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Flashcards in Diseases of the head and neck Deck (35):

What accounts for 90-94% of malignant tumours of the oral cavity?

Squamous cell carcinoma


What accounts for 90-94% of malignant tumours of the oral cavity?

Squamous cell carcinoma


Which parts of the oral cavity represent the highest frequency of SCC?

Floor of mouth

Ventrolateral tongue

Retromolar region

Lower lip

Soft palate



What is the aetiology of carcinoma of the oral cavity?

The dominant risk factors are tobacco use and alcohol abuse
- Strongly synergistic
- Account for 75% of the disease burden of oral and oropharyngeal malignancies
- Oral smokeless tobacco is a major cause in the Indian subcontinent, parts of South-East Asia, China and Taiwan
- May be consumed in betel quids containing areca nut and calcium hydroxide


Which virus is a risk factor for carcinoma of the oral cavity?

Human papillomavirus (HPV) infection
- High oncogenic genotypes such as HPV16 and 18 are also found in a variable but small proportion of oral and up to 50% oropharyngeal squamous cell carcinomas particularly involving the tonsils and tongue base
- Speculation that HPV infection arising from oral/genital contact might be important
- Interestingly these patients have a better overall survival than HPV negative patients


What dietary factors are involved in carcinoma of the oral cavity?

Fruits and vegetables (high in vitamins A and C) are described as protective against oral neoplasia, related to inherent anti-oxidant properties

Meat and red chilli powder are thought to be risk factors


What genetic factors are involved in carcinoma of the oral cavity?

Increasing epidemiologic evidence that a family history of head and neck cancer may be a risk factor for the disease and it is postulated that inherited genomic instability may increase susceptibility


What precancerous lesions may be present in the oral cavity?

Submucous fibrosis

Actinic keratosis

Lichen planus

Leukoplakia and erythroplakia

Chronic hyperplastic candidosis


What worsens the prognosis in carcinoma of the oral cavity?

Lymphovascular invasion


What is usually the mechanism of spread from the oral cavity?

Tumour embolism


Where are metastases from carcinoma of the oral cavity commonly found?

Local metastases = cervical lymph nodes

Distant = mediastinal lymph nodes, lung, liver, bone


What is the most common carcinoma of the larynx?

Squamous cell carcinoma most common

The age-adjusted incidence is 3.6 per 100,000


What is the aetiology of carcinoma of the of the larynx?

Tobacco and alcohol are recognized as the major risk factors

Infection with human papillomavirus (6 and 11)

Diets low in green leafy vegetables and rich in salt preserved meats and dietary fats

Metal/plastic workers

Exposure to paint, diesel and gasoline fumes, asbestos

Exposure to radiation

Laryngopharyngeal reflux

Genetic susceptibility


What is lichen planus?

Muco-cutaneous condition

Unknown pathogenesis however suggested to be a T cell–mediated autoimmune response

Cutaneous lesions = itchy, purple, papules forming plaques with Wickham’s striae

Oral lesions = reticular striations, plaque-like, erosive, ulcerative lesions, desquamatve gingivitis

Small risk of malignant transformation


What are vocal cord nodules and polyps?

Reactive lesions

Most often seen in heavy smokers or in individuals who impose great strain on their vocal cords (singers’ nodules)

Adults and predominantly men affected

Most commonly associated with a voice change e.g. hoarseness, change in voice quality, and increased effort in producing the voice

Usually located on the true vocal cords


What are nasal polyps?

Recurrent attacks of rhinitis can eventually lead to focal protrusions of the mucosa

May reach 4cm in size

When large -/+ multiple can encroach the airway and impede sinus drainage

Features point to an allergic aetiology, but most patients with nasal polyps are not atopic


What is the histology of nasal polyps?

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


What is sinusitis?

Acute sinusitis usually proceeded by acute or chronic rhinitis

Maxillary sinusitis can arise from the extension of a periapical infection from an upper tooth through the antral floor
- Oral flora
- Inflammatory reaction is non specific

Acute sinusitis may progress into chronic, especially when there is impairment of sinus drainage
- As a result of the inflammatory oedema of the mucosa
- May impound the suppurative exudate producing empyema of the sinus

Obstruction most often affects the frontal and anterior ethmoid sinuses


What are the causitive organisms in acute sinusitis?

Mixed microbial flora usually inhabitants of the oral cavity, severe forms may be caused by fungi e.g. mucomycosis esp in diabetics


What are the complications of acute sinusitis?

Potential of spread into the orbit or into the enclosing bone producing cranial osteomylitis, meningitis or cerebral abscess – very rare!


Who usually gets otitis media?

Occurs mostly in infants and children


What is often the aetiology of otitis media?

Often viral and associated with generalised upper respiratory tract symptoms


What are the usual causative bacterial agents in acute otitis media?

Streptococcus pneumoniae

H. influenzae

Moraxella catarrhalis


What does chronic otitis externa usually result from?

Recurrent +/- persistent episodes and failure of resolution of acute bacterial infections


What are the usual causitive agents in chronic otitis externa?

Pseudomonas aeruginosa,

Staphylococcus aureus



What are the potential complications of otitis externa?

Perforation of eardrum

Aural polyps, cholesteatoma

Mastoiditis, temporal cerebritis or abscess

Destructive necrotising otitis consequence of otitis media in a diabetic person especially when P. aeruginosa is the causative organism


What is cholesteatoma?

Cystic lesions lined by keratinising squamous epithelium and filled with debris and cholesterol clefts

Precipitates surrounding inflammatory reaction which is enhanced if the cyst ruptures and may result in a foreign body giant cell reaction

Associated with chronic otitis media


What is the pathogenesis of cholesteatoma?

Chronic inflammation and perforation of the eardrum with ingrowth of the squamous epithelium or alternatively metaplasia of the secretory epithelial lining of the middle ear are responsible


What are the potential complications of choleseatoma?

Progressive enlargement may lead to erosion of ossicles, the labyrinth (dizziness) and adjacent bone or the surrounding soft tissue

Hearing loss

Very rarely CNS complications: brain abscess and meningitis


What is otosclerosis?

Abnormal bone deposition in the middle ear

Usually bilateral

Usually begins in early decades of life, most cases are familial


What is the pathogenesis of otosclerosis?

Uncoupling of normal bone resorption and bone formation

Initially fibrous ankylosis -> bony overgrowth -> anchorage of middle ear bones to oval window

Degree of immobilisation governs the severity of hearing loss


What is labyrithitis?

Inflammatory disorder of the inner ear or labyrinth

Produces disturbances of balance and hearing 

Bacteria or viruses can cause acute inflammation of the labyrinth in conjunction with either local or systemic infections

Autoimmune processes e.g. Wegener granulomatosis or polyarteritis nodosa


What is the aetiology of external ear carcinomas?

Basal cell and squamous cell carcinomas, tend to occur in elderly men and are associated with actinic radiation


What is the aetiology of ear canal carcinomas?

Squamous cell carcinoma, middle-aged to elderly women, not associated with sun exposure


What are paragliomas?

Most common tumour of the middle ear, originating in the paraganglia
Presenting symptoms - pulsatile tinnitus, hearing loss, aural pressure/fullness, dizziness, otalgia, and bloody otorrhea

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