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13. CP - Diseases of the Skin and Soft Tissues > (64) Diseases of the head and neck > Flashcards

(64) Diseases of the head and neck Flashcards

1
Q

What accounts for 90-94% of malignant tumours of the oral cavity?

A

Squamous cell carcinoma

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2
Q

What are the survival rates in oral squamous cell carcinoma?

A

Less than 50%

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3
Q

Where do oral squamous cell carcinomas arise?

A

In any part of the oral cavity

  • highest frequency in the floor of the mouth
  • ventrolateral tongue
  • retromolar region
  • lower lip
  • soft palate
  • gingiva
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4
Q

Name two dominant risk factors for oral squamous cell carcinoma

A
  • tobacco
  • alcohol abuse

Strongly synergistic

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5
Q

What accounts for 75% of the disease burden of oral and oropharyngeal malignancies?

A

Alcohol and tobacco

eg. oral smokeless tobacco is a major cause in some countries

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6
Q

Which virus is found in variable but small proportion of oral and up to 50% of oropharyngeal squamous cell carcinomas?

A

Human papilloma virus (HPV)

High oncogenic genotypes (HPV16 and 18)

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7
Q

How do dietary factors affect risk of oral carcinoma?

A
  • fruits and veg (high vitamin A and C) = protective, related to anti-oxidant properties
  • meat and red chilli powder = risk factors
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8
Q

Are there genetic factors involved in oral carcinoma?

A
  • FH of head and neck cancer may be a risk factor

- inherited genomic instability may increase susceptibility

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9
Q

Describe the stages in the pathogenesis leading to oral SCC

A
  • normal
  • hyperplasia/hyperkeratosis
  • mild/moderate dysplasia
  • severe dysplasia/CIS
  • SCC
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10
Q

What are the pre-cancerous lesions and conditions associated with oral SCC?

A
  • submucous fibrosis
  • actinic keratosis
  • lichen planus
  • leukoplakia and erythroplakia
  • chronic hyperplastic candidosis
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11
Q

What are the local metastases of oral carcinoma?

A

Cervical lymph nodes

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12
Q

What are the distant metastases of oral carcinoma?

A

Mediastinal lymph nodes, lung, liver, bone

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13
Q

What worsens the prognosis of oral carcinoma?

A

Lymphovascular invasion

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14
Q

The mechanism of spread of oral carcinoma is what?

A

Almost always tumour embolism

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15
Q

What is the most common carcinoma of the larynx?

A

Squamous cell carcinoma of the larynx

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16
Q

How was SCC of the larynx treated historically?

A

Total laryngectomy

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17
Q

What are the major risk factors for carcinoma of the larynx?

A

Tobacco and alcohol

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18
Q

Which virus is associated with carcinoma of the larynx?

A

HPV 6 and 11

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19
Q

What type of diet is associated with carcinoma of the larynx?

A

Low in green leafy vegetable and rich in salt, preserved meats and dietary fats

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20
Q

What are the other things that could lead to carcinoma of the larynx?

A
  • metal/plastic workers
  • exposure to paint, diesel, and gasoline fumes, asbestos
  • exposure to radiation
  • laryngopharyngeal reflux
  • genetic susceptibility
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21
Q

What are the stages in the pathogenesis of carcinoma of the larynx?

A
  • hyperplasia
  • dysplasia
  • carcinoma in situ
  • invasive carcinoma
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22
Q

What is lichen planus?

A

A disease of the skin and/or mucous membranes that resembles lichen

Small risk of malignant transformation

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23
Q

What is the cause of lichen planus?

A

Unknown, but suggested to be a T cell-mediated autoimmune response

24
Q

Describe the cutaneous lesions in lichen planus

A

Cutaneous lesions = itchy, purple, papule forming plaques with Wickham’s striae

25
Q

Describe the oral lesions in lichen planus

A

Reticular stations, plaque-like, erosive, ulcerative lesions, desquamative gingivitis

26
Q

Who are vocal cord nodules and polyps seen in?

A

Heavy smokers or those who impose great strain on vocal cords (singers’ nodules)

Adults and predominantly men

27
Q

Vocal cord nodules and polyps are most commonly associated with what symptoms?

A

A voice change eg. hoarseness, changes in voice quality, and increased effort in producing the voice

28
Q

Where are vocal cord polyps usually located?

A

On the true vocal cords

29
Q

What causes nasal polyps?

A

Recurrent attacks of rhinitis leading to focal protrusions of the mucosa

30
Q

What problems can nasal polyps when large or multiple?

