Chapter 16- Head And Neck Flashcards by Taylor Horlock

What causes oral caries?

Demineralization of tooth structure due to acidic metabolites of fermenting sugars from bacteria

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What is another name for caries?

Cavities

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What is gingivitis?

Inflammation of the oral mucosa surrounding teeth

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What is periodontitis?

Inflammation that affects the supporting structures of the teeth, alveolar bone and cementum

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What is periodontitis associated with?

Shifts in bacteria types and poor oral hygiene

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Periodontitis can be the origin of what important systemic diseases?

Infective endocarditis

Pulmonary and brain abscesses

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What inflammatory/reactive lesions are common in the oral cavity?

Apthous ulcer/canker sore

Irritation/traumatic fibroma

Pyogenic granuloma

Peripheral ossifying fibromas

Glossitis

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What kind of lesion is a canker sore?

Superficial oral ulceration

Hyperaemic, thin exudate layer, zone of erythema

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What do irritation fibromas occur?

Along the bite line

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What patients are pyogenic granulomas commonly found in?

Pregnant women and children

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What can peripheral ossifying fibromas arise from?

Pyogenic granulomas

Cells of the periodontal ligament

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Why are infections in the oral cavity normally resisted?

Normal oral flora outcompetes pathogens

High IgA levels

Saliva

Dilution (food and drink)

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What infections are seen in the oral cavity?

Herpes simplex virus

Oral candidiasis

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What form of herpes simplex is most common found in the oral cavity?

HSV-1

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What are the characteristics of oral HSV infections?

Vesicle with serious fluid that rupture causing shallow ulcerations

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What test is performed to diagnose HSV-1?

Tzanck test (look for multinucleate polykaryons)

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What is another name for oral candidiasis?

Thrush

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What patients does thrush affect?

Immunocompromised

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What is the most common form of thrush and what are the characteristics?

Pseudomembranous

Superficial, grey-white membrane composed of suppurative exudates (contain fungus)

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What are the three forms of oral candidiasis?

Membranous
Erythematous
Hyperplastic

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What systemic diseases show early oral manifestations and what are they?

EBV- hairy leukoplakia (lateral tongue lesion with white hyperkeratotic thickenings)

Scarlet fever- red or white tongue with papillae

Measles- spotty enanthema, ulcerations cause Koplik spots

Mono- acute pharyngitis and tonsillitis, grey-white membrane

Diphtheria- inflammatory membrane over tonsils and retropharynx

HIV- oral infections, Kaposi lesions, hairy leukoplakia

Lichen planus- keratotic lesions

Pemphigus- hyperaemic erosions from ruptured vesicles

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What precancerous lesions are seen in the oral cavity?

Leukoplakia- white plaque

Erythroplakia- red, velvety, flat lesion

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Which precancerous lesion shows a higher risk of transformation in the oral mucosa?

Erythroplakia

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What cancer makes up 95% of head and neck cancers?

Squamous cell carcinoma

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What increases the risk of developing SCC in the oral cavity?

Smoking Alcohol Betel nut and paan chewing Sunlight

Half of all SCCs in the oral cavity harbour what infection?

HPV 16

What are the characteristics of early and late SCC in the oral cavity?

Early- raised, firm, pearly plaques or irregular, roughened/verrucous areas Late- ulcerated and protruding masses with irregular and indurated borders

Where are odontogenic cysts found?

In the mandible and maxilla

What are odontogenic cysts derived from?

Odontogenic remnants

What forms of odontogenic cysts are there? What are their locations? What type of epithelium lines them?

Dentigerous- near crowns of unerupted teeth, stratified squamous epithelium Odontogenic keratocysts- posterior mandible males), parakeratinized stratified squamous epithelium Periapical- at tooth apices from long standing pulpitis

What type of odontogenic cyst is potentially aggressive?

Odontogenic keratocysts

What are the two forms of odontogenic tumours?

1. Ameloblastoma | 2. Odontoma

What type of odontogenic tumour is most common?

Odontoma

What disorders are associated with the nose?

Infectious rhinitis Allergic rhinitis Nasal polyps Chronic rhinitis Sinusitis Necrotizing lesions

What type of immune reaction causes allergic rhinitis?

IgE mediated (type I hypersensitivity)

What are the characteristics of nasal polyps?

Seen with recurrent rhinitis Edematous mucosa infiltrated by neutrophils, eosinophils and plasma cells

What are the common causes of sinusitis?

Preceded by rhinitis Extension of a periapical tooth infection

What can nasal necrotizing lesions be caused by?

