9 - TUMORS & c.

Lymphosarc - Superior spread to

INFECTIOUS oma anterior cranial fossa
GRANULOMAS OF URT d. Melanoma - Inferior spread to
& EAR pterygoid plates
TUMORS OF THE Symptoms
NOSE Inferior spread 3. Biopsy
RHINOPHYMA - Palate swelling/ erosion
- Males past middle age - Teeth loosening Treatment
- Leads to deformity, - Wide alveolar ridge in 1. External
distress & edentulous ptt irradiation
disfigurement - 6000 rads full course
Lateral spread
Examination - Cheek redness& 2. Radical surgery:
- Hypertrophy of swelling Maxillectomy
sebaceous gland of - Obliteration of buccal - do 6 weeks after
nose tip sulcus radiation
- Bulbous swelling of
nasal apex Upward Spread 3. Palliative
- Coarse & pitted skin - Epiphora (nasolacrimal - General nursing care
- Oily skin duct block) - Psychological support
- Red/ blue skin - Diplopia (inferior - Pain relief
oblique/rectus mm
Treatment fixation) 4. Chemotherapy
- Shave off excess tissue - Proptosis (globe lateral - if lymphomatous
displacement)
MALIGNANT TUMOR Maxillectomy
OF NOSE Medial Spread Risk
Etiology - Nasal obstruction 1. Removal of eye
1. In sinuses - Purulent (superior spread)
- Maxillary sinus serosanguinesous 2. Cheek soft tissue
- Ethmoidal sinus discharge resection
- Frontal sinus
- Sphenoid sinus Posterior Spread Contraindication
1. To pterygoid 1. Elder with other
2. In nasal tumor plates coexisting dss
- Septum - Spasm & trimus of 2. Trismus
- Lateral wall masticotory mm 3. Cervical glandular
enlargement
Pathology 2. To base of skull 4. Erosion of base of
1. Carcinoma - intense headaches skull
a. Squamous 5. Distant
cell carcinoma(80%) Late metastases
b. Adenocarcin - Pain
oma - Lymph nodes spread Prognosis
c. Adenoid - Better if anterior &
cystic carcinoma Examination inferior spread
d. Transitional 1. Anterior - Poor if superior
carcinoma rhinoscopy - In children & young
- friable granuloar tumor adults – grave ouitlook
2. Sarcoma mass bleeds easily - Common squamous
a. Fibrosarcom carcinomas: 30% 5
a 2. X – Ray / year survival.
b. Myxosarcom Tomography
a
- Salivary gland origin 2. Based & attached
tumor: better short at sphenoid bone body Treatment
term prognosis. 3. Fill nasopharynx 1. Radical
4. Offshoots to: a. Operative
TUMORS OF PHARYNX a. Nasal removal
BENIGN TUMORS OF sinuses i. Preoperative
NASOPHARYNX b. Upper jaw therapeutic
- Usually c. Sphenoid embolization of
nasopharyngeal sinus vessel to  bleeding
angiofibroma d. Pterygopalat ii. Pr
- Male 20 – 25 ine fossa eliminary ligation of
- If juvenile n.a = 10 – e. Cheek E.C.A
25 yrs f. Ethmoid sinuses
g. Orbit 2. Palliative
Symptoms - Expansion to middle
Nose 5. Erode base of skull cranial fossa
- Nasal obstruction into cranial cavity - High operation risk
- Purulent rhinosinusitis - Options:
- Spontaneous bleeding Diagnosis a. Radiotherap
fr nose/pharynx 1. Palpation y
- Rhinolali a clausa 2. Mirror b. Hormone
3. Nasopharyngosco therapy
Ear pe loupe endoscope
- Conductive deafness 4. X – ray & RARE BENIGN
- Middle ear catarrh Tomograms NASOPHARYNGEAL
- Purulent otitis media - anterior / posterior / TUMORS
lateral planes Types
Head 1. Chordoma
- Headaches 5. Angiograms 2. Teratoma
- Bilateral ext & int 3. Dermoid
Posterior Rhinoscopy carotid aa 4. Fibroma
1. Tumors in 5. Lipoma
nasopharynx 6. Therapeutic
- Smooth embolizaiton Chordoma
- Greyish red - superselective - Man – 20 – 50 y.o
- Lobulated angiography of carotid - Dev fr notochord and
- Penetrate choana / branches extend to
rosenmuller fossa 1. Skull  cranial nn
- Vessels on surface 7. CT Scan lesion
