Throat/Mouth Flashcards
1
Q
What is the health status of the oral cavity linked to?
A
Cardiovascular disease
Diabetes
Systemic Illnesses
2
Q
What should you assume head and neck infections or swelling to?
A
Odontogenic in origin
3
Q
What is a dental carie?
A
Infection that is bacterial in origin and causes demineralization and destruction of the hard tissues of the teeth
4
Q
What can cause a dental carie?
A
A dry mouth
5
Q
What mouth disease remains one of the most common diseases throughout the world?
A
Dental carie
6
Q
What are risk factors for dental infection?
A
Low socioeconomic status/ poor access to care Poor oral hygiene Poor nutrition Inadequate fluoride Decreased saliva flow Use of anticholinergic medications
7
Q
How do we prevent dental problems?
A
Flossing Brushing with fluoride toothpaste Biannual cleaning Avoid smoking Good control of systemic diseases
8
Q
What pathogen causes dental infections?
A
Streptococcus mutants
9
Q
What dental diseases are common in pregnant women?
A
Pregnancy gingivitis caused by hormonal changes which promote pathogen growth
Pyogenic granuloma
10
Q
What disease is a systemic risk factor for periodontal disease?
A
Diabetes
11
Q
What are the two main clinical presentations of periodontal disease?
A
Sensitivity to hot or cold stimuli
Pain on biting
12
Q
If a child < 4 comes in with a stiff neck, sore throat, and dysphagia, what should they be worked up for?
A
Retropharyngeal abscess secondary to molar infection
13
Q
What labs might you obtain if a patient has periodontal disease and when is the only time you would obtain these?
A
If the patient looks extremely ill —>
CBC with differential
Culture and sensitivity to test for aerobic and anaerobic pathogens
14
Q
What might you use a CT scan for with periodontal disease?
A
TO determine the extent and density of swelling, as well as, the location of an abscess within soft tissue or bone
15
Q
What differential diagnoses might you consider with periodontal disease?
A
Sinusitis
Jaw pain is an angina equivalent in postmenopausal women or long-term diabetic patients
16
Q
What is the first line treatment for dental infection?
A
Penicillin VK
Loading dose of 1000mg followed by 500mg QID for 7-10 days
IN kids its 40-60 mg/kg/day divided four times a day
17
Q
What is the second line treatment for dental infection and when should you use it?
A
If there is a longstanding infection or previously treated infection that does not respond to first line; or PCN allergy
Oral Clindamycin 300mg TID for 7-10 days
18
Q
If a patient has a severe dental infection, what should the treatment be?
A
Loading dose of CLINDAMYCIN 600mg or 900mg IV, then 300mg every 6 hours
COnsider double coverage with metronidazole
19
Q
What must be obtained before a patient with a dental infection can be released from the hospital?
A
Dental consult and follow up dental care appointment scheduled
20
Q
What anti inflammatory agents should be used in dental infection?
A
Aspirin or NSAIDS
Careful with opioids
21
Q
What is the criteria for admission to the hospital for patient with dental infection?
A
Swelling involving deep spaces (pre-fascial planes) of neck Unstable vital signs Fever Chills Confusion or delirium Evidence of invasvie infection
22
Q
If a patient has an I&D for their dental infection, what is the treatment?
A
Warm salt water rinses several times a day to encourage drainage
Chlorhexidine gluconate twice a day
23
Q
When can you discharge a patient from the hospital after they are admitted for a dental infection?
A
If airway is not compromised
If abscess and sepsis are eliminated
If the patient is able to take PO and ambulate
24
Q
What should be avoided in young children in order to prevent dental caries?
A
Sleeping with a bottle
25
What are potential complications of dental infections?
Ludwig angina
Vincent's angina
Retropharyngeal abscess/infection
Mediastinal infection
26
What is ludwig angina?
sublingual cellulitis with or without tracking abscess inferiorly
27
What is Vincent's angina?
trench mouth
acute necrotizing ulcerative gingivitis
28
What are the two clinical pearls of dental infections?
Do not ignore toothache pain
| Treat patients with facial swelling aggressively, as infections can quickly spread
29
What is tonsillitis?
inflammation of palatine tonsil glands
30
What is pharyngitis?
Inflammation of any structure of the pharynx, including adenoids and lingual tonsils
31
When is tonsillitis and pharyngitis usually seen?
winter and early spring
32
What virus typically causes tonsillitis or pharyngitis?
Rhinovirus
33
What bacteria typically causes tonsillitis or pharyngitis?
