diseases of ent
TRANSCRIPT
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
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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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“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
CERUMEN CASTwww.freelivedoctor.com
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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