Week 4: Oral cavity and salivary glands Flashcards
1
Q
Oral Cavity Infections
A
- tonsilitis is main infection of pharnx
- ddx can be difficult
- differentiate from aphthous ulcers (canker sores)
1. Exudative tonsilitis: Strep, Mono, Diphtheria
2. Complications of tonsillitis - spread of infection to the neck
- peritonsilar abscess: Most common, asymmetric soft palate, deviated uvula, hot potato voice, infection can spread
2
Q
Oral cavity neoplasms
A
- Squamous cell carcinoma: usually related to tobacco, alcohol use, sun exposure
- tends to be of the lower lip
- lip carcinoma accounts for 25-30% of oral carcinoma. 95% on lower lip - Basal cell carcinoma
- most common cancer of upper lip - oral tongue cancer: anterior 2/3rds
- 20% or oral cavity cancers
- may present with occult bilateral lymph node metastases
3
Q
Salivary Gland Inflammation
A
- Mumps: paramyxovirus
- most common viral infection of salivary glands, affects parotid gland most frequently
- cause of sensorineural hearing loss in children and adults - Suppurative parotitis
- staph infection, see purulent discharge
- especially in dehydrated and debilitated hosts, post surgical or trauma patients - salivary gland calculi
- 80-95% found in submandibular gland/duct because has to go up against gravity over mylohyoid muscle
- mostly calcium. Parrot gland stones mainly translucent - Nutritional disease
- Bulimia, Pellagra, beriberi, kwasshiokor, malabsorption, alcoholism, diabetes
4
Q
Pathophysiology of salivary gland inflammation/stones
A
- stasis of saliva flow
- trapped bacteria
- local infection
- chronic destructive process and repeated infection
5
Q
Salivary gland neoplasms
A
- Benign: 75% of salivary gland neoplasms
- Pleomorphic adenoma: mixed, 85%
- Warthin’s tumor: papilary cystadenoma lymphomatosum, 10% - Malignant: 25%
- mucoepidermoid cancers, 33%
- adenoid cystic carcinoma, 25%, gets into nerves
- all other, 42%
6
Q
General Considerations of salivary gland neoplasms
A
- previous head and neck irradiation exposure associated with pleomorphic adenoma and mucoepidermoid tumors with latency of 7-30 years
- 50% of minor salivary gland tumors are malignant: mucoepidermoid or adenoid cystic cancers
- MOST IMPORTANT factor in prognosis is stage of disease at initial presentation
- Adenoid cystic carcinomas are well differentiated but invade nerve sheaths and metastasize
- slow facial paralysis, consider tumor as part of ddx
7
Q
Benign vascular tumors
A
- Hemangiomas
- capillary, cavernous and mixed
- strawberry hemangiomas: raised above surrounding skin, blanch with pressure, 90% of infant hemangioma
- Rx steroid or propranolol - Lymphangiomas
- 80% of time involves the neck
- need surgical excision
- hemangiomas and lymphangiomas are most common salivary gland tumors in pediatrics
8
Q
Congenital pathology: thyroglossal duct cysts, branchial clefts, laryngomalacia
A
- thyroglossal duct cysts
- the duct is a midline connection between foramen caecum at tongue base and thyroid gland
- cysts may form from remnants of this migratory path
- excision of hyoid bone may be needed to remove the cyst
- congenital carcinomas may arise from these cysts - Branchial cleft cysts, fistulas, sinuses
- anterior to anterior border of SCM (from the 4th arch)
- 2nd branchial cleft cysts most common: a failure of obliteration of the second branchial cleft in embryonic development - laryngomalacia: most common laryngeal anomaly causing airway obstruction
- due to immaturity of laryngeal cartilages
9
Q
Acute supraglottitis (acute epiglottitis)
A
- children 2-7 yo
- rapidly progressive
- H. influenzae type B
- progressive dyspnea that my progress to complete airway obstruction
- medical emergency
- swollen bright red epiglottis that is obstructing the pharynx at the base of the tongue.
- diagnosis made in operating room. Intubation, sedation, muscle relaxation, and IV antibiotics
10
Q
Laryngotracheal bronchitis (croup)
A
- acute lower respiratory infection from larynx to smaller subdivisions of bronchial tree
- viral: parainfluenzae type 1 and 4, but also have bacterial species cultured
- children 3-5 yo
- starts out like common cold with early presence of bark cough that is associated with hoarseness
- No life threatening stridor and airway obstruction that is seen in acute epiglottitis
- Rx: IV steroids, antibiotics, humidification, O2
11
Q
Laryngeal diphtheria
A
- must consider Klesiella rhinoscromatis (sclera of larynx), and fungal infections in ddx
- thick inflammatory membrane
- Corynebacerium diphtheria
- myocarditis, may be fatal
12
Q
Laryngeal trauma
A
- Vocal fold paralysis
- most often from surgery
- injury to recurrent laryngeal nerve
- or from birth trauma
- bilateral injury may require tracheostomy - Gastroesophageal reflux
- persistant irritation of past cricoid region and lead to formation of ulceration and contact granuloma formation
- chronic cough, and in severe cases laryngospasm - Laryngeal papiloma
- most common laryngeal tumor in children
- HPV 6 and 11
- surgical removal or laser vaporaization. Recurrences often occur.
13
Q
Patterns of lymph node drainage and anatomic area
A
I. submandibular and submental nodes: drains oral cavity and submandibular gland
II. IJV skull to carotid bifucation: drains nasopharynx, oropharynx, parotid, supraglottic larynx
III. IJV from bifuctation to omohyoid: drains oropharynx, hypopharynx, supraglottic layrnx
IV. IJV from omohyoid to below cricoid cartilage: drains subglottic larynx, hypo pharynx, esophagus and thyroid
V. posterior triangle: nasopharynx and oropharynx
VI. paratracheal nodes inferior to thyroid gland into superior mediastinum: thyroid and larynd
14
Q
Carcinoma of the larynx
A
- squamous cell in origin
- strong association with alcohol and tobacco
- association with HPV 16 and 18
15
Q
Pharyngitis and tonsilitis causes
A
rhinovirus parainfluenza RSV EBV herpes simplex adenovirus enteroviruses