- assess intracranial 2. Sphenoid sinus
Later Stage cavity involvement 3. Neck metastasis
- Swelling of lateral part
+ face + nasal 8. Biopsy Treatment
skeleton - may lead to massive 1. Radical: Surgery
- Cheek protrusion bleeding 2. Palliative:
- Hard tumor on Radiotherapy
palpation Differential Diagnosis
Pathogenesis 1. Hypertrophied MALIGNANT TUMORS
- Benign histologically adenoids OF NASOPHARYNX
- Malignant grossly 2. Choanal polyp 1. Most common
(soft, x bleed) (man 2x women)
Course: 3. Lymphoma a. Squamous
1. Roof of 4. Chordoma cell carcinoma
nasopharynx 5. Teratoma
 b. Lymphoepith Diagnosis TUMORS OF
elial tumor 1. Rhinoscopy OROPHARYN
2. Nasopharyngosco X
2. In children py Classification Of
a. Lymphoma 3. Palpation Oropharynx by
b. Plasmacyto 4. Soft palate UICC
ma retraction Acc To Site
c. Burkitt’s 5. Biopsy 1. Roof : Soft
lymphoma 6. Tomograms (A,P,L palate
view) 2. Floor : Post
Symptoms 7. CT Scans 3rd tongue &
Oral & Nose lingual
- Nasal obstruction Treatment epiglottis
- Bloodstain purulent 1. For mesenchymal 3. Lateral wall :
nasal discharge tumor & anaplastic Tonsil, ant & post
- Massive node bleeds carcinomas pillars
- Oral fetor a. Radiotherap 4. Posterior wall :
y Post wall pharxnx
Ear b. Chemothera fr hard
- Unilateral conductive py palate to
deafness hyoid level
- Middle ear discharge 2. For small
- Middle ear effusion circumscribed Acc To T Staging
Head nasopharyngeal tumor 1. T1 : < 2cm
- Headaches a. Surgery 2. T2 : 2 – 4cm
-  unilateral pain in b. Electrocoagu 3. T3 : > 4cm
head and face lation 4. T4 : to bone,
- Gradual protrusion of c. Post mm, skin, neck
soft palate operative
- Loss mobility of soft radiotherapy Tumors Elements
palate 1. Squamous
- Exophthalmos 3. For advanced epithelium
carcinomas 2. Lymph tissue
Neurological a. Radiotherap 3. Minor salivary
A. Oculomotor paralysis y glands
1. III (3rd) b. Chemothera
2. IV (4th) py Incidence
3. VI (6th) Type
4. For lymph nodes 1. Squamous cell
B. Other cranial nn metastasis carcinoma -
1. V (5th) a. Neck 75%
2. IX (9th) dissection after 2. Lymphoma -
3. X (10th) destroy 1 tumor 15%
4. XI (11th) Prognosis 3. Lymph
5. XII (12th) - 15% 5 year survival epitheliioma - 5%
- For stage 1, 30% 5 4. Minor salivary
Metastases year survival gland tumor - 5%
1. Lung
2. Liver Site
3. Skeleton 1. Lateral wall -
4. Retropharyngeal & 45%
nuchal lymph nodes 2. Base of tongue -
metasis 40%
3. Posterior wall - b. Surgery 3. Malignant salivary
10% tumor
4. Soft palate - 5% 2. If palpable neck a. 1st 5 years:
gland 70%
Individual a. Surgery to b. > 10 years:
- Men: female = 10: 1 remove 5%
- Age 80 y.o - fauces
- part of palate 4. Squamous
Clinical Features - base of tongue carcinoma
History - part of mandible a. Tonsillar
- Sore throat - radical neck tumor > base of
- Otalgia dissection tongue tumor
- Dysphagia b. No
- Lump in throat feeling 3. Reconstruction prediction of soft
- Gland in neck (only after surgery palate & posterior
symptom in tonsillar - Due to crippled oral wall tumor
carcinoma) cavity
- graft TUMORS OF THE
a. forehead LARYNX
Nasopharyngeal & flap BENIGN TUMORS
Laryngeal Mirror b. Fibroma Of Larynx
- Ulcerated carcinoma myocutaneous flap of Symptoms
- Smooth enlargement pectoral mm - Hoarseness
lymphoma / salivary - Aphonia (return if
gland tumor For Posterior Wall polyp has pedial &
Carcinoma floating btw cord)
Investigations 1. Radiotherapy - Coughing attack
1. X – Ray 2. Lateral - Dyspnea (if large)
- x help if mandibular pharyngotomy
invasion 3. Recosntruction Pathogenesis
