Disease of Head and Neck - Mouth and Upper Airway

Question 1

Caries

Answer 1

Tooth Decay
Common

Bacteria ferment sugars and produce acids that dissolves minerals in enamel

Prevention - Brushing, fluoride forms fluorapatite in enamel which increases resistance to bacterial acids

Question 2

Gingivitis

Answer 2

Inflammation of sqamous mucosa - edema and bleeding
Cause - improper oral hygiene - plaque formation (bacteria, saliva protein and cell debris)
Prevention - brushing flossing

Question 3

Periodontitis

Answer 3

Inflammation goes deeper
Can cause tooth loss, sepsis, infective endocarditis, local and systemic abscesses

Higher risk in immunecompromised pts - AIDS, Diabetes, Crohn’s, leukemia,

Question 4

Tori

Answer 4

Benign - nodular bony overgrowth of jaw bone

Hard as a rock
Bilateral on the mandible (torus mandibularis)
hard palate is most common location (torus palatines)
Uncertain cause - bruxism

Question 5

Fibroma

Answer 5

Reactive fibrous papule from chronic irritation
benign

Associated with jagged teeth, ill fitting denture

Question 6

Pyogenic granuloma

Answer 6

Benign
Pregnant women

Capillary hemangioma
Rapid growth, ulceration, cellularity and mitotic activity

Question 7

Peripheral Giant Cell granuloma

Answer 7

Benign

proliferation of giant cells and fibrous stroma in gingiva

Question 8

Mucocele

Answer 8

Accumulation of mucin producing mass
Extravasation type - trauma to minor salivary glands
Retention type - blovked salivary dict with mucin filled epithelial lines cyst

LIP

Question 9

Aphthous Ulcers (canker sores)

Answer 9

Superficial oral ulcers 
Very painful - not dangerous 
In children mostly 
May be associated with celiac disease or IBS 
cause unknown

Question 10

Glossitis

Answer 10

Inflammation of the tongue
Nutritional deficiencies - B vit and Iron
May be traumatic - ill fitting dentures and jagged teeth

Question 11

Oral Herpes Simplex Virus Infections

Answer 11

Mostly HSV1 (HSV2 can also be sexually transmitted)
Usually asymptomatic in young children. can develop acute herpetic gingivostomatitis

Question 12

Acute herpres Gingivostomatitis

Answer 12

Abrupt onset of vesicles throughout mouth
Fever, Lymphadenopathy, anorexia
Take 3-4 weeks to clear
May be diagnosed by cytology (Tzanck test)

Question 13

Recurrent Oral Herpes Simplex

Answer 13

HSV dormant in local nerve ganglia
Can cause recurrent stomatitis when patient is ill, IC
Recurrent lesions usually heal in 10 days
Denivir

Question 14

Oral Candidiasis (Thrush)

Answer 14

Fungus - normal flora
Overgrowth in IC or altered oral flora
Superficial curdy white membrane of inflammatory debris - easily scraped off

Question 15

Hairy Leukoplakia

Answer 15

White fluffy patches - lateral border of tongue
In IC
Cant be scraped off
Caused by EBV

Question 16

Squamous cell carcinoma

Answer 16

Most common cancer of mouth!
Predisposing factors - Tobacco, Alcohol and HPV
Precursors - leukoplakia and Erythroplakia
Often diagnosed after invasion/metastasis has occurred
Field cancerization
met - lymph, lung, liver bone

Question 17

Leukoplakia

Answer 17

White patch that doesn’t scrape off
clinical presentation hyperkeratosis
dysplasia is seen. should be considered premalignant until proven otherwise

Question 18

Erythroplakia

Answer 18

Red, often ulcerated or eroded lesion

Can become cancerous

Question 19

Odontogenic cysts and tumor

Answer 19

Arising in tissues that form teeth
tumor is rare (both benign and malignant)
most common lesions include dentigerous cysts, keratocysts, ameloblastoma

Question 20

Dentigerous Cyst

Answer 20

Cyst that originates around an unerupted tooth
Squamous lining
Complete excision is curative
can recur if incompletely excised

Question 21

odontogenic keratocyst (OKC)

Answer 21

More locally aggresive than odontogenic cyst
High recurrence rate in parakerotic variant
Multiple OKC + Many cutaneous basal cell carcinoma - Nevoid basal cell carcinoma syndrome

Question 22

Ameloblastoma

Answer 22

Low grade malignant tumor from odontogenic epithelium
Locally invasive tumor
Recurs if not completely excised
metastases rare

Question 23

Rhinitis

Answer 23

Inflammation of nasal mucosa
Caused by viruses - adeno, echo, rhino
can get secondary bacterial infections

Question 24

allergic rhinitis

Answer 24

hypersensitivity to pollen, fungi etc
IgE mediated
Eosinophils

Question 25

Chronic rhinitis

Answer 25

Repeated infections or allergic rhinitis More severe superimposed bacterial infections that extend into sinuses LEAD TO NASAL POLYPS

Question 26

Nasal inflammatory Polyps

Answer 26

After chronic rhinitis Edematous mucosa orinflamed stroma Can ulcerate and grow quite large

Question 27

Pharyngitis and Tonsillitis

Answer 27

Viral - rhino, echo, adeno, influneza Bacteria - strep and staph Strep can cause - RF and then RHD Post streptococcol glomerulonephritis

Question 28

Angiofibroma

Answer 28

Nasopharyngeal tumor - benign Exclusive to adolescent males androgen receptor positive Bleeds easily and profusely *

Question 29

Olfactory Neuroblastoma (Esthesioneurblastoma)

Answer 29

Malignant neuroblastic tumor of olfactory nerve any age - median 50 bad prognosis - depending on grade and stage Long cytoplasmic processes - fibrillary background

Question 30

Nasopharyngeal carcinoma

Answer 30

African childhood cancer * Also in Chinese Risk factor - EBV, nitroamines in diet and smoking Three histologic types (based on differentiation keratinizing squamous - least radiosensitive Non keratinizing squamous Undifferentiated - most radiosensitive Up to 70% - lymph node metastasis this tumor if patient has squamous or undifferentiated carcinoma in cervical nodes without a known primary otitis media in adults - think of this epistaxis, local invasion of cranial nerve VI

Question 31

sinusitis

Answer 31

most common caused by viruses as part of common cold Chronic - secondary bacterial infection preceded by rhinitis Can cause meningitis

Question 32

Unusual Sinusitis

Answer 32

kartagener syndrome - defective ciliary action - bronchiectasis ans situs inversus Fungi - diabetes or IC if aggresive and necrotizing - consider mucormycosis

Question 33

Murcormycosis

Answer 33

aka zygomycosis Bread mold fungi Mucor, rhizopus, absidia, cunninghamella In IC

Question 34

Sinonasal papilloma

Answer 34

Benign tumors of squamous mucosa Two Types Exophytic - more common Inverted - high recurrence ! more aggressive