Disease of Head and Neck - Mouth and Upper Airway Flashcards
Caries
Tooth Decay
Common
Bacteria ferment sugars and produce acids that dissolves minerals in enamel
Prevention - Brushing, fluoride forms fluorapatite in enamel which increases resistance to bacterial acids
Gingivitis
Inflammation of sqamous mucosa - edema and bleeding
Cause - improper oral hygiene - plaque formation (bacteria, saliva protein and cell debris)
Prevention - brushing flossing
Periodontitis
Inflammation goes deeper
Can cause tooth loss, sepsis, infective endocarditis, local and systemic abscesses
Higher risk in immunecompromised pts - AIDS, Diabetes, Crohn’s, leukemia,
Tori
Benign - nodular bony overgrowth of jaw bone
Hard as a rock
Bilateral on the mandible (torus mandibularis)
hard palate is most common location (torus palatines)
Uncertain cause - bruxism
Fibroma
Reactive fibrous papule from chronic irritation
benign
Associated with jagged teeth, ill fitting denture
Pyogenic granuloma
Benign
Pregnant women
Capillary hemangioma
Rapid growth, ulceration, cellularity and mitotic activity
Peripheral Giant Cell granuloma
Benign
proliferation of giant cells and fibrous stroma in gingiva
Mucocele
Accumulation of mucin producing mass
Extravasation type - trauma to minor salivary glands
Retention type - blovked salivary dict with mucin filled epithelial lines cyst
LIP
Aphthous Ulcers (canker sores)
Superficial oral ulcers Very painful - not dangerous In children mostly May be associated with celiac disease or IBS cause unknown
Glossitis
Inflammation of the tongue
Nutritional deficiencies - B vit and Iron
May be traumatic - ill fitting dentures and jagged teeth
Oral Herpes Simplex Virus Infections
Mostly HSV1 (HSV2 can also be sexually transmitted) Usually asymptomatic in young children. can develop acute herpetic gingivostomatitis
Acute herpres Gingivostomatitis
Abrupt onset of vesicles throughout mouth
Fever, Lymphadenopathy, anorexia
Take 3-4 weeks to clear
May be diagnosed by cytology (Tzanck test)
Recurrent Oral Herpes Simplex
HSV dormant in local nerve ganglia
Can cause recurrent stomatitis when patient is ill, IC
Recurrent lesions usually heal in 10 days
Denivir
Oral Candidiasis (Thrush)
Fungus - normal flora
Overgrowth in IC or altered oral flora
Superficial curdy white membrane of inflammatory debris - easily scraped off
Hairy Leukoplakia
White fluffy patches - lateral border of tongue
In IC
Cant be scraped off
Caused by EBV
Squamous cell carcinoma
Most common cancer of mouth!
Predisposing factors - Tobacco, Alcohol and HPV
Precursors - leukoplakia and Erythroplakia
Often diagnosed after invasion/metastasis has occurred
Field cancerization
met - lymph, lung, liver bone
Leukoplakia
White patch that doesn’t scrape off
clinical presentation hyperkeratosis
dysplasia is seen. should be considered premalignant until proven otherwise
Erythroplakia
Red, often ulcerated or eroded lesion
Can become cancerous
Odontogenic cysts and tumor
Arising in tissues that form teeth
tumor is rare (both benign and malignant)
most common lesions include dentigerous cysts, keratocysts, ameloblastoma
Dentigerous Cyst
Cyst that originates around an unerupted tooth
Squamous lining
Complete excision is curative
can recur if incompletely excised
odontogenic keratocyst (OKC)
More locally aggresive than odontogenic cyst
High recurrence rate in parakerotic variant
Multiple OKC + Many cutaneous basal cell carcinoma - Nevoid basal cell carcinoma syndrome
Ameloblastoma
Low grade malignant tumor from odontogenic epithelium
Locally invasive tumor
Recurs if not completely excised
metastases rare
Rhinitis
Inflammation of nasal mucosa
Caused by viruses - adeno, echo, rhino
can get secondary bacterial infections
allergic rhinitis
hypersensitivity to pollen, fungi etc
IgE mediated
Eosinophils
Chronic rhinitis
Repeated infections or allergic rhinitis
More severe superimposed bacterial infections that extend into sinuses
LEAD TO NASAL POLYPS
Nasal inflammatory Polyps
After chronic rhinitis
Edematous mucosa orinflamed stroma
Can ulcerate and grow quite large
Pharyngitis and Tonsillitis
Viral - rhino, echo, adeno, influneza
Bacteria - strep and staph
Strep can cause - RF and then RHD
Post streptococcol glomerulonephritis
Angiofibroma
Nasopharyngeal tumor - benign
Exclusive to adolescent males
androgen receptor positive
Bleeds easily and profusely *
Olfactory Neuroblastoma (Esthesioneurblastoma)
Malignant neuroblastic tumor of olfactory nerve
any age - median 50
bad prognosis - depending on grade and stage
Long cytoplasmic processes - fibrillary background
Nasopharyngeal carcinoma
African childhood cancer *
Also in Chinese
Risk factor - EBV, nitroamines in diet and smoking
Three histologic types (based on differentiation
keratinizing squamous - least radiosensitive
Non keratinizing squamous
Undifferentiated - most radiosensitive
Up to 70% - lymph node metastasis
this tumor if patient has squamous or undifferentiated carcinoma in cervical nodes without a known primary
otitis media in adults - think of this
epistaxis, local invasion of cranial nerve VI
sinusitis
most common caused by viruses as part of common cold
Chronic - secondary bacterial infection
preceded by rhinitis
Can cause meningitis
Unusual Sinusitis
kartagener syndrome - defective ciliary action - bronchiectasis ans situs inversus
Fungi - diabetes or IC
if aggresive and necrotizing - consider mucormycosis
Murcormycosis
aka zygomycosis
Bread mold fungi
Mucor, rhizopus, absidia, cunninghamella
In IC
Sinonasal papilloma
Benign tumors of squamous mucosa
Two Types
Exophytic - more common
Inverted - high recurrence ! more aggressive
