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Upper Airway Path, Ear, Upper Airways LARYNX INFLAMMATIONS - Laryngitis - Most common d/o Esp via URI or heavy tob smoke exposure -tob->squamous epith changes->CA -allergic, viral, bacterial, chemical insult -also affected in TB, diphtheria All mostly self-limited, but serious in kids, infants->obstruction H.influenzae->laryngoepiglottitis, GAS Croup=laryngotracheobronchitis in kids -inspiratory stridor via narrowed airway -Parainfluenzae, Upper Airways TUMORS OF NOSE, SINUSES, NP MALIGNANT Isolated Plasmacytoma -lymphoids near nose, sinuses -can protrude into cavities -covered by intact mucosa -histo like plasma cell tumor -rarely -> mult myeloma Olfactory Neuroblastoma-small cell tumor (Esthesioneuroblastoma)-Zellballen -highly malign, mets, uncommon -from superolateral neuroendocrine cells -secretory granules, some w/ trisomy 8 Stain-Enolase, S-100 protein, Chromogranin Nasopharyngeal Carcinoma-environmental -Africa-most frequent childhood CA -China-most common adult CA, no kid -US-rare -related to lymphoid tissue(mimic lymphoma) -ass’d w/ heredity, age, EBV 1.Keratinizing SqCC 2.Nonkeratinizing -poorly diff’d; EBV 3.Lymphoepithelioma (bad name)Undiff’d- non-neoplastic, lympho infiltrate- EBV(in epith) -syncytial arrangement, Upper Airways TUMORS OF NOSE, SINUSES, NP BENIGN Nasopharyngeal Angiofibroma-vasc -ADOLESCENT MALES -benign but BLEEDS during surg Inverted Papilloma-benign, but locally aggressive in nose, sinuses -squamous epith grow IN -can invade orbit, vault -can recur or rarely->frank CA (15%) -HPV in some, Upper Airways NOSE INFLAMMATIONS Infectious Rhinitis-“common cold” -Adeno, Rhino, Echovirus (ARE) ->profuse catarrhal discharge -initial-mucosa thickened, edematous, red -nasal cavities narrowed, enlarge turbs can->pharyngotonsillitis -2° bac->more inflam->mucopurulent, supp -cleared in 7+days Allergic Rhinitis-hay fever -plant pollens, fungi, animals, dust mites -Type I HS – IgE; early, late phases -mucosal redness, edema, secretion -eosinophilic infiltrate, Salivary Glands NEOPLASMS Parotid>Submandib>others Malignancy-Subling>other> Subman>Par -inverse to size of gland PLEOMORPHIC ADENOMA - up to 6 cm “Benign Mixed tumors”-60% of par. tumors -epith, mesenchymal diff’ation (myxoid, hyaline, chondroid, osseous) -myoepith or ductal reserve cell origin -radiation increases risk MORPH-mostly encapsulated -mixed presentations -awful regrowth if not excised completely CLINICAL-painless, slow, mobile -infrequently->carcinoma (very aggressive) Carcinoma ex PA, Upper Airways EAR TUMORS - Rare epith, mesenchymal tumors -BCC, SCC in pinna more common -elderly men, ass’d w/ actinic radiation -SCC w/in canal -middle-aged women, not ass’d w/ sun can->invasion of cranial cavity, mets to LN -5 yr mort = 50% Papules->extend, erode, invade locally -often don’t extend beyond local invasion, Upper Airways NOSE NECROTIZING LESIONS Via: spreading fungi (mucor in DM) Wegener’s Granulomatosis (c-ANCA) Lethal Midline Granuloma (polymorphic reticularis) -angiocentric NHL (NK cells) -lymphomatous lesions elsewhere ->ulceration, bac infx -effective Tx achievable, Salivary Glands NEOPLASMS Parotid>Submandib>others Malignancy-Subling>other> Subman>Par -inverse to size of gland MUCOEPIDERMOID CA - up to 8 cm Mix of squamous, mucus-secreting, hybrid cells -in cords or sheets 15% of all saliv tumors, mostly in parotids -large portion of small gland tumors -most common MALIGNANT tumor -most common RADIATION-INDUCED CA MORPH-entirely circumscribed -but infiltrative at margins -small, mucin-containing cysts -mixed cells w/ mucus, but squamous -cells can look benign or malignant -low-grade w/ mucus cells->glands -high-grade w/ squamous CLINICAL-depends on grade (% non-cystic), Neck TUMOR PARAGANGLIOMA (CAROTID BODY) Rare, 6th decade, Auto Dom transmission (Mult. Endocrine Dysplasia Syn) Paraganglia-neuroendocrine clusters 2 locations: 1.Paravertebral paraganglia-sympa, chromaffin+ 2.Aorticopulmonary chain w/ carotid bodies -parasympa-NON-chromaffin -infrequent catecholamines MORPH-red-pink – brown Zellballen of chief cells in fibrous trabecs -Enolase, S-100, chromogranin stains OFTEN RECUR after excision, 50% fatal, Upper Airways NASOPHARYNX INFLAMMATIONS - Pharyngitis, Tonsillitis -Viral URIs(Adeno, Rhino, Echo, RSV, Flu) ->reddening, slight edema of mucosa -enlarged LNs -bac primary or 2ndary (GAS, S. aureus) Severe-kids, infants-no protective imm -Adults w/ immunodef, DM, disrupted oral flora (ABX) ->pseudomembrane (exudative) ->enlarged palatine tonsils (exudatious) -“follicular tonsillitis” Strep throat can->RF, Glomerulonephritis Recurrent tonsillitis->residually big LNs