Tumeurs : cavité buccale, nano-sinus, pharynx et larynx

Question 1

2 major classes of tumors:

Answer 1

> Oral cavity, oropharynx, hypopharyng and larynx : men ++ (45-70), tobacco, alcohol, squamous cell carcinoma ++, lymphadenopathy, few metastases

> Rhinosinusal, rhinopharynx :

• ethmoidal tumor = wood dust ++ adenocarcinoma
• undifferenciated carcinoma of nasopharynx (EBV++)

Question 2

Ostéoradionécrose

Answer 2

=> osteoradionecrosis : mandibular irradiation

• dentary prevention
• fluoridation per and post TTT

Question 3

Oral cavity tumor

Answer 3

> Symptoms : leucoplasia, ulceration, glossodynia, lymphadenopathy

> Diagnosis : Biopsy => squamous cell carcinoma ++ more or less well differentiated

> TTT : surgery + lymphadenectomy (sentinel lymph node) + radiotherapy

Question 4

Oropharyngeal tumor

Answer 4

> Symptoms : pharyngeal discomfort, earache, high dysphagia, lymphadenopathy

> Diagnosis : Biopsy => squamous cell carcinoma ++

> TTT : Radiotherapy + chemotherapy + surgery and lymphadenectomy

= lymphophilic ++ recurrent

(!!) : young people = HPV causes tonsils tumor ++

Question 5

Hypopharyngeal tumor

Answer 5

> Symptoms : // oropharynx

> Dg // (priform sinus ++)

> TTT : chemotherapy =
° if regression : radiotherapy
° if not : pharyngolaryngectomy

> Prognosis : bad ++

Question 6

Laryngeal tumor

Answer 6

> Glottic floor : tobacco ++ chronic laryngitis
° S : precocious, progressive and permanent dysphonia
° Dg : Biopsy -> squamous cell carcinoma
° TTT : conservative or total laryngectomie

= best prognosis, less lymphophilic, precocious diagnosis (dysphonia ++)

> Subglottic floor : rare ++ laryngeal dyspnea
° poor prognosis, recurrences, lymphphilic ++ (mediastinum)

> Supraglottic floor : // hypopharynx, lymphophilic ++

Question 7

Nasopharynx tumor

Answer 7

=> Undifferenciated carcinoma (UNCT ++)

4 factors :

• geographic : maghreb, south east asia
• all ages
• no connection with tobacco and alcohol
• constant positive EBV serology

> Symptoms :

• high cervical lymphadenopathy
• otologic : unilateral tubal/nasal obstruction, earache, hypoacousia
• rihnorrhea, epistaxis
• neuro : neuralgia, paralysis

> Diagnosis : rhiniscopy
Biopsy => UCNT +++ or sometimes non-hodgkin lymphoma

> TTT : Rx + chemotherapy

Question 8

Nasal and sinuses cavities tumor

Answer 8

Ethmoidal tumor :

• no influence of tobacco and alcohol
• exogenous factors of professional origin ++ : dust wood (adenocarcinoma of the olfactory cleft)

> Symptoms :

• nasal : unilateral nasal obstruction, permanent, restitant, mucopurulent rhinorrhea, hyposmia, spontaneous and unilateral epistaxis ++
• ophtalmic : sign of an advanced tumor = superior palpebral edema, exophthalmia, ptosis, paralysis, diplopia
• neurologic : rare, specific less

> Diagnosis : Biopsy => adenocarcinoma of the olfactory cleft ++

> TTT : surgery + Rx + chemotherapy if extended tumor, metastatic

Question 9

Maxillary sinus tumor

Answer 9

> old person ++

> Symtoms : typical facial nevralgia, molar mobility

=> squamous cell carcinoma

Question 10

Diagnosis and pre-therapeutic

Answer 10

> Local extension :

• ENT clinical examination (laryngoscopy, fibroscopy, rhinoscopy)
• Panendoscopy (general anesthesia)
• Imaging (TDM, IRM)

> Regional extension :

• lymphadenopathy
• Imaging : ecographia, TDM, IRM

> General extension :

• thoracic TDM systematic ++
• others if symptoms

=> at the end : TNM stage +++