A

Can encroach the airway and impede sinus drainage

May reach 4cm in size

31
Q

What is seen on histology in nasal polyps?

A

Oedematous mucosa with loose stroma containing hyperplastic/cystic mucous glands and infiltrated with mixed inflammatory infiltrate rich in eosinophils

32
Q

Acute sinusitis is usually proceeded by what?

A

Acute or chronic rhinitis

33
Q

Maxillary sinusitis can arise from what?

A

Extension of a periapcial infection from an upper tooth through the astral floor

  • oral floor
  • inflammatory reaction is non-specific
34
Q

Acute sinusitis may progress into chronic, especially when…

A

There is impairment of sinus drainage

  • as a result of the inflammatory oedema of the mucosa
  • may impound the suppurative exudate producing empyema of the sinus
35
Q

What are the causative organisms of sinusitis?

A
  • mixed microbial flora usually inhabitant of the oral cavity
  • severe forms may be caused by fungi eg. mucomycosis esp in diabetes
36
Q

What are the complications of sinusitis?

A

Potential spread into the orbit or into the enclosing bone producing cranial osteomyelitis, meningitis or cerebral abscess

37
Q

Acute and chronic otitis media mainly affect who?

A

Infants and children

38
Q

What is the cause of acute otitis media?

A

Often viral and associated with URT symptoms

May also be bacterial:

  • strep. pneumoniae
  • H. influenzae
  • moraxella catarrhalis
39
Q

How is chronic otitis media caused?

A

From recurrent/persistent episodes and failure of resolution of acute bacterial infections

40
Q

What are the causative agents in chronic otitis media?

A
  • pseudomonas aeruginosa
  • staphylococcus aureus
  • fungal
41
Q

What are the potential complications of otitis media?

A
  • perforation of eardrum
  • aural polyps, cholesteatoma
  • mastoiditis, temporal cerebritis, abscess
  • destructive necrotising otitis (in diabetes, esp. P. aeruginosa)
42
Q

What is a cholesteatoma?

A

A destructive and expanding growth consisting of keratinising squamous epithelium in the middle ear and/or mastoid process

Cystic lesions lined by keratinising squamous epithelium and filled with debris and cholesterol clefts

Precipitates surrounding inflammatory reaction which is enhanced if the cyst ruptures and may result in a foreign body giant cell reaction

43
Q

Cholesteatoma is a complication of what?

A

Chronic otitis media

44
Q

Describe the pathogenesis of cholesteatoma

A

Chronic inflammation and perforation of the eardrum with ingrowth of squamous epithelium, or alternatively squamous metaplasia of the secretory epithelial lining of the middle ear

45
Q

What are the potential complications associated with cholesteatoma?

A
  • progressive enlargement may lead to erosion of ossicles, the labyrinth (dizziness) and adjacent bone or surrounding soft tissue
  • hearing loss
  • very rarely CNS complications: brain abscess and meningitis
46
Q

What is otosclerosis?

A

Abnormal bone deposition in the middle ear - usually bilateral

Begins in early decades of life, mostly familial

47
Q

Describe the pathogenesis in otosclerosis

A
  • uncoupling of normal bone resorption and bone formation

- fibrous ankylosis - bony overgrowth - anchorage of middle ear bones to oval window

48
Q

What does otocleosis eventually lead to?

A

Hearing loss - degree of immobilisation of middle ear bones governs the severity of hearing loss

49
Q

What is labyrinthitis?

A

Inflammatory disorder of the inner or or labyrinth

50
Q

Labyrinthitis produces disturbances of what?

A

Balance and hearing

51
Q

Labyrinths can be a result of autoimmune processes such as…

A

Wegener granulomatosis of polyarteritis nodosa

52
Q

What cancers occur in the external ear (pinna)?

A

Basal cell and squamous cell carcinoma, tend to occur in elderly men and are associated with actinic radiation

53
Q

What cancers occur in the ear canal?

A

Squamous cell carcinoma, middle-aged to elderly women, not associated with sun exposure

54
Q

What is the most common tumour of the middle ear?

A

Paraganglioma - originating in the paraganglia

55
Q

What are the presenting symptoms of paraganglioma of the middle ear?

A
  • pulsate tinnitus
  • hearing loss
  • aural pressure/fullness
  • dizziness
  • otalgia
  • blood otorrhoea

13. CP - Diseases of the Skin and Soft Tissues (3 decks)

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