diseases of ent

Nasopharynx

Oropharynx

Laryngopharynx

Soft Palate

Epiglottis

Esophagus

ENTwww.freelivedoctor.com

Head & Neck (ENT) PATHOLOGY

OTOLARYNGOLOGY

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Objective;

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: 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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Glossitis:

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herpes

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Herpes, dried vesicle with inflammation

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Herpes, dried vesicle with ulceration and secondary inflammation. Acute or chronic?

TZANCK SMEAR

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Monilia, thrush-mouth

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LEUKOPLAKIA.

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“Hairy” leukoplakia

“Hairy” leukoplakia

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NORMAL DYSPLASIA CARCINOMA-IN-SITUINFILTRATING MALIGNANCY

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INFILTRATIVE SQUAMOUS CELL CARCINOMA

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squamous cell cancer,

WELL

MODERATE

POORwww.freelivedoctor.com

ODONTOGENICCYSTS/TUMORS

• INFLAMMATORY CYSTS (e.g., “Radicular”[periapical] most common)

• DEVELOPMENTAL CYSTS (DENTIGEROUS most common)

• 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 Carcinomawww.freelivedoctor.com

INFLAMMATORY “POLYPS” OF NASAL CAVITY

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www.freelivedoctor.comMultiple appearances of nasal polyps

“NECROTIZING” Upper Airway Lesions

• “WEGENER” Granulomatosis

• “Lethal” Midline Granuloma

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PAPILLOMA “INVERTED” PAPILLOMA

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ANGIOFIBROMAwww.freelivedoctor.com

PLASMACYTOMA

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NEUROBLASTOMA(OLFACTORY)

ESTHESIONEUROBLASTOMA

ROSETTE

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NASOPHARYNGEALCARCINOMA

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normal vocal cords.

LARYNGITIS

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POLYPS PAPILLOMASCARCINOMAS

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Polyp, or “singer’s” nodule

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Papilloma, but there may be some cancer microscopically.

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Otitis externa

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normal tympanic membrane.

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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Acute middle ear infection

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Chronic “serous” otitis media

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Cerumen impaction

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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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Squamous metaplasia of an interlobular duct

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Mucocele of an accessory salivary gland duct,

MUCOCELE

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P

A

R

O

T

I

D

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Viral parotitis, i.e., mumps

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 TUMORwww.freelivedoctor.com

PAPILLARY CYSTADENOMA LYMPHOMATOSUM

Better known as: WARTHIN TUMOR

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MUCOEPIDERMOID

CARCINOMA

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ADENOID CYSTIC

CARCINOMA

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