Diseases of the Head and Neck Flashcards
Most common squamous cell carinoma in the oral cavity
SCC
Appearance of SCC in the oral cavity
White patch>red ulcerated lesion. Exophytic, firm, indurated tumour in late phases.
Prognosis for SCC in oral cavity
less than 50% at 5yrs
Risk factors for SCC in the oral cavity
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
What has a better prognosis- HPV or not HPV related SCC in the oral cavity?
HPV-respond better to radiotherapy
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.
Submucous fibrosis
White patches on oral mucosa that cannot be removed, associated with dysplasia and malignancy
Leukoplakia
Pathology of chronic hyperplastic candidosis
Candida produces nitrosamines-stimulate proliferation of epithelial cells.
What is the most common cacinoma of the larynx
SCC usually above the level of the vocal cord.
Treatment for SCC of the larynx
Partial laryngectomy or radiotherapy.
Risk factors for carcinoma of the larynx
Tobacco Alcohol HPV 6&11- weak assocation Diet Metal/plastic workers, exposure to paint, diesel, aspestos, radiation. Laryngopharyngeal reflux Genetic susceptibility
Name 4 non malignant inflammatory condition
Lichen Planus
Vocal cord nodules and polyps
Nasal polpys
Sinusitis
Lichen planus
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
Vocal cord nodules and polyps
Reactiv elesions. Heavy smokers or singers. M>F.
Hoarseness, change in voice qualitis. Simple excision
Nasal polyp
Recurrent attacks of rhinitis. Focal protrusions of mucosa up to 4cm. When large and multiple, can enroach the airway and impede sinus drainage.
Histology of nasal polyp
Oedematous mucosa with loose stroma containing hyperplastic/cystic mucous, glands and infiltrated with mixed inflammatory exudate rich in eosinophils
Sinusitis
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.
Complications of sinusitis
Potential of spread into the orbit or into the enclosing bone-cranial osteomylitis, meningitis or cerebral abscess.
Otitis media
Usually infants and children
Often viral
Causative organisms of acute otitis media
strep pneumonia, H, influenzae, moraxella catarrhalis
Causative organisms of chronic otitis media
pseudomonal aeruginosa
Staph A
Fungal
Complications of otitis media
Polyps, perforation of eardrum or cholesteoma
In DM-necrotising otitis esp when P. aeroginosa is the causative organism
Cholesteatoma
Associated with chronic otitis media
Cystic lesions lined by keratinising squamous epithelium and filled with debris and cholesterol deposists.
Pathogenesis of cholesteatoma
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
Complications of cholesteatoma
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
Osteosclerosis
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
Labyrinthitis
Inflammatory disorder of the iner ear
Disturbances of balance and hearing
Can be bacterial or viral cause or autoimmune e.g. wegener’s granulomatosis
Cacinomas of the external ear
BCC and SCC, in elderly men, association with solar radiation
Carcinomals of the ear canal
Squamous cell carcinoma- middle age to elderly women. No associated with sun exposure.
Tumour of the middle ear
Paragangliomas- neuroendocrine tumours. Result in pulsatile tinnitis, hearing loss, dizziness, bloody otorrhoea. Affects females 40-60yrs. Benign. Treatmetn = surgery.
