Doc Erf Handouts! Flashcards
mouth is lined by what epithelium?
non-keratinizing squamous epithelium with abundant scattered salivary glands
most common major malformation of the mouth.
cleft palate and cleft lip
physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. • Separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.
Cleft lip
split or opening in the roof of the mouth • May involve the hard palate and/or the soft palate
Cleft palate
Few cases of cleft lip and palate are associated with what chromosomal abnormalities
Trisomy 13 and 18
he most common primary viral infections of the oral cavity
Human herpesvirus (HHV) and human papillomavirus (HPV)
most frequently seen in infants in a pseudo-membranous form called “thrust” characterized as white patches composed on tangled hyphae mixed with fibrinopurulent exudate and desquamated epithelium
Fungal infections – candida albicans
common; most important those occurring at the back of the mouth and oropharynx
Bacterial infection
relatively common condition (esp. dark-skinned people) that may involve any portion of the oral cavity
Flat, brown, solitary or multiple mucosal discoloration of mucosa • Produced by focal increase in melanin deposition along with an increase in melanocyte count. • Commonly involves the lip, buccal mucosa, gingiva and palate
Oral pigmentation
defined by the WHO as “a white patch or plaque that cannot be scraped off and cannot be characterized clinically or pathologically as any other disease.”
• Considered as precancerous until proven otherwise by histologic evaluation.
Leukoplakia
flat or slightly depressed red, velvety sometimes eroded area in the oral mucosa
• Lining epithelium severely dysplastic; higher risk of evolving into a malignancy compared to leukoplakia
• Usually associated with tobacco use.
Erythroplakia
constitutes about 95% of cancers of the head and neck
- 7.1. Associated with chronic use of tobacco, alcohol and betel leaf chewing
- 7.2. About 70% associated with HPV-16, an oncogenic variant of HPV
- 7.3. Involves accumulation of mutations and epigenetic changes (e.g., oncogenes and tumor suppressor genes)
- 7.4. Commonly occurs in the tonsils, tongue base and pharynx
=Squamous Cell Carcinoma (SCC)
T or F?
SCC associated with HPV have a greater long-term survival compared with HPV negative cases.
t
usually in the mandibular molar region causing intraoral swelling; cyst lined stratified squamous epithelium with keratin layer; aggressive behavior
Odontogenic keratocysts
what cyst? mostly involve the third molar or canine teeth; cyst envelops the crown of an unerupted or displaced tooth and attached to neck of tooth; cyst lined by stratified squamous epithelium
Dentigerous cysts
what cyts lie alongside the tooth; lined by stratified squamous epithelium.
Lateral periodontal cyst
most common inflammatory cyst:
Characterized by the development of a periapical granuloma associated with ingrowth of squamous epithelium; central dissolution of the inflammatory mass leads to cyst formation.
Radicular cyts
most common type of benign tumor in the mouth mucosa?
Fibrous or fibroepithelial polyp (papilloma)
most common malignant tumor accounting for over 90% of oral cancers
Squamous cell carcinoma
most common HPV types associated with of malignant transformation of SCC in the mouth?
HPV 16 and 18
most common tumor derived from the odontogenic epithelium
• Benign and does not metastasize; slow growing locally invading the bone
• Bone expansion leads to separation and, occasionally. loosening of teeth
• Composed of islands of odontogenic epithelium with mixed fibrous stroma.
AMELOBLASTOMA
- Part of the pharynx continuous with the mouth below the soft palate and above the epiglottis
- Common site of viral and bacterial infections (sore throat)
Orophraynx
Recurrent infection with group A Streptococcus associated with the development of
post-streptococcal glomerulonephritis and acute rheumatic fever.
Waldeyers ring is composed of?
composed of palatine tonsils (tonsils), nasopharyngeal tonsils (adenoids)
and lymphoid tissue in the posterior third of the tongue submucosal region (lingual tonsil)
most common cause of tonsillar enlargement
Reactive lymphoid hyperplasia
usually a component of a wide-spread acute bacterial pharyngitis
• Tonsils swollen due to hyperemic mucosa; partly covered with creamy exudate and pus exuding from the surface.
Acute tonsillitis
most common malignant tumor of the palatine tonsil? Second most common?
