Ch 16. Head And Neck From Robbins Path

Front 1

Most common fibrous proliferative lesion of the oral cavity

Back 1

61% fibroma, 22% peripheral ossifying fibroma, 12% pyogenic granuloma, 5% peripheral giant cell granuloma

Front 2

Most common inflammatory/reactive ulcerations of the oral cavity

Back 2

Traumatic and aphthous ulcers

Front 3

Lesion in buccal mucosa along bite line or at gingival margin

Back 3

Irritation fibroma

Front 4

Nodular mass of fibrous tissue, few inflammatory cells, covered by squamous mucosa, tx with surgical excision

Back 4

Irritation fibroma

Front 5

Highly vascular peduncular lesion (similar to granulation tissue), occurring in the gingiva of children, young adults, and pregnant women

Back 5

Pyogenic granuloma

Front 6

Red to purple in color, growth may be rapid, could this be a malignant neoplasm of the oral cavity?

Back 6

Pyogenic granuloma

Front 7

40% of the population in the US, more common in the first 2 decades of life, painful, recurrent, may be prevalent within certain families; lesions resolve spontaneously within 7-10 days, may persist for weeks

Back 7

Aphthous ulcers

Front 8

Single or multiple, shallow, hyperemic ulcerations covered by thin exudate and rimmed by a narrow zone of erythema

Back 8

Aphthous ulcers

Front 9

Inflammatory infiltrate of a shallow, hyperemic ulceration often on inner surface of lips = mononuclear, secondary bacterial infection introduces neutrophils

Back 9

Aphthous ulcers

Front 10

Atrophy of the papillae of the tongue, thinning of the mucosa - exposing the underlying vasculature

Back 10

Beefy-red tongue appearance of glossitis

Front 11

Vitamin B12 (pernicious anemia), riboflavin, niacin, pyrodixine, deficiency, sprue, iron-deficiency anemia

Back 11

Glossitis

Front 12

Combination of iron-deficiency anemia, glossitis, and esophageal dysphagia

Back 12

Plummer-Vinson or Paterson-Kelly syndrome

Front 13

Ulcerative lesions associated with jagged carious teeth, ill-fitting dentures, and, rarely, with syphillis, inhalation burns, or ingestion of corrosive chemicals

Back 13

Glossitis

Front 14

Most common orofacial herpetic infection

Back 14

HSV-1

Front 15

Viral infection of children age 2-4 years, asymptomatic, no significant morbidity; may reactivate later in adulthood as vesicular ulcerous lesions

Back 15

HSV-1

Front 16

Acute herpetic gingivostomatitis

Back 16

In 10-20% of HSV-1 infections, abrupt onset of vesicles and ulcerations throughout the oral cavity, esp. the gingiva

Front 17

Painful, red-rimmed, and shallow ulcerations; eosinophilic intranuclear viral inclusions or multinucleate polykaryons

Back 17

HSV-1

Front 18

Tzanck test

Back 18

Microscopic examination of the vesicular fluid of oral, serous ulcers for the detection of HSV-1 viral inclusions

Front 19

Spontaneously clear within 3-4 weeks, but virus remains dormant in the local trigeminal ganglia

Back 19

HSV-1

Front 20

Trauma, allergies, exposure to UV light, upper respiratory tract infections, pregnancy, menstruation, immunosuppression, and excessive exposure to heat or cold

Back 20

Possible influences predisposing to activation of latent HSV-1

Front 21

Herpes zoster, EBV (mononucleosis), CMV, enterovirus (herpangina, hand-foot-and-mouth dz, acute lymphonodular pharyngitis), and rubeola (measles)

Back 21

Other viral infection besides HSV that may present in the head and neck region

Front 22

The most common fungal infxn in the oral cavity

Back 22

Candidiasis/Thrush

Front 23

Candida albicans is a normal component of the oral flora in __% of the population.

Back 23

Candida albicans is a normal component of the oral flora in 50% of the population.

