Diseases of the Head and Neck

Question 1

Most common squamous cell carinoma in the oral cavity

Answer 1

SCC

Question 2

Appearance of SCC in the oral cavity

Answer 2

White patch>red ulcerated lesion. Exophytic, firm, indurated tumour in late phases.

Question 3

Prognosis for SCC in oral cavity

Answer 3

less than 50% at 5yrs

Question 4

Risk factors for SCC in the oral cavity

Answer 4

Alcohol-acetaldehyde is a carcinogen
Smoking-enhances the activation of procarcinogens in tobacco
SYNERGISTIC
Areca nut
HPV 16 and 18
Diet-antioxidents confer protection
Genetic- fanconi anamia or Li fraumeni

Question 5

What has a better prognosis- HPV or not HPV related SCC in the oral cavity?

Answer 5

HPV-respond better to radiotherapy

Question 6

Associated with betel quid or areca nut chewing; a habit similar to tobacco chewing in Asia. Fibrosis of lining of the moouth-strictures, connective tissue replaced by dense, fibrous tissue. Small risk of malignancy.

Answer 6

Submucous fibrosis

Question 7

White patches on oral mucosa that cannot be removed, associated with dysplasia and malignancy

Answer 7

Leukoplakia

Question 8

Pathology of chronic hyperplastic candidosis

Answer 8

Candida produces nitrosamines-stimulate proliferation of epithelial cells.

Question 9

What is the most common cacinoma of the larynx

Answer 9

SCC usually above the level of the vocal cord.

Question 10

Treatment for SCC of the larynx

Answer 10

Partial laryngectomy or radiotherapy.

Question 11

Risk factors for carcinoma of the larynx

Answer 11

Tobacco
Alcohol
HPV 6&11- weak assocation
Diet
Metal/plastic workers, exposure to paint, diesel, aspestos, radiation. 
Laryngopharyngeal reflux
Genetic susceptibility

Question 12

Name 4 non malignant inflammatory condition

Answer 12

Lichen Planus
Vocal cord nodules and polyps
Nasal polpys
Sinusitis

Question 13

Lichen planus

Answer 13

Muco-cutaneous condition. Skin, anal mucosa, oral cavity. T cell mediated autoimmune response.
Cutaneous lesion-itchy, purple, papules forming plaques with Wickham’s striae.
Commonly found on the wrists and arms
Oral lesions-reticular striations, plaque like, erosive, ulcerative lesions, desquamative gingivitis.
Small risk of malignant transformation.
Treatment - steroids

Question 14

Vocal cord nodules and polyps

Answer 14

Reactiv elesions. Heavy smokers or singers. M>F.

Hoarseness, change in voice qualitis. Simple excision

Question 15

Nasal polyp

Answer 15

Recurrent attacks of rhinitis. Focal protrusions of mucosa up to 4cm. When large and multiple, can enroach the airway and impede sinus drainage.

Question 16

Histology of nasal polyp

Answer 16

Oedematous mucosa with loose stroma containing hyperplastic/cystic mucous, glands and infiltrated with mixed inflammatory exudate rich in eosinophils

Question 17

Sinusitis

Answer 17

Acute is usually preceded by acute/chronic rhinitis or extension of a tooth infection.
Acute-inflammatory reaction, may procede to chronic.
Chronic-impairment of sinus drainage as a result of inflammatory oedema of the mucosa. May impound the suppurative exudate producing empyema of the sinus.

Question 18

Complications of sinusitis

Answer 18

Potential of spread into the orbit or into the enclosing bone-cranial osteomylitis, meningitis or cerebral abscess.

Question 19

Otitis media

Answer 19

Usually infants and children

Often viral

Question 20

Causative organisms of acute otitis media

Answer 20

strep pneumonia, H, influenzae, moraxella catarrhalis

Question 21

Causative organisms of chronic otitis media

Answer 21

pseudomonal aeruginosa
Staph A
Fungal

Question 22

Complications of otitis media

Answer 22

Polyps, perforation of eardrum or cholesteoma

In DM-necrotising otitis esp when P. aeroginosa is the causative organism

Question 23

Cholesteatoma

Answer 23

Associated with chronic otitis media

Cystic lesions lined by keratinising squamous epithelium and filled with debris and cholesterol deposists.

Question 24

Pathogenesis of cholesteatoma

Answer 24

Chronic inflammation and perforation of the eardrum-ingrowth of squamous epithelium or metaplasia of secondary epithelial lining. Precipitates surrounding inflammatory reaction-enhanced if the cyst ruptures and may result in a foreign body giant cell reaction

Question 25

Complications of cholesteatoma

Answer 25

Progressive enlargement may lead to erosion of ossicles, the labyrinth (dizziness) and adjacent bone or surrounding soft tissue.
hearing loss
V. rarely CNS complications, brain abscesses and meningitis

Question 26

Osteosclerosis

Answer 26

Abnormal bone deposition in the middle ear. Usually bilateral
Usually begins in early decades, most cases are familial.
Initially fibour ankylosis> bony overgrowth> anchorage of middle ear bones to oval window
Eventually results in marked hearing loss

Question 27

Labyrinthitis

Answer 27

Inflammatory disorder of the iner ear
Disturbances of balance and hearing
Can be bacterial or viral cause or autoimmune e.g. wegener’s granulomatosis

Question 28

Cacinomas of the external ear

Answer 28

BCC and SCC, in elderly men, association with solar radiation

Question 29

Carcinomals of the ear canal

Answer 29

Squamous cell carcinoma- middle age to elderly women. No associated with sun exposure.

Question 30

Tumour of the middle ear

Answer 30

Paragangliomas- neuroendocrine tumours. Result in pulsatile tinnitis, hearing loss, dizziness, bloody otorrhoea. Affects females 40-60yrs. Benign. Treatmetn = surgery.