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Flashcards in URT and Salivary Disorders Deck (33):
1

Common Infections

Otitis MediaTonsilitis/Pharyngitis

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Otitis Media

viral/bacterial ascending infection from nasopharynx that spreads to ear via eustachian tubeCommon in children and infantsExam: red, bulging tympanic membraneBacterial: febrile, more common to have purulent exudateStrep pneumo, H flu, MoraxellaViral: less of a fever, more common to have serous exudateRSV, Rhinovirus, CoronavirusComplications: perforation and possible loss of hearing

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Tonsilitis/Pharyngitis

mucosal edema, erythemia, and reactive lymphoid hyperplasia90% are viral -> Rhinovirus, Echovirus, AdenovirusIf bacterial -> Group A Strep or Staph aureusIf Group A Strep -> can caused Acute Rheumatic Fever and/or Post-Strep Glomerulonephritis - hematuriaWhite inflammatory exudates over tonsils

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Life Threatening Infections

(usually immunocompromised)Necrotizing External OtitisRhinocerebral Zyngomycosis

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Necrotizing External Otitis

Usually caused by Pseudomonas Rarely by AspergillusStarts with minor trauma to auditory canal, progressing with pain, swelling and purulent dischargeLate complications: osteomyelitis of mastoid bone (possibly causing Bell’s Palsy) and meningitis, extension to temporal boneIntracranial extensions! Tx: debride dead tissue and long-term abx

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Rhinocerebral Zygomycosis

Fungal infection that starts in sinonasal tract and spreads through blood vessels -> Can spread into CNSMASSIVELY destructive and very high mortality rateTypical fungi: Rhizopus, Absidia or MucorHistology: broad, non-septate hyphae with right angle branchingPt presents w/ sniffles, progresses over 1-3 d to intracranial extension, proptosis, etc.Tx: early detection and debridement, plus anti-fungal

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Epistaxis

Pyogenic GranulomaJuvenile Nasopharyngeal Angiofibroma

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Pyogenic Granuloma

Benign polypoid vascular proliferation of capillariesMore common in adultsCommon location is anterior nasal septumEtiology: trauma? Pregnancy?Gross appearance: smooth, lovulated, red polypoid massTx: Local excision. Recurrence is rare

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Juvenile Nasopharyngeal Angiofibroma

Benign neoplasm w locally destructive growthUsually in young males (no females) Originates in lateral or upper-posterior nasopharynxUnilateralHistology: antler-like thin walled vessels with collagenous stroma w stellate fibroblastsTx: complete resectionIf recurs: hormone modulation (estrogen therapy)

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Nasal Obstruction

Sinonasal inflammatory polypsSinonansal papillomasRhabdomyosarcomaOlfactory neuroblastomaSinonasal MelanomaNasopharyngeal Carcinoma

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Sinonasal Inflammatory Polyps

Non-neoplastic inflammatory swellings of sinonasal mucosaCan be unilateral or bilateralMost often in adults >20 y/oSymptoms: nasal obstruction, rhinorrhea and headacheAssociated with: CF, DM, allergies, infection, aspirin intoleranceGross: edematous pink/gray masses protruding into nasal cavityHistology: intact surface epithelium with a lot of eosinophilsTx: Excision

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Sinonasal Papillomas

Benign neoplasm of sinonasal mucosaRare to see malignant transformation -> but can cause damage if it impinges on local structuresAssociated with HPV 6 and 11Locally destructive, potentially fatalUsually unilateral, may be bilateralSx:nasal obstruction, epistaxis, pain3 forms: SeptalCylindrical (exophytic)Inverted (endophytic) -> much more difficult to resectTx: wide surgical incision

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Rhabdomyosarcoma

t(2;13), t(1;13)malignant tumor of skeletal muscleMost common sarcoma in head/neck of kidsMost common locations: orbit > nasopharynx > ear > sinonasal cavityGross: sarcoma botryoides (“grape-like mass”)Histology: looks like skeletal muscle (striated muscle fibers)Good survival at early stage

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Olfactory Neuroblastoma

Malignant small round blue cell tumorUnilateral nasal obstruction, epistaxis and visual disturbancesCenter of lesion is usually in cribiform plate -> possible damage to CN 1If stays confined, good prognosisIf extension into nasal cavity, orbit, sinuses, it can get very largeSx: epistaxis, headaches, visual disturbancesTx: radical surgery and radiationHistology: small, round blue cell w/ rosettesMarkers: NSE, Chromogranin, S100

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Sinonasal Melanoma

very raremalignant & likely to metastasizePOOR prognosisHistology: black spots (pigmented melanin)Polyploid mass causing obstructionTx: surgical resection of large part of nasal plate

