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ENT > BENIGN TUMORS H & N > Flashcards

BENIGN TUMORS H & N Flashcards

1
Q
  • Originates at the floor of the pharynx at the foramen cecum at the 4th week of gestation
  • Descends ventrally in the midline of the neck in close proximity with the hyoid bone
A

Thyroid gland

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2
Q
  • The diverticulum that is formed is called
  • Normally resorbs by the 10th week of gestation
  • Thyroglossal duct cysts/sinuses
    + Formed when all or part of the diverticulum persist
A

thyroglossal duct

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3
Q
  • Present as a midline mass in childhood
  • May be located as much as 2 cm from the midline
  • May also present for the first time in adults
  • 80% = at or just below the hyoid bone
  • Level of the mass elevates with protrusion of the tongue.
  • Normally do not have external sinuses
  • May become infected during a course of an upper respiratory tract infection
  • 5% may contain functional thyroid tissues
  • May harbor thyroglossal duct papillary carcinoma
  • Diagnostics: Thyroid panel and Ultrasound
A

THYROGLOSSAL DUCT CYST

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4
Q
  • May be the only thyroid tissue the patient may have
  • Important to document presence of thyroid tissue in its normal location either by clinical examination or by radioactive scans.
  • Treatment:
    + Sistrunk procedure:
    > Resection of the cysts en bloc with the central portion of the hyoid bone
    > Following the sinus superiorly up to the base of the tongue.
A

Ectopic Thyroid (Lingual thyroid)

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5
Q
  • Appears in the 4th week of embryonic life
  • Normally involutes fully at 7th week
  • Contributes to the formation of various head and neck structures
  • Results from incomplete fusion of the branchial clefts
  • Epithelium (Squamous) lined cysts or sinuses with or without openings and cartilaginous rest.
  • Occasionally ciliated columnar epithelium was reported
  • Usually present in the first decade of life
  • May go undetected until adulthood
  • May contain lymphoid tissues which may enlarge during an upper respiratory tract infection
A

Branchial Cleft Anomalies

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6
Q

Branchial Cleft Anomalies

~ Cartilaginous rest
Typically are subcutaneous
- Medial to the tragus
- Treatment: simple excision
~ Cysts and sinuses
- Located above the level of the hyoid bone just below the body of the mandible
- Extend supero-laterally through the parotid to end within the membranous external auditory canal.
- Treatment:
+ Excision of cyst to prevent complication associated with
recurrent infection
+ Dissection should be meticulous to avoid injury to the facial, hypoglossal, vagus and lingual nerves and the carotid vessels

A

First branchial cleft

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7
Q
  • Most common (95%) type of cleft anomaly
  • Found at the middle third of the sternocleidomastoid
    muscle.
  • Cysts and sinuses:
    + Extends more deeply into the neck
    + superiorly along the carotid sheath
    + medially over the hypoglossal nerve
    + between the internal and external carotid arteries
    + ends at the pharynx adjacent to the piriform sinus or
    + tonsillar fossa
A

Branchial Cleft Anomalies:
Second Branchial Cleft

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8
Q

Bailey’s Clasification of 2nd Branchial Cleft Remnants

  • Superficial cysts lying anterior and adjacent to the SCM muscle
A

Type I

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9
Q

Bailey’s Clasification of 2nd Branchial Cleft Remnants

  • lesions extending between internal and external carotid arteries
A

Type III

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10
Q

Bailey’s Clasification of 2nd Branchial Cleft Remnants

  • Cyst lying on greater vessels, may adhere to internal jugular vein
A

Type II

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11
Q

Bailey’s Clasification of 2nd Branchial Cleft Remnants

  • Lesions lying in the parapharyngeal space next to the pharygeal wall
A

Type IV

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12
Q
  • Rare
  • Arise anterior to the middle and lower thirds of the sternocleidomastoid muscle.
  • Course behind the carotid artery and end at the pyriform sinus.
  • Treatment: excision
A

Branchial Cleft Anomalies: Third Branchial Cleft

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13
Q
  • Increased mitotic activity
  • Considered a true neoplasm
  • Typically absent at birth or only as a faint vascular blush
A

HEMANGIOMAS

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14
Q

Phases of HEMANGIOMAS

A
  • Rapid Proliferative Phase
    + First several months of life
    + Grow to a very large size
  • Involution Phase
    + Majority
    + By the age of seven years old
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15
Q

Involution: Hemangioma

A
  • 3 years old- 30%
  • 5 years old- 50%
  • 7 years old- 70%
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16
Q

HEMANGIOMAS
- Complications:

A
  • Ulceration
  • Bleeding
  • Obstruction of the eye with subsequent amblyopia
  • Airway obstruction
  • Thrombocytopenia (Kasabach-Merrit syndrome)
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17
Q