GABHS:
Strep pyogenes or GAS
34
What are the clinical manifestations of viral tonsillitis/pharyngitis?
Chronic sore throat and symptoms of common cold
```
Coryza
Cough
Malaise
Fatigue
Hoarseness
```
35
What symptoms are associated with viral tonsillitis/pharyngitis caused by mono?
Viral symptoms
Posterior LAD
Kissing tonsils
Hepatosplenomegaly
36
What are the clinical manifestations of Bacterial tonsillits/pharyngitis?
Lack of cough, coryza, or other URI symptoms
Sudden onset of sore throat
Anterior LAD
Fever
Petechiae of soft palate
37
What can bacterial tonsillits/pharyngitis lead to in children?
Scarlett fever (GABHS Pharyngitis)
38
What are the clinical manifestations of Scarlett fever?
strawberry tongue
| Sandpaper rash on trunk and armpits
39
What are the general symptoms of Tonsillitis/pharyngitis?
```
Dysphagia
Odynophagia
Sore throat
Fever
LAD
Exudate
Headache
N/V
Abdominal pain
```
40
What do we use to diagnose GABHS pharyngitis/tonsillitis?
Centor Criteria
41
What is the centor criteria?
Fever
Anterior LAD
Tonsillar exudate
Absence of cough
1 symptom = likelihood low for strep
2-3 symptoms = confirm via rapid strep test
4 symptoms = treat for strep pharyngitis
42
What do we treat Adult bacterial pharyngitis with?
Pen VK 500MG twice a day for 10 days
43
What do we treat child bacterial pharyngitis with?
Amoxicillin 50mg/kg PO every day for 10 days
or
24 mg/kg PO twice a day for 10 days
44
What is the secondline treatment for bacterial pharyngitis if the patient has a penicillin allergy?
Cephalexin or Macrolide
45
What is the treatment for viral pharyngitis?
```
Gargle with warm water
Antipyretics
Analgesis for bad cases of mono
Rest
Decadron single dose if tonsils are really enlarged
IVF if dehydrated
```
46
What are the complications of strep pharyngitis/tonsillitis?
Peritonsilar abscess
Rheumatic fever
Glomerulonephritis
47
What is the most common complication seen with strep pharyngitis/tonsillitis?
Peritonsilar abscess
48
What is a peritonsilar abscess?
Collection of pus located between the capsule of palatine tonsil and pharyngeal muscles
49
What are the causative steps of peritonsilar abscess?
Tonsillitis/pharyngitis --> cellulitis --> abscess
50
What is considered the most common deep space infection of the head and neck?
peritonsilar abscess
51
What is a peritonsilar abscess caused by?
GABHS
Others:
S. aureus
Neisseria
Corynebacterium
52
What are the clinical manifestations of peritonsilar abscess?
Severe sore throat that is unilateral
| Muffled/"hot potato voice"
53
What are other symptoms of peritonsilar abscess?
```
Fever
Ipsilateral ear pain
Fatigue
Irritability
Decreased PO intake
Trismus
Neck pain with movement
Unilateral, swollen, and fluctuant tonsil with contralateral deviation of uvula
Pooling of saliva/drooling
Neck swelling
Rancid or fetor breath
Erythema or exudate of the tonsil
```
54
What are differential diagnoses of peritonsilar abscess?
```
Retropharyngeal abscess
Ludwig angina
Dental infection
Peritonsilar cellulitis
Infectious mononucleosis
```
55
What typically occurs after patient has had viral pharyngitis?
peritonsilar cellulitis
56
What is the diagnostic tool used to diagnose a peritonsilar abscess?
CT neck with IV contrast
57
If you get an xray of the neck and see a positive thumb sign, what is diseased?
epiglottis
58
When would you get imaging for a peritonsilar abscess?
If you are uncertain about your diagnosis
59
How is a peritonsilar abscess treated?
Drainage
Empiric antibiotics --> Augmentin 875 mg twice a day for 14 days or Unasyn IV or clindamycin IV
Antipyretics
Analgesia
60
What is rheumatic fever?
Delayed, non-suppurative sequelae of GABHS pharyngitis involving lesions of joints, heart, subcutaneous tissue, and CNS
61
What is the concern with rheumatic fever?
lifelong complications and damage to cardiac valves
62
What are the clinical manifestations of rheumatic fever?
```
Carditis/Valvulitis
Migratory arthritis
Erythema marginatum
Sydenhaum chorea
Subcutaneous nodules
```
63
What symptoms are assocaited with carditis/valvulitis in rheumatic fever?
