Mouth, Throat, Ear, Nose Pathophys Flashcards
Which type of cells line the air tract?
Columnar (pseudostratified)
Which type of cells line the food tract?
Stratified squamous
What occurs when columnar cells become damaged?
Metaplasia- they become squamous
When can you expect deciduous teeth to erupt?
6m to 2yrs of age
How many permanent teeth does a human have?
32
Which tissue is the most mineralized in the body?
Enamel
What is enamel synthesized by?
ameloblasts
What does dentin contain?
dentinal tubules
What is destroyed by caries?
Enamal and Odontoblasts which produce dentin
The pulp is rich in…
Nerve bundles, lymphatics, and capillaries
What does the Periodontal ligament do?
connects cementum to alveolar bone
What does Periodontal DZ cause?
tooth loss
What does S. mutans metabolize?
Sucrose to lactic acid
What does Lactobacilli metabolize
lactose to lactic acid
What is Bifidobacteria and what can result from it?
gram + bacteria used in probiotics. May increase risk for caries.
What does flouride do?
incorporates into enamel structure and becomes resistant to degradation by bacterial acids.
what does fluorosis cause?
Hypomineralization causing brown pitted enamel and weak(bowed) bones. Occurs with flouide intake >0.05mg/kg/day
What is plaque made from?
bacteria, proteins, and desquamated epithelial cells forming a “bacterial bioflim”
What is Calculus?
mineralized plaque AKA tartar.
What causes gingivitis?
Lack of proper oral hygiene leading to dental plaque and calculus.
Is gingivitis reversible?
Yes
What is periodontitis?
Inflammation of supporting structures (periodontal lig., alveolar bone, and cementum)
Is periodontitis only caused from gingivitis?
No, it can also be an independent DZ or present with other systemic DZs
Which bacteria cause periodontitis?
Actinobacillus, Porphyromanas, Prevotella
What are the manifestations of Periodontitis?
loosening or loss of teeth
What criteria are used for periodontitis diagnosis?
Main=attachment loss,
2nd= Probing depth,
3rd= Radiographic alveolar bone loss
Periodontitis Tx?
Includes debridement, scaling and root planing of subgingival biofilm and calculus by a periodontist, general dentist or dental hygienist. Topical or systemic antibiotics can be used in adjunct.
What are Fibrous proliferative lesions of the oral cavity
Fibroma (61%), peripheral ossifying fibroma(22%), Pyogenic granuloma (12%), peripheral giant cell granuloma (5%)
Where do most oral fibromas occur?
Buccal mucosa along bite line
oral fibroma Tx?
surgical excision if bothersome. Cannot aspirate bc it is fibrolytic with few inflammation cells.
How do you recognize a pyogenic granuloma?
They occur in gingiva and are red to purple due to it being highly vascularized
Pyogenic granuloma Tx?
regress spontaneously or surgical excision
Which type of lesion can occur in the oral cavity with pregnancy?
Pyogenic granuloma- no need for treatment
peripheral ossifying fibroma Tx?
surgical excision down to periosteum
What are peripheral giant cell granulomas made from?
Made of aggregation of multinucleate foreign body like giant cells separated by fibroangiomatous stroma
Peripheral giant cell granuloma Tx?
refer to ENT or Oral Surgery
What 2 diseases can Aphthous ulcers be associated with?
Celiac, IBD
What is Plummer-Vinson or Paterson-Kelly syndrome?
Combination of iron deficiency anemia, glossitis and esophageal dysphagia
What is glossitis associated with?
Vitamin B12 deficiency Deficiency of: riboflavin, niacin, or pyridoxine Sprue and iron deficiency anemia Bact or viral infection Irritants= tobacco, ETOH, spices
Which type of Herpes is most common for oral infections?
HSV type1
What is herpetic gingivostomatitis?
abrupt onset of vesicle and ulcerations in oral cavity
Oral HSV Tx?
Symptomatic Tx-acyclovir (within 72 to 96hrs)
Which form of oral candidiasis is Thrush?
Pseudo membranous form. It can be scrapped off
Which form of oral candidiasis cannot be scrapped off?
Hyperplasitic
What is important to remember with oral disorders?
Many occur from systemic Dzs. Its important to look at the big picture.
What are premalignant lesions of the oral cavity?
Leukoplakias, erythroplakia, oral lichen planus
What are malignant lesions of the oral cavity?
squamous cell carcinoma(HPV is a major cause)
What causes oral lichen planus?
chronic inflammatory autoimmune disorder with many phenotypes
What does hypermethylation of the p16 gene cause?
Inactivation of p16( a inhibitor of cyclin-dependent kinase) = hyperplasia
What does a mutation of p53 cause
dysplasia (size, shape, organization)
95% of cancers of the head and neck are SCC. What are the remaining?
adenocacinomas (salivary gland in origin)
What size would indicate Head and neck squamous cell carcinomas(HNSCC) having a low chance of metastasis?
less than 4mm in depth
how are HNSCC lesions less than 2cm in diameter treated?
often cured by local resection
What are the pathogenesis of HNSCC
Often multifactoral from... Smoking Alcohol Actinic radiation(sunlight) HPV
Where does HNSCC often metastasize to?
submandibular, superficial and deep cervial lymph nodes. A majority of those who die from HNSCC have a distant site.