HEMANGIOMAS
- Treatments:

A
  • Arrest of the proliferative phase
    + Systemic dexamethasone
    + Intravenous interferon-
    + Propanolol
  • Intralesional steroid or sclerosing agent injection
    + Triamcinolone; Bleomycin
    + Smaller hemangiomas of the lips or eyelids
    + Temporary control
  • Photodynamic laser therapy:
    + Prevents the onset of the proliferative phase
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18
Q
  • Normal rate of endothelial cell turn over
  • Results from congenital errors of vascular morphogenesis
  • Classification:
    > Capillary
    > Venous
    > Arterial
    > Lymphatic
A

Vascular Malformations

19
Q
  • From gross abnormalities connecting the arterial and venous systems
    ○ Cause:
     Massive hemorrhage
     High-output congestive heart failure
     Hemolytic anemia
     Skeletal abnormalities
  • Bone hypertrophy
  • Distortion
A

Vascular Malformations
- High-flow lesions: (Arteriovenous Malformation)

20
Q
  • Cystic hygromas
    > Lymphatic malformation
    > Classically occur in the neck or in floor of the mouth
  • All malformations are present at birth
  • May not be clinically evident until ectatic vessels dilate under hormonal or other physiologic influences.
  • Normally grow proportionally with the child
  • Do not regress spontaneously
A

Vascular Malformations

21
Q
  • Highly infiltrative
    ○ Complete pre-operative evaluation
    > Extent
    > Vascularity
    ○ Evaluation:
    > Physical examination
    > CT scan
    > MRI
    > Angiography
    > Technetium labeled red blood cell scintigraphy
    > Open biopsy to rule out malignancy
A

Cystic Hygroma

22
Q

Indications for early surgical resection of Cystic Hygroma

A
  • Recurrent infection
  • Obstructive symptoms
  • Hemorrhage
  • Significant aesthetic deformities
23
Q

Subject to chronic irritant in the lower lip

A
  • Pipe
  • Smoking
  • Lip biting
  • Damaging effect of chronic actinic exposure
24
Q

Process in the nesios in the lip being benign

A

Lower lip
> Subject to chronic irritant
> Basal layer of the epidermis
> Dysplasia
> Parakeratosis
> Dyskeratosis : Proliferation and abnormal orientation of epithelial cells
> Carcinoma in situ

25
Q
  • Submucosal accumulation of mucus
  • No epithelial lining
  • Caused by rupture of duct system of minor salivary glands of the lip
  • Most commonly located at the labial mucosa of the
    lower lip.
  • Treatment:
    > Excision
    > Marsupialization – reserved for extensive lesions
A

Mucocele

26
Q
  • A type of mucus retention cyst
  • Arises from major salivary glands
  • Commonly involves the sublingual glands
  • Treatment:
    > Excision
    > Meticulous dissection to avoid injury to the nerve and avoid hematoma formation
    > Resection the affected sublingual gland in toto to prevent recurrence.
A

Ranula

27
Q
  • Granulomatous lesion of the gingiva
  • Exaggerated inflammatory response to minor injury
  • Subtypes:
    > Congenital epulis
    + Typically found in the anterior maxilla of newborns
    > Epulis gravidarum
    + Occurs in 1 percent of pregnant women
    + Resolves spontaneously upon termination of pregnancy
  • Only symptomatic epulis are excised
A

Epulis

28
Q
  • Common in the tongue and larynx
  • Caused by human papilloma virus (6, 11, 16, 18, 31, 33, 35)
    > Induce squamous epithelial proliferation
    > Soft, irregular, pedunculated lesions
    > May cause airway obstruction
  • Treatment:
    > Excision
    > Carbon dioxide laser cauterization
A

Papillomas

29
Q
  • Derived from Schwann cells
  • Arise throughout the aerodigestive tract
  • In the tongue
    > Firm, submucosal swellings in the middle one-third
    > Mimic squamous cell carcinoma
  • Treatment:
    > Wedge excision
A

Granular cell myoblastoma of the Oral Cavity

30
Q
  • Most common type of ulcerative condition
  • Present as a cyclic painful ulceration and spontaneous healing several times a year and for many years
A

Idiopathic aphthous ulcer

31
Q
  • Common within the nasal cavity and paranasal sinuses
  • Equal frequency between male : female in all age group after adolescence
  • 10% occurrence in patients with cystic fibrosis
  • Often multiple and bilateral
  • May present with nasal obstruction, mucoid nasal discharges or anosmia
A

Polyps

32
Q
  • Also called Schneiderian papilloma
  • Polypoid mass on the lateral nasal wall
  • Occuring in middle aged men
  • Causes: HPV and smoking
  • Inverted proliferative growth pattern
  • Presents with symptoms of nasal obstruction
  • 8-12% associated with invasive squamous carcinoma
  • Management:
    > More extensive resection – reduce recurrence to 6%
    > Close follow up
A

