Diseases of Head & Neck Flashcards
What is rhinitis?
Inflammation of the nasal cavity
Viral and bacterial causes of rhinitis?
Viral –> RSV, para-influenza, coronaviruses
Bacterial –> haemophilus infleunzae
Most common cause of rhinitis?
Inhaled allergen/hypersensitivity reaction (hayfever)
What common allergens trigger hayfever?
pollens, animal dander, dust mites, mold
What is sinusitis?
Inflammation of paranasal sinuses
Clinical features of sinusitis?
Blockage of draining orifices can lead to blockage and abscess formation
What can severe cases of sinusitis lead to?
meningitis, cerebral abscess, cranial osteomyelitis
What are nasal polyps?
- Soft, fleshy polypod lesions with a myxoid or mucoid appearance
- May be unilateral or bilateral, single or multiple
What is the cause behind nasal polyps?
Due to chronic allergic irritation or infection of nasal cavity & sinuses
What is rhinorrhoea?
Runny nose
What is Samter’s triad?
a) nasal polyps
b) asthma
c) aspirin intolerance
What cell type may predominate in polyps of infectious origin?
Neutrophils
Cell composition of nasal polyps?
Mixed chronic inflammatory cell infiltrate predominantly composed of eosinophils (mainly in allergic), plasma cells, and lymphocytes.
Structure of nasal polyps?
Surface respiratory epithelium with underlying oedematous stroma
What is oral lichen planus?
- Oral manifestation of Lichen planus (a non-infectious inflammatory mucocutaneous condition)
- Often presents as a chronic dermatologic disease but also commonly affects the oral mucosa.
- Up to 35% of patients with LP have only oral manifestations.
Gender distribution of oral lichen planus?
Female > male
What is a lichenoid drug eruption?
Also called drug-induced lichen planus, is an uncommon cutaneous adverse effect of several drugs. It is characterized by a symmetric eruption of flat-topped, erythematous or violaceous papules resembling lichen planus on the trunk and extremities.
What are the 3 forms of oral lichen planus?
- Reticular (papular, plaquelike)
- Erythematous (atrophic)
- Erosive (ulcerative or bullous) in buccal mucosa and tongue
Which disease is ‘Wickham striae’ seen in?
Lichen planus, typically in the oral mucosa
What are Wickham striae?
Wickham striae are whitish lines visible in the papules of lichen planus and other dermatoses, typically in the oral mucosa. The macroscopic appearance shows hypergranulosis.
Clinical features of oral lichen planus?
- Interlacing white striae (Wickham striae)
- Skin itchy, violaceous papules, blisters particularly on palms and soles
Histological findings in oral lichen planus?
- Basal keratinocytes damage and hydropic degeneration –> Civatte bodies
- Lichenoid tissue reaction pattern characterised by basal cell damage
- Inflammatory infiltrate in the interface/junction between epithelium and stroma
- Epithelium acanthosis or atrophy and saw tooth rete ridges
Treatment for oral lichen planus?
- Topical steroids
- Antifungal treatment if superimposed fungal infection (e.g. candidiasis)
Why can epiglottitis be life threatening?
Can lead to airway obstruction
Treatment of epiglottitis?
Treated with intubation/tracheostomy/antibiotics
Causative organism behind epiglottitis?
Capsulated forms of Haemophilus influenzae type B
What is allergic laryngitis caused by?
- Inhalation of allergens/ irritants
- If severe can lead to gross oedema and obstruction of airway
What are the 4 major causes of vocal cord polyps/nodules?
- Due to voice abuse (phonatory trauma) –> singer’s nodes
- Infection (laryngitis)
- Alcohol
- Smoking
What are the clinical features of vocal cord polyps?
Hoarseness or change in voice
Pathogenesis behind vocal cord polyps?
Non-neoplastic stromal reactive process related to inflammation and/or trauma
Histological features of vocal cord polyps?
