Lecture B Perzin - Head Neck - Columbia · 2009. 3. 18. · Lethal Midline Granuloma Midline...
Transcript of Lecture B Perzin - Head Neck - Columbia · 2009. 3. 18. · Lethal Midline Granuloma Midline...
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Infections
Nasal Cavity
Paranasal Sinuses
Viral
Bacterial
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Polyp
Any growth
protruding from
mucous membrane
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Polypoid Lesions Nasal Cavity, Paranasal Sinuses
1. Inflammatory polyp
2. Benign tumors
3. Malignant tumors
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Inflammatory Polyps Nasal Cavity, Sinuses
A. Common
B. Allergy, infection
C. One, multiple
D. Obstruction
E. Bleeding
F. Up to 1.5cm
Papillomatosis Inverted Papillomas
Sqamous Papillomas
1. One, multiple polyps
2. Nasal cavity, sinuses
3. Nasal obstruction
4. Bleeding
5. 25 to 50x less common
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Papillomatosis
A. Human Papilloma Virus
B. Recurrences: 50 – 70%
Multiple Recurrences
Invasive Carcinoma: 5%
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1. Uncommon
2. Papillomatosis
3. Chronic infections
4. Wood workers
5. Nickel smelting
6. Thorotrast
Carcinoma Nasal Cavity, Sinuses
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1. Polyp, mass
2. Obstruction
3. Epistaxis
4. Pain
Carcinoma Nasal Cavity, Sinuses
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A. Destructive lesions nasal
cavity, sinuses
B. Perforation, nasal septum
C. Collapse, nasal bridge
Lethal Midline Granuloma Midline Granulomatous Disease
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Malignant lymphomas
Wegener’s Granulomatosis
Carcinoma
Syphilis
TBC, Leprosy, Fungus
Cocaine Sniffing
Lethal Midline Granuloma
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1. Hyperplastic lymphoid tissue:
Nasopharynx
2. Difficulty breathing
3. Middle ear infections
Adenoids
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1. Epistaxis
2. Middle ear infections
3. Met.: Cervical L.N.
4. Cranial nerve paralysis
5. Nasopharyngoscope
6. Biopsy
7. Radiation therapy
Carcinoma, Nasopharyx
1. Chinese
a) In china
b) Exiles
2. Middle East
3. HLA subgroups
4. Wood smoke esp. childhood
5. High titers: EB Virus
? Transforming Agent
Carcinoma of Nasopharyx
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1. Common
2. Children
3. Tympanic membrane ruptures
4. Chronic otitis media
5. Mastoiditis
6. Myringotomy
Middle Ear Infections (Acute, Chronic Otitis Media)
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1. Chronic otitis media
2. Cuboidal epithelium replaced by squamous epithelium
3. ? Metaplasia
? Ingrowth
4. Keratin: Mass
5. Destruction of ossicles
Cholesteatoma
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1. Nasopharynx
2. Tonsils
3. Lingual tonsils
4. Uvula, pharynx
5. Hypopharyx
Waldeyer’s Ring Lymphoid Tissue
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Squamous cell carcinoma
Oral cavity, oropharynx
Pharynx, hypopharynx
Esophagus
Smoking, drinking
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Tumors: pharynx
1. Dysphagia
2. Ulcers, masses
3. Unilateral tonsillar swelling
4. Squamous cell carcinoma
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Polyps of Vocal Cord
1. Common
2. Hoarseness
3. ? Voice abuse
4. Polypectomy
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Papillomas: Larynx
Young people
Hoarseness
Human Papilloma Virus
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Leukoplakia
1. Hyperplasia
Hyperkeratosis
2. Dysplasia
3. In situ carcinoma
4. Invasive carcinoma
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Squamous Cell Carcinoma Larynx
1. 10,000 new cases / year
2. Heavy smoking
3. Vocal apparatus:
hoarseness
4. Supraglottic area: large;
dysphagia
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Trachea
Tumors Rare
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Major Salivary Glands
Parotid
Submandibular
Sublingual
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“Minor” Salivary Glands Serous and Mucous Glands Nasal Cavity
Paranasal Sinuses
Nasopharynx
Oral Cavity
Pharynx
Esophagus
Larynx
Trachea
Bronchi
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Salivary Gland Tumors
Parotid: 75%
Submandibular: 10%
Sublingual: 15%
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Benign and Malignant Tumors by Site
Site Benign Malignant
Parotid 80% 20%
Submandibular 55% 45%
Sublingual -- 100%
“Minor” Glands 55% 45%
Lacrimal 50% 50%
Benign Mixed Tumors
Most common
Slowly growing, painless
Middle aged
Females: 60%
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