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Flashcards in URT and Salivary Disorders Deck (33):

Common Infections

Otitis MediaTonsilitis/Pharyngitis


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



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


Life Threatening Infections

(usually immunocompromised)Necrotizing External OtitisRhinocerebral Zyngomycosis


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


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



Pyogenic GranulomaJuvenile Nasopharyngeal Angiofibroma


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


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)


Nasal Obstruction

Sinonasal inflammatory polypsSinonansal papillomasRhabdomyosarcomaOlfactory neuroblastomaSinonasal MelanomaNasopharyngeal Carcinoma


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


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



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


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


Sinonasal Melanoma

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


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


Midline Destructive Lesions

Wegener's GranulomatosisExtranodal NK/T cell Lymphoma


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


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



Laryngeal NodulesLaryngeal PolypsLaryngeal Papilloma and PapillomatosisSquamous Cell Carcinoma of the Larynx


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


Laryngeal Polyps

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


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


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)


Parotid Gland Enlargement

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


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


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


Warthin Tumor

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


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


Developmental and Neoplastic Lesions of Neck

Branchial Cleft CystThyroglossal Duct CystParaganglioma


Branchial Cleft Cyst

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


Thyroglossal Duct Cyst

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



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)