- Squamous mucosa with underlying oedematous and myxoid stroma with fibrin deposition
- Amyloid like material in stroma (pink material)
Treatment of vocal cord polyps?
- Surgery: Laser surgery can be used to remove benign superficial lesions
- Voice therapy decreases the risk of recurrence
- Vocal cord nodules/polyps can recur up to 5 years after diagnosis/therapy
What are the 3 major salivary glands?
- Parotid
- Submandibular
- Sublingual
What is sialadenitis?
Infection/inflammation of salivary glands
Which glands are mst commonly affected in sialadenitis?
Parotid & submandibular
Which infection causes viral sialadenitis?
Mumps
Who does bacterial sialadenitis typically occur in?
People with xerostomia (dry mouth due to reduced saliva)
What is salivary gland mucocele?
A mucocele is a benign, mucus-containing cystic lesion of the minor salivary gland.
What is salivary gland mucocele 2ary to?
- a mucous plug
- intraluminal sialolith
These lead to obstruction
What is a ranula?
A is form of mucus retention cyst or mucus extravasation phenomenon specifically occurring in the floor of the mouth in association with the ducts of the sublingual gland. (i.e. form of mucocele)
What is a pleomorphic salivary adenoma?
Benign salivary gland tumour
Where do the majority of pleomorphic salivary adenomas occur?
80% in parotid gland
Pleomorphic salivary adenoma can sometimes progress to what malignant form?
Carcinoma ex pleomorphic adenoma
Histological appearance of Pleomorphic salivary adenoma?
Mixed tumour –> Has varied appearances and formed of mixture of epithelial and myoepithelial cells with chondromyxoid stroma
What cranial nerve is prone to injury during surgery to remove a pleomorphic salivary adenoma?
Facial nerve
What is a Warthin tumour?
Benign tumour of salivary gland
What is the most common type of minor salivary gland malignancy in adults?
Mucoepidermoid carcinoma
Age group typically affected by head and neck cancer?
70s
What is the most common malignant neoplasm of the oral cavity?
Oral squamous cell carcinoma (95%)
Major cause of oral SCC? How is this reflected in gender?
SMOKING (including chewing tobacco) + ALCOHOL (multiplicative effect)
- More common in men than in women (historically related to greater use/abuse of tobacco and alcohol by men)
- However, gender predilection may alter in the next few decades due to increase use of tobacco and alcohol by women
Most common site of oral SCC?
Lower lip
Which viruses may predispose you to oral SCC?
- HPV (high risk types 16, 18)
- EBV
Which environmental factor may also contribute to lip carcinoma?
Sunlight
Which 2 nutritional factors may predispose you to oral SCC?
- Cirrhosis
- Plummer Vinson syndrome (chronic iron defiency)
Which 2 inflammatory skin conditions can be linked to development of oral SCC?
- Lichen planus
- Submucous fibrosis (a chronic, premalignant condition of the oral cavity, characterised by juxta-epithelial inflammatory reaction and progressive fibrosis of the submucosal tissues)
Can poor oral hygiene predispose to SCC?
Yes
Signs/symptoms of oral SCC?
- Small lesions may be asymptomatic
- Leukoplakia (white patch), erythroplakia (red patch), or speckled leukoplakia (mixed leukoplakic and erythroplakic)
- Mass lesion
- Ulceration
- Pain (local and referred)
- Difficulty swallowing, speaking, chewing, and opening the mouth
- Bleeding
- Weight loss
- Enlarged neck nodes (neck mass) / metastasis
2 major risk factors for laryngeal cancer?
- Smoking
- Asbestos
Typical symptom of laryngeal cancer?
Hoarseness of voice (lesion usually identified along true vocal cord)
Define;
a) leukoplakia
b) erythroplakia
c) speckled leukoplakia
when describing lesions of the mouth.
Are these malignant?
a) one or more white patches or spots (lesions) forms inside the mouth
b) red plaque
c) red and white areas are associated or white patches are present over the red plaque
Are oral precancerous lesions that have a high potential for malignant transformation.
