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
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
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
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)
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
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
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
8
Q
Bailey’s Clasification of 2nd Branchial Cleft Remnants
- Superficial cysts lying anterior and adjacent to the SCM muscle
A
Type I
9
Q
Bailey’s Clasification of 2nd Branchial Cleft Remnants
- lesions extending between internal and external carotid arteries
A
Type III
10
Q
Bailey’s Clasification of 2nd Branchial Cleft Remnants
- Cyst lying on greater vessels, may adhere to internal jugular vein
A
Type II
11
Q
Bailey’s Clasification of 2nd Branchial Cleft Remnants
- Lesions lying in the parapharyngeal space next to the pharygeal wall
A
Type IV
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
13
Q
- Increased mitotic activity
- Considered a true neoplasm
- Typically absent at birth or only as a faint vascular blush
A
HEMANGIOMAS
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
15
Q
Involution: Hemangioma
A
- 3 years old- 30%
- 5 years old- 50%
- 7 years old- 70%
16
Q
HEMANGIOMAS
- Complications:
A
- Ulceration
- Bleeding
- Obstruction of the eye with subsequent amblyopia
- Airway obstruction
- Thrombocytopenia (Kasabach-Merrit syndrome)
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
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
- 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
Mucocele
26
- 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.
Ranula
27
- 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
Epulis
28
- 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
Papillomas
29
- 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
Granular cell myoblastoma of the Oral Cavity
30
- Most common type of ulcerative condition
- Present as a cyclic painful ulceration and spontaneous healing several times a year and for many years
Idiopathic aphthous ulcer
31
- 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
Polyps
32
- 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
Inverted papilloma
33
- 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
Juvenile nasopharyngeal angiofibromas
34
- 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
Paranasal sinuses: Mucous retention cysts
35
- 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
Paranasal sinuses: Mucoceles
36
Common arise: ( in order of frequency ) of Paranasal sinuses: Mucoceles
- Frontal sinuses
> Present with frontal headache
> 60% erode into the floor of the sinus
+ Proptosis
+ Frontal swelling
+ Diplopia
+ Blindness
+ Ethmoid
+ Maxillary
+ Sphenoid
37
- 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
Larynx: Papilloma
38
- 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
Laryngocele
39
- 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
Laryngocele
40
- Cysts or tumors arising from the progenitor cells of tooth development (Rests of Malassez)
- Arise from bone not involve in tooth development
- Odontogenic Tumors
- Nonodontogenic Tumors
41
> 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
Ameloblastomas (adamantinomas)
42
- Less aggressive
- Treatment:
> Enucleation
> Excision of the entire lining of the lesion
Calcifying odontogenic cysts (Gorlin’s cysts, ameloblastic fibromas, cementomas, keratocysts)
43
- 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
Torus
