Oral cavity and salivary glands

Question 1

Oral cavity infections

Answer 1

• Tonsillitis (bacterial or viral) is main infection of the pharynx
• Exudative tonsillitis can be cause by streptococcal organisms, mononucleosis, and diphtheria
• Complications: spread of infection to the neck, peritonsillar abscess (uvula deviates to contralateral side and hot potato voice), infection of heart valves and kidneys

Question 2

Oral cavity neoplasms (squamous cell CA)

Answer 2

• Risk factors: tobacco, alcohol, sun exposure (lip CA)
• Lip CA (most common CA in oral cavity) is almost always on lower lip (squamous cell), but basal cell CA is usually on upper lip
• Anterior 2/3rds of tongue is second most common site of CA in oral cavity
• Tongue CA often leads to occult bilateral LN mets

Question 3

Salivary glands

Answer 3

• Major glands: parotid (serous cells), submandibular (most likely to see stone, mixed cell types), and sublingual (mucous cells)
• Inflammation of a salivary gland is usually due to viral infection (usually mumps), and most often affects parotid gland
• Suppurative parotitis: staph infection of the parotid gland, often in dehydrated/debilitated hosts, post op/trauma pts, radiation pts

Question 4

Salivary gland calculi

Answer 4

• Almost all form in the submandibular gland or duct

- Most calculi are radiopaque, but ones in parotid can be mildly translucent

Question 5

Nutritional diseases

Answer 5

• Affect the size of the glands

- Ex: beriberi, malabsorption, alcoholism, diabetes, bulimia, pellagra

Question 6

Key point in salivary gland pathophysiology

Answer 6

• Salivary gland inflammation consists of decreased saliva flow and/or stasis
• This decreased flow will trap bacterial and set up the inflammation
• If left untreated this process yields chronic destructive inflammation and repeated infection

Question 7

Salivary gland neoplasms

Answer 7

• 75% are benign, usually in parotid
• Most of the benign neoplasms are pleomorphic adenoma, w/ 10% being warthin’s tumor (papillary cystadenoma lympomatosum)
• 25% of salivary tumors are malignant, most important ones are mucoepidermoid CA and adenoid cystic CA

Question 8

General considerations of salivary gland neoplasms

Answer 8

• Head/neck radiation is associated w/ development of pleomorphic adenoma and mucoepidermoid tumors
• Most of the large salivary gland tumors (i.e. parotid) are benign, but 50% of minor salivary gland tumors are malignant
• The single most important factor in prognosis is the stage of the disease at initial presentation

Question 9

Hemangiomas

Answer 9

• Present at birth or appear w/in first year of life
• Many tumors regress spontaneously
• They are raised and blanch
• Lymphangiomas are most common tumor in children

Question 10

Congenital pathology of the pharynx

Answer 10

• Remnants of the thyroglossal duct (connects foramen ceacum to thyroid) can be a source of cysts, and when removed you must take out part of the hyoid bone
• Brachial cleft cysts: always anterior to the border of the SCM
• Laryngomalacia: immaturity of the laryngeal cartilages (fusion/stenosis of true vocal folds)

Question 11

Acute infections of the larynx, trachea, and bronchi

Answer 11

• Acute epiglottitis due to H flu type B is a medical emergency
• Characterized by a bright red swollen epiglottis it necessitates intubation/tracheostomy
• Croup (laryngotracheal bronchitis): lower respiratory infection that extends from the larynx to the smaller subdivisions of the bronchial tree
• Etiology is usually viral (parainfluenza), but can be bacterial (H flu, strep and staph)
• Pts present w/ barky cough

Question 12

Laryngeal trauma

Answer 12

• Most common: vocal cord abuse, smoking, irritating chemicals
• Forms nodules on vocal cords (singer’s nodules)
• Vocal cord paralysis: injury to recurrent laryngeal nerve usually during surgery
• GERD: irritates posterior cricoid region and can lead to formation of ulcers and granulomas in posterior larynx
• Laryngeal papilloma: caused by HPV
• CA of larynx: usually squamous cell and has strong association w/ smoking, alcohol, and HPV

Question 13

Zones of the neck

Answer 13

• Zone 1: submandibular/submental nodes
• Zone 2: just beneath the angle of the mandible and pinna of ear; contains IJV from skull base down to carotid bifurcation
• Zone 3: directly under zone 2, contains IJV from carotid bifurcation down to omohyoid muscle (to hyoid bone)
• Zone 4: directly under zone 3, contains IJV from omohyoid/hyoid bone to below the cricoid cartilage
• Zone 5: most posterior zone, extends the length of zone 2-4 but just posterior to them (posterior triangle)
• Zone 6: just under zone 1, extends the length of 2-4 but anterior to them

Question 14

Drainage of neck zones

Answer 14

• Zone 1 drains the oral cavity and submandibular gland
• Zone 2 drains the nasopharynx, oropharynx, parotid, supraglottic larynx
• Zone 3: oropharynx, hypopharynx, supraglottic larynx
• Zone 4: infraglottic larynx, hypopharynx, esophagus and thyroid
• Zone 5: nasopharynx and oropharynx
• Zone 5: thyroid and larynx