www.freelivedoctor.com
ENT
Soft
Palate
Nasopharynx
Oropharynx
Epiglottis
Laryngopharynx
Esophagus
Head & Neck (ENT)
PATHOLOGY
OTOLARYNGOLOGY
www.freelivedoctor.com
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
www.freelivedoctor.com
.ETIOLOGY
.PATHOGENESIS
.MORPHOLOGY
.CLINICAL
MANIFESTATIONS
www.freelivedoctor.com
EVERYTHING that
touches AIR
(columnar) or FOOD
(squamous) in the
HEAD/NECK region
ORAL CAVITY
“UPPER” RESPIRATORY TRACT
EARS
NOSE
SALIVARY GLANDS
www.freelivedoctor.com
www.freelivedoctor.com
ORAL CAVITY
• TEETH/GINGIVA/ALVEOLAR BONE
• INFLAMMATORY/”REACTIVE”
LESIONS
• INFECTIONS: HSV, VIRAL, FUNGI
• LEUKOPLAKIA/”HAIRY”
LEUKOPLAKIA
• SQUAMOUS TUMORS: BEN/MALIG
• ODONTOGENIC CYSTS/TUMORS
www.freelivedoctor.com
UPPER AIRWAYS
• NOSE: Inflammation, Tumors
• NASOPHARYNX: Inflammation,
Tumors
• PARANASAL SINUSES:
Inflammation, Tumors
• LARYNX: Inflammation, Tumors
www.freelivedoctor.com
EARS
• DEGENERATION: OTOSCLEROSIS
• INFLAMMATION:
• NEOPLASMS:
www.freelivedoctor.com
NECK
• BRANCHIAL (cleft) CYST
• THYROGLOSSAL (duct/tract) CYST
• PARAGANGLIOMA (Carotid Body
Tumor)
www.freelivedoctor.com
SALIVARY GLANDS
• DEGENERATION: Xerostomia
• INFLAMMATION
• NEOPLASMS
– BENIGN: Pleomorphic Adenoma (aka,
“Mixed” Tumor), Warthin Tumor
– MALIGNANT: (Mucoepidermoid, Adenoid
Cystic, Adenocarcinomas)
www.freelivedoctor.com
www.freelivedoctor.com
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
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
Periodontal Disease
• Bacteria
–Actinobacillus
–Porphyromonas
–Prevotella
• Gingiva, periodontal ligaments,
bone, cementum
www.freelivedoctor.com
“Irritation” Fibroma
www.freelivedoctor.com
PYOGENIC
GRANULOMA
www.freelivedoctor.com
“Canker” sore = Aphthous ulcer
www.freelivedoctor.com
Glossitis:
www.freelivedoctor.com
herpes
www.freelivedoctor.com
Herpes, dried vesicle with inflammation
www.freelivedoctor.com
Herpes, dried vesicle with ulceration and secondary
inflammation. Acute or chronic?
www.freelivedoctor.com
TZANCK SMEAR
www.freelivedoctor.com
Monilia, thrush-mouth
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
LEUKOPLAKIA.
www.freelivedoctor.com
“Hairy” leukoplakia
www.freelivedoctor.com
“Hairy” leukoplakia
www.freelivedoctor.com
NORMAL DYSPLASIA CARCINOMA-IN-SITUINFILTRATING MALIGNANCY
www.freelivedoctor.com
INFILTRATIVE SQUAMOUS CELL CARCINOMA
www.freelivedoctor.com
squamous cell cancer,
www.freelivedoctor.com
WELL
MODERATE
POOR
www.freelivedoctor.com
ODONTOGENIC
CYSTS/TUMORS
• INFLAMMATORY CYSTS (e.g.,
“Radicular”[periapical] most
common)
• DEVELOPMENTAL CYSTS
(DENTIGEROUS most common)
• MALIGNANT TUMORS of
ODONTOGENIC ORIGIN
(AMELOBLASTOMAS) (rare)
www.freelivedoctor.com
DENTIGEROUS
CYST
www.freelivedoctor.com
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.
www.freelivedoctor.com
NOSE/SINUS/NASOPHARYNX
“TUMORS”
•
•
•
•
•
•
“Polyps”---really NOT a tumor
Angiofibroma
Papilloma
Plasmacytoma
Neuroblastoma
Nasopharyngeal Carcinoma
www.freelivedoctor.com
INFLAMMATORY “POLYPS” OF NASAL CAVITY
www.freelivedoctor.com
Multiple appearances of nasal polyps
www.freelivedoctor.com
“NECROTIZING”
Upper Airway Lesions
• “WEGENER” Granulomatosis
• “Lethal” Midline Granuloma
www.freelivedoctor.com
PAPILLOMA
“INVERTED” PAPILLOMA
www.freelivedoctor.com
ANGIOFIBROMA
www.freelivedoctor.com
PLASMACYTOMA
www.freelivedoctor.com
NEUROBLASTOMA
(OLFACTORY)
ESTHESIONEUROBLASTOMA
www.freelivedoctor.com
ROSETTE
NASOPHARYNGEAL
CARCINOMA
www.freelivedoctor.com
normal vocal cords.
www.freelivedoctor.com
LARYNGITIS
www.freelivedoctor.com
POLYPS
PAPILLOMAS
CARCINOMAS
www.freelivedoctor.com
Polyp, or “singer’s” nodule
www.freelivedoctor.com
Papilloma, but there may be some cancer
microscopically.
www.freelivedoctor.com
www.freelivedoctor.com
www.freelivedoctor.com
Otitis externa
www.freelivedoctor.com
normal tympanic membrane.
www.freelivedoctor.com
The Tympanic Cavity
Incus
Tendon of
Stapedius M.
(CN VII)
Chorda
Tympani N.
(CN VII)
Tendon of
Tensor
Tympani M.
(V3)
Stapes
Cut edge of tympanum
www.freelivedoctor.com
Malleus
Acute middle ear infection
www.freelivedoctor.com
Chronic “serous” otitis media
www.freelivedoctor.com
Cerumen impaction
www.freelivedoctor.com
www.freelivedoctor.com
CERUMEN CAST
OTOSCLEROSIS
www.freelivedoctor.com
www.freelivedoctor.com
ZELLBALLEN
CAROTID BODY TUMOR
“balls of cells”
“zellballen”
www.freelivedoctor.com
www.freelivedoctor.com
NORMAL
ACUTE SIALADENITIS
CHRONIC SIALADENITIS
Squamous metaplasia of an interlobular duct
www.freelivedoctor.com
Mucocele of an accessory salivary gland duct,
www.freelivedoctor.com
MUCOCELE
www.freelivedoctor.com
P
A
R
O
T
I
D
www.freelivedoctor.com
Viral parotitis, i.e., mumps
www.freelivedoctor.com
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
www.freelivedoctor.com
PLEOMORPHIC ADENOMA
i.e., MIXED TUMOR
www.freelivedoctor.com
PAPILLARY CYSTADENOMA LYMPHOMATOSUM
Better known as: WARTHIN TUMOR
www.freelivedoctor.com
MUCOEPIDERMOID
CARCINOMA
www.freelivedoctor.com
ADENOID CYSTIC
CARCINOMA
www.freelivedoctor.com