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Surgical Excision
Enoi Bartolome
Enoi Bartolome
Complications:
Otologic:
TM perforation acute OM- heal spontaneously
after the infection has resolved
Intracranial:
Meningitis Most common intracranial
complication
H. Influenza B-most common org.
in children
Brain abcess
Otitic hydrocephalus
Pharyngeal and Adenotonsillar Disease
Waldeyers Ring
Enoi Bartolome
Strep pneumoniae
Anerobes
Cornybacterium diptheriae
Fungal : candida
Non infectious
Reflux
Radiotherapy
Immune mediated
Erythema multiforme
Treatment:
Antibiotic-for open fractures
Closed reduction and 6 week intermaxillary
fixation (IMF) with arch bar applied via
circumferential wiring
Enoi Bartolome
Classification:
Subconjunctival hemorrhage
Malocclusion
Facial ecchymosis and hematoma
Widening or inner canthi and bridge of the
nose
Midface numbness due to injury of the
maxillary division of the trigeminal nerve
Ocular signs/symptoms
Mobility of the maxillary complex
BENIGN LESIONS
Benign Lesion: LIP
Clinical Manifestation
Visible or palpable lesion
Thickening of the lip and vermillion junction
Lip scaling
Scaling/Thickeningof the Lips
Leukoplakia
Transverse
Occurs secondary to fronto-occipital trauma
Facial nerve is injured in 50% of cases
Involves the otic capsule
Sensory neural hearing loss
Loss of vestibular function
hemotypanum
Facial nerve injury
Treatment:
Conservative treatment
Delayed or partial paralysis
Nerve decompression
Immediate paralysis that doesnt
resolve after 7 days
Electroneuromyography/EMG
90% degeneration 72 hrs
after the onset of
complete paralyssis
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Treatment:
Excision
Marsupialization for extensive
lesions
Central Giant Cell Reparative Granulomas
Of bony origin: less common than the peripheral
type
Expansile endosteal lesion typically within the
mandible
May also arise from the paranasal sinuses, orbit,
cranial vault and temporal bone
Ranula
Epulis
Granulomatous lesion of the gingiva
Exaggerated inflammatory response
Two subtypes:
1. Congenital Epulis: typically in anterior
maxilla of newborn
2. Epulis gravidarum: occurs in approximate 1% of
pregnant women
Resolves spontaneously
Excision for symptomatic epulides
Congenital Epulis
ULCERATIVE LESIONS
Idiopathic Aphthous Ulcer
Most common ulcerative lesion of the oral cavity
Cycle of painful ulceration and spontaneous healing
(several times a year for many years)
nutritional deficiencies including vitamin B, folate or
iron and emotional stress
Treatment:
Topical steroids
Necrotizing Sialometaplasia
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Lichen Planus
Polyps:
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Laryngeal granuloma
Occurs in the posterior larynx
Pain on swallowing-most common complaint
Etiology:
Acid reflux
Voice abuse
Chronic throat clearing
Endotracheal intubation
Vocal cord paralysis
Diagnostic work up
Fiberoptic laryngoscopy
Voice analysis
EMG
PH probe testing
Treatment
Voice rest
Voice retraining therapy
Anti-reflux therapy
Surgery
If carcinoma is considered
Airway obstruction
Vocal Cord paralysis
Iatrogenic
Surgery of the thyroid ,parathyroid
, cardiothoracic procedures
Malignancy
Idiopathic
A presenting sign of malignancy of
the thyroid, lungs and esophagus
Treatment
Bilateral: Tracheotomy,
arytenoidectomy
Unilateral: Speech therapy
Surgery: Injection laryngoplasty,
Laryngeal framework surgery, implantation of
cartilage, silicone, etc
Laryngocele
Herniation of the laryngeal ventricles
Three forms categorized by site presentation:
o Internal Laryngocele:
confined to the larynx
presents as enlargement of the false
vocal cord
o External Laryngocele:
protrudes through the thyrohyoid
membrane causing swelling in the
anterior neck
o Mixed Laryngocele:
combination of the above types
Pathogenesis related to chronic increases in intralaryngeal pressure
Propensity to singers and musician
Treatment:
o Ligation of stalk or the Laryngocoele and
repair of the ventricular weakness
Odontogenic Tumors
Tumors arising from progenitors cells of tooth
development
Usually involving the mandible and the maxilla
Most are benign
NON-ODONTOGENIC TUMORS
Torus
Torus Palatinus
Ameloblastoma/adamantinoma
Arise from dental lamina
Associated with impacted teeth in young patients
Painless jaw mass
Common in the mandible
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Exostoses
Localized bone overgrowths in the jaw, can be
multiple, flat or pedunculated
Common in the maxilla at the canine fossa
Treatment:
Excision if symptomatic
Osteomas
Slow-growing tumors of mature bone that arise
within (intraosseous) or at the periphery of the
involved bone
Peripheral lesions often attached to the cortical bone
by a dense pedicle; most commonly in the mandible
