5- sinonasal pathology

3 skin conditions of the nose caused by UV radiation

1. solar (actinic) keratosis

2. basal cell carcinoma

3. squamous cell carcinoma

clinical presentation of solar (actinic) keratosis

scaly plaques on face, lip, ears, scalp, neck, arms, etc

basal cell carcinoma is caused by a mutation of what

PTCH1 → loss of function

T/F: basal cell carcinoma rarely metastasizes

true

treatment for basal cell carcinoma

local excision

3 skin conditions of the nose caused by inflammation

1. lupus erythematosus

2. rosacea

3. rhinophyma

clinical presentation of lupus erythematosus

• discoid rash: erythematous raised patches w/ adherent keratotic scaling + follicular plugging

• malar rash: fixed erythema, flat/raised, over malar eminences

lupus erythematosus is exacerbated by

UV light

4 stages of rosacea

1. pre-rosacea: flushing episodes

2. mild: persistent erythema + telangiectasia (visible blood vessels)

3. moderate: pustules + papules

4. severe: rhinophyma (permanent thickening of nasal skin by erythematous papules + prominent follicles)

rosacea affects men or women more

women

which form of rosacea is common in men

rhinophyma

rhinophyma is associated w/

hypertrophy of sebaceous glands + follicular plugging by keratotic debris

what’s rhinitis

inflammation of nasal cavity

3 types of rhinitis

1. infectious (common cold): caused by adeno-, echo-, rhinoviruses

2. allergic

3. chronic: repeated attack of acute rhinitis from allergy or microbial

what’s sinusitis

inflammation of paranasal sinuses

what’s rhinosinusitis

inflammation of nasal cavity + paranasal sinuses

clinical presentation of nasal polyps

• smooth surfaced

• semi-transparent

• ovoid shaped

histopathology presentation of nasal polyps

• immense edema

• scattered chronic inflammatory cells: mainly plasma or eosinophils

nasal polyps are most often associated w/ what condition

allergic rhinosinusitis

5 possible causes of nasal polyps

1. infections

2. asthma

3. aspirin intolerance

4. cystic fibrosis

5. diabetes

what’s epistaxis

nosebleed

8 possible causes of epistaxis

1. Trauma

2. Hereditary hemorrhagic telangiectasia (HHT)

3. Hypertension

4. Thrombocytopenia

5. Nasopharyngeal angiofibroma

6. Sarcoidosis

7. Granulomatosis with polyangiitis (Wegener granulomatosis)

8. Hemangioma

what’s anosmia

loss of smell

4 possible obstructive causes of anosmia

1. rhinitis

2. sinusitis

3. nasal polyps

4. tumors

2 possible sensorineural causes of anosmia

1. trauma

2. tumors

2 types of maxillary sinusitis

1. acute

2. chronic

acute maxillary sinusitis usually comes after

acute or chronic rhinitis

acute maxillary sinusitis can be caused by what dental condition

periapical infection

acute maxillary sinusitis can lead to severe infections of

ethmoid + frontal sinuses, brain meninges

drainage for acute maxillary sinusitis must occur at

ostia

chronic maxillary sinusitis is caused by

• recurring episodes of acute sinusitis or symptomatic disease lasting longer than 3 months

• failure of acute inflamed sinus to drain

chronic maxillary sinusitis can be mistaken for

painful, abscessed tooth

T/F: chronic maxillary sinusitis can be caused by fungal infection

true

4 benign tumors of nose/paranasal sinuses

1. squamous papilloma

2. fungiform + inverted papillomas

3. hemangioma (vascular malformation)

