Ch 16- Head and Neck Flashcards
what makes up the upper airways
- nose
- pharynx
- larynx
infectious rhinitis
- aka common cold
- profuse catarrhal discharge
- may extend to pharyngotonsililitis
- secondary bacterial infection may happen
what are the most common causes of infectious rhinitis
- adenoviruse
- echovirus
- rhinovirus
what happens in the acute stage of infectious rhinitis
- nasal mucosa that is thickened, edematous, and red
- nasal cavities narrowed
- turbinates enlarged
mucopurulent discharge
mucus and pus combo
suppurative discharge
pus only discharge
allergic rhinnitis
- aka hay fever
- hypersensitivity rxn
- IgE mediated
what is the main difference between asthma and allergic rhinitis?
- both IgE mediated
- main dif is where it occurs
- asthma- lungs
- allergic rhinitis- upper airways
characteristics of allergic rhinitis
- mucosal edema
- redness
- mucus secretion
- leukocytic infiltration with eosinophils
- sx related to histamine released by mast cells
nasal polyps
- due to repeated infections causing enlargement
- mucus has neutrophils, eosinophils, and plasma cells
- can become ulcerated or infected
sinusitis
- inflammation of lining of paranasal sinuses
- usually seen with concurrent rhinitis
what is the main/most basic cause of sinusitis?
- decreased ciliary action
clinical features of sinusitis
- facial pain
- red nose, cheeks, eyelids
- postnasal discharge
- blocked nose
- persistent cough or pharyngeal irritation
- hyposmia
most common causes of pharyngitis and tonsillitis
- rhinovirus
- echovirus
- adenovirus
- beta-hemolytic streptococci (for bacterial causes)
pathophys of sinusitis
- impaired drainage of sinus by inflammatory edema -> infection/ empyema of sinus
- outflow obstruction can cause mucocele
clinical features of pharyngitis and tonsillitis
- reddening and edema of mucosa
- reactive enlargement of tonsils and lymph nodes
what is the pseudomembrane in pharyngitis
- pharynx gets infected and exudate forms
- is the pseudomembrane
- sign of bacterial infection
follicular tonsililitis
- enlarged, reddened tonsils
- have white dots on them due to exudate
what can develop as a result of untreated streptococcal sore throats?
- rheumatic fever
- glomerulonephritis
nasopharyngeal carinomas
- rare in US
- associated with EBV
- heredity and age also play a role in development
patterns of nasopharyngeal carinomas
- keratinizing squamous cell carcinoma - difficult to treat
- non-keratinizing SCC- highly radiosensitive
- undifferentiated- nonneoplastic lymphocytes
cinical presentation of nasopharyngeal carcinoma
- nasal obstruction
- epistaxis
- cervical lymph nodes mets
what are some causes of laryngitis
- allergic reaction
- virus
- bacteria
- chemical insult
- heavy exposure to environmental toxins
croup
- aka laryngotracheobronchitis
- occurs in children
- inflammatory narrowing of airway -> inspiratory stridor
laryngitis in smokers
- predisposes them to squamous epithelial metaplasia
- leads to squamous cell carinomas
singers nodules
- bilateral lesions on vocal cords
- occurs due to excessive strain
vocal cord nodules and polyps
- smooth, rounded
- sessile or pedunculated (no stalk or stalk)
- located on true vocal fold
- covered in squamous epithelium
- can ulcerate
- almost never cancerous
symptoms of vocal cord nodules
- change in voice
- progressive hoarseness
laryngeal squamous papilloma
- benign neoplasm
- usually located on true vocal fold
- raspberry-like small proliferations
- not malignant but often reoccur
cause of laryngeal squamous papilloma
- HPV types 6 and 11
- often single nodes in adult and multiple in kids
laryngeal carinomas
- typically SCC chronic smokers
- usually males in 60’s
- manifests as hoarseness, dysphagia, dysphonia
contributing factors to laryngeal carinomas
- nutritional factors
- exposure to asbestos
- irradiation
- infection with HPV
acute/ chronic otitis
- mostly in infants and children
- usually viral (serous)
- can be bacterial (suppurative)
common cause of acute otitis media
- s. pneumoniae
- h. influenzae
- m. catarrhalis
common cause of chronic otitis media
- pseudomonas aeruginosa
- staph. aureus
- fungus
complications of chronic otitis media
- perforation of ear canal
- temporal cerebritis or abscess (very serious)
- spread into mastoid space
- cholesteatomas- abnormal fluid filled cysts in middle ear
otosclerosis
- abnormal bone deposition in middle hear at oval window
- aka fibrous ankylosis of footplate
- usually affects both ears
- degree of immobilization directly related to hearing loss
branchial cyst
- congenital cyst due to failure of 2nd branchial cleft/ pharyngeal cleft in embryonic development
- common in adults 20- 40 y/o
- found along SCM
- enlarge slowly
- rarely malignant
clinical features of branchial cyst
- dysphagia
- dysphonia
- dyspnea
- stridor
- contents may be clear and watery or mucinous with cellular debris
thryoglossal duct cyst
- cysts that are left over when thyroid migrates from base of tongue into neck before birth
- connected to back of tongue
- lie in front of adam’s apple
paraganglioma
- aka carotid body tumor
- carotid body = chemoreceptor
- dev from primitive neural cells
- trigger is chronic hypoxia
- can be benign of malignant
xerostomia
- dry mouth
- prevalent in elderly
- present as dry mucosa and/or atrophy of papillae of tongue
- fissuring and ulceration of tongue
causes of xerostomia
- sjogren syndrome (autoimmune)
- radiation therapy
- many medications
complications of xerostomia
- dental caries
- candidiasis
- difficulty speaking or swallowing
mucocele
- common lesion of salivary gland
- usually found on lower lip
- often due to trauma
- most common in toddlers, young adults, and elderly
cause of mucocele
- block or rupture of salivary gland duct
- consequential leakage of saliva into surrounding CT
presentation of mucocele
- fluctuant swelling of lower lip
- blue translucent hue
- filled with mucin and inflammatory cells, especially macrophages
ranula
- mucocele in floor of mouth
- epithelial lined cysts
- occur when duct of sublingual gland has been damaged
plunging ranula
- cyst that has dissected through CT connecting two bellies of mylohyoid muscle
sialadenitis
- infection of salivary gland
- unilateral involvement of a single gland
- inflammation -> painful enlargement and purulent duct discharge
- can be due to secondary ductal obstruction produced by stones
causes of sialadenitis
- trauma
- virus- most common mumps
- bacteria- s. aureus or strep viridans
- autoimmune disease
salivary gland neoplasms
- uncommon
- smaller the gland the more likely its malignant
- generally detected quickly because of rapid growth
- 90% are benign
pleomorphic adenoma
- benign, mixed tumor of salivary gland
- has epithelial cells and myoepithelial cells
- most common type of salivary gland tumor
- most common tumor of parotid
- radiation increases risk
- may lead to adenocarcinoma
symptoms of pleomorphic adenoma
- painless
- slow growing
- mobile
- discrete mass
- found in parotid or submandibular areas, or buccal cavity
warthin tumor
- 2nd most common salivary gland tumor
- benign
- exclusively found in parotid
- smokers are at a 8 times greater risk of development
mucoepidermoid carcinoma
- variable mixture of squamous cells, mucus secreting cells, and intermediate cells
- mainly found in parotid
cause of mucoepidermoid carcinoma
due to MECT1- MAML2 gene fusion
cause of pleomorphic carcinoma
mutation in PLAG1 gene
