Disease of Head and Neck - Ears, Neck, larynx and glands Flashcards
Otitis Media
Infection of middle ear
usually viral with superimposed bacterial
Common in children
Acute - Strep pneumonia, H. influenza
Chronic - P. aeroginosa, Staph aureus
Diabetes - aggressive and destructive otitis from P. aeruginosa
Can lead to eardrum perforation
Cholesteatoma
keratinous cyst due to repeated bouts of otitis media
Can rupture and cause local inflammatory reaction
Otosclerosis
Abnormal bone deposition in middle ear - mostly stapes
Hearing loss
Usually familial
Ear tumors
Basal cell and Squamous cell cancers - don’t metastasize but lethal
Brachial Cleft Cyst
Benign remnant
Near SCM
Early adulthood
Fluid filled
Thyroglossal Duct Cyst
Thyroid migration remnant Anterior midline neck, base of tongue Any age Squamous or respiratory lining can develop tumors
Paraganglioma
Arises from paraganglia - neuroendocrine cells
Adrenal medulla, Carotid body *
Slow growing tumor
May be malignant
AKA - carotid body tumor
Arises in cells from carotid body - near bifurcation
can locally invade, engulf carotid
Sustenacular cells - Balls of cell - Zellballen
Laryngitis
infectious, chemical, smoking, toxins
Main findings - erythema, swelling, inflammation and focal ulceration
wheezing - do a tracheostomy
laryngoepiglottitis
Hemophilus Influenza
Dangerous in kids - airway obstruction
Croup -inspiratory stridor from inflammatory narrowing of airway - often caused by parainfluenza virus
Laryngeal nodules and polyps
Yelling, singing or smoking
benign
nodules are bilateral
polyp is unilateral
laryngeal papillomas
Benign squamous proliferations common on true vocal cords typically unilateral associated with HPV 6 and 11 In kids, multiple papillomas can lead to airway obstruction Histology - Koilocytes**
Laryngeal carcinoma
95% are squamous cell carcinoma
Risk factor - cigarette smoking, alcohol
mass - it is this until proven otherwise
Hyperplasia –> dysplasia –> carcinoma seq
Mostly on true vocal cords
treatment - removal and irradiation
prognosis - 1/3rd die of disease
Xerostomia
Dry mouth
Causes - Sjogren Syndrome
Drugs - anticholinergics, antipsychotics, diuretics, antihistamines, antihypertensive
Complications - dental caries and candidiasis
Sjogren’s Syndrome
Chronic disease with dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca) resulting from AI destruction of salivary and lacrimal glands
could be primary or secondary to RA or Lupus
Mikulicz Disease
used to describe the inflammatory reaction seen in salivary glands in sjogren’s syndrome
Marked lymophocytic infiltrates and germinal centers
proliferation of ductal epithelium
may develop secondary lymphomas
Mucocele
Most common salivary gland lesion
lower lip
Ranula - large mucocele at floor of mouth
Sialadenitis
Inflammation of salivary gland
Can be caused by AI disease, viral infection (mumps) or bacterial infection)
Often secondary to sialolithiasis
Salivary Gland Tumor
Parotid - Less malignant most common
Saubmandibular
Sublingual
Minor - more malignant least common
Tumors of Salivary Gland
Pleomorphic Adenoma - Benign Warthin - Benign Mucoepidermoid carcinoma Adenoid cystic carcinoma Acinic cell carcinoma
Pleomorphic adenoma
MOST COMMON benign Parotid gland mostly Irregular borders Derived from myoepithelial cells Mixed cell - chondroid aread, myxoid tissue, epithelium Painless
Carcinoma ex pleomorphic adenoma
Malignant tumor arising in preexisiting pleomorphic adenoma
Most are undifferentialted
Prognosis is good if pleomorphic is confined
Warthin Tumor
Aka Papillary Cystadenoma lymphomatosum Almost all in parotid Benign Most common bilateral Arise from salivary gland inclusions within intraparotid lymph nodes
Mucoepidermoid Carcinoma
Most common primary salivary gland cancer
often cystic
composed of squamous cells mucin producing glandular cells and intermediate cells
Grade influences prognosis
Adenoid Cystic Carcinoma
Tubular solid cribiform patterns of cells with reduplicated basal lamina
Perineural invasion
Slow but relentless
histology - punched out spaces
Acinic Cell carcinoma
Show acinar cell differentiation with zymogen granules
slow growing
may involve facial nerve
high recurrence relentless
Acinic Cell carcinoma
Show acinar cell differentiation with zymogen granules
slow growing
may involve facial nerve
high recurrence relentless