4. nasopharyngeal angiofibroma

which benign tumor of nose/paranasal sinuses can have malignant transformation

fungiform + inverted papillomas

which benign tumor of nose/paranasal sinuses present w/ epistaxis

hemangioma (vascular malformation) + nasopharyngeal angiofibroma

which benign tumor of nose/paranasal sinuses exclusively affects young men

nasopharyngeal angiofibroma

malignant tumor of paranasal sinuses

squamous cell carcinoma, often affects maxillary sinus

malignant tumor of nasopharynx

nasopharyngeal carcinoma

nasopharyngeal carcinoma is caused by

Epstein-barr virus

nasopharyngeal carcinoma is prevalent in which countries

China, Southeast Asia, East Africa

3 clinical signs of nasopharyngeal carcinoma

1. nasal obstruction

2. epistaxis

3. cervical lymph node metastasis

3 risk factors for nasopharyngeal carcinoma

1. smoking

2. salted fish

3. pickled food

what’s Waldeyer’s ring

ring containing the 4 structures:

1. palatine tonsils

2. nasopharyngeal tonsils (adenoids)

3. lingual tonsils

4. tubal tonsils (eustachian)

4 pathological conditions of the oropharynx

1. viral + bacterial infections: cold, flu, mono (from EBV)

2. reactive lymphoid hyperplasia

3. pharyngitis: mild + severe

4. tonsilitis

what’s the most common cause of tonsillar enlargement

reactive lymphoid hyperplasia

complications of severe pharyngitis + tonsillitis

• peritonsillar abscess “quinsy”

• acute rheumatic fever

• acute post-streptococcal glomerulonephritis

severe pharyngitis + tonsillitis can accompany which conditions

beta-hemolytic streptococcal + adenovirus infection

diphtheria presents w/

• pseudomembrane produced on soft palate + pharynx

• fever

• malaise

• sore throat

• neck swelling

diphtheria is usually found in individuals that have had contact w/

farm animals or dairy products

4 pathologies of the larynx

1. laryngitis

2. allergy + toxin damage

3. reactive nodules

4. benign/malignant tumors

4 types of laryngitis

1. acute: inhalation of irritant, allergy rxn, common cold

2. diphtheria: produces exotoxins + pseudomembrane

3. tuberculosis: from infected, coughed up sputum

4. croup (laryngotracheobronchitis): from parainfluenza virus

which type of laryngitis affects children

croup (laryngotracheobronchitis)

which type of laryngitis presents w/ hoarseness + temporary loss of voice

acute

which type of laryngitis presents w/ harsh persistent cough

croup (laryngotracheobronchitis)

how is the larynx damaged via allergic rxn

type 1 hypersensitivity rxn → angioedema, can be life-threatening

how is the larynx damaged via toxins

1. acute toxic laryngitis: via toxic fumes

2. chronic toxic laryngitis: via cigarettes, premalignant

polyps can be found where in the larynx

true vocal cords

polyps on the true vocal cords can cause

hoarseness

clinical presentation of polyps on the true vocal cords

1. unilateral

2. smooth + round

3. sessile + pedunculated

clinical presentation of singer’s nodules

bilateral lesions on true vocal cords

2 treatment options for singer’s nodules

1. voice/speech therapy

2. behavior modification

benign tumor of larynx

squamous papilloma, caused by HPV

squamous papilloma of larynx occurs where

true vocal cords

squamous papilloma of larynx presentation in adults vs. children

• adults: solitary mass

• children: multiple masses, known as recurrent respiratory papillomatosis or juvenile laryngeal papillomatosis

recurrent respiratory papillomatosis or juvenile laryngeal papillomatosis can extend from larynx to the

trachea

recurrent respiratory papillomatosis or juvenile laryngeal papillomatosis is caused by

HPV 6 + 11

malignant tumor of larynx

laryngeal carcinoma, usually squamous cell carcinoma

laryngeal carcinoma affects men or women more

men

best prognosis of laryngeal carcinoma involves which part of the larynx

true vocal cords

metastasis of laryngeal carcinoma can occur from

area of supraglottis (usually to cervical lymph nodes)

4 risk factors of laryngeal carcinoma

1. chronic cigarette smoking

2. HPV

3. alcohol

4. asbestos exposure