ORL

Sudden inflammation of any of the salivary glands. - Usually affects one gland- Common in 50s and 60s Etiology:- Infectious: Staphylococcus aureus, Streptococcus viridans, Haemophilus influenzae, mumps, HIV- Reduced salivary flow: dehydration, Sjögren syndrome, anticholinergics, postoperative, sialolithiasis Acute sialadenitis:- Pain, swelling, redness of the skin, less saliva, bad taste from pus, painful to open mouth- Fever, chills, can devlop into an abscess Chronic sialadenitis:- Less painful, gland enlarges following meals, lack of redness- Associated with conditions of decreased salivary flow, autoimmune disease (Sjögren syndrome) Diagnosis: - Swollen salivary gland- Lab culture of pus collected by milking the gland- ↑ serum amylase- Imaging studies: check for abscess, salivary stone, tumor Treatment: Hydration, glandular massage, medication to stimulate saliva- Intravenous antibiotic treatment: nafcillin + metronidazole OR clindamycin

1. Interstitielle Infiltration aus Lymphozyten, Histiozyten Plasmazellen, Granulozyten 2. Kollagenvermehrung 3. Parenchymatrophie 4. Gangektasien Eine Sonderform stellt der Küttner-Tumor dar. In diesen Fällen steht die periduktale sklerosierende Entzündung im Vordergrund. Eine Kombination mit einer Sialolithiasis ist häufig.

1. Bindegewebskapsel 2. Zellstränge und tubuläre Formationen (= epithelialer Anteil) 3. Reichlich Tumorstroma, teils homogen aufgelockert (= myxoid) und zellarm, teils knorpelähnlich (= chondroid) (= mesenchymaler Anteil des Tumors) 4. Malignitätskriterien fehlen

Epidemiology: F > MPeak incidence: 40-60 years Accounts for 85% of benign salivary gland tumors. Etiology: Ionizing radiation, environmental/occupational exposure (eg, rubber manufacturing, cosmetologists, nickel compound exposure) Location: mostly the parotid gland (∼80% of cases) Symptoms: Gradual and painless unilateral swelling of the parotid gland- Robust, movable tumor Diagnostics:- Ultrasound: diagnostic method of choice in salivary gland tumors- MRI: sharply limited, lobulated hyperintense mass- Histology: → Mixed cellular constitution with myoepithelial cells and chondroid tissue→ Cytokeratin is expressed immunohistochemically Complications: Recurs if incompletely excised; rarely malignant degeneration (∼5% of cases). Treatment: Superficial parotidectomy

Benign:- Pleomorphic adenoma (80%)- Warthin tumor (10%)- Other: Oncocytoma (~2%), basal cell adenoma (1-2%), myoepithelioma (~1%) Malignant:- Mucoepidermoid carcinoma→ Most common malignant salivary gland tumor in children→ Involves both epidermal and mucosal cells- Adenoid cystic carcinoma → Growth along nerve sheaths→ Cribriform or tubular growth pattern→ Very slow, but dangerous infiltrative growth- Acinic cell carcinoma- Adenocarcinoma- Metastases

Benign, slow-growing tumor of the parotid gland. Risk factors: Smoking, age, Caucasian, male, radiation.- Bilateral in 10%; multifocal in 10%. Cystadenoma: Ducts grow in size and fill with serous fluid & cellular debris which forms a large cyst.Papillary: The layer of epithelial cells starts to fold into the duct, which forms a finger-like projection.Lymphomatosum: Epithelial layer gets infiltrated by lymphocytes, which organize themself to what looks like germinal centers. Histology:- Papilli- Lymphocytes- Cystic space where the serous fluid and cellular debris are.- Not malignant → Does not break through basement membrane- Connective tissue capsule Symptoms: - Gradual and painless unilateral swelling of the parotid- May push against nerve → impaired hearing, ear aches, tinnitus, facial paralysis Diagnosis: - Imaging: X-ray, US, CT, MRI- Tissue biopsy Treatment: Surgical removal with preservation of facial nerve.

1. Bindegewebskapsel 2. Zystisch erweiterte Drüsengänge 3. Papilläre Strukturen in den Lichtungen: zweireihige, hoch prismatisches Epithel aus onkozytär differenzierten Zellen 4. Lymphozyten und sekundäre Keimzentren

1. Charakteristische kribriforme, teils tubuläre Architektur 2. Pseudozystische Räume sind gefüllt von Alcianblau-positivem mukoidem oder hyalinem eosinophilem Material 3. Perineuralscheideninfiltration (PNI) 4. Diffus ausbreitend