Occurs mostly in kids and lasts long-term
30-60% of patients get this on first occurence
Effects pericardium, epicardium, myocardium, and valves
MITRAL VALVE IS MOST AFFECTED
Pericardial friction rub
New murmur
CHF symptoms
64
What are the symptoms associated with migratory arthritis?
```
Lasts 4 weeks
Seen in older teens/adults
75% will get on first occurence
Asymmetric pattern
Large joints effected
Edema
Swollen joints
```
65
What are the symptoms associated with erythema marginatum?
lasts weeks to months
Seen in kids and rarely adults
10% will get on first attack
Non-pruritic, serpinginous erythematous eruption on the trunk
Effects trunk more than proximal extremities
Non-pruritic rash
66
What are the symptoms associated with sydenhaum chorea?
```
Lasts 2-3 years
Seen in children and rarely in adults
Females are most likely to get this
25% will get on first occurence
Neurological and pyschological components
Abrupt rhythmic, purpseless movement
Emotionally labile
```
67
What are the symptoms associated with Subcutaneou nodules?
```
Rare and assocaited with carditis
Persists for 1-2 weeks
Rare to get
Painless nodules over tendon sheaths
Occurs on elbows, wrist, ankles, and achilles
```
68
How do we diagnose Rheumatic fever?
Jones criteria
69
What is the Jones criteria?
Evidence of recent strep infection +
2 major
Or
1 major and 2 minor
Or
3 minor if recurrent
70
What are the major symptoms associated with Jones' criteria?
```
Migratory arthritis
Carditis/valvulitis
Sydenhaum chorea
Erythema marginatum
Subcutaneous nodules
```
71
What are the minor symptoms associated with Jones' criteria?
Arthralgia
Fever
Elevated ESR or CRP
Prolonged PR interval
72
How are adults with rheumatic fever treated?
Pen VK 500mg twice a day for 10 days
| Bed rest until fever is gone and labs/EKG normalize
73
How are children with rheumatic fever treated?
Pen VK 250 mg twice a day for 10 days
| Bed rest until fever is gone and labs/EKG normalize
74
What is the secondary prophylaxis treatment for rheumatic fever?
PCN Benzathine G 1.2 million units IM every 4 weeks for
5 years without carditis or 10 years with carditis
75
What is post-streptococcal glomerulonephritis?
Kidney injury caused by a strep infection from impetigo or sore throat that can cause nephritis
76
What is nephritis syndrome?
inflammation of glomerulus
77
Where is post-strep glomerulonephritis most common?
in developing countries
78
What are the clinical manifestations of post-strep glomerulonephritis?
```
Edema
Hematuria
Hypertension
Oliguria
Proteinuria
```
79
What are some nonspecific symptoms associated with post-strep glomerulonephritis?
General malaise
Weakness
Anorexia
N/V
80
How do we diagnose post-strep glomerulonephritis?
Urine dip and microscopy to test for hematuria/proteinuria and RBC casts
Streptozyme test
Rapid strep/strep culture
Renal function for increased BUN/Creatinine which would signify AKI
81
What antigens does the streptozyme test test for?
```
Anti-Dnase B
Antinicotinamide-adenine dinucleotiase (Anti-NAD)
Antistreptokinase (ASKase)
Antihyaluronidase (Ahase)
Antistreptolysin (ASO)
```
82
How would we treat post-strep glomerulonephritis?
```
Treat the underlying condition
Symptomatic/supportive care:
Restrict water and salt intake
+/- diuretics for edema
HTN control with diuretics, CCB, and ACE's
Limit activity
+/- dialysis if needed
```
83
What is laryngitis?
inflammation of vocal fold mucosa and larynx
84
What is the funciton of the larynx?
Voice
| Prevent aspiration of food
85
What is acute laryngitis caused by?
```
VIRUS
bacteria
GERD
Environmental
Vocal trauma
```
86
How long is acute laryngitis?
Resolves in 7-10 days
87
How long is chronic laryngitis?
> 3 weeks
88
What are the clinical manifestations of laryngitis?
Hoarseness (dysphonia)
Preceding or concurrent URI symptoms like cough and rhinitis
Odynophonia
Odynophagia
89
What is the treatment for laryngitis?
VOICE REST
| inhaled humidifier
90
What is the most common virus that causes Non-suppurative sialadenitis?
MUMPS
91
What bacteria typically causes suppurative sialadenitis?
