Oral Cavity & Neck

·         Adenoid cystic carcinoma is often described as having a Swiss cheese appearance based on its histology.

Tubular: best prognosis

Cribriform: fair to "middlin"

Solid: worst prognosis

·         After patotid,The sites most commonly affected by pleomorphic adenomas of the salivary glands are the lips, tongue, and palate.

·         Verrucous carcinoma is a less aggressive form of locally invasive buccal cancer than the usual epidermoid form. Its frequency is increased in people who chew tobacco. The tumor usually grows very slowly, occurs chiefly in the gingivobuccal gutter, and has a tendency to invade bone. It is identified by its characteristic exophytic, white, shaggy appearance. Wide excision is the best initial treatment for this neoplasm. Even though the tumor may regress in response to radiation, it tends to recur in a more malignant form with metastases. Cervical metastases usually are not present when the lesion is first diagnosed; it is only for the most highly malignant grades of verrucous carcinoma that radical neck dissection and block excision of the cheek are indicated.

·         Acinic cell carcinoma can present bilaterally in 3% of cases.

·         "FACIAL NERVE---secretomotor N.fibres of SphenoPalatine Ganglion supply the Lacrimal gland, Injury to Facial N.at Geniculate Ganglion-->Dryness of eyes, Site of lesion of F.N. causing Lacrimal gland involvement is Matoid Foramen, FACIAL NERVE PALSY---common cause--Bell's Palsy, F.N.P.-due Trauma, Immediate Rx--Decompression,"

·         A Simonart's band is a thin remnant of tissue in the floor of the nasal vestibule bridging the medial and lateral lip elements across the cleft. The tissue may consist of skin and/or mucosa and subcutaneous tissue with or without muscle fibers. The origin of the term is obscure, but many attribute it to Pierre Joseph Cécilien Simonart, a Belgian obstetrician (1817-1847).

·         repair of unilateral cleft lip:

Tennison-Randell repair: The medial lip element is lengthened by introduction of a triangular flap from the inferior portion of the lateral lip element.

Hagedorn-LeMesurier repair: A quadrilateral flap developed from the lateral lip element is introduced to lengthen the medial lip element.

Rose-Thompson repair involves curved or angled paring of the cleft margins to lengthen the lip as a straight-line closure.

Skoog repair: The medial lip element is lengthened through the introduction of two small triangular flaps developed from the lateral lip element.

·         repair of bilateral cleft lip:

Millard rotation-advancement repair: The medial lip element is rotated inferiorly and the lateral lip element is advanced into the resulting upper lip defect. The columellar flap is then used to lengthen the columella or create the nasal sill.

Veau repair: The Veau operation is a straight-line closure without elevation of the prolabial skin and correspondingly without any attempt to restore the continuity of the orbicularis oris.

Millard's repair involves complete elevation of the prolabium and reconstitution of the orbicularis across the premaxilla. In addition, Millard banked lateral segments of the prolabium as "forked flaps" that were meant to add columellar height at a later stage.

Manchester repair: Manchester preferred to maintain the prolabial vermilion to create the cupid's bow and tubercle, but similarly to Veau, Manchester did not repair the orbicularis because he thought it would create an overly tight lip.

·         cleft palate repair:

Two-flap palatoplasty

Wardill-Kilner V-Y advancement

Von Langenbeck palatoplasty

Furlow double-reversing Z-plasty

·         Burning mouth syndrome (BMS):

BMS is an intraoral pain disorder that occurs despite a clinically normal appearance of the oral mucosa. The tongue tip, anterior hard palate, and oral lower lip are most frequently affected. For most patients, the burning pain starts midmorning or early afternoon and is followed by dry mouth, dysgeusia, and thirst. Most patients diagnosed with BMS are postmenopausal women. The etiology is still unclear. The dysgeusia involves either a persistent taste or an alteration in taste perception. The persistent taste is most commonly described as bitter or metallic in quality.

Some patients find relief with clonazepam, a benzodiazepine, which is often used as an anticonvulsant. Treatment starts at 0.25 mg of clonazepam taken at bedtime for 1 week. The daily dose can be increased by 0.25 mg each week, up to a total dosage of 3 mg.

 

·         Zinc is commonly prescribed in the treatment of taste and smell disorders. There is, however, no evidence that it is helpful. A double-blind study demonstrated that it was no more effective than a placebo in the treatment of taste and smell dysfunction. Zinc appears to be helpful only when the patient is zinc deficient.

·         CLINICAL MANIFESTATIONS OF ORAL CANDIDIASIS

1.       Pseudomembranous candidiasis (thrush)

2.       Acute atrophic-erythematous candidiasis

3.       Chronic atrophic candidiasis

4.       Angular cheilitis

5.       Chronic hyperplastic candidiasis

6.       Median rhomboid glossitis

·         Palatal and mandibular tori are smooth swellings of bone along the palate and lingual surface of the mandible, respectively.

·         Herpes zoster oticus, in its simplest form, is characterized by intense ear pain and vesicles on the external auditory canal and concha, thus indicating that the dormant herpes zoster (chickenpox) virus has reactivated to affect sensory afferent neurons. If viral involvement progresses to involve the efferent motor axons of the facial nerve, then Ramsay Hunt syndrome has developed. This syndrome is characterized by the coexistence of (1) a facial nerve palsy and (2) vesicular eruptions on the head and neck in the distribution of the affected cranial nerve or cervical plexus.

·         OPMD (oculopharyngeal muscular dystrophy) is an autosomal dominant form of muscular dystrophy that is asymptomatic until middle age, when it produces ptosis and dysphagia.

The ptosis is treated by surgery to suspend the upper eyelid. The dysphagia can be treated by cricopharyngeal myotomy, esophageal dilation, or botulinum toxin injection into the CP muscle.

·         The salivary glands arise as epithelial outpouchings from the primitive oral cavity, or stomodeum, beginning in the fourth week. The parotids usually arise first (week 4), followed by the submandibular glands (week 6) and the sublingual glands and the minor salivary glands (week 9).

·         The retropharyngeal space lies just anterior to the alar layer and posterior to the esophagus and pharynx. Just posterior to this is a potential space known as the danger space, which lies between the alar fascia anteriorly and the prevertebral space posteriorly. This potential space goes from the skull base to the mediastinum. It has only loose connective tissue and is an easy route of spread into the mediastinum, causing mediastinitis. This may be a point of anatomic minutia. During surgical drainage of these areas, a dissecting finger is used to disrupt and drain the retropharynx and the danger space as one unit. The retropharyngeal space also contains lymph nodes, so occult metastases may occur here.

·         Cherubism is a benign, self-limiting disease of the jaw bones. This rare congenital disorder displays an autosomal dominant inheritance pattern. It is more common in males and usually presents prior to the age of 5 years with premature tooth displacement and loss. Symmetric mandibular enlargement may lead to a mild cosmetic deformity, giving these children a round, cherub-like face. Radiographically, the lesions are bilateral, multiple, multilocular, well-defined radiolucencies with a thin or absent cortex. The prognosis is generally favorable. Some patients may require facial contouring, but the disease features generally regress spontaneously by puberty.