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Nasopharyngeal Carcinoma

Associated with EBVUncommon in USA but more common in Asia (in adults) and Africa (in kids)3 patterns: Keratinizing Squamous Cell Carcinoma: least radiosensitive, worst prognosis, dividing slowlyNon-keratinizing SCCUndifferentiatied: most radiosensitive, best prognosisTx: radiation

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Midline Destructive Lesions

Wegener's GranulomatosisExtranodal NK/T cell Lymphoma

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Wegener's Granulomatosis

non-infective vasculitisTriad: Sinonasal, Lung, KidneyUlceration/necrosis of palate due to obstruction of blood vesselsMore common in males, 30-50 y/oPossible autoimmuneSymptoms of nasal involvement: sinusitis, purulent rhinorrhea, obstruction, painPathology - ulceration in the palateLabs: increased ESR, cANCA (anti-proteinase3)Histology: caseating granulomas plus necrosisTx: If limited: steroids or cyclophosphamide If systemic: high-dose steroids and cyclophosphamide and possible TNF antagonist

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Extranodal NK/T cell Lymphoma

VERY rare in US, more common in AfricaHighly destructive angiocentric T Cell Lymphoma (malignant T cells attack the blood vessels)Extreme tissue loss (bone, soft tissue)Radiologic findings are same as Wegener’sHistology: tumor cells express NK markers (CD2, CD16, CD56, TIA-1, cytoplasmic CD3)Prognosis: if localized, not so bad. If systemic, rapidly lethal

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Hoarseness

Laryngeal NodulesLaryngeal PolypsLaryngeal Papilloma and PapillomatosisSquamous Cell Carcinoma of the Larynx

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Laryngeal Nodules

non-neoplasticDue to chronic irritation -> trauma or inflammation“Singer’s nodules” -> bilateralSingle nodule, following voice abuse, infection, alcohol, smoking, hypothyroidismMost common in middle 1/3

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Laryngeal Polyps

Unilateral Caused by: voice abuse, infection, EtOH, smoking, hypothroidSimgle, on middle 1/3Benign

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Laryngeal Papilloma and Papillomatosis

Benign, exophytic neoplastic growthAdult type -> single lesion that rarely recursJuvenile type -> multiple lesions with high recurrence Often associated with HPV 6 and 11, may be acquired at birthUsually regresses at pubertyRx: laser ablation, antiviral therapyMalignant transformation

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Squamous Cell Carcinoma of the Larynx

>95% are squamous cellM 50 y/oRisk Factors: smoking, EtOH, asbestosSymptoms: hoarseness, dysphagia, hemoptysisComplication: Infection/metastasisLocations: glottic, supraglottic, subglottic, transglottic (rare, but worse)

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Parotid Gland Enlargement

Sjogren'sSalivary Gland Neoplasms - Pleomorphic Adenoma, Warthin Tumor, Mucoepidermoid Carcinoma

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Sjogren Syndrome

Auto-immune disease most common in women >50 y/oAssociated with other autoimmune diseasesImmune-mediated destruction of lacrimal and salivary glandsSymptoms: dry eyes, dry mouth (xerostomia), blurred vision, dysphagiaLabs: auto-antibodies against SS-A and SS-BCommon complication (~5%) -> Non-Hodgkin’s Lymphoma

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Pleomorphic Adenoma

Tumor in the parotid gland w/ MIXOID MATRIXmost common, usually asymptomatic, with epithelial and stromal componentTx: surgically removing parotid (Risk: damage CN VII), need to do a wide excision thoughCells are of myoepithelial origin

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Warthin Tumor

(aka Papillary Cystadenoma Lymphomatosum)10% bilateral (greatest percent of these 3 neoplasms)Histology: lymphocytic infiltrateProminent pink cytoplasm w/ pink infiltrate

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Mucoepidermoid Carcinoma

Most common malignant salivary gland tumorImportant translocation t(11;19)Fusion gene MEC1-MAML2Turnover of cAMP pathway, malignant formationComposed of mucocytes & epidermoid cells

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Developmental and Neoplastic Lesions of Neck

Branchial Cleft CystThyroglossal Duct CystParaganglioma

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Branchial Cleft Cyst

remnant of 2nd branchial cleft that remains patentLATERAL side of neckCyst wall can be either squamous or columnar with lymphoid infiltrate

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Thyroglossal Duct Cyst

remnant of thyroglossal ductMIDLINE on neckMoves when you move tongue / swallowCommonly w/ lymphoid infiltrateTx: excision

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Paraganglioma

Carotid Body tumor -> can be benign or malignantArises from extra-adrenal paraganglia Neuroendocrine cellsActs like pheochromocytomaSporadic or familial - MEN2 (Multiple Endocrine Neoplasia Type 2)Nests of neuroendocrine cells (zellballen patterns)