64 - Diseases of the head and neck Flashcards
Most common malignant tumour of oral cavity?
SCC
most likely spot to get tumour in oral cavity?
floor of mouth
Carcinoma of oral cavity - aetiology
Tobacco and alcohol note synergistic relationship between two
Meat and red chilli powder
genetics
HPV types
HPV16 and 18
Protective factors for oral cavity carcinomas
anti oxidants in fruit and veg (vit A and C)
Pre-cancerous lesions and conditions
submucous fibrosis actinic keratosis lichen planus leukoplakia and erythroplakia chronic hyperplastic candidosis
most common cancer in larynx
SCC
HPV numbers for laryngeal cancer
6 and 11
Risk factors for laryngeal cancer
Tobacco and -OH
Diet with low green leafy veg and rich in salt preserved meats and dietary fats
Metal/plastic workers
Exposure to paint, diesel and gas fumes, asbestos.
Radiation
Laryngopharyngeal reflux
Genetics
Lichen planus -
muco-cutaneous condition
Lichen planus - pathogenesis
unknown however suggested t-cell mediated immune response
Lichen planus - clinical presentation
itchy, purple papules forming plaques with Wickham’s striae
Oral lesions = reticular striations, plaque-like, erosive, ulcerative lesions, desquamative gingivitis
Small risk of malignant transformation
Vocal cord nodules and polyps
Reactive lesions
Heavy smokers or singers
Adults and men affected
Vocal cord nodules and polyps - clinical presentation
hoarseness
change in vocal quality
increased effort producing voice
usually located on the true vocal cords
Nasal polyps
Recurrent attacks of rhinitis
4cm
allergic aetiology
Nasal polyps - histology
oedematous mucosa with loose stroma containing hyperplastic/cystic mucous glands infiltrated with mixed inflammatory infiltrate rich in eosinophils
Acute and chronic otitis media -
infants and children
viral w/ general URTI
Acute and chronic otitis media - causative organisms
strep. pneumoniae
h.influenzae
moraxella catarrhalis
Acute and chronic otitis media - causative organisms chronically
pseudomonas aeruginosa, staph. aureus
Acute and chronic otitis media - complications
perforation of ear drum
aural polyps, cholesteatoma
mastoiditis, temporal cerebritis or abscess
destructive necrotising otitis
Destructive necrotising ostitis is a consequence of otitis media
in a diabetic person esp. when P. aeruginosa is the causative organism
Cholesteatoma -
Associated w/ chronic otitis media
Cholesteatoma - pathogenesis
chronic inflammation and perforation of the eardrum due to ingrowth of squamous epithelium or metaplasia of secretory epithelial lining of middle ear
Cholesteatoma - microscopically
cystic lesions lined by keratinising squamous epithelium and filled with debris and cholesterol clefts
Cholesteatoma - complications
precipitates surrounding inflam rxn enhance by rupture and may result in foreign body giant cell rxn
erosion of ossicles, the labyrinth and adjacent bone
hearing loss
v. rare. CNS complications: brain abscess and meningitis
Otosclerosis
abnormal bone deposition in the middle ear usually bilateral. begins early in life and familial
Otosclerosis - pathogenesis
uncoupling of normal bone resorption and formation
fibrous ankylosis -> bony overgrowth -> anchorage of middle ear bones to oval window
Otosclerosis - clinical features
Degree of immobilisation governs the severity of hearing loss
Slowly progressive leading to hearing loss
Labyrinthitis -
inflammatory disorder of inner ear
Labyrinthitis - clinical presentation
disturbances of balance and hearing
Labyrinthitis - autoimmune processes
Wegener granulomatosis or polyarteritis nodosa
Carcinomas - ear
External (pinna) - BCC and SCC. elderly men
Ear canal - SCC, middle-aged to elderly women not associated w/ sun exposure
Paragangliomas -
most common tumour of the middle ear, originating in the paraganglia
Paragangliomas - presenting symptoms
pulsatile tinnitus, hearing loss, aural pressure/fullness, dizziness, otalgia and bloody otorrhea
