Head & neck

• Caries (Tooth Decay)

  • Caused by focal demineralization of tooth structure (enamel and dentin) by acidic products of bacterial sugar fermentation
• Gingivitis

  • Inflammation of oral mucosa surrounding the teeth
  • Caused by accumulation of dental plaque and calculus
• Most prevalent and severe in adolescence — gingivitis
• Gingivitis

  • Erythema, edema, bleeding, changes in contour, Reversible
• Periodontitis

  Inflammatory process that affects the supporting structures of the teeth (periodontal ligaments), alveolar bone, and cementum
• Sequelae - destruction of periodontal ligament
• Aphthous Ulcers (Canker Sores)

  • Common, often recurrent, painful
• Aphthous Ulcers (Canker Sores)

  • Affect 40% of population
  • Resolve spontaneously in 7-10 days; sometimes persists for weeks
• Fibrous Proliferative Lesions

  • Irritation fibroma
  • Traumatic fibroma
  • Focal fibrous hyperplasia
• Pyogenic Granuloma

  • Gingiva in children, young adults, pregnant women
  • Red to purple, frequently ulceratedHighly vascularized proliferation of organizing granulation tissue
• Peripheral Ossifying Fibroma

  • Red, ulcerated, nodular lesions of gingiva
  • Reactive rather than neoplastic
  • Some arise from long-standing pyogenic granuloma; de novo
• Peripheral Giant Cell Granuloma

  • Covered by intact gingival mucosa
  • Contain aggregates of multinucleate, foreign body-like giant cells separated by a fibroangiomatous stroma
• Herpes Simplex Virus Infections

  • Gingivostomatitis (children), pharyngitis (adults), chronic mucocutaneous infection (immunocompromised)
• HSV-1 (orofacial herpes); HSV-2 (genital herpes)

  Often asymptomatic; may present with acute herpetic gingivomastitis, abrupt onset of vesicles and ulcerations
• Oral Candidiasis (Thrush)

  • Candida albicans

  Pseudomembranous, erythematous, or hyperplastic
• Precancerous and Cancerous Lesions

  Leukoplakia

  • White patch or plaque. Cannot be scraped off
  • Cannot be characterized clinically or pathologically as any other disease
• Erythroplakia

  • Red, velvety

  Erythroplakia

  • Remains level with or slightly depressed relative to the surrounding mucosa
• Squamous Cell Carcinoma

  • 95% of cancers of the head and neck
  • Pathogenesis multifactorial
  • Infection with high-risk HPV
  • Tobacco smoking and alcohol. Actinic radiation
• Dentigerous Cyst

  • Originates around the crown of an unerupted tooth
  • Lined by thin layer of stratified squamous epithelium
  • Dense chronic inflammatory cell infiltrate surrounding the connective tissue
• Keratocystic Odontogenic Tumor

  • 10 and 40 years of age, males, within posterior mandible
  • Thin layer of keratinized stratified squamous epithelium with prominent basal cell layer, corrugated epithelial surface
• Radicular Cyst

  • Tooth apex
  • Result of long-standing inflammation of tooth
• Odontoma

  • Most common odontogenic tumor
  • Associated with extensive enamel and dentin deposition
• Ameloblastoma

  • Does not display ectomesenchymal differentiation
  • Cystic, slow-growing locally invasive; indolent course
• Sinonasal (Schneiderian) Papilloma

  • Arise from respiratory or Schneiderian mucosa lining the nasal cavity and paranasal sinuses
  • Exophytic (most common), endophytic (inverted), oncocytic (cylindrical)
• Laryngitis

  • Commonly associated with generalized upper respiratory tract infection, heavy environmental exposure, or gastroesophageal reflux due to irritating effects of gastric contents
• Acute and Chronic Otitis Media

  • Most often in infants and children
  • Viral infection; induces serous exudate
  • Repeated bouts of acute otitis media with failure of resolution lead to chronic disease
• Cholesteatoma

  • Non-neoplastic, cystic lesions associated with chronic otitis media
  • Cysts - 1-4cm in diameter
• Otosclerosis

  • Abnormal bone deposition in the middle ear about the rim of the oval window into which the footplate of the stapes fits
• Neck — Branchial Cleft Cyst (Cervical Lymphoepithelial Cyst)

  • Arise from remnants of 2nd branchial arch and are most commonly observed in young adults between 20 and 40 years of age
  • Usually appear on the upper lateral aspect of neck along sternocleidomastoid muscle
  • Well-circumscribed, 2-5cm in diameter; lined by stratified squamous or pseudostratified columnar epithelium
• Salivary Glands

  • Xerostomia - Dry mouth due to decrease in saliva production Characteristic of Sjogren syndrome
  • Most often a side effect of commonly prescribed medications
• Inflammation (Sialadenitis)

  • May be induced by trauma, viral or bacterial infection, or autoimmune disease
  • Mucocele - most prevalent form
  • Mumps - most common viral cause
• Mucocele

  • Most often on lower lip as a result of trauma
• Salivary Glands

  Ranula

  • Epithelial-lined cysts
  • Arise when the duct of the sublingual gland has been damaged
• Pleomorphic Adenoma

  • Most common salivary gland neoplasms
  • Mixture of ductal (epithelial), myoepithelial, and mesenchymal cells
• Warthin Tumor

  (Papillary Cystadenoma Lymphomatosum)

  • Second most common salivary gland neoplasm
  • Arises almost exclusively in the parotid gland
  • Risk increased eightfold in smokers