T10-L4: Diseases of the Head and Neck

Question 1

Give examples of aetiologies of Rhinitis.

Answer 1

• Viruses e.g. RSV, Parainfluenza, coronaviruses etc.
• Bacterial e.g. H. Influenzae
• Hypersensitivity reaction - common allergens include pollen, animal dander, dust mites and mould. This is the most common aetiology.

Question 2

Give complications of sinusitis.

Answer 2

Inflammation of the sinus can lead to accumulation, blockage and abscess formation. In severe cases it can extend to the cranial cavity leading to meningitis, cerebral abscesses and cranial osteomyelitis.

Question 3

What cell are polyps due to allegory abundant in?

Answer 3

Eosinophils

Question 4

What 3 components make up Samter’s triad?

Answer 4

Samter’s Triad is a condition in which an individual has asthma, sinus inflammation with recurring nasal polyps, and sensitivity to aspirin and some other NSAIDs. When aspirin or a similar drug is taken, people with Samter’s Triad have a severe reaction with both upper and lower respiratory symptoms.

Question 5

What are lichenoid drugs?

Answer 5

These drugs, such as NSAIDs and antibiotics, cause lesions that have a similar morphological and histological appearance in reaction to oral lichen planus.

Question 6

What forms of oral lichen planus can we see?

Answer 6

Oral lichen planus is a non-infectious inflammatory immunological mucocutaneous disorder. It often presents with a chronic dermatological disease though lichen planus most commonly affects the oral mucosa.

Presentation of oral lichen planus include:

• Reticular form - plaque like, erythematous and erosive (ulcers/bullae) in the buccal mucosal and tongue. This is the most common presentation.
• Interfacting white striae (Wickham striae) seen on the lining of the mucosa

The patient will have itchy skin, violaceous papules and blisters particularly on the palms and soles.

Question 7

What factors make up the characteristic histological appearance of lichenoid inflammation?

Answer 7

• Thickened or atrophic epithelium with short tooth rete ridges
• Band of chronic lymphocytic inflammatory infiltrates in the junction between the epithelium and storma
• It may also show basal keratinocyte damage and hydronic damage

Question 8

What is the most common cause of Epiglottitis?

Answer 8

Haemophillus influenzar type B

Question 9

Give causes of vocal polyps.

Answer 9

• Voice abuse - phonatory trauma
• Infection (laryngitis - which can be viral or bacterial)
• Smoking
• Alcohol

It is due to a non-neoplastic stromal reactive process related to inflammation and/or trauma. Histologically we see squamous mucosa with underlying oedematous and myxoid stroma (mesenchyme and mucin) with fibrin deposition and amyloid like material in the stroma.

Question 10

What population does bacterial sialadenitis occur in?

Answer 10

Bacterial sialadenitis (inflammation of the salivary glands) is uncommon but occurs in patients with xerostomia (dry mouth).

Question 11

What is a salivary gland mucocele? Therefore what is ranula?

Answer 11

Salivary gland mucocele is a general term used to describe minor salivary gland lesions resulting from obstruction secondary to a mucous plug (leading to a mucous retention cyst) or intraluminal sialolith. It is common in young people. It can also be secondary to trauma which can lead to mucus extravasation.

Ranula is a form of mucous retention cyst/mucocele/mucus extraversion phenomena present in the floor of the mouth in association with the ducts of the sublingual gland. This forms a large mucocele.

Question 12

Give details of the most common tumour of the salivary gland.

Answer 12

Pleomorphic adenoma is the most common tumour of the salivary gland (2/3rd). It is benign but they trend to recur after extension.

80% are present in the parotid. A small proportion can undergo malignant chance to carcinomas ex pleomorphic adenoma. This change would happen after many year.

The appearance is variable, it can be composed of a mixture of: epithelial cells, mesenchymal cells and chondromyxoid stroma.

Question 13

What complication can occur as a result of parotidectomy?

Answer 13

Facial nerve damage leading to dropping of the face.

Question 14

What is the most common cancer of the oral cavity? Give it’s aetiologies.

Answer 14

Oral Squamous Cell Carcinoma.

Aetiology:

• Alcohol and Tobacco - independent risk factors that can have a combined effect
• Oncogenic viruses such as HPV - type 16 and 18 - and EBV
• Sunlight leading to lip carcinoma
• Nutritional factors such as Plummer-Vinson Syndrome (chronic iron deficiency) and cirrhosis
• Immunocompromised states - especially in gingival carcinomas

Question 15

Give conditions linked to the development of oral carcinoma/

Answer 15

• Lichen plays
• Submucous fibrosis
• Other factor such as trauma/dental excision and poor oral hygiene

Question 16

What is the presentation of oral carcinoma?

Answer 16

Signs and symptoms of oral SCC depends on size and location of the lesion
- Small lesions may be asymptomatic - The patient may just have a leukoplakia (white patch), erythroplakia (red patch), or speckled leukoplakia (mixed leukoplakic and erythroplakic)

In more advances lesions the patient may have:
- Larger mass lesion
- Ulceration
- Pain (local and referred)
- Difficulty swallowing, speaking, chewing, and opening the mouth
- Bleeding
- Weight loss
Enlarged neck nodes (neck mass) / metastasis - in some cases this is the only presentation

Question 17

What is teh most common laryngeal cancer?

Answer 17

Laryngeal squamous cell carcinoma. It is more common in mean than in women and shows a peak in the sixth decade of life. It is also associated with cigarette smoking and chronic asbestos exposure.