minarcik robbins 2013_ch16-ent
TRANSCRIPT
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Nasopharynx
Oropharynx
Laryngopharynx
Soft Palate
Epiglottis
Esophagus
ENT
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CHAPTER 16Head & Neck (ENT)
PATHOLOGYOTOLARYNGOLOGY
OBJECTIVE:
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Understand the common disorders of the upper airway and upper digestive tract (i.e., head and neck) in the usual context of:
DEGENERATIVE,
INFLAMMATORY,
and
NEOPLASTIC
…deviations of normal anatomy and histology
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ETIOLOGY
PATHOGENESIS
MORPHOLOGY
CLINICAL MANIFESTATIONS
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EVERYTHING that touches AIR (columnar) or FOOD (squamous) in the HEAD/NECK region
ORAL CAVITYORAL CAVITY
““UPPER” RESPIRATORY TRACTUPPER” RESPIRATORY TRACT
EARSEARS
NOSENOSE
SALIVARY GLANDSSALIVARY GLANDS
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ORAL CAVITY• TEETH/GINGIVA/ALVEOLAR BONE• INFLAMMATORY/”REACTIVE”
LESIONS• INFECTIONS: HSV, VIRAL, FUNGI• LEUKOPLAKIA/”HAIRY”
LEUKOPLAKIA• SQUAMOUS TUMORS: BEN/MALIG• ODONTOGENIC CYSTS/TUMORS
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“UPPER” AIRWAYS• NOSE: Inflammation, Tumors
• NASOPHARYNX: Inflammation, Tumors
• PARANASAL SINUSES: (3) Inflammation, Tumors
• LARYNX: Inflammation, Tumors
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EARS• DEGENERATION:
OTOSCLEROSIS
• INFLAMMATION:
• NEOPLASMS:
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NECK• BRANCHIAL (cleft) CYST
• THYROGLOSSAL (duct/tract) CYST
• PARAGANGLIOMA (Carotid Body Tumor)
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SALIVARY GLANDS• DEGENERATION: Xerostomia
• INFLAMMATION
• NEOPLASMS–BENIGN: Pleomorphic Adenoma (aka,
“Mixed” Tumor), Warthin Tumor
–MALIGNANT: (Mucoepidermoid, Adenoid Cystic, Adenocarcinomas)
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Tooth Decay (Cavities, “Caries”)
• “Processed” carbohydrates, i.e., sugars
• Bacterial (Strep. mutans, lactobacilli) acidic erosion of enamel
• Role of pH, spacing, brushing, Fl• Tartarplaquecalculus =
bacteria, proteins, cells
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Periodontal Disease• Bacteria
–Actinobacillus
–Porphyromonas
–Prevotella
• Gingiva, periodontal ligaments, bone, cementum
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“Irritation” Fibroma
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PYOGENIC
GRANULOMA
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“Canker” sore = Aphthous ulcer
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TZANCK SMEAR
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Arnault Tzanck, Russian dermatologist, 1886-1954
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“Hairy” leukoplakia
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NORMAL DYSPLASIA CARCINOMA-IN-SITUINFILTRATING MALIGNANCY
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WELL
MODERATE
POOR
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ODONTOGENICCYSTS/TUMORS
• INFLAMMATORY CYSTS (e.g., “Radicular”[peri-apical] most common inflammatory cyst)
• DEVELOPMENTAL CYSTS (DENTIGEROUS most common developmental cyst and surgical specimen)
• MALIGNANT TUMORS of ODONTOGENIC ORIGIN (AMELOBLASTOMAS) (rare)
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DENTIGEROUS
CYST
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Rhinitis/Sinusitis• Very often allergic, a swab showing
many eosinophils may prove this
• Very often associated with URI’s in general, usually viral
• Just about every organism imaginable has been implicated at one time or another, bacteria, virus, fungus, etc.
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NOSE/SINUS/NASOPHARYNX“TUMORS”
• “Polyps”---really NOT a tumor
• Angiofibroma
• Papilloma
• Plasmacytoma
• Neuroblastoma
• Nasopharyngeal Carcinoma
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INFLAMMATORY “POLYPS” OF NASAL CAVITY
The INFLAMMATION/NEOPLASM LINK?
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“NECROTIZING” Upper Airway Lesions
• “WEGENER” Granulomatosis
• “Lethal” Midline Granuloma
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PAPILLOMA “INVERTED” PAPILLOMA
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ANGIOFIBROMA
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PLASMACYTOMA
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NEUROBLASTOMA(FROM OLFACTORY EPITHELIUM)
ESTHESIONEUROBLASTOMA
ROSETTE
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NASOPHARYNGEALCARCINOMA
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LARYNGITIS
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POLYPSPAPILLOMASCARCINOMAS
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The Tympanic Cavity
Chorda Tympani N. (CN VII)
Tendon of Tensor Tympani M. (V3)
Incus
Tendon of Stapedius M. (CN VII)
Stapes
Cut edge of tympanum Malleus
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CERUMEN CAST
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OTOSCLEROSIS
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CAROTID BODY TUMOR“balls of cells”
“zellballen”
ZELLBALLEN
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NORMAL
ACUTE SIALADENITIS
CHRONIC SIALADENITIS
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MUCOCELE
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P
A
R
O
T
I
D
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Most Common SALIVARY Gland Tumors
• BENIGN– “PLEOmorphic adenoma, i.e., “MIXED” tumor”– Warthin Tumor (PAPILLARY CYSTADENOMA
LYMPHOMATOSUM)
• MALIGNANT– All are adenocarcinomas. Why?– Mucoepidermoid carcinoma– Adenoid cystic carcinoma
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PLEOMORPHIC ADENOMA
i.e., MIXED TUMOR
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PAPILLARY CYSTADENOMA LYMPHOMATOSUM
Better known as: WARTHIN TUMOR
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MUCOEPIDERMOID
CARCINOMA
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ADENOID CYSTIC
CARCINOMA