Staph aureus
92
Which salivary duct most commonly is inflammed?
parotid duct
93
What are the clinical manifestations of bacterial suppurative sialadenitis?
Sudden onset of pain, fever, and chills
Unilateral
Firm and tender
Expression of pus
94
How do we diagnose sialadenitis?
Physical exam
MUMPS titer -RT PCR or serology if indicated
HIV RNA if indicated
If unclear or unimproved:
Ultrasound
CT face/neck
Sialadenoscopy
95
How do we treat bacterial sialadenitis?
```
Paraenteral or oral antibiotics --> nafcillin, dicloxacillin, Augmentin
Massage of duct
Warm compresses
Sialagogues
Surgical drainage if abscess develops
```
96
What is chronic or recurrent sialadenitis?
Caused by obstruction (stone or stricture of duct)
Repeated episodes of pain, swelling, and recurrent infections
Swollen or firm gland; imaging revels calculus of dilated ducts
Treat with hydration, gland massage, sialedonscopy, or surgery and antibiotic
97
What is neoplasm sialadenitis?
Benign or malignant
Painless, firm, slow growing
Imaging; CT or MRI; FNA
Surgical removal of gland
98
What is autoimmune sialadenitis?
Caused by Sjogren's
Gradual onset swelling bilateral parotid or submandibular
Lab work specific to Sjogren's
Supportive treatment
99
What is parotitis?
Acute-onset of parotid swelling lasting about 2 days
Parmyxoviral disease spread by respiratory routes like saliva, droplets, and fomites
100
What is parotitis caused by?
exposure to MUMPS about 2-3 weeks before symptom onset
101
Who are most effeced by parotitis?
Children but college students are now being seen with it due to waning immunity to vaccines
102
What are the clinical manifestations of parotitis?
Bilateral parotid gland edema
Flu like prodrome 48 hours before
Unilateral testicular swelling and tenderness
103
What are the complications of parotitis?
Deafness
Orchitis
Meningitis
Fetal congenital abnormalities
104
How do we treat parotitis?
```
Supprtive care:
Bed rest
Hydration
Sialagogues
Analgesia
warm or cold compresses on parotid
Testicular pain is treated with scrotal sling
```
105
What are cancers of the oral cavity associated with?
Ulcers or masses that DO NOT HEAL
106
What accounts for 80% of Squamous cell carcinoma of the head and neck?
Tobacco and Alcohol use
107
What is aphthous stomatitis?
Canker sore
Painful oral lesion that often reoccurs
108
What is the most common acute oral lesion?
Aphthous Stomatitis
109
When do aphthous stomatitis usually develop?
First during adolescence and will wane with increasing age
110
Where does aphthous stomatitis usually occur?
in middle east and south asia
111
What type of aphthous stomatitis is most commoN?
simple aphthous
112
What is simple aphthous (Mikulicz)?
Several episodes a year
May be 1 sore to several at a time
They can last up to 14 days
Limited only to oral mucosa
113
What is a complex aphthous?
```
Can be oral or genital
More numerous lesions will occur
Lesions are > 1 cm
Takes 4-6 weeks to resolve
So frequent that patients almost always have them
```
114
What are aphthous stomatitis caused by?
Multifactorial causes that are often unknown
Immune dysregulation
Exaggerated proinflammatory process
Weak anti-inflammatory response
Possibel genetic predisposition
Certain foods can exacerbate them
May be seen in celiac disease, IBD, or Crohn's
Conditions that cause decrease in mucosal thickening
Use of antimetabolites such as methotrexate for RA
Vitamin B12, folic acid, or iron deficiency
Neutropenia of any cause
115
What are the risk factors of aphthous stomatitis?
```
Smoking cessation
Familial tendency
Trauma like dental cleaning
Hormonal factors like progestin falling in luteal phase of menstrual cycle
Emotional stres
Food or drug hypersensitivity
Immunodeficiency
```
116
What are the clinical manifestations of Aphthous stomatitis?
```
1-5 can occur at one time
Round to oval shape
Clearly defined ulcers
Erythematous rim
Yellowish/whitish central space
Small, usually 1-3 cm
Painful
```
117
How do we treat aphthous stomatitis?
Oral hygiene with non-alcohol mouthwash and soft toothbrush
Pain control-->
viscous lidocaine 2% applied directly or swish and spit
Diphenhydramine liquid swish and spit
Dyclonine lozenges
Topical steroids-->
Dexamethasone elixir swish and spit
Clobetasol gel
Triamcinolone paste
118
How do we treat complex aphthous stomatitis?
