Exam 2, Head & Neck set 1

Question 1

Define Upper Airway

Answer 1

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.

Question 2

Tooth Decay (caries)

Answer 2

Bacterial acid erodes enamel.
Sugars
Tartar-> plaque-> calculus

Question 3

Periodontal Dz

Answer 3

Gingiva -> periodontal ligaments -> bone -> cementum

Main precursor is gingivitis, caused by 400 bacteria species! Most common is acintobacilli, porphyromonas and prevotella

Question 4

Irritation Fibroma

Answer 4

Response to oral trauma. It is not neoplastic, but a fibrous tumor. Probably would not blanch.

Question 5

Pyogenic Granuloma

Answer 5

Another not-neoplasm, and not pussy either, so bad name. Probably would blanch though.

Question 6

Aphthous ulcer - Canker sore

Answer 6

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.

Question 7

Glossitis

Answer 7

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.

Question 8

Oral Herpes

Answer 8

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.

Question 9

Tzanck Smear

Answer 9

Test for herpes family viruses.

Scrape vesicle, smear & stain & look for enlarged squamous nuclei with inclusions.

Question 10

Oral Candida*

Answer 10

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

Question 11

Leukoplakia

Answer 11

-Dry, flat plaque on oral mucosa. Non-malignant, non-dysplastic, 100% reversible. *Might be pre-malignant though

**Clinical description, not a clinical/pathological entity

Question 12

Hairy leukoplakia

Answer 12

white tongue fuzz -» usually a sign of HIV.

Question 13

Super Important - Development of ANY Squamous Cell Carcinoma

Answer 13

Normal -> Dysplasia -> Carcinoma in-situ -> Infiltrating Malignancy!

Regardless of genetics, molecular biology, or etiology.

Question 14

Squamous Cell carcinoma

Answer 14

-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

Question 15

Sialolithiasis

Answer 15

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

Question 16

Sialadenitis

Answer 16

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

Question 17

Location of Parotid gland

Answer 17

Any swelling between the tip of the ear and the angle of the mandible indicates potential tumor or other parotid involvement.

Question 18

Mikulicz syndrome

Answer 18

Combination of salivary & lacrimal gland enlargement (painless) and xerostomia (dry mouth)

Possible etiologies: leukemia, lymphoma, Sjogren, sarcoidosis, and other granulomatous dzs.

Question 19

Xerostomia

Answer 19

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

Question 20

Mucocele

Answer 20

• 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

Question 21

Salivary Gland Neoplasms

Answer 21

• 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

Question 22

Salivary Gland Malignancy

Answer 22

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%

Question 23

Most Common Salivary Gland Tumors

Answer 23

• 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

Question 24

Pleomorphic Adenoma

Answer 24

• 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%

Question 25

Problems that happen in the upper airways

Answer 25

Nose - inflammation, tumors
Nasopharynx - inflammation, tumors
Paranasal sinuses - inflammation, tumors
Larynx - inflammation, tumors

Problems arise when ciliated columnar epithelium does squamous metaplasia. Can happen through a variety of injurious stimuli/