Head and neck

1
Head and neck

• Oral cavity
• Teeth
• Gingiva
• Lip
• Tongue
• Nasopharynx
• Nose and sinuses
• Salivary gland
• Ear

2
Head and neck

• Teeth
• Numerical disorders

3
Caries Bacteria destroy the compact material
Cause necrosis of the pulp defensive agent
saliva bacteriostatic material
lysosime, lactoferrin Further
events pulpitis oedema, pain,
necrosis (bacteria, chemical, toxic, thermic
effects), periapical granuloma / abscess
radicular cyst osteomyelitis
4
Pathology of the gingiva Gingivitis bacterial,
viral, traumatic, chronic irritation,
drugs Parodontitis inflammation of the
periodontal tissues might be followed by
endocarditis ! (40-of patients with
endocarditis had dental intervention some days
earlier) Parodontal abscess Source of general
infections Patients with high risk patients
having prosthetic valve rheumatic patients
stenosis-vitium Congenital vitium Patients
with bad mouth hygiene have 4 fold risk of
having cerebrovascular insults
5
Risk of cardiovascular diseases coronary
sclerosis 3,7 fold more frequent cause
persistent bacterial invasion chewing, dental
cleaning causes bacteriaemia 60 after tooth
extraction 88 after peridontal surgery 40
after cleaning of the teeth most frequent
bacterium streptococcus viridans 15-40 of the
patients with endocarditis have dental
intervention in the case history Patients with
high risk patients having prosthetic valve
rheumatic patients stenosis-vitium Cong
enital vitium Patients with bad mouth hygiene
have 4 fold risk of having cerebrovascular
insults
6
Oral cavity developmental anomalies

• Cleft lip -cheiloschisis (labium leporinum)
• failure of the fusion of the lateral nasal and
  maxillary swellings
• Cleft palate palatoschisis (palatum fissum, faux
  lupina) failure of fusion of palatine shelves
  palatoschisis
• Combined cheilognathopalatoschisis

7

• Branchial cleft cyst
• A branchial cleft cyst is an oval, moderately
  movable cystic mass that develops under the skin
  between the sternocleidomastoid (neck) muscle and
  the pharynx. It is a remnant of embryonic
  development. Branchial cleft cysts can become
  infected. Neither of these conditions will
  resolve spontaneously.
• A branchial cleft sinus is a small opening
  along the neck muscle which may connect to the
  mouth.

8
Leukoplakia

• White plaque on the
• oral mucous membrane
• that cannot be scraped
• off
• Microscopically
• thickening of the
• mucosa
• -
• hyperkeratosis without / with atypia

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Erythroplakia

• Red, velvety, often eroded area on the oral
  mucosa
• Micr. most cases
• show marked
• dysplasia

10
Both erythroplakia and leukoplakia should be
considered
as a precancerous lesion, until it is proved
otherwise!!!
11
Squamous cell carcinoma

• Tobacco, alcohol
• (Protracted irritation)
• HPV -6,16,18
• Site floor of the mouth,
• tongue, hard palate, base
• of the tongue, tonsils
• Metastasis mediastinal
• lymph nodes, lungs, liver,
• bones

12
Head and neck tumors and tumor-like
conditions papilloma HPV infection koilocytosi
s (virions) in the nuclei of the epithelial cells
13
Other tumors, or tumor like conditions
Benign haemangioma lymphangioma naevus
pigmentosus fibroma, neurinoma lipoma,
leiomyoma goiter of the basis of the
tongue branchial cleft cysts Malignant malignan
t variants of the above mentioned
tumors malignant teratoma
30
14
Nasopharynx

• Tumors
• Nasopharyngeal angiofibroma
• Papilloma / Inverted papilloma
• Isolated plasmocytoma
• Olfactory neuroblastoma
• Nasopharyngeal carcinoma

15
Salivary gland disorders

• Sialadenitis
• Acute
• viral - parotitis epidemica
• bacterial
• Chronic
• stones
• autoimmune
• Tumors

16
Sjögren syndrome Insufficiency of the exocrine
glands Rheumatic (autoimmune?)chronic
inflammation Most patients are women
perimenopausal years ovarial insufficiency Cau
se unknown Symptoms keratoconjunctivitis dry
mucosa, keratosis - Xerostomia
parotismagnagyobbodás, stone formation achlorhyd
ria atrophy of sweat and sebaceous glands
pigmentanomalies chronic polyarthritis
arteriitis Hyperfibrinogenaemia hypochrom
anaemia - Mikulicz disease
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Soft tissue lesions- pseudotumors

• Gingivitis hyperplastica
• hormonal effects puberty, pregnancy
• drugs diphenylhydantoin
• cyclosporin
• Cause mitogenic effect on gingival fibroblasts
• 1. inflammatory-granulomatosus pseudotumor
  epulis gigantocellularis
• 2. pyogenic granuloma
• 3. irritation fibroma

pregnancy
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Salivary gland tumors

• Malignant
• Mucoepidermoid cc
• Adenocarcinoma NOS
• Acinic cell cc
• Adenoid cystic cc
• Malignant mixed tu
• Squamous cell cc
• Malignant lymphoma
• Metastatic breast, small cell, MM

• Benign
• Pleomorph adenoma
• Warthin tumor
• Oncocytoma
• Other adenomas
• Basal cell adenoma
• Canalicular
• Ductal papilloma

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Nose

• Rhinitis
• Infectious (viral, secondarily bacterial)
• Allergic
• Chronic
• Sinusitis

Nasal polyp