Special Considerations - Head and Neck

According to the Rule of 7s, what diagnosis corresponds to a neck mass duration of ~7 days?

Inflammatory

According to the Rule of 7s, what diagnosis corresponds to a neck mass duration of ~7 months?

Neoplastic

According to the Rule of 7s, what diagnosis corresponds to a neck mass duration of ~7 years?

Congenital

What embryologic remnant forms a Thyroglossal Duct Cyst?

Residual thyroid tissue left behind during its descent

In what patient population do Thyroglossal Duct Cysts most commonly present?

Midline neck mass in children

Where do 80% of Thyroglossal Duct Cysts occur relative to the hyoid bone?

At or just below the hyoid bone

What physical maneuvers cause a Thyroglossal Duct Cyst to move on examination?

Moves with deglutition or tongue protrusion

What percentage of Thyroglossal Duct Cysts contain functional thyroid tissue?

5%

What is the definitive surgical treatment for a Thyroglossal Duct Cyst?

Sistrunk procedure

What is the external opening location for a 1st Branchial Cleft Cyst?

Pre-auricular area

What is the internal opening location for a 1st Branchial Cleft Cyst?

Middle ear

What is the external opening location for a 2nd Branchial Cleft Cyst?

Lateral neck at SCM

What is the internal opening location for a 2nd Branchial Cleft Cyst?

Tonsillar fossa

What is the external opening location for a 3rd Branchial Cleft Cyst?

Lateral neck at SCM

What is the internal opening location for a 3rd Branchial Cleft Cyst?

Pyriform sinus

What is the most common branchial cleft anomaly?

2nd branchial cleft anomaly

In which decade of life do branchial cleft cysts usually present?

1st decade of life

What is the definitive treatment for a Branchial Cleft Cyst?

Complete excision

What primary developmental defect leads to a Cystic Hygroma?

Maldevelopment and obstruction of lymphatic system

Do sequestrations of lymphatic tissue in a Cystic Hygroma communicate with the lymphatic system?

No communication with the lymphatic system

What physical palpation features describe a Cystic Hygroma?

Soft, compressible, and non-tender mass

Where are Cystic Hygromas usually located in the neck?

Lateral or posterior triangle of the neck

What is the preferred imaging modality for evaluating a Cystic Hygroma?

MRI

What is the primary surgical treatment approach for a Cystic Hygroma?

Complete surgical resection preserving vital neck structures

What intralesional sclerosing agents are injected for Cystic Hygroma treatment?

OK-432, bleomycin

What are the clinical manifestations of anterior oral cavity neoplasms?

Fleshy exophytic mass, heaped-up ulcers, pain, tooth loosening, impairment of tongue mobility

What clinical manifestation characterizes tonsillar fossa or retromolar trigone neoplasms?

Trismus with infiltration of pterygoid muscles

What are the clinical manifestations of larynx neoplasms?

Hoarseness, dysphagia, dyspnea, pain, cervical lymphadenopathy

What are the clinical manifestations of nasopharynx neoplasms?

Nasal obstruction, decreased hearing acuity, ocular motor palsy, cervical lymphadenopathy

What are the clinical manifestations of maxillary sinus neoplasms?

Cheek swelling, palatal bulging, orbit extension

What are the clinical manifestations of salivary gland neoplasms?

Asymptomatic firm lump, skin or mucosal ulceration, paresthesia or paralysis, cervical lymphadenopathy

What tissues comprise Waldeyer's ring?

Palatine tonsils, lingual tonsils, adenoid, and tubal tonsils

What are the most common disorders affecting Waldeyer's ring?

Chronic or recurrent adenotonsillitis, adenotonsillar hypertrophy

What is the typical etiology and presentation of benign lip lesions?

Subject to chronic irritation, presenting as scaling lesions

What histologic spectrum of lesions can present as lip scaling lesions?

Dysplasia, hyperkeratosis, parakeratosis, dyskeratosis, carcinoma in situ, invasive carcinoma

What is the treatment for benign lip lesions?

Wide excision +/- reconstruction

What is the underlying pathophysiology of a mucous retention cyst in the oral cavity?

Submucosal mucus accumulation, mostly due to ruptured ductal system rather than ductal obstruction

What are the physical appearance and typical size of a mucous retention cyst?

Bluish hue cystic structure, typically less than 1 cm, smooth

What is a ranula?

Mucous retention cyst involving the sublingual gland

What is the treatment for a ranula?

Excision or marsupialization

What defines an epulis?

Granulomatous lesions due to exaggerated inflammation

Where does congenital epulis occur?

In the anterior maxilla

In what percentage of pregnant women does pregnancy epulis occur, and what is its course?

Occurs in 1% of pregnant women, resolves spontaneously

What is the treatment for an epulis?

Excision if symptomatic and persistent

What is the origin and appearance of a peripheral giant cell reparative granuloma?

Soft tissue in origin; polypoid, submucosal, and fibrous; may ulcerate and bleed

What is the treatment for a peripheral giant cell reparative granuloma?