at the lingual aspect of the ramus or angle of the
mandible
May also involve the paranasal sinuses
Excision advised when continues growth encroaches
upon vital structures
Etiology
Carcinogen: agent that initiates cancer
development
1. Ultraviolet Rays (Sunlight)
Lip cancer; skin cancer in head and
neck
2. Tobacco
Lip cancer; oral cavity cancer;
laryngeal cancer; NPCA
3. Alcohol
4. Occupational related
NPCA: In wood workers and shoe
factory workers
5. Race
Chinese: Nasopharyngeal
carcinoma
Genetic and viral (Epstein-Barr
Virus)
6. Radiation Exposure
Thyroid cancer; salivary gland
cancer
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DIAGNOSIS
History
Elicit past history and Family history of cancer
Four (4) most common presenting symptoms
Pain
Bleeding
Mass
Obstruction
Biopsy
To establish definitive diagnosis
Techniques
1. Punch Biopsy
2. Incisional Biopsy
3. Fine Needle Aspiration Biopsy
Exception: Very small lesions that can completely
removed by same biopsy procedure
Additional Studies
1. Radiologic Studies
2. CT Scan
3. MRI
4. Contrast Studies/Barium Swallow
Use to assess the extent of tumor invasion to
adjacent structure
Use for better treatment planning
Levels of cervical lymph nodes
Types of SND
Neck dissection
Selective neck dissection
Preservation of one or more group of lymph
nodes
Internal jugular, spinal accessory nerve and
SCN are preserved
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Treatment:
Resection with clear margins or radiation
Cure rate of 90% for stage I and 50-80% for stage II
If + for lymph node-ipsilateral or bilateral neck
dissection
Resection with primary closure
Involves less than one-third of the
lip
Burrow triangle flap
More than one-third
Enoi Bartolome
Commando Operation
CA of Tongue
Oral tongue
Primary tumors
Leiyomyomas.leiomyosarcoma,rhebdomyosarcoma,
neurosrcoma
Clinical manifestation
Ulcerations/exophytic masses
Ipsilateral paresthesias and deviation of the
tongue
Submandibular and upper cervical
Lymphadenopathy
Treatment
T1-T2
Wide local excision with primary
closure
Partial glossectomy
Removes large portion of the
lateral oral tongue
Prosthetic augmentation
Faciocunatneous free flaps
MRND or SND
CARCINOMA OF THE NASOPHARYNX
Ohngrens Line
Nasopharyngeal carcinoma
Examinations:
Fiberoptic endoscope
CT w/ contrast-best for determining bone
destruction
MRI- intracranial and soft tissue extension
Treatment:
Stage 1 and 2
Irradiation
For more advanced ca
Irradiation +chemotherapy
CARCINOMA OF THE NASAL CAVITY AND PARANASAL SINUSES
st
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Total Laryngectomy
Incidence of Malignancy
Parotid tumors - 25%
Submandibular tumors 40%
Sublingual and Minor Gland tumors 70%
Since 70% of salivary gland tumors occur in the
parotid and three-fourth of these are benign, the
majority of salivary gland neoplasms are benign
Pathology
Benign:
Plemorphic Adenoma (Benign mixed tumor)
Most frequent, most in females middle
aged
10% recurrence with surgery
Papillary Cystadenoma Lymphomatosum(Warthins
Tumor)
Mostly in males
10 15% bilateral
Hemangioma
Most common salivary tumor in children
Pleomorphic Adenoma
Mucoepidermoid Carcinoma
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Malignant tumors
Mucoepidermoid carcinoma-most common
Low grade-composed of mucin
secreting cells
High grade-epidermoid cells
predominate
Adenoid cystic
second most common in adults
Propensity for neural invasion
High incidence of distant
metastasis
Display an indolent growth
Parotid Tumors
Approximately 2/3 of malignant salivary tumor occur
in the parotid
Most Parotid tumor are benign
Tumors more common in the superficial lobe
Cranial Nerve VII (Facial Nerve)
Courses along the substance of the gland
If patient with CN VII palsy, probably
malignant
Treatment
Superficial parotidectomy-those that arise from the
lateral lobe
Total parotidectomy-involves the deep lobe
CN VII preservation is mandatory unless grossly
involved by a malignant lesion
Ispsilateral neck dissection must be
performed for clinically palpable nodes
Superficial Parotidectomy
History
Physical Examination
Panendoscopy
Nasopharyngoscopy
Laryngoscopy
Bronchoscopy
Esophagoscopy
Suspicious lesions are biopsied
Fine needle aspiration cytology
Excision:
Should not be the initial step
Can be done with concomitant neck
dissection
Nasopharyngoscopy
Video-Laryngoscopy
st
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Direct Laryngoscopy
Bronchoscopy
Esophagoscopy
Unknown primary Ca
Treatment:
Neck Dissection ( levels 1-5) + chemoRdx
N1 (single ipsilateral 3cm or less)
w/o extracapsular spread
w/o hx of incision or excision
biopsy
Radiotherapy /chemotherapy
N2 or greater
w/extracapsular spread
w/ hx of previous biopsy
Enoi Bartolome