Flashcards in Rubin's 29: Head and Neck (gave up on this one ignore it) Deck (19):
Crouzon Syndrome, Apert Syndrome
- autosomal dominant disorders
- associated with craniosynostosis (premature fusion of the cranial sutures)
- can lead to brachycephaly (flat head), scaphocephaly or dolichocephaly (the head is disproportionately long and narrow or “boat” shaped) or trigonocephaly (triangular shaped)
- FGFR2 mutation on chromosome 10
- severe craniosynostosis leads to "cloverleaf" skull
encodes a transmembrane protein that, upon binding its ligands, signals to induce bone maturation
aggregates of sebaceous glands in the oral cavity (choristoma)
- Abnormal descent of the thyroid during development may create submucosal foci of ectopic thyroid between the tongue and suprasternal notch
- MC site: The base of the tongue between the foramen cecum and epiglottis--> lingual thyroid
- removal --> hypothyroid, cretinism
- malignancy: papillary thyroid carcinomas.
- may affect parathyroid gland development and localization.
Thyroglossal duct cysts
Result from persistence and cystic dilatation of the thyroglossal duct midline in the neck
- occurs above the thyroid isthmus but below the hyoid bone
- under age 40, nodule moves up and down upon swallowing.
- Surgery is the treatment of choice.
- papillary thyroid carcinomas in up to 1% of thyroglossal duct cysts.
Branchial cleft cyst
- originate from branchial arch remnants
- in the lateral anterior neck or parotid gland in young adults
- contain thin, watery fluid and mucoid or gelatinous material
- lined by squamous epithelium, with occasional foci of ciliated respiratory or pseudostratified columnar epithelium.
- caused by several strains of β-hemolytic streptococci (Streptococcus pyogenes)
- Damage to vascular endothelium by the erythrogenic toxin results in a rash on the skin and oral mucosa (strawberry tongue)
- Untreated scarlet fever can lead to glomerulonephritis and heart disease
Apthous stomatitis (canker sores)
- painful, recurrent, solitary or multiple, small ulcers of oral mucosa, unknown cause
- shallow ulcer covered by a fibrinopurulent exudate, with underlying mononuclear and polymorphonuclear inflammation
- heal without scarring
Acute necrotizing ulcerative gingivitis (Vincent angina)
- caused by infection with two symbiotic organisms, a fusiform bacillus and a spirochete (Borrelia vincentii)
- caused by inadequate nutrition, immunodeficiency or poor oral hygiene
- characterized by punched-out erosions of the interdental papillae. Tends to spread and eventually involves all gingival margins, which become covered by a necrotic pseudomembrane
- severe fusospirochetal infection in people who are malnourished, debilitated from infections or weakened by blood dyscrasias
- rapidly spreading gangrene of oral and facial tissues
- Large masses of tissue slough and leave the bones exposed, especially in children
- rapidly spreading cellulitis originating in the submaxillary or sublingual space but extending to involve both.
- potentially life-threatening inflammatory process
- uncommon in developed countries except in patients with chronic illnesses associated with immunosuppression.
- related to dental extraction or trauma to the floor of the mouth.
After extraction of a tooth, hairline fractures may occur in the lingual cortex of the mandible, providing microorganisms ready access to the submaxillary space.
- may dissect into the parapharyngeal space along fascial planes and from there into the carotid sheath.
- mycotic internal carotid artery aneurysm may result, erosion of which may cause massive hemorrhage.
- inflammation may also dissect into the superior mediastinum to involve the pleural space and pericardium.
- patchy pseudomembrane, often begins on the tonsils and pharynx but may also involve the soft palate, gingiva or buccal mucosa
- Primary tuberculosis of the oral mucosa is rare.
- lesions spread from the lung, with bacilli carried in sputum and entering small breaks in the mucosa. There, they produce irregular, painful ulcers, mostly on the tongue.
- Caseating granulomatous inflammation
- Primary syphilitic chancres may form on the lips, tongue or oropharyngeal mucosa after contact with an infectious lesion
- Regional lymphadenitis follows and heals by itself in a few weeks
- diffuse mucocutaneous eruption of the secondary stage follows. Syphilitic lesions in the oral mucosa are multiple gray-white patches overlying ulcerated surfaces. May remit and also recur spontaneously.
- Gummas may appear years after initial infection as firm nodular masses that ulcerate and may cause palatal perforation
- Actinomyces bovis or Actinomyces israelii
- produces chronic granulomatous inflammation and abscesses that drain by fistula formation, with suppurative infection containing characteristic yellow “sulfur granules.” - In cervicofacial actinomycosis, soft tissue infection may extend to adjacent bones, most often to the mandible.
- To cause disease, the fungus must penetrate tissues, albeit superficially
- Oral candidiasis mostly seen in diabetics and people with compromised immune systems.
- Lesions are white, slightly elevated, soft patches that consist mainly of fungal hyphae.
- Aerosol transmission
- painful inflammation of affected mucosa, followed shortly by formation of vesicles, resulting from “ballooning degeneration” of epithelial cells, some of which show intranuclear inclusions
- vesicles rupture to form shallow, painful, which heal spontaneously without scarring.
- it remains dormant in the trigeminal ganglion until stresses such as trauma, allergy, menstruation, pregnancy, UV light, and other viral infections reactivate it.