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Flashcards in Diseases of the Head and Neck Deck (30):
1

Most common squamous cell carinoma in the oral cavity

SCC

2

Appearance of SCC in the oral cavity

White patch>red ulcerated lesion. Exophytic, firm, indurated tumour in late phases.

3

Prognosis for SCC in oral cavity

less than 50% at 5yrs

4

Risk factors for SCC in the oral cavity

Alcohol-acetaldehyde is a carcinogen
Smoking-enhances the activation of procarcinogens in tobacco
SYNERGISTIC
Areca nut
HPV 16 and 18
Diet-antioxidents confer protection
Genetic- fanconi anamia or Li fraumeni

5

What has a better prognosis- HPV or not HPV related SCC in the oral cavity?

HPV-respond better to radiotherapy

6

Associated with betel quid or areca nut chewing; a habit similar to tobacco chewing in Asia. Fibrosis of lining of the moouth-strictures, connective tissue replaced by dense, fibrous tissue. Small risk of malignancy.

Submucous fibrosis

7

White patches on oral mucosa that cannot be removed, associated with dysplasia and malignancy

Leukoplakia

8

Pathology of chronic hyperplastic candidosis

Candida produces nitrosamines-stimulate proliferation of epithelial cells.

9

What is the most common cacinoma of the larynx

SCC usually above the level of the vocal cord.

10

Treatment for SCC of the larynx

Partial laryngectomy or radiotherapy.

11

Risk factors for carcinoma of the larynx

Tobacco
Alcohol
HPV 6&11- weak assocation
Diet
Metal/plastic workers, exposure to paint, diesel, aspestos, radiation.
Laryngopharyngeal reflux
Genetic susceptibility

12

Name 4 non malignant inflammatory condition

Lichen Planus
Vocal cord nodules and polyps
Nasal polpys
Sinusitis

13

Lichen planus

Muco-cutaneous condition. Skin, anal mucosa, oral cavity. T cell mediated autoimmune response.
Cutaneous lesion-itchy, purple, papules forming plaques with Wickham's striae.
Commonly found on the wrists and arms
Oral lesions-reticular striations, plaque like, erosive, ulcerative lesions, desquamative gingivitis.
Small risk of malignant transformation.
Treatment - steroids

14

Vocal cord nodules and polyps

Reactiv elesions. Heavy smokers or singers. M>F.
Hoarseness, change in voice qualitis. Simple excision

15

Nasal polyp

Recurrent attacks of rhinitis. Focal protrusions of mucosa up to 4cm. When large and multiple, can enroach the airway and impede sinus drainage.

16

Histology of nasal polyp

Oedematous mucosa with loose stroma containing hyperplastic/cystic mucous, glands and infiltrated with mixed inflammatory exudate rich in eosinophils

17

Sinusitis

Acute is usually preceded by acute/chronic rhinitis or extension of a tooth infection.
Acute-inflammatory reaction, may procede to chronic.
Chronic-impairment of sinus drainage as a result of inflammatory oedema of the mucosa. May impound the suppurative exudate producing empyema of the sinus.

18

Complications of sinusitis

Potential of spread into the orbit or into the enclosing bone-cranial osteomylitis, meningitis or cerebral abscess.

19

Otitis media

Usually infants and children
Often viral

20

Causative organisms of acute otitis media

strep pneumonia, H, influenzae, moraxella catarrhalis

21

Causative organisms of chronic otitis media

pseudomonal aeruginosa
Staph A
Fungal

22

Complications of otitis media

Polyps, perforation of eardrum or cholesteoma
In DM-necrotising otitis esp when P. aeroginosa is the causative organism

23

Cholesteatoma

Associated with chronic otitis media
Cystic lesions lined by keratinising squamous epithelium and filled with debris and cholesterol deposists.

24

Pathogenesis of cholesteatoma

Chronic inflammation and perforation of the eardrum-ingrowth of squamous epithelium or metaplasia of secondary epithelial lining. Precipitates surrounding inflammatory reaction-enhanced if the cyst ruptures and may result in a foreign body giant cell reaction

25

Complications of cholesteatoma

Progressive enlargement may lead to erosion of ossicles, the labyrinth (dizziness) and adjacent bone or surrounding soft tissue.
hearing loss
V. rarely CNS complications, brain abscesses and meningitis

26

Osteosclerosis

Abnormal bone deposition in the middle ear. Usually bilateral
Usually begins in early decades, most cases are familial.
Initially fibour ankylosis> bony overgrowth> anchorage of middle ear bones to oval window
Eventually results in marked hearing loss

27

Labyrinthitis

Inflammatory disorder of the iner ear
Disturbances of balance and hearing
Can be bacterial or viral cause or autoimmune e.g. wegener's granulomatosis

28

Cacinomas of the external ear

BCC and SCC, in elderly men, association with solar radiation

29

Carcinomals of the ear canal

Squamous cell carcinoma- middle age to elderly women. No associated with sun exposure.

30

Tumour of the middle ear

Paragangliomas- neuroendocrine tumours. Result in pulsatile tinnitis, hearing loss, dizziness, bloody otorrhoea. Affects females 40-60yrs. Benign. Treatmetn = surgery.