EENT #9 (Nose/Sinus) Flashcards
Erythroplakia is an uncommon oral lesion with a high risk of malignant transformation. 90% is either dysplastic or shows evidence of
Squamous cell carcinoma
Risk factors for erythroplakia
-Chronic irritation due to tobacco, smoking, age > 65
Clinical manifestations of erythroplakia
Painless, erythematous soft velvety patch in the oral cavity on mouth floor, ventral aspect of tongue, and soft palate
What diagnostic should be done on erythroplakia?
Biopsy to rule out SCC
Management for erythroplakia
Complete excision depending on biopsy results
Sialolithiasis (salivary gland stones) are MC in
Wharton’s duct (submandibular gland duct) and Stensen’s duct (parotid gland duct)
Risk factors for salivary gland stones
-Decreased salivation (dehydration, anticholinergic medications, diuretics)
Symptoms of sialolithiasis
- Sudden onset of salivary gland pain and swelling with eating or in anticipation of eating
- Stone may be palpated in salivary gland
Management of sialolithiasis
- First line therapy: sialagogues (tart hard candies, lemon drops, Xylitol gum)
- Increase fluid intake
- Gland massage
- Moist heat to affected area
- Laser lithotripsy or surgery for refractory cases
What is acute bacterial sialadenitis (suppurative sialadenitis)
-Bacterial infection of the parotid or submandibular salivary glands
MC etiology of acute bacterial sialadenitis
-S. Aureus (MC)
Risk factors for acute bacterial sialadenitis
-Salivary gland obstruction from a stone
Dehydration
Chronic illness
Symptoms of acute bacterial sialadenitis
- Sudden onset of a very firm and tender gland swelling with purulent discharge (pus if the duct is massaged)
- Dysphagia
- Trismus (lockjaw, spasm of the muscles of mastication)
- Fever and chills
What is the diagnostic of choice for acute bacterial sialadenitis
CT scan
Treatment for acute bacterial sialadenitis
- Anti-Staph ABX + Sialagogues to increase salivary flow
- -Dicloxacillin or Nafcillin. Metronidazole can be added
- -Clindamycin
What is oral hairy leukoplakia?
Mucocutaneous manifestation of EBV (HHV4)
Oral hairy leukoplakia is almost exclusively seen with ______
HIV infection
But other immunocompromised states such as post-transplant, chemotherapy, chronic steroid use as well
Symptoms of oral hairy leukoplakia
-Painless, white smooth or corrugated hairy plaque along lateral tongue borders that cannot be scraped off
Management for oral hairy leukoplakia
No specific treatment required (may spontaneously resolve)
Antiretroviral therapy in patients with HIV
What is acute herpetic pharyngotonsillitis?
Primary manifestation of HSV-1 in adults
Symptoms of acute herpetic pharyngotonsillitis
-Vesicles that rupture, leading ulcerative lesions with grayish exudates in the posterior pharyngeal mucosa
Treatment for acute herpetic pharyngotonsillitis
Oral hygiene - lesions usually resolve within 7-14 days
What is acute herpetic gingivostomatitis?
Primary manifestation of HSV-1 in children (MC between 6 months and 5 years)
Symptoms of acute herpetic gingivostomatitis
- Prodrome: sudden onset of fever, anorexia, malaise, oral lesions
- Gingivostomatitis: ulcerative lesions of gingiva (gum swelling and bleeding) and vesicles on mucous membranes with perioral vesicular lesions clustered on an erythematous base (dew drops on a rose petal)
- After rupture, vesicles become ulcerated, yellow, and surrounded by erythematous halo
- Regional LAD
Treatment for acute herpetic gingivostomatitis
- Supportive care mainstay: hydration, oral hygiene, barrier cream to the lips
- Oral Acyclovir if within 72-96 hours of onset if they are unable to drink or painful
- IV Acyclovir if immunocompromised
What are some ototoxic medications?
- Loop Diuretics: Furosemide, Ethacrynic acid (Most ototoxic)
- ABX: Vancomycin, Macrolides (erythromycin), Tetracyclines, Aminoglycosides (Gentamicin)
- Aspirin, NSAIDs
- Chloroquine, Hydroxychloroquine, Quinine