Front 24

3 factors that influence the likelihood of clinical Candida infxn

Back 24

(1) immune status of the individual (2) the strain of C. albicans present; and (3) the composition of an individual's oral flora

Front 25

Another name for the "thrush" form of candidiasis

Back 25

Pseudomembranbous candidiasis

Front 26

Superficial, curdy, gray to white inflammatory membrane composed of matted organisms enmeshed in a fibrinosuppurative exudate that can be readily scraped off

Back 26

Candida albicans

Front 27

DM, organ or bone marrow transplant recipients, those with neutropenia, chemotherapy-induced immunosuppression, or AIDS patients are at risk of what normal inhabitant of the oral cavity?

Back 27

Candida albicans

Front 28

80% of patients with hairy leukoplakia have been infected with ___

Back 28

80% of patients with hairy leukoplakia have been infected with HIV

Front 29

White, confluent patches of fluffy hyperkeratotic thickenings on the lateral border of the tongue

Back 29

Hairy leukoplakia

Front 30

Hyperpkeratosis and acnathosis with "balloon cells" in the upper spinous layer, with koilocytosis suggestive of HPV infection

Back 30

No HPV, this is hairy leukoplakia

Front 31

Premalignant oral cavity lesions

Back 31

Leokoplakia and erythroplakia

Front 32

Defined by the WHO, "a white patch of plaque that *cannot be scraped off* and cannot be characterized clinically or pathologically as any other disease"

Back 32

Leukoplakia

Front 33

How often are leukoplakias actually premalignant?

Back 33

Somewhere between 5% and 25% of these lesions are premalignant - and without histologic evaluation, all leukoplakias must be considered precancerous.

Front 34

Less common, much more ominous; red, velvety, possibly eroded area within the oral cavity; epithelium is atypiocal

Back 34

Erythroplakia

Front 35

2:1 male preponderance, tobacco is the most common antecedent, usually between ages 40 and 70

Back 35

Leokoplakia and erythroplakia

Front 36

95% or cancers of the head and neck are ________.

Back 36

95% or cancers of the head and neck are squamous cell carcinomas.

Front 37

"Field cancerization"

Back 37

Multiple individual primary tumors develop independently in the upper aerodigestive tract as a result of years of chronic exposure of the mucosa to carcinogens.

Front 38

In N. America and Europe, squamous cell carcinoma of the oral cavity is most commonly associated with...

Back 38

...middle-aged men who have been chronic abusers of smoked tobacco and alcohol.

Front 39

Predisposing factors of squamous cell carcinoma of the lower lip

Back 39

Actinic radiation (sun light) and pipe smoking

Front 40

Outside of N. America and Europe, major predisposing influences of head and neck squamous cell carcinoma...

Back 40

...chewing betel quid and paan in India and parts of Asia.

Front 41

Favored locations of squamous cell carcinoma of the head and neck to develop

Back 41

(1) ventral surface of the tongue (2) floor of the mouth (3) lower lip (4) soft palate (5) gingiva

Front 42

Ulcerated, protruding masses that have irregular, firm, and indurated borders

Back 42

Head and neck squamous cell carcinoma

Front 43

Normal progression to SCC

Back 43

Normal --> hyperplasia/hyperkeratosis --> mild/moderate dysplasia --> severe, full thickness dysplasia/CIS --> SCC

Front 44

Local metastasis of SCC of the head and neck?

Back 44

Cervical lymph nodes

Front 45

Distant metastasis of SCC of the head and neck?

Back 45

Mediastinal lymph nodes, lungs, liver, and bones

Front 46

Dry mouth (xerostomia) and dry eyes (keratoconjunctivitis sicca) is a major feature of what autoimmune disorder?

Back 46

Sjorgen syndrome; a lack of salivary secretions can also be a complication of radiation therapy

Front 47

Sialadenitis can be caused by...

Back 47

..traumatic, viral, bacterial, or autoimmune origin.

Front 48

Most common viral sialadenitis

Back 48

Mumps, usually parotid glands = epidemic parotitis

Front 49

The most common lesion of the salivary glands

Back 49

Mucocele, results from either blockage or rupture of a salivary gland duct, with consequent leakage of saliva into the surrounding connective tissue stroma

Front 50

Where do you most commonly find mucoceles?

