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Flashcards in Head & Neck Deck (34):
1

Choanal atresia

• Septum b/w nose and pharynx
• Newborns turn cyanotic when breast-feeding, pink again after crying
• Associated with other congenital anomalies

2

Nasal polyps

• Nonneoplastic, result of chronic inflammation
• Allergic polyps with h/o IgE allergies
• Can be cystic fibrosis-associated

3

Obstructive sleep apnea

• Obesity MCC; also tonsillar hypertrophy, septal deviation, hypothyroidism, acromegaly
• Decreased PaO2 and O2 sat; respiratory acidosis during apneic episodes
• Can cause pulmonary HTN followed by RVH, as well as secondary polycythemia as EPO tries to compensate for hypoxemia

4

Sinusitis most common organisms

Strep pneumoniae, H. influenzae, Moraxella catarrhalis

5

Nasopharyngeal carcinoma

• Male-dominant, inc. in Chinese and African pops
• EBV association
• Neurologic Sx, hearing disturbance, CN involvement
• Metastasizes early to cervical lymph nodes
• SCC, nonkeratinizing squamous carcinoma, or undifferentiated

6

Laryngeal carcinoma

• Risk factors: smoking, alcohol, squamous papillomas, papillomatosis (HPV 6 and 11)
• Mostly located on true vocal cords
• Mostly keratinizing SCCs
• Hoarseness with cervical lymphadenopathy

7

Oral manifestations of HIV

Candidiasis, aphthous ulcers (painful ulcers covered by shaggy gray membrane), hairy leukoplakia, Kaposi sarcoma in hard palate

8

Dental caries organisms

Strep viridans or mutans

9

Behçet syndrome

• Turkey and Mediterranean
• Immune complex small vessel vasculitis
• Recurrent aphthous ulcers and genital ulcerations, uveitis, erythema nodosum

10

Leukoplakia and erythroleukoplakia

• Squamous hyperplasia of epidermis
• High rate of progression to cancer
• Oral hairy leukoplakia: shaggy parakeratosis

11

Squamous papilloma

• Ages 20-40
• Benign, exophytic tumor with fibrovascular core
• Associated w/ HPV 6, 11
• In larynx, may obstruct airway
• Rarely, progresses to SCC

12

Ameloblastoma

• Locally invasive but non-metastasizing
• Arises from enamel organ epithelium or dentigerous cyst
• "Soap bubble" appearance in bone
• May have APC gene mutation

13

Sjögren syndrome

• Autoimmune destruction of salivary and lacrimal glands (dry eyes)
• Associated with RA
• Glands replaced by immune cells + germinal centers

14

Pleomorphic adenoma

• Often middle-aged women
• Usually on parotid gland
• Painless, movable mass at angle of jaw
• Epithelial cells w/ myxomatous and cartilaginous stroma
• May become malignant (sign: facial nerve involvement)
• PLAG1 gene activated in 8q12 translocation

15

Warthin tumor

• Most common in men 50+
• Benign parotid gland tumor
• Risk from smoking
• Heterotopic salivary gland tissue trapped in benign lymphoid tissue of node

16

Mucoepidermoid carcinoma

• Most common malignant salivary gland tumor, usu. located in parotid gland
• Mixture of neoplastic squamous and mucous-secreting cells
• MECT1-MAML2 gene fusion

17

Vincent angina

• Necrotizing ulcerative gingivitis with necrotic pseudomembrane
• Fusospirochetal infection of Borrelia vincentii

18

Noma (cancrum oris)

• Rapidly spreading gangrene of oral and facial tissues, exposing bone
• Fusospirochetal infection in malnourished/debilitated pts

19

Ludwig angina

• Cellulitis that spreads from submaxillary or sublingual space
• Related to dental extraction or floor of mouth trauma
• May cause mycotic ICA aneurysm
• May dissect into pleural space, pericardium

20

Actinomycosis

• Chronic granulomatous inflammation, abscesses that drain by fistula formation
• Suppurative infection with yellow "sulfur granules"

21

Dentigerous cyst

Fluid b/w crown of impacted/unerupted tooth (usu. 3rd molar) and enamel epithelium

22

Mucocutaneous leishmaniasis

• Central & South America
• Skin sores followed by lesions of nose or upper lip
• Tuberculoid granulomatous response

23

Wegener granulomatosis

• Vasculitis, ischemic necrosis, chronic inflammation, giant cells, microabscesses
• No actual granulomas
• Septal perforation, mucosal ulceration, progressive destruction of nose and paranasal sinuses
• "Saddle nose" deformity
• Elevated ANCAs and PR3

24

Schneiderian papilloma

• Benign neoplasm of sinonasal mucosa
• Squamous or columnar epithelial proliferation

25

Inverted papilloma

• Benign neoplasm in lateral nasal wall, may spread to sinuses
• Epithelium inverts into underlying stroma
• HPV 6 and 11
• Increased SCC risk

26

Olfactory neuroblastoma

• Ages 10-19 or 50-59
• Superior inner nose
• Neural crest origin (express NSE)
• May display rosettes
• Lymphatic spread

27

Nasal-type angiocentric NK/T-cell lymphoma

• EBV association
• Tumor cells surround and infiltrate blood vessels, causing local ischemia/necrosis
• Ulcers covered by black crust; midface skin involvement

28

Complications of peritonsillar abscess

• Obstruct or rupture into airway
• Weaken carotid artery wall
• Penetrate into mediastinum or base of skull

29

Nasopharyngeal angiofibroma

• Boys 10-19
• Benign but locally invasive highly vascular pharyngeal neoplasm
• Posterolateral nasal wall w/ local mass effect
• May regress spontaneously
• Association with familial adenomatous polyposis (FAP) syndrome

30

Chordoma

• Age 40+
• Originate from clivus, may reach nasopharynx
• Large vacuolated cells w/ abundant ICM

31

Chondrosarcoma

• Men 70+
• Nonepithelial
• Exophytic, polyploid mass in pharynx

32

Oncocytoma (oxyphil adenoma)

• Benign epithelial cells swollen w/ mitochondria
• May proliferate in parotid glands of elderly

33

Adenoid cystic carcinoma

• 40-60 y/o
• Slow-growing tumor of minor salivary gland (usually), often painful
• "Cylindromatous" appearance on histology
• t(6;9) translocation

34

Acinic cell adenocarcinoma

• Men 20-30 y/o
• Small round masses in parotid gland
• Uniform cells w/ abundant basophilic cytoplasm