Clin Med - Neoplasia/Congenital Disorders Flashcards
Choanal atresia
Congenital narrowing of the back of the nasal cavity that causes difficulty breathing. (1 or both posterior nasal cavities)
How does a choanal atresia effect a newborn?
Normal newborn is obligate nasal breather, so:
- Incapable of reflex breathing through the mouth
- Will succumb to respiratory arrest if not recognized
S/S of choanal atresia
- Cyclic respiratory distress relieved with crying
- Noisy breathing
- Feeding difficulties
Dx of choanal atresia
- Nasal endoscopy
* CT scan
Tx of choanal atresia
•Dependent upon severity
•Unilateral can be monitored if no respiratory distress or feeding issues. Nasal salinerinses.
•Bilateral must be treated as soon as possible. Surgical repair to open nasal
airway sufficiently to allow the infant to breathe on their own.
Causes of cleft palate/lip
usually unknown. suspect genetic, drugs, viruses, other toxins.
Complication of cleft palate/lip
- Appearance
- Feeding problems
- Failure to gain weight
- Poor growth
- Recurrent ear infections
- Speech difficulties
Dx of cleft palate/lip
Routine ultrasound during pregnancy
Tx of cleft palate/lip
- Early surgical repair (lip usually by 2-12 months, palate by 9-18 months)
- Prosthetic palate device to help with feeding until surgery
- Speech therapy
- Orthodontics
Nasoalveolar Molding Device (NAM)
passively molds the gums/nostrils prior to surgery. Held in place with rubber bands and tape. Slowly adjusted as the baby grows.
Reduces the size of the cleft prior to surgery, improves the position of the lip and nose, helps with feeding
papillomatosis
Benign epithelial tumors that grow inside the larynx, vocal cords, or respiratory tract
cause of papillomatosis
Caused by infection with the human papilloma virus (HPV) - but not considered a STD, transmitted during childbirth
Complications of papillomatosis
- they eventually may block the airway passage and cause difficulty breathing.
- Very rarely may undergo malignant change to squamous cell carcinoma w/ a poor prognosis
S/s of papillomatosis
Voice hoarseness and breathing difficulties most common presenting symptom
Dx of papillomatosis
• Indirect laryngoscopy • Direct laryngoscopy
Tx of papillomatosis
• Tumors have a tendency to return
• Surgery:
-May need repeated surgery for debulking
-Carbon dioxide laser surgery
inverted papilloma
•Benign unilateral tumor of the nasal passage •Often misdiagnosed as nasal polyp
etiology of inverted papilloma
- Epstein-Barr virus has been found in 65% (human herpes virus 4)
- Often contain HPV (Human papilloma virus)
S/S of inverted papilloma
•Most commonly present with recurrent epistaxis
Complication of inverted papilloma
- 10-15% will transform into squamous cell carcinoma
- Bony destruction
- Intracranial extension
Tx of inverted papilloma
Surgery, usually laser
Appearance of inverted papilloma
- Arises from the lateral nasal wall
- Typical granular “mulberry” like appearance
What is the most common site for a salivary gland mass/enlargement?
parotid gland
Salivary gland enlargement/mass commonalities
- Unilateral or bilateral: bilateral suggests benign process
- Bilateral diffuse swelling with dry mouth = Sjogren Syndrome
- Often seen with Diabetics
- Masses may be malignant or benign
S/S of salivary gland enlargement/mass
Painless slow-growing mass
Dx/Tx of salivary gland enlargement/mass
- Fine needle biopsy • CT scan to determine depth of tumor
* Surgery
Pleomorphic Adenoma
most common benign neoplasm of salivary glands, specifically of the the parotid gland
About the pleomorphic adenoma
- Female > males
- Non-painful, isolated swelling or mass
- Parotidectomy is treatment of choice
Warthin tumor
- mostly found in parotid gland
- Benign cystic tumor of the salivary glands
- Males > Females, associated with smoking
- Non-painful, slow growing, tail of the parotid near the angle of the mandible
- Complete excision with clear margins required
Vocal cord nodules aka singers or screamers nodes
- Localized, benign, superficial growths on the medial surface of the true vocal folds
- “Calluses” of the vocal cords
- Nodules are bilateral
vocal cord nodules are most common in who?
- women aged 20-50 years
- Also found commonly in children (more frequently in boys than in girls) who are prone to excessive shouting or screaming.
What is believed to be the cause of vocal cord nodules?
phonotrauma
vocal cord polyps
• Unilateral; have a broad spectrum of appearances, from
hemorrhagic to edematous, pedunculated
• Due to phonotrauma
• Can develop after an episode of hemorrhage
• Involve the free edge of the vocal fold mucosa
S/S of vocal cord polyps/nodules
- Voice change
- Generalized and persistent hoarseness • Change in voice quality
- Low, gravelly voice
- Airy or breathy voice • Increased effort in producing the voice