NASOPHARYNGEAL CARCINOMA - Undifferentiated CA of squamous cell origin - Higher frequency in Mediterranean and Far Eastern population - Usually asymptomatic until disease is advanced; usually metastasized by the time of diagnosis - Sx: recurrent otitis media (due to obstruction of Eustachian tube by tumor), recurrent epistaxis, and/or nasal obstruction - Strong association: positive serologies for EBV. The association is so strong that EBV titer levels may be used to track the progress of therapy for this malignancy - Other associations: smoking and with chronic nitrosamine consumption (as in diets rich in salted fish)
DEEP NECK SPACE INFECTION - They have become rare because of antibiotics - Can spread rapidly and can be fatal
RETROPHARYNGEAL SPACE INFECTION/ABSCESS: - C/F: neck pain, fever, and limited neck mobility secondary to pain, difficulty swallowing (dysphagia), pain with swallowing (odynophagia). Trismus (inability to open the mouth normally) and limited cervical extension— very common - Source of infection: usually local penetrating trauma, which may occur after instrumentation or following an injury from a chicken bone - Complete evaluation of extent of infection: CT of the neck and/or lateral radiographs of the neck— may demonstrate lordosis of the cervical spine with gas and swelling in the retropharyngeal space. - Treatment: IV broad-spectrum antibiotics and urgent drainage of the abscess—to avoid spread into the mediastinum - Complications: Highest risk of spread to mediastinum, particularly anterior and posterior portions of superior mediastinum + entire length of posterior mediastinum Abscess can form in “danger space”, which is the space between alar and prevertebral fascia and drain by gravity in to posterior mediastinum, resulting in acute necrotizing mediastinitis Early diagnosis and debridement of mediastinum—essential in treatment of this severe complication
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LUDWIG ANGINA - An infection in the submandibular space, also known as Ludwig’s angina, typically begins in the floor of the mouth and extends through the submandibular and sublingual space into the tissues surrounding the airway It does not commonly extend into the mediastinum - Sublingual space is a division of the submandibular space. As a result, an infection in the sublingual space is classified as a submandibular infection as well, which typically involves the tongue, palate, pharynx, epiglottis, and tissues surrounding the upper airway.
TORUS PALATINUS - Chronic benign bony growth (i.e. exostosis) located on midline suture of hard palate - Can be due to genetic or environmental factors - More common in younger pts, women and Asians - Usually <2cm but can ↑ in size throughout a person’s life - Non-tender and chronic - Thin epithelium overlying bony growth, ulcerates with normal trauma of oral cavity and heal slowly due to poor vascular supply - Management: surgery for those in whom mass becomes symptomatic, interferes with speech or eating, causes problems with fitting of dentures later in life