What is a dentigerous cyst
Cyst around crown of unerupted tooth. Often associated with impacted third molar.
What can incomplete excision of a dentigerous cyst cause?
Recurrence, Neoplastic transformation (ameloblastoma)
What viruses often cause infectious rhinitis?
adenovirus, echoviruses, rhinoviruses
What are signs of infectious rhinitis
nasal mucosa thickened, edematous and red, nasal cavities narrowed, turbinates enlarged
What are nasal polyps often related to ?
Allergies- contains inflammatory cells
What is recurrent acute rhinosinusitis?
4 or more episodes of ARS per year with interim symptom resolution. Usually results from drainage problem in sinuses.
What can impaired sinusitis drainage with a suppurative exudate lead to?
Empyema (collection of pus)
What is “saddle nose” associated with?
wegener granulomatosis
Nasopharyngeal Angiofibroma Tx?
May respond to estrogen therapy
What is sinonasal (Schneiderian) papilloma associated with?
HPV types 6 and 11
what are the 3 types of Sinonasal papilloma?
1) Everted- origin on nasal septum
2) Inverted- origin on lateral nasal or sinus wall
3) cylindrical or oncocytic
Where do olfactory neuroblastomas arise from?
olfacoty mucosa (neuroendocranial cells) covering superior third of nasal septum
What is the geographical distribution of nasopharyngeal carcinoma?
African children, Chinese adults w/ HLA-A2
What the factors contribute to development of nasopharyngeal carcinoma?
Heredity, age, and EBV
What therapy is nasopharyngeal carcinoma most sensitive to?
Radiation
Where does nasopharyngeal carcinoma commonly metastasize to?
Cervical lymph nodes
What causes laryngoepiglottitis?
respiratory syncytial virus, H. flu or beta hemolytic strep
What is laryngotracheobronchitis?
Croup- narrowing produces inspiratory stridor
Of singers nodules and polyps, which are unilateral and which are bilateral?
singer nodules are usually bilateral, polyps are unilateral
Are singers nodules or polyps malignant?
They rarely transform to malignancy
What are squamous papilloma?
benign neoplasms on true vocal cords.
What can cause multiple recurring papilloma of the vocal cords?
HPV 6 and 11
What is the difference between intrinsic and extrinsic laryngeal carcinoma?
Intrinsic is confined within larynx. Extrinsic arises or extends outside larynx.
What is the most common manifestation of laryngeal carcinoma?
Hoarseness
What type of cells compose the the outer surface of the TM?
squamous epithelium
What type of cells compose the inner surface of the TM?
cuboidal epithelium
What type of cells compose the middle layer of the TM?
dense fibrous epithelium
What causes relapsing polychondritis?
Antibodies to type 2 collegen and chrondroitin sulfate
relapsing polychondritis Tx?
steroids
What causes malignant OE?
pseudomonas aeruginosa
What can occur with chronic serous OM
goblet cell metaplasia
Can otosclerosis be genetic?
Yes, autosomial dominant
Where are branchial cleft cysts located?
lateral part of the neck
What causes branchial cysts?
failure of obliteration of the second branchial cleft in embryonic development causing excess fluid buildup
What causes thyroglossal duct cyst?
Same etiology as branchial cleft cyst. Remnants of thyroid follicles in cyst.
What are the locations of thyroglossal duct cysts?
Intralingual-2%
suprahyoid-24%
thyrohyoid-61%
suprasternal-13%
Are thyroglossal duct cysts malignant?
Potentially, thyroid cancer present in 1-2% of cysts
Thyroglossal duct cyst Tx?
Sistrunk operation- excision of cyst as well as the tract which passes through the central portion of the hyoid bone to the base of the tongue.
What is a paraganglioma?
Carotid body tumor- develops within the adventitia of the medial aspect of the carotid bifurcation.
What are the different types of carotid body tumors?
Familial, Sporadic, Hyperplastic
What is characteristic about the rate of growth in paragangliomas?
slow-growing tumor- 7 yr doubling time
Paraganglioma presentation?
Typically asymptomatic palpable neck mass in the anterior triangle of the neck. 10% involve cranial nerve palsy.
What is Xerostomia?
“dry mouth” due to a decrease in production of saliva. Associated with Sjogren syndrome.
What is Sjogren Syndrome?
autoimmune against salivary and lacrimal glands. Decreases tear and saliva production.
What can be caused by blockage or rupture of salivary gland ducts?
Mucoceles
What are benign tumors of the facial lymphatics?
pleomorphic adenoma, warthin tumor(papillary cystadenoma lymphomatosum)
What are malignant tumors of facial lymphatics?
mucoepidermoid carcinoma, adenoid cystic carcinoma