Lymphoma;
SCC
Significant proportion of tonsillar SCCs may be associated with oncogenic infection of waht?
oncogenic HPV-16 infection.
Lining epothelium of nose?
Nose lined by tall columnar ciliated epithelium with large amounts of mucus produced by mucus-secreting glands
part of the pharynx immediately behind the nose
- 4.1. Contains large amount of lymphoid tissue
- 4.2. Lined by respiratory-type columnar epithelium.
nasopharynx
most common source of nasal manifestations seen in clinical practice
3.5.1. Usually due to infection or allergy
Rhinitis
usually viral
• Virus causes necrosis of surface epithelium followed by exudation of fluid and mucus from the damaged area; submucosal edema leads to swelling and partial blockage of the airways.
what rhinitis?
Infective rhinitis
Type I hypersensitivity reaction to allergens
• Antigenic stimulation may persist for weeks; persistent submucosal edema may lead to an irregular, swollen, polypoid mucosa (nasal polyps).
Allergic rhinitis
most important type of sinus inflammation
• Swelling of the mucosa may block the foramen of the sinus and the drainage of the maxillary sinus secretion into the nasal cavity
• Secondary bacterial infections may cause the secretion to become purulent
• Infection may spread to the ethmoid and frontal sinuses and into the meninges.
maxillary sinusitis
due to failure of the acute episode to drain resulting in a thickened and inflamed mucosa and persistent fluid accumulation
• Results commonly from chronic exposure to cigarette smoke and industrial irritants
• Susceptible to superimpose bacterial and viral infections
• Can lead to nasal septal deviation or nasal polyps.
Chronic maxillary sinusitis
most comon malignant tumors of the nose?
: squamous and transitional cell carcinomas
most common tumor in the nasopharynx?
• Strongly linked to the Epstein-Barr virus • Higher risk in people who smoke, chronic alcohol intake and expose to chemicals (e.g., formaldehyde)
Squamous cell carcinoma
common usually involving the supraglottic and glottis regions producing hoarseness and temporary loss of voice
4.1.1. Infections may extend to the bronchi producing the symptom complex called upper respiratory tract infection (URTI)
bacterial infection of the larynx
common cause of airway obstruction that may be life threatening.
- 2.1. Can result from various causes like inhalation of flame or irritant gases, infections, anaphylactic reactions, tumors, foreign bodies
- 2.2. Usually due to a Type I hypersensitivity reaction; frequently associated with facial swelling (angioneurotic edema). 4.2.3. Common complication after extubation in intensive care patients and may arise from direct mechanical trauma to the larynx by the endotracheal tube
Laryngeal edema
common among chronic heavy smokers
4.3.1. Long standing inflammation may result in dysplastic changes; may progress to squamous cell carcinoma, most common type of malignancy in this site.
Chronic laryngitis
mainly seen amongst singers and professional voice users
4.4.1. Small nodules seen between the posterior two-third and anterior third of the vocal cords composed of submucosal fibrosis.
Singer’s node
common benign tumor associated with HPV infections (particularly types 11 and 16) in larynx
pappilomas
most common type of malignancy (90% of all laryngeal cancers); mostly in males (96%), usually 40 years and above. • Major risk factors smoking, heavy alcohol consumption
• HPV is not an early factor but positive in 20% of cases, usually HPV 16
• EBV a factor in 40% of cases
• Usually arise in areas of severe dysplasia progressing to carcinoma-in-situ and to invasive carcinoma
Squamous cell carcinoma
- Can occur in the supraglottic, glottis or subglottic regions
- Most common site – glottis region (true vocal cords); best prognosis if detected early due to poor lymphatic drainage except at the commissures; remains localized for a while until the tumor invades into the surrounding tissue • Grossly – pink to gray ulcerated mass
- Metastasis to the cervical lymph nodes.
Squamous cell carcinoma (LARYNX)
most common cause of viral infection involving the major glands commonly the parotids
Mumps
due to obstruction in the ducts of the major salivary glands
• May be caused by a calculus or inspissated secretion
• Back-pressure leads to duct dilatation and gland atrophy; eventually leading to interstitial fibrosis and lymphocytic infiltrates.
