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Otolaryngology > Adenotonsillar disease and malignancy > Flashcards

Adenotonsillar disease and malignancy Flashcards

1
Q

What is the most common cause of sleep apnoea in children?

A

Obstructive adenotonsillar hypertrophy

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2
Q

Describe the growth of tonsils after birth

A

Tonsils and adenoids continue to grow from birth to 12 years of age, with the greatest increase in size during the ages of 2 and 8

During this period of time, the disproportionate growth of the adenoids and tonsils compared to the skeletal boundaries results in a relatively narrower upper airway

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3
Q

Describe the growth of tonsils after birth in adenotonsillar hyperplasia

A

During this period of time, the disproportionate growth of the adenoids and tonsils compared to the skeletal boundaries results in a relatively narrower upper airway

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4
Q

How will adenoid hyperplasia present?

A
  • Obligate mouth breathing
  • Hyponasal voice
  • Snoring and other signs of sleep disturbance
  • AOM/OME
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5
Q

How will tonsillar hyperplasia present?

A
  • Snoring and other signs of sleep disturbance
  • Muffled voice
  • Visibly enlarged tonsils without symptoms means nothing
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6
Q

How will adenotonsillar hyperplasia managed?

A

Removal of the tonsils and adenoids is indicated if there is recurrent or persistent obstructive or infectious symptoms related to adenoid hypertrophy

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7
Q

What is meant by apparent tonsillar enlargement?

A

Tonsil is displacement medially by PTA or parapharyngeal space mass

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8
Q

What are some non-neoplastic causes of true unilateral tonsillar enlargement?

A
  • Acute or chronic infective
  • Hypertrophy
  • Congenital
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9
Q

What are some neoplastic causes of unilateral tonsillar enlargement?

A

Benign papillomas
Lymphoma
Squamous cell carcinoma

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10
Q

What are some chronic infective causes of unilateral tonsillar enlargement?

A
  • Tubercular tonsillitis
  • Actinomycosis
  • Congenital syphilis
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11
Q

What are some congenital causes of unilateral tonsillar enlargement?

A
  • Teratoma
  • Hemangioma
  • Lymphangioma
  • Cystic hygroma
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12
Q

How is unilateral tonsillar enlargement investigated?

A

Rule out malignancy - CT, PET scan

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13
Q

What are some cancers affecting the head and neck?

A

Squamous cell carcinoma
Nasopharyngeal carcinoma
Laryngeal carcinoma
Oropharyngeal carcinoma
Oral cavity carcinoma

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14
Q

What are some risk factors for developing squamous cell carcinoma?

A
  • Smoking
  • Alcohol
  • HPV type 16
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15
Q

How does HPV type 16 cause squamous cell carcinoma?

A

Produces proteins E6 and E7 which disrupt p53 and RB pathways respectively, leading to cellular immorality

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16
Q

What are some associations with nasopharyngeal carcinoma?

A

South China
EBV

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17
Q

What are some associations with laryngeal carcinoma?

A

Cigarettes
Alcohol

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18
Q

What are some associations with oropharyngeal carcinoma?

A

HPV (In the West)

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19
Q

What are some associations with oral cavity carcinoma?

A

South Asia
Chewing tobacco

20
Q

Describe the histology of SCC

A
  • Depends on grading of tumour
  • Well differentiated - epithelial cells with keratinisation and prickle cells
  • Poorly differentiated - lacks these characteristics
21
Q

Where do supra-glottic tumours drain to?

A

Superior deep cervical nodes

22
Q

Where do glottic tumours drain to?

A

95% stay on the cords

23
Q

How do glottic tumours (On cords) present?

A

voice changes/airway obstruction

24
Q

Where do sub-glottic tumours drain?

A

Paratracheal nodes

25
What are some symptoms of head and neck cancer?
- Dysphonia - Dysphagia - Odynophagia - Unilateral otalgia - Neck lump - Stridor and obstruction
26
How is head and neck cancer diagnosed?
- US + FNA - Confirm with panendoscopy and biopsy under general anaethesic (Direct laryngoscopy, tracheoscopy, oesophagoscopy)
27
What are soem staging investigations required in head and neck cancer?
- CT neck - lymph nodes, larynx - CT chest - staging e.g. looking for metastasis or second primary tumour - MRI - nasopharynx and tongue base - PET - metastases
28
What are some symptom control strategies in head and neck cancer?
Pain management Rehydrate Improve oral intake if necessary (may need admission)
29
How is early (T1/T2) stage laryngeal cancer managed?
- Transoral laser surgery - Radiotherapy - 90% 5-year survival
30
How is advances (T3/T4) stage laryngeal cancer managed?
- Partial or total laryngectomy - often curative - Chemo and radiotherapy
31
How is lymph node metastasis managed in laryngeal cancer?
In both cases will need treatment, either chemo/radiotherapy or surgery
32
How is early (T1/T2) stage oropharyngeal cancer managed?
- Transoral laser surgery - Radiotherapy - 90% 5-year survival
33
How is advanced (T3/T4) stage oropharyngeal cancer managed?
Chemo and radiotherapy
34
How is lymph node metastasis in oropharyngeal cancer managed?
Chemo/radiotherapy or surgery
35
How is nasopharyngeal cancer managed?
Treatment is with (chemo) radiotherapy
36
What is the prognosis for nasopharyngeal cancer?
stage 1 is 100%, stage 4a is 67% = 5-year survival
37
What is a paraganglioma?
Tumours arising in clusters of neuroendocrine cells dispersed throughout the body
38
What are some genetic syndromes that can cause paragangliomas?
MEN2, von Hippel-Lindau syndrome, neurofibromatosis type 1
39
Where do paragangliomas of the sympathetic system affect?
Generally arise in paraganglia below the level of the neck Paravertebral - organ of Zuckerkandl, rarely bladder
40
Where do paragangliomas of the parasympathetic system affect?
Related to great vessels of the head and neck Carotid bodies, aortic bodies, jugulotypanic ganglia, ganglia nodosum of vagus and clusters around oral cavity, nose, nasopharynx, larynx and orbit
41
Describe the histology of paragangliomas
Nests of round/oval cells surrounded by delicate vascular septae
42
How sympathetic paragangliomas present?
Features of catecholamine excess e.g. such as headaches, palpitations, diaphoresis and hypertension
43
How do parasympathetic paragangliomas present?
Present more commonly with mass effects such as cranial nerve palsies, a neck mass or tinnitus
44
What are some investigations required in paraganglioma?
CT, MRI, MIBG, PET
45
How are paragangliomas managed?
Surgical resection or radiotherapy
46

Otolaryngology (23 decks)

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