinus (3)
Normal variant. Bony exostosis that comes off hard palate in midline.
Classic Hx of dentures not staying in
Sialolithiasis (4)
Stones in salivary ducts.
Most comonly in the submandubilar gland (wharton’s).
Can lead to infection (Sialadenitis)
Chronic obstruction can lead to fatty atrophy of the gland.
Odontogenic infection (5)
Can be dental or peridontal in origin.
Infection is more common from an extracted tooth than an abscess involving intact tooth.
Attachment of the myelohyoid muscle to the myelohyoid ridge dictates spread of infection to the sublingual and submandibular spaces - above the myelohyoid line (anterior submandibular teeth) goes to sublingual space, below the myelohyoid line (second and third molars) goes to the submandibular space.
Odontogenic abscess is commonest masticator space “mass” in adults.
Ludwig’s angina (2)
Agressive cellulitis in the floor of the mouth, gas forming.
Most cases start with orthodontic infection.
Osteonecrosis of the mandible (3)
Related to prior radiation, licking radium paint brush, or bisphosphonate treatment.
Cancer (mouth) (3)
Squamous cell cancer is most common.
Older - smoking and drinking. Younger - HPV.
HPV related SCCs tend to present with large, necrotic, level 2a nodes (NOT a brachial cleft cyst).
Thyroglossal duct cyst (3)
Can occur anywhere between the foramen cecum (base of tongue) and thyroid gland.
Usually found in midline at or above the hyoid.
Looks like thin walled cyst.