Intralesional or oral glucocorticoids for recalcitrant lesions or severe disease:
Colchicine
Dapsone
Pentoxifylline as bronchodilator and immunomodulator
Thalidomide in HIV infected patients
119
What is oral leukoplakia?
Benign reactive process
| Clinical significance depends on degree of and presence of dysplasia
120
What is the change that oral leukoplakia will progress to carcinoma in 10 years?
1-20%
121
Who most commonly gets oral leukoplakia?
Men more than women
Those with HPV
Smokeless tobacco users
122
What are the clinical manifestations of oral leukoplakia?
Leukplakic lesions that show up in trauma prone regions like the cheek and dorsum of tongue where mucosa is normally thicker
Thin areas of mucosa like ventral tongue or retromolar triangle show more dysplasia
Not painful
Whitish grey lesions
Flat
Not well defined
Can't scrape off easily
123
How do we treat oral leukoplakia?
Most won't need treatment but if they do, surgery, cryoprobe, or chemoprevention
124
What is oral hairy leukoplakia?
NOT premalignant
EBV associated
Occurs almost entirely in HIV affected patients
125
Who is Herpes simplex virus (HSV-1) most common in?
women
126
What are the characteristics of primary HSV-1 infection?
HIghly variable and usually severe and systemic
127
What are the characteristics of recurrent HSV-1 infection?
Common but typically less severe and more local
128
What are the clinical manifestations of HSV-1?
Herpetic gingivostomatitis
Multiple oral vesicular lesions and erosions surrounded by erythematous base
Painful
Prodromal of signs and burning, tingling, and pain will occur 24 hours prior to outbreak
129
Where do recurrent outbreaks of HSV-1 usually occur?
on lip borders
130
What are the symptoms that young children infected with HSV-1 will have?
Fever
LAD
Drooling
Decreased oral intake
131
Where will sores be located in primary herpetic gingivostomatitis?
Inside of mouth
132
Where will sores be located in recurrent herpetic gingivostomatitis?
On outside of mouth
133
What are the risk factors for HSV-1?
Sunlight exposure
Stress
Trauma
134
What labs could you get to confirm HSV-1?
Tzanck smear, immunofluorescent smear or viral culture
135
How do we treat HSV-1?
Systemic antiviral --> Acyclovir, valacyclovir, or Famciclovir
Swish and spit miracle mouthwash
Supportive care
Popsicles for kids
136
What is oral candida?
Common local infection involving oropharyngeal and esophageal mucous membranes
137
Who most commonly gets oral candida?
```
Young infants
Older adults who wear dentures
Those on antibiotics
Those on chemotherapy
Those on radiation of head and neck
Those that are immunodeficient
Those that have inhaled corticosteroids
Those with xerostomia
```
138
What is oral candida caused by?
Candida albicans
139
What is pseudomembranous oral candida?
White plaques on buccal mucosa, palate, tongue, and oropharynx
140
What is atrophic oral candida?
Found around upper dentures and appear as erythema without papules
141
What are the clinical manifestations of oral candida?
```
Asymptomatic
Dry mouth
Loss of taste
Pain with swallowing or eating
White plaques on buccal mucosa, palate, or tongue
Erythema without placques in denture wearers
Painful swallowing if esophageal
Beefy, red tongue with denture wearers
Angula chelitis
Painful fissuring
```
142
How do we treat oral candida in healthy patients?
Local therapy
Nystatin suspension swish and swallow
Clotimazole troches
Miconazole buccal tabs
143
How do we treat oral candida in immunocompromised patients?
Diflucan PO
144
What structures are in the oropharynx?
Posterior 1/3rd of tongue
Soft palate
Lateral and posterior walls of throat
Tonsils
145
What are the regions of the throat?
Nasopharynx
Oral cavity
Oropharynx
Larynx
146
What are malignant neoplasms of head and neck?
Epithelial carcinomas of head and neck that arise from mucosal surfaces and are overwhelmingly Squamous cell carcinomca
147
What are anterior cancers of head and neck caused by?
Tobacco and alcohol
148
What are posterior cancers of head and neck caused by?
HPV 16 and 18
149
What are anterior cancers of head and neck associated with?
nonhealing ulcers or masses
| Dental changes or poorly fitting dentures
150
WHo have a 3-8X greater risk of developing oral cancer?
moderate to heavy drinkers
151
Who has a 30X greater risk for oral cancers?
extremely heavy drinkers
152
Who has a 100X greater risk for oral cancers?
