CHAPTER 16 Head

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ENT
Nasopharynx
Oropharynx
Laryngopharynx
Esophagus
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Head Neck (ENT) PATHOLOGYOTOLARYNGOLOGY
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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 de
viations 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 CAVITY UPPER RESPIRATORY
TRACT EARS NOSE SALIVARY 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
• Tartar?plaque?calculus 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?
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TZANCK SMEAR
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Monilia, thrush-mouth
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LEUKOPLAKIA.
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Hairy leukoplakia
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Hairy leukoplakia
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NORMAL? DYSPLASIA? CARCINOMA-IN-SITU?INFILTRATING
MALIGNANCY
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INFILTRATIVE SQUAMOUS CELL CARCINOMA
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squamous cell cancer,
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WELL MODERATE POOR
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ODONTOGENICCYSTS/TUMORS

• INFLAMMATORY CYSTS (e.g., Radicularperiapical
  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 URIs 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/NASOPHARYNXTUMORS

• Polyps---really NOT a tumor
• Angiofibroma
• Papilloma
• Plasmacytoma
• Neuroblastoma
• Nasopharyngeal Carcinoma

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INFLAMMATORY POLYPS OF NASAL CAVITY
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Multiple appearances of nasal polyps
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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(OLFACTORY)ESTHESIONEUROBLASTOMA
ROSETTE
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NASOPHARYNGEALCARCINOMA
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normal vocal cords.
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LARYNGITIS
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POLYPS PAPILLOMASCARCINOMAS
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Polyp, or singers 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.
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The Tympanic Cavity
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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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CERUMEN CAST
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OTOSCLEROSIS
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ZELLBALLEN
CAROTID BODY TUMOR balls of cells 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,
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MUCOCELE
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P A R O T I D
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Viral parotitis, i.e., mumps
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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