Acute fungal infections Wegener granulomatosis (autoimmune blood vessel inflammation) Lethal midline granuloma (lymphoma of NK cells infected with EBV)

What is Wegener granulomatosis now called?

Granulomatosis with polyangitis (GPA)

What are two common upper respiratory tract infections?

1. Pharyngitis | 2. Tonsillitis

How does follicular tonsillitis differ from normal tonsillitis?

Normal- enlarged, covered by exudate Follicular- dotted by pinpoints of exudate from crypts

What are the most common tumours of the nose, sinuses and nasopharynx?

Nasopharyngeal angiofibroma- benign, vascularized, adolescent boys Sinonasal (Schneiderian) papilloma- benign squamous or columnar epithelial Olfactory neuroblastoma- highly malignant tumour of the neuroectodermal olfactory cells Nasopharyngeal carcinoma- close relationship to lymphoid tissue and associated with EBV

What form of sinonasal papilloma is locally aggressive?

Inverted papilloma

What are the different types of nasopharyngeal carcinoma?

Keratinizing vs nonkeratinizing squamous cell Undifferentiated with lymphocytic infiltrates

What disorders are associated with the larynx?

Laryngitis Reactive nodules Squamous papilloma and papillomatosis Carcinoma

What bacterial infection can cause life threatening laryngitis?

H. influenzae

How do reactive nodules differ between smokers and singers?

Smokers- unilateral due to transformation Singers- bilateral

What are the characteristics of squamous papilloma?

1cm benign squamous epithelial lined lesions on true vocal cords

What is the difference between juvenile and adult squamous papilloma?

Juvenile- multiple lesions that can spontaneously regress Adult- multiple recurring lesions caused by HPV 6 and 11

What are the characteristics of laryngeal carcinoma?

Squamous cell carcinoma On vocal cords primarily Intrinsic- larynx proper Extrinsic- extends/occurs outside the larynx

What is otosclerosis?

Abnormal bone deposition in the middle ear about the rim of the oval window

What are the most common aural disorders?

Otitis Symptomatic otosclerosis Polyps Labrynthitis Carcinomas Paragangliomas

What type of ear infection is cholesteatoma associated with?

Chronic otitis media

What are the characteristics of branchia cysts?

Benign lesions with fibrous walls lined by stratified squamous or psuedostratified columnar epithelium with lymphocytic infiltrates On anterolateralneck

What are the characteristics of thyroglobulin cysts?

Lined by stratified squamous or pseudostratified columnar epithelium Walls can have lymphoid or thyroid tissue On midline

What are the characteristics of paragangliomas?

Carotid body tumour Nests of neuroendocrine cells enclosed by fibrous trabecular and elongated sustentacular cells Bifurcation of the carotid

What are the nests of neuroendocrine cells in paragangliomas called?

Zellballen

What is the difference between sporadic and familial forms of paragangliomas?

Sporadic- single MENII- multiple

Here do 70% of extra-adrenal paragangliomas occur?

Head and neck

What are the major salivary glands and what type of glands are they?

Parotid- serous Submandibular- mucous Sublingual- mucous

What disorders affect salivary glands?

Xerostomia (dry mouth) Sialadentitis (inflammation) Mucocele (mucin cyst) Sialolithiasis (stone formation) Neoplasms

Xerostomia is a common feature of what?

Autoimmune disorders Drug side affect

What is the most common salivary gland lesion?

Mucocele

A ranula is a mucocele from which gland?

Salivary

Risk of malignancy of salivary neoplasms increases as gland size increases or decreases?

Decreases

What neoplasms occur in the salivary glands?

Pleomorphic adenoma Warthin tumour Mucoepidermoid carcinoma Adenoid cystic carcinoma Acinic cell carcinoma

What are the characteristics of pleomorphic adenoma?

Benign Epithelial and mesenchymal elements (epithelial nests in matrix) 10% undergo malignant transformation 60% of all parotid tumours

What are the characteristics of Warthin tumours?

Almost exclusively parotid Mutinous or serous cysts Columnar cell’s with eosinophilic cytoplasm and lymphoid stroma

What are the characteristics of mucoepidermoid carcinomas?

Mixture of squamous and mucous secreting cells Infiltrative

What stain can be used to visualize mucins in mucoepidermal carcinomas?

Mucicarmine

What is the most common primary malignant tumour of salivary glands?

Mucoepidermoid carcinoma

What are the characteristics of adenoid cystic carcinoma?

Small cells with scant cytoplasm in cribriform pattern Secrete excess basement membrane Perineural invasion

What are the characteristics of acinic cell carcinoma?

Most common in parotid Resemble serous acinar cells Form sheets or microcystic, glandular, follicular or papillary patterns