Exam 2, Head & Neck set 1 Flashcards
Define Upper Airway
Airspaces leading ultimately into the lung & the structures therein -> nasal sinuses, auditory tubes, ears, nasolacrimal duct, tonsils & salivary glands!
AKA anything that touches air or food in the head/neck region.
Tooth Decay (caries)
Bacterial acid erodes enamel.
Sugars
Tartar-> plaque-> calculus
Periodontal Dz
Gingiva -> periodontal ligaments -> bone -> cementum
Main precursor is gingivitis, caused by 400 bacteria species! Most common is acintobacilli, porphyromonas and prevotella
Irritation Fibroma
Response to oral trauma. It is not neoplastic, but a fibrous tumor. Probably would not blanch.
Pyogenic Granuloma
Another not-neoplasm, and not pussy either, so bad name. Probably would blanch though.
Aphthous ulcer - Canker sore
Painful ulcerating oral lesion related to stress, fatigue, illness, injury from biting, hormonal changes, menstruation, sudden wt loss, food allergies, deficient B12, iron, and folic acid. Thus, “obscure” etiology b/c so much is related.
Glossitis
Inflammation of the tongue.
Bacterial or viral infx (indluding herpes simplex)
Mechanical injury, irritants, allergies, and vitamin deficiencies can all cause this. “Geographic tongue” means only part of it is inflamed.
Oral Herpes
Herpes simplex 1 or 2 around the border of the lips. Type 1 used to be “oral” and type 2 “genital” now we don’t differentiate so much b/c so many people have been sharing all over.
Vesicles, ulceration, crust. More inflammation = more acute.
Tzanck Smear
Test for herpes family viruses.
Scrape vesicle, smear & stain & look for enlarged squamous nuclei with inclusions.
Oral Candida*
Names: Monilia, thrush-mouth, candida
- whitish oral film w/out underlying inflammation/erythema
- prefers non-keratinized stratified squamous mucosa
- normal flora, opportunistic
- common in babies, diabetics, and immunocompromised
- can be scraped away easily
- Dx: NON-septate hyphae with yeasts/budding yeasts in office lab. PAS stain is best -> bright red color to yeast & pseudohyphae
Leukoplakia
-Dry, flat plaque on oral mucosa. Non-malignant, non-dysplastic, 100% reversible. *Might be pre-malignant though
**Clinical description, not a clinical/pathological entity
Hairy leukoplakia
white tongue fuzz -» usually a sign of HIV.
Super Important - Development of ANY Squamous Cell Carcinoma
Normal -> Dysplasia -> Carcinoma in-situ -> Infiltrating Malignancy!
Regardless of genetics, molecular biology, or etiology.
Squamous Cell carcinoma
-biopsy at the edge I assume, for normal tissue to compare to.
3 types: well, moderate, poor (regarding differentiation)
-well: see pearls
-moderate: see intercellular bridges, not pearls
-poor: doesn’t look squamous at all, need chemical markers and stuff to identify
Sialolithiasis
Salivary duct stones.
Risk factors:
-obstruction from food, edema or cellular debris
-prior traumatic injury to duct
-dehydration
Calcium phosphate stones are the most common, submandibular gland is most commonly obstructed
Sialadenitis
Inflammation of salivary gland with or without an infection.
- Can be acute, chronic, or recurrent.
- Causes: infections, trauma, food sensitivities, autoimmune conditions (Sjogren’s causes dry mouth/xerostomia), obstructions (stones)
- Most common viral form is secondary to Mumps!
- Generally unilateral
- Often causes mildly to severely painful enlargement, may result in serous or purulent discharge
Location of Parotid gland
Any swelling between the tip of the ear and the angle of the mandible indicates potential tumor or other parotid involvement.
Mikulicz syndrome
Combination of salivary & lacrimal gland enlargement (painless) and xerostomia (dry mouth)
Possible etiologies: leukemia, lymphoma, Sjogren, sarcoidosis, and other granulomatous dzs.
Xerostomia
Dry mouth
- Major feature of Sjogren syndrome (usually also dry eyes) along with inflammatory enlargement of salivary glands
- Can be caused by radiation therapy
- Might present as dry mucosa, or atrophy of papillae of tongue with fissuring and ulcerations
Mucocele
- Caused by trauma or blockage of a duct
- Usually on lower lip
- Usually toddlers, young adults & geriatric population (from falling… :-/ )
- Size may fluctuate, esp. with meals. Bluish hue
- Usually resolve spontaneously
- If chronic, excision may be necessary, incomplete excision can result in recurrence
Salivary Gland Neoplasms
- Usually in adults, slight female preference except Warthin tumors, which are much more common in males
- Benign tumors often appear 50-70yo, malignants tumors more in 70+ yrs
Salivary Gland Malignancy
Risk factor: head/neck radiation, like tx for CA. That's really the ONLY thing. Malignancy… Parotid tumors: 15-30% Submandibular tumors: 40% Minor Salivary glands: 50% **Sublingual tumors: 70-90%
Most Common Salivary Gland Tumors
- Not very many malignant tumors come from here…
- Even though its malignancy is the lowest, most salivary gland tumors (65-80%) originate in the parotid
- Most SG tumors are found in older adults
Benign:
- pleomorphic adenoma (mixed tumor)
- Warthin tumor (more common in males)
Malignant (adenocarcinomas):
- Mucoepidermoid carcinoma
- Adenoid cystic carcinoma
Pleomorphic Adenoma
- 50% of benign salivary tumors, over half of the tumors in the parotid gland
- Painless, slow-growing, mobile masses within parotid or submandibular areas or in buccal cavity
- “Mixed” tumor (histological diversity)
- Among most aggressive salivary gland malignancies - 30-50% mortality in 5 years
- Recurrence rate is ~4%, but if you try to take it out the rate goes up to 25%