Chronic sialadenitis
most common lesion resulting from blockage or rupture of a duct thus causing the saliva leakage into the surrounding connective tissue.
• Occurring commonly on the lower lip as a result of trauma
• Presents as fluctuant swellings of the lower lip with a blue translucent hue
• Histologically – cyst-like spaces lined by inflammatory granulation tissue or by fibrous tissue and filled with mucin and inflammatory cells.
Mucocele
refers to epithelial-lined cysts arising from a damaged sublingual duct.
Ranula
Most (~70%) salivary gland tumors originate in the _______________ with the bulk of the remainder arising in the ___________ and in the minor salivary glands.
parotid gland; submandibular gland
most common parotid neoplasm representing about 60% of all parotid tumors
Pleomorphic adenoma
As the size of the salivary gland decreases (i.e., submandibular, sublingual and minor salivary), the incidence of malignancy [decreases/increases.]
increases
benign tumor exclusively occurring in the parotid gland
• Only tumor virtually restricted to the parotid
• Commonly in males usually in the 5th to 7th decades of life
• Can occur within the cervical lymph nodes.
Warthin Tumor (Papillary Cystadenoma Lymphomatosum
common malignant tumors, the former more common esp. in the minor salivary glands • Malignant salivary gland neoplasms may be slowly growing, well circumscribed and non-tender thus simulating a benign tumor.
Mucoepidermoid carcinoma and adenoid cystic carcinoma
Minor salivary gland tumors may originate throughout the oral mucosal except for the following locations:
Midline and anterior hard palate, gingiva, and attached alveolar mucosa
most common tumors of the minor salivary glands
Pleomorphic adenoma
most common cause of eardrum perforation
Infections
inflammation of the external auditory canal 6.2.1. May manifest as a localized furuncle or as a diffuse infection of the entire canal often referred to as “swimmer’s ear” due to repeated water exposure making the ear canal more vulnerable to inflammation.
Otitis externa
OTITIS EXTERNA IS USUALLY CAUSED BY?
Usually caused by bacteria (e.g., Pseudomonas aeruginosa, Proteus vulgaris) or fungi (e.g., Aspergillus niger or Candida albicans), is less common.
common cause of hearing loss and earache in children 6.3.1. Most common between ages 3 months and 3 years. • At this age, the eustachian tube structurally and functionally immature • Angle of the eustachian tube more horizontal rendering the opening mechanism less efficient.
- 3.2. Usually a consequence of viral upper respiratory tract infection superimposed with bacterial infection
- 3.3. URTI blocks the eustachian tube due to hyperplastic adenoids
- 3.4. Complications – eardrum perforation, chronic suppurative otitis media, acute mastoiditis.
Acute otitis media
usually associated with persistent non-healing eardrum perforation
6.4.1. Persistent discharge from the external auditory canal.
Chronic suppurative otitis media
bacterial infection of the mastoid air cells surrounding the inner and middle ear. 6.5.1. Mastoid bone part of the temporal bone. • The mastoid air cells are thought to protect the delicate structures of the ear, regulate ear pressure and possibly protect the temporal bone during trauma
• Mastoid contiguous to and an extension of the middle ear cleft 6.5.2. Often as a result of an unresolved otitis media
6.5.3. Virtually every child or adult with otitis media, acute or chronic has mastoiditis.
• In most cases, the symptomatology of the middle ear predominates and the disease within the mastoid not considered a separate entity.
mastoidits
abnormal skin growth in the middle ear frequently associated with eardrum perforation 6.6.1. Repeated infections and/or a tear or pulling inward of the eardrum can allow the ingrowth of skin into the middle ear.
Cholesteatoma
When the eustachian tubes work poorly (e.g., allergy, a cold, or sinusitis), the air in the middle ear is [produced/absorbed] creating a partial vacuum in the ear
Absorbed
cystic structure lined by squamous epithelium constantly producing keratin.
Cholesteatoma
are common skin cancers that can develop on the external ear after repeated and prolonged exposure to the sun.
Basal cell carcinoma and squamous cell carcinoma
(cancer of the cells that produce earwax) develops in the outer third of the ear canal; does not metastasize to other areas but destructive to the ear canal.
Ceruminoma