Inverted papilloma

33
Q
  • Benign, highly expansile and destructive fibrovascular neoplasm
  • Arise in adolescent male 10-20 years of age
  • Originates in the superior nasal cavity (sphenopalatine foramen); most common vessel involved (internal maxillary artery)
  • Can erode into the paranasal sinuses, orbit, pterygomaxillary fossa and middle cranial fossa
  • Symptoms:
    > Nasal obstruction, Anosmia, Proptosis, Cranial nerve dysfunction
  • Management:
    > Preliminary angiographic embolization
    > Surgical extirpation
    + 10 % require combined intra and extra cranial approach
    > Radiation therapy
    + For residual or recurrent lesions
A

Juvenile nasopharyngeal angiofibromas

34
Q
  • Blockage of secretion from microscopic secretory ducts of mucous glands within the lining of the paranasal sinus cavity.
  • Fluid mass remains separate from the bony wall and surrounded by air except at the base
  • Most common location is in the maxillary sinus
  • Considered as the most common benign lesion of the maxilla
  • Mostly are asymptomatic and are radiographic incidental findings
  • Conservative management unless with obstruction
A

Paranasal sinuses: Mucous retention cysts

35
Q
  • Benign
  • Expansile and highly destructive
  • Due to macroscopic blockage of a sinus ostium by epithelial or osseous neoplasm, inflammatory process or trauma.
  • Mucinous secretions accumulate in the entire sinus
    > Pressure effect
    > Displacement of the sinus epithelium and bony wall
    > Thinning and destruction of the wall
    > “Invasion: of the adjacent vital structure
A

Paranasal sinuses: Mucoceles

36
Q

Common arise: ( in order of frequency ) of Paranasal sinuses: Mucoceles

A
  • Frontal sinuses
    > Present with frontal headache
    > 60% erode into the floor of the sinus
    + Proptosis
    + Frontal swelling
    + Diplopia
    + Blindness
    + Ethmoid
    + Maxillary
    + Sphenoid
37
Q
  • Most common benign neoplasm (90%)
  • Caused by human papilloma virus
  • Most common location: vocal cord
  • Usual presentation: hoarseness
  • Presents as a pedunculated exophytic mass
  • Classification:
    > Juvenile:
    + 2:1 female predominance
    + Multiple lesions
    + Recurs and spreads rapidly after excision
    > Adult:
    + 2:1 male predominance
    + Usually solitary
    + Rarely recurs after excision
  • Management: CO2 laser obliteration
A

Larynx: Papilloma

38
Q
  • Herniation of the laryngeal ventricle
  • Three forms:
    > Internal laryngocele
    + Confined to the larynx
    + Presents as enlargement of the false cords
    + Cause hoarseness
    > External laryngocele
    + Protrudes through the thyrohyoid membrane
    + Presents as swelling in the anterior neck
    + Usually asymptomatic
    > Mixed laryngocele
    + Combination of the internal and external laryngocele
A

Laryngocele

39
Q
  • Associated with chronic increase in intralaryngeal pressure
  • Singers and musicians have propensity for the development of it
  • Treatment:
    > Ligation of the laryngocele stalk
    > Repair of the ventricular weakness
A

Laryngocele

40
Q
  • Cysts or tumors arising from the progenitor cells of tooth development (Rests of Malassez)
  • Arise from bone not involve in tooth development
A
  • Odontogenic Tumors
  • Nonodontogenic Tumors
41
Q

> From the dental lamina
Often associated with impacted tooth in young patients
Usual presentation:
+ Painless, locally destructive mass of the jaw
+ X-ray : uniloculated/ multiloculated, radiolucent mass
+ More frequent in the mandible than in the maxilla
+ Slow growing
+ May grow to a large size and erode adjacent bone
- Treatment:
> Resection of the entire lesion with a margin of bone to
prevent recurrence

A

Ameloblastomas (adamantinomas)

42
Q
  • Less aggressive
  • Treatment:
    > Enucleation
    > Excision of the entire lining of the lesion
A

Calcifying odontogenic cysts (Gorlin’s cysts, ameloblastic fibromas, cementomas, keratocysts)

43
Q
  • Benign slow-growing projection from the surface of the bone
  • Turos palatinus:
    > Midline of the hard palate
  • Torus mandibularis
    > Lingual surface of the mandible opposite the premolars
    > Often bilateral
  • Genetically inherited by autosomal dominant genes
  • May induce ulceration on the overlying mucosa mimicking a mucosal neoplasm
  • No therapy is needed unless it interfere with speech,
    mastication or use of dentures
  • Treatment: simple excision
A

Torus

ENT (9 decks)

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