Diseases of the Head and Neck

Question 1

What is the most common type of carcinoma arising from the oral cavity? What does it look like?

Answer 1

• Squamous cell carcinoma
• Dark brown pigmented lesion
• arise anywhere in oral cavity

Question 2

What are squamous cell carcinomas of the mouth attributed to?

Answer 2

Smoking and alcohol

HPV (16/18) - from oral/genital contact

Dietary factors

Genetic

Question 3

What are the most common type of carcinoma arise from the larynx? Where do they mostly arise from

Answer 3

Squamous cell carcinoma

Supra glottis (above vocal cords)

Question 4

How is squamous cell carcinoma of the larynx treated?

Answer 4

Layngectomy

Question 5

What are the main causes of squamous cell carcinoma in the larynx?

Answer 5

Alcohol and alcohol

HPV (types 6 and 11)

Diet (low antioxidants)

Layngopharyneal reflux

Question 6

What is lichen planus?

Answer 6

Inflammatory condition - destruction of keratinocytes (probably autoimmune TNF/interferon gamma from T cells0

Question 7

How does lichen planus present? Can it be malignant?

Answer 7

Oral - ulcerative, erosive lesions, desquamative gingivitis (red gums)

Skin - itchy, purple papule - plaques with Wickman striae

Small risk of malignant transformation

Question 8

What are local cord nodule an d polyps? Whwere and who do they effect?

Answer 8

Benign reactive lesion (excision)

Occur mostly on true vocal cord

Most effects heavy smokers and singers ‘singer nodule’

Question 9

What are local cord nodules/polyps associated with ?

Answer 9

Hoarse voice

Increase effort too increase voice

Question 10

What is the main cause of nasal polyps?

Answer 10

Recurrent rhinitis

Question 11

What is acute sinusitis usually proceeded by?

Answer 11

Rhinitis

Dental infection - oral flora/non specific inflammatory reaction

Question 12

What is the cause and consequence of chronic sinusitis?

Answer 12

Sinus drainage is blocked

Inflammatory oedema accumulates and empyema (pus formation)

Question 13

Where does sinusitis usually take place? (i.e. which sinus)

Answer 13

Frontal/ethmoid sinuses

Question 14

What are the infective organisms associated with ACUTE otitis media?

Answer 14

Usually viral (upper resp tract infection)

Bacterial:
H influenzae
Moraxella caterhalis
S pneumoniae

Question 15

What is chronic otitis media? What are the causative organisms?

Answer 15

Recurrent/persistent infection or failure of acute infection resolution

Pseudomonas aeruginosa

Staph Aureus

Question 16

What are the complications of otitis media

Answer 16

Perforation of eardrum
Aural polyps, cholesteatoma
Mastoiditis/abcess

Question 17

What condition is cholesteatoma associated with>?

Answer 17

Chronic otitis media

Question 18

What is the pathogenesis of cholesteatoma?

Answer 18

• Chronic infection and perforated ear drum
• squamous cell epithelium grows into inner ear and proliferates
• cystic lesions, keratinised with cholesterol clefts
• inflammatory reaction which can RUPTURE

Question 19

What are the complications of cholesteatoma?

Answer 19

• Erosion of ossicles, labyrinth and adjacent bone

- Hearing loss

Question 20

What is otosclerosis?

Answer 20

Abnormal deposition of bone in middle ear (due to imbalance in bone reabsorption and bone deposition)

Question 21

What are the complications of otosclerosis?

Answer 21

Anchoring of ossicles to oval window (usually bilateral)

Progressive hearing loss

Question 22

What are the symptoms of labyrinthitis?

Answer 22

Infection/inflammation of inner ear

-Hearing and balance distrubances

Question 23

What are the causative viral/bacterial organisms for labyrinthitis?

Answer 23

Bacteria - H influenzae, S pneumoniae, Staphylcoccal species

Virus - mumps, rubella, CMV

Question 24

What cancers affect the a) external ear and b) ear canal.

Answer 24

a) basal cell carcinoma and squamous cell -
SUN EXPOSURE

b) squamous cell carcinoma - not sun exsposure

Question 25

What is a paraganglioma?

Answer 25

Tumour of middle ear, occurring in the paraganglia

Question 26

What does a paraganglioma present with?

Answer 26

Dizziness, pulsatile tinnitus, hearing loss, bloody discharge