Excision

What is the origin and radiographic appearance of a central giant cell reparative granuloma?

Expansile endosteal lesion of the mandible of bony origin

What is the treatment for a central giant cell reparative granuloma?

Curettage

What alternative name is given to a granular cell myoblastoma?

Abrikossoff tumor

From what cell type is a granular cell myoblastoma derived?

Schwann cells

Where in the tongue does a granular cell myoblastoma typically present?

Firm, submucosal swelling in the mid 1/3 of tongue

What is the treatment for a granular cell myoblastoma?

Wedge excision

What benign/inflammatory ulcerative lesions occur in the oral cavity?

Aphthous ulcer, pemphigus vulgaris, necrotizing sialometaplasia, white sponge nevus, Lichen planus, and Oral hairy leukoplakia

What is the general management approach for ulcerative lesions of the oral cavity?

Usually resolves spontaneously, otherwise treated with steroids; biopsy if needed to rule out carcinoma

What common clinical symptom do polyps and squamous papillomas of the nose cause?

Nasal obstruction

What is the treatment for nasal polyps and squamous papillomas?

Excision

What defines a juvenile nasopharyngeal angiofibroma (JNA)?

Highly expansile and destructive fibrovascular neoplasm

In what patient demographic do juvenile nasopharyngeal angiofibromas typically occur?

Adolescent males

How does a juvenile nasopharyngeal angiofibroma present clinically?

Epistaxis which can be massive

What is the primary treatment for a juvenile nasopharyngeal angiofibroma?

Angioembolization

What percentage of epistaxis comes from the anterior nasal septum?

90%

What clinical clues suggest posterior nasal septum epistaxis?

Massive epistaxis, bilateral bleeding, hemodynamic instability, aspiration

Where do laryngeal papillomas usually arise?

True vocal cord

What is the primary presenting symptom of a laryngeal papilloma?

Hoarseness

Which type of laryngeal papilloma usually recurs after treatment?

Juvenile type

What is the treatment for laryngeal papilloma?

Excision or laser ablation

What is a laryngocele?

Herniation of the laryngeal ventricles due to chronic increase in intralaryngeal pressure

What is the treatment for a laryngocele?

Ligation of stalk and repair of the ventricles

From what structures do odontogenic tumors arise?

Progenitors of tooth development

Which facial bones are involved in odontogenic tumors?

Maxilla and mandible

What is the primary management approach for most odontogenic tumors?

Conservative

From what structure does an ameloblastoma (adamantinoma) arise?

Dental lamina

What dental abnormality is associated with an ameloblastoma?

Impacted tooth

What are the clinical characteristics of an ameloblastoma?

Painless benign but locally aggressive mandibular mass that may erode the bone cortex

What classic radiographic finding is seen in ameloblastoma?

Soap-bubble appearance

What is the definitive surgical treatment for ameloblastoma?

Resection (marginal vs sectional)

What facial deformity is associated with ameloblastoma?

Andy-Gump deformity

Why is curettage not recommended for ameloblastoma?

High recurrence rate

What are the established risk factors for malignant head and neck tumors?

Tobacco use, alcohol consumption, nutritional deficiencies, immunosuppression, viruses (HPV, EBV), occupational exposures (wood dust, nickel, paint), fumes/metal works/textiles/radiation/asbestos, older age, low socioeconomic status

What percentage of head and neck squamous cell carcinoma (HNSCC) is HPV-positive?

20%

What percentage of head and neck squamous cell carcinoma (HNSCC) is HPV-negative?

80%

What viral proteins are expressed in HPV-positive HNSCC?

E6 and E7 positive

What is the p53 status in HPV-positive HNSCC?

Mainly wild-type TP53

What is the prognosis for HPV-positive HNSCC?

Favorable prognosis

What percentage of HPV-negative HNSCC cases have high CIN?

65%

What percentage of HPV-negative HNSCC cases have low CIN?

15%

What is the p53 status in HPV-negative HNSCC with high CIN?

Mainly mutated TP53

What is the incidence trend for HPV-negative HNSCC?

Decreasing

What is the incidence trend for HPV-positive HNSCC?

Increasing

What are the primary etiologies of HPV-negative HNSCC?

Smoking, excessive alcohol use

What is the primary etiology of HPV-positive HNSCC?

Oral sex

What is the typical patient age for HPV-negative HNSCC?

Above 60 years

What is the typical patient age for HPV-positive HNSCC?

Under 60 years

Is field cancerization present in HPV-negative HNS

What tumor size defines T1 stage in HNSCC TNM staging?

2 cm or less in diameter, confined to site of origin

What tumor size defines T2 stage in HNSCC TNM staging?

>2 to 4 cm in diameter

What tumor size defines T3 stage in HNSCC TNM staging?

>4 cm in diameter

What tumor characteristics define T4 stage in HNSCC TNM staging?

Massive tumor with invasion of surrounding structures

What nodal status defines N0 in HNSCC TNM staging?

No regional lymph node metastasis

What nodal status defines N1 in HNSCC TNM staging?

Metastasis in a single ipsilateral node < 3 cm