Heavy smokers and heavy drinkers
153
Who has a 5-9X greater risk for oral cancers?
Smokers
154
Who has a 17X greater risk for oral cancers?
heavy smokers
155
What are the risk factors for oral cancers?
Smoking
Alcohol abuse
HPV infection
EBV infection
156
Who most commonly get oral cancers?
males
157
Who do HPV related oral cancers occur in?
younger patients usually in their 40s
158
What are the clinical manifestations of posterior tongue cancers?
HPV 16
Does not produce visible lesions/discolorations
There are no warning signs
There will be erythema but no ulcers
159
What are the clinical manifestations of Oral cavity cancers?
Lesions present as exophytic, ulcerative, and often painful
160
What do 2/3rds of patients with primary tongue lesions also have?
nodal disease
161
What is oral cavity squamous cell carcinoma usually proceeded by?
Leukplakia
Erythroplakia
Speckled Erythroplakia
162
What is erythroplakia?
Red patch similar to leukoplakia except that is has erythematous components
163
What is speckled erythroplakia?
Combination of red and white freatures
Fiery red patch taht cannot be identified clinically/pathologically as any other definable disease
Will show evidence of high grade dysplasia, carcinoma in situ, or invasive SCC
Lesions appear as red, velvety patho that is often demarcated
Some lesions may have rough, granular surface
164
What are the clinical manifestations of oral cavity squamous cell carcinoma?
Painless
can appear as ulcer without adjacent mucosal change
Continued growth can result in a mass with raised, rolled borders
Pain/tenderness often will develop but later in the disease
165
What is the most common site of oral squamous cell carcinoma?
Tongue
166
What is the second most common site of oral cavity squamous cell carcinoma?
Floor of mouth
167
Where do the vast majority of tongue lesions in OC-SCC occur?
lateral and ventrolateral aspects
168
Where does oralpharyngeal squamous cell carcinoma develop?
Tonsillar region and base of tongue
169
What are the clinical manifestations of oropharyngeal squamous cell carcinoma?
Appear as ulcerated mass, fullness, or irregular erythematous mucosal changes
Presents at more advanced stage as it grows undetected and has higher propensity for metastasis
Presene of neck mass
Sore throat
Dysphagia
170
What are the clinical manifestations of SCC with leukoplakia?
Rough, papillary patch of leukoplakia seen in retromolar trigone and soft palate
Large size and nonhemogenous nature of lesions worrisome for malignancy
Biopsy shows invasive SCC
171
What are symptoms of oral cavity cancers?
```
pain that will occur in stage 3 or 4
Otalgia
Dysphagia
Odynophagia
Airway obstruction
Neuropathies
```
172
What are the signs of oral cavity cancers?
```
Cervical LAD
Cranial neuropathies
Decreased tongue mobility
Fistulas
Skin involvement
```
173
Where can oral cancer occur in oral cavity?
```
lips
tongue
floor of mouth
Maxillary alveolar ridge/hard palate
Mandibular alveolar ridge
Buccal vestibules
```
174
Where can oral cancer occur in oropharynx?
Tongue base
Soft palate
Palatine tonsils
Posterior wall of pharynx
175
Where can oral cancer occur in hypopharynx?
Piriform sinuses and postcricoid area leading into esophagus below
176
Where can oral cancer occur in larynx?
Supraglottis (epiglottis and false vocal cords)
| Cancers here will spread to lymph nodes early
177
Where can oral cancer occur in glottis?
true vocal cords
| Presents with hoarseness
178
What are some later symptoms of oral cancer?
```
Bleeding
Loosening of teeth
Difficult wearing dentures
Dysphagia
Dysarthria
Hoarseness
Development of a neck mass
```
179
How do we figure the extent of oral cancers?
Contrast or noncontrast CT scan of neck and head
180
What are the three clinical groups for treatment of oral cancers?
Localized disease
Locally or regionally advanced disease
Recurrent and/or metastatic disease
181
How do we treat localized oral cancers?
Curative intent by either surgery or radiation
182
How do we treat locally or regionally advanced disease?
Curative intent but with combined modality therapy using:
Surgery
Radiation therapy
chemotherapy
183
How do we treat recurrent and/or metastatic oral cancer?
Treated with palliative care
| THis can't be cured so radiation and chemo just extend the patients life for a few months and relieve the pain
184
Which oral cancer has the best overall 3 year survival rate?
Those caused by HPV