Back 50

The lower lips of toddlers, geriatric patients, and young adults who recently had trauma to that region

Front 51

Fluctuant swelling of the lower lip with blue translucent hue; fluctuating size, often associated with meals

Back 51

Mucocele

Front 52

What's inside a mucocele?

Back 52

Mucin; tx with complete excision of the cyst with the minor salivary gland lobule of origin may be req'd

Front 53

Sialolithiasis

Back 53

Salivary duct obstruction that increases risk of secondary bacterial sialadenitis, esp. submandibular glands

Front 54

Most common offenders of bacterial sialadenitis

Back 54

S. aureus and Streptococcus viridans

Front 55

General rule of salivary gland malignancies

Back 55

The likelihood of a salivary gland tumor being malignant is more or less inversely proportional to the size of the gland

Front 56

Warthin tumors are more common in....

Back 56

...males.

Front 57

Benign salivary gland tumors occur most often in the ____ decades of life.

Back 57

Benign salivary gland tumors occur most often in the fifth to seventh decades of life.

Front 58

Where are the parotid glands?

Back 58

In front of and below the ears

Front 59

Most common salivary gland tumor?

Back 59

Pleomorphic adenoma; a mixed tumor of ductal (epithelial) and myoepithelial cells, thus showing both epithelial and mesenchymal differentiation.

Front 60

Radiation exposure increases risk of what benign salivary gland neoplasm?

Back 60

Pleomorphic adenoma

Front 61

Painless, benign, slow-growing, mobile discrete masses within the parotid gland

Back 61

Pleomorphic adenoma; may become a carcinoma ex pleomorphic adenoma with 10% risk of PA is kept for more than 15 years

Front 62

Second most common salivary gland neoplasm; almost always appears in the parotid gland; males>females; smokers at increased risk

Back 62

Warthin tumor

Front 63

Mixture of squamous cells, mucus-secreting cells, and intermediate cells; 15% of all salviary gland tumors; parotids; most common primary malignant tumor of the salivary glands

Back 63

Mucoepidermoid carcinoma

Front 64

Minor salivary gland tumor, malignant

Back 64

Adenoid cystic carcinoma

Front 65

Intraoral purpuric discoloration or violacesous raised nodular mass; associated with AIDS and HIV; HHV8; LANA-1

Back 65

Kaposi Sarcoma

Front 66

Necrotizing nasal lesions

Back 66

1. spreading fungal infections (mucromycosis)
2. wegner granulomatosis
3. lethal midline granuloma, polymorphic reticulosis, neoplasm of NK cells

Front 67

Distinctive geographic distribution, EBV; close anatomic relation to lymphoid tissue; three patterns relating to squamous cell carcinoma and undiff. carcinomas; African children, Southern Chinese adults; nasopharynx, tonsils, posterior tongue, and upper airways; tx via radiotherapy; PAP stain

Back 67

Nasopharyngeal Carcinoma

Front 68

Arising in extradrenal paraganglia; clusters of neuroendocrine cells; bifurcation of common carotid; 6th decode of life; sporadic or MEN2 syndrome; may metastasize

Back 68

Paraganglioma/Carotid body tumor

Front 69

Benign cyst; anterolateral aspect of neck; remnants of branchial arch or salivary gland inclusions; squamous or columnar lining with mural lymphoid infiltrate; tx with surgery

Back 69

Branchial cleft cyst

Front 70

Midline developmental cyst lined by respiratory type or squamous epitheliuml wall contains lymphoid tissue, thyroid tissue, glands; complications include abscess formation or papillary ca; tx with surgical excisision

Back 70

Thyroglossal duct cyst

Front 71

Benign lymphoepithelial lesions are associated with what autoimmune d/o?

Back 71

Sjogren's syndrome

Front 72

Nonneoplastic uni or bilateral enlargement of parotid or other salivary glands; may be isolated or associated with Sjogren's; F>M; 5th decade of life; dense lyumphoid proliferation within gland

Back 72

Benign lymphoepithelial lesions

Front 73

Cystic enlargement of parotid gland; associated with HIV; multiple and bilateral; pathogenesis: duct obstrxn due to lymphoid hyperplasia or duct destrxn

Back 73

Benign lymphoepithelial cysts