Oral cavity: Lips, gingiva (gums), floor of mouth, buccal mucosa, anterior 2/3 of the tongue, hard palate, retromolar trigoneOropharynx: Soft palate, tonsils, walls of the throat, posterior 1/3 of tongue Keratinized stratified squamous epithelium: Hard palate, dorsal surface of tongue, gingivaNonkeratinized stratified squamous epithelium: buccal mucosa, floor of the mouth, lateral & ventral surfaces of tongue, soft palate, retromolar trigone Premalignant changes:- Leukoplakia: White plaque, usually painless, can't be scraped away. Risk factor: Tobacco. - Proliferative verrucous leukoplakia: Affects women, rough white lesions, dysplasia - Erythroleukoplakia: Lesions develop red spots, epithelium becomes atrophic → visible blood vessels (red) → erythroplakiaDD: Frictional keratosis - Squamous cell carcinoma→ sun exposure, actinic chelitis, tongue, lower lip vermillon- Adenocarcinomas- Extranodal lymphomas- Melanomas Risk factors: Tobacco smoking, alcohol abuse, UV radiation, exposure to metal dust/chemicals, Plummer-Vinson syndrome, immune deficiencies- Tumors of the oral cavity are not associated with HPV (vs. oropharyngeal cancers) Diagnosis: Biopsy- Lymph node biopsy + imaging for TNM tumor staging

Fehlbildungen:- Mediale Halszyste- Laterale Halszyste Entzündliche Schwellung:- Furunkel- Abszess- Phlegmone- Entzündung der Schilddrüse oder Speicheldrüse Tumoren:- Hämangioma oder Lymphangiome- Glomustumoren- Neurogene Tumoren- Lipome- Tumoren der Schilddrüse oder Speicheldrüse Lymphome:- Lymphadenitis- Maligne Lymphome- Metastase

Location: - Primarily in the submandibular gland (∼ 80% of cases)- Parotid gland (∼ 20% of cases) Etiology: Dehydration or trauma Clinical features: - Sudden, significant pain while eating- Partial swelling of the glands Diagnostics:- Sonography- Sialography (rarely)- Possibly x-ray of the skull (particularly the base of mouth) Complications: acute or chronic sialadenitis Treatment: - Conservative: NSAIDs, gland massage, warm compresses, sour candies (to promote salivary flow).- Dilatation of the salivary duct or ultrasonic lithotripsy 

1. Massive lymphozytäre Infiltrate 2. Ausgeprägte Parenchymzerstörung mit praktisch vollständigem Verlust der Drüsenazini 3. Proliferation des Gangsystems mit Entwicklung epithelialer Zellinseln (proliferierte Gänge sowie wenig Restparenchym: LU-5-positiv)

Pharyngitis: - Viral (more common) or bacterial (Group A Streptococcus)- Reddened pharynx with white-yellowish deposits on both tonsils Tonsillitis in infectious mononucleosis:- Epstein-Barr virus (EBV)- Enlarged erythematous tonsils with white and grey deposits - Generalized lymphadenitis Tonsillitis in diphtheria:- Corynebacterium diphtheriae- Pseudomembranes Herpangina: - Coxsackie A virus- Multiple 1-mm vesicles located on the posteriororopharynx and tonsils; pharyngeal and tonsillar redness- May occur as a component of the hand, foot, and mouth disease Herpetic pharyngotonsillitis:- HSV-1- Multiple small oral lesions located in the anterior oropharynx and lips Vincent angina:- Synergistic mixed infection with Treponema vincentii and Fusobacterium nucleatum- Unilateral ulcers on the pharyngeal tonsils- Foul breath Oral thrush:- Candida albicans- Pseudomembranous stomatitis with white plaques

- Peritonsillar abscess - Parapharyngeal abscess - Otitis media - Sinusitis

All malignant tumors arising in the nasopharynx, oropharynx, or hypopharynx.- M > F - Nasopharyngeal cancer is rare in the United States; most common in Mediterranean and Chinese patients Risk factors: Tobacco, alcohol, poor oral hygiene, exposure to radiation Associations:- Nasopharyngeal carcinoma: EBV infection- Oropharyngeal carcinoma: human papillomavirus infection- Diseases causing atrophy of the mucosa (eg, Plummer-Vinson syndrome) Clinial presentation:- First manifestation often swollen cervical lymph node(s)Nasopharyngeal cancer:- Painless lymphadenopathy- Obstruction of the Eustachian tube: recurrent otitis media; conductive hearing loss- Discharge, nosebleeds, impaired nasal breathingOropharyngeal cancer and hypopharyngeal cancer:- Severe ear pain- Foreign body sensation, dysphagia, sore throat- Muffled voice Diagnosis:- Panendoscopy with biopsy and histopathological examination (confirmatory test): determines type, grade, and extent of the tumor- CT or MRI imaging 3 Subtypes:1. Keratinizing squamous cell carcinoma2. Non-keratinizing squamous cell carcinoma3. Undifferentiated squamous cell carinoma Treatment: Combination of surgery, radiation therapy, and chemotherapy