- essential in lymphoma - Most common
For Lymphomas - Usually in Man
2. Lab investigation 1. Irradiation
3. Biopsy 2. Chemotherapy (if Etiology
spread) 1. Laryngitis agent
Treatment 3. Surgery (if involve 2. Hyperkinetic voice
For Carcinoma tonsil) disorder
20% non curable due to: 3. Vocal abuse
1. Highly anaplastic Prognosis
tumor Depends on: Laryngoscopy
2. Bilateral neck 1. Tumor - Fibroma on free edge
gland 2. Size of vocal cord
3. Trismus 3. Neckgland - Pedicle / sessile
4. Distant metastasis metastasis - Seroedematous /
5. Refusal to 4. Age hemoprrhagic
treatment 5. General state of - Firm in old fibromas
6. Advanced age patient
7. Poor general Treatment
condition Survival 1. Endolaryngeal
1. Lymhoma 70% ( microsurgery
For Tonsil Carcinoma in head & neck) - preserve vocal
1. If no palpable 2. Benign salivary ligament
neck gland gland tumor low - preserve vocalis mm
a. Irradiation recurrence
2. Direct / indirect - increase incidence w Forms
laryngoscopy removal smoking 1. Carcinoma
a. Keratinizing
Papillomas TNM System squamous cell
Symptoms T (Tumor) carcinoma
- Hoarseness T1 - 1 anatomical site in b. Non
- Respiratory obstruction larynx keratinizing
T2 - 1 region of larynx squamous cell
Pathogenesis T3 - > 1 region but in carcinoma
- Viral cause larynx c. Verrucous
- Juvenile papilloma T4 - beyond larynx carcinoma
gone at puberty d. Adenocarcin
(hormone) N(Regional LymphNodes oma
Metastasis)
Diagnosis N0 - None 2. Sarcoma
1. Indirect / direct N1 - mobile homolateral a. Carcinosarco
laryngoscopy nodes ma
- In larynx – oropharynx N2 - mobile b. Fibrosarcom
– subglottic space contra/bilateral nodes a
tumor is: N3 - fixed nodes c. Chondrosarc
o pedicled M (Distant Metastasis) oma
o solitary M0 - None
o widespread M1 - Present Metastasis / Spreading
1. Supraglottic
- surface: Regions carcinoma
o yellow to red 1. Supraglottic To preepiglottic space
1.Lower -part
o granular + villous epiglottis
o raspberry appearace 2.
2.False cords Glottic carcinomas
- to
3.Ventricles subglottic space
2. Histologic 4.Arytenoids
examination 2. Glottic 3.
1.Vocal cords Transglottic
2.Anteriorcarcinoma
Treatment - cant find site of origin
comissures
Spontaneous regression Factors Of Metastasis
3.Posterior
possible. 1.
comissures Intralaryngeal
1. Immunologic 3. Subglottic lymphatic
1.Subglottis wall
2. Antiviral characteristic
3. Microsurgery Symptoms 2. Symptom duration
4. Laser surgery - hoarseness 3. Histologic
- feeling of foreign body differentiation
Surgical Disadvantage - throat clearing 4. Size of tumor
1. Recurrence - pain in thrapat 5. Site of tumor
tendency - dyspnea
2. New foci - Dysphagia Frequency Of Metastasis
3. Vocal cord - Cough 1. Subglottic
function interference - Hemopatysis carcinoma - 20%
- Lymph node 2. Supraglottic
MALIGNANT TUMORS metastasis carcinoama - 40%
Laryngeal Carcinoma 3. Transglottic
- 45% of head & neck Pathogenesis carcinoma - 40%
carcinoma - Carcinoma in situ 
- 45 – 75 y.o, men 10x > dysplasia  invasivev Diagnosis
women carcinoma 1. Indirect
laryngoscopy
2. Telescopic Surgical Procedures Treatment
laryngoscopy For Laryngeal - Antibiotic:
3. Microlaryngoscopy Carcinoma Streptomycin,
4. Biopsy 1. Microsurgical tetracycline
5. Histological decortication of vocal - Local excision
examination cord - Dilatation of nasal
- severe dysplasia cavities
Differential Diagnosis - carcinomas in situ - Insertion of polythene
1. Chronic laryngitis tube 2 mo
2. Benign laryngeal 2. Cordectomy
tumors - vocal cord carcinoma Scleroma Of Larynx
w mobile vocal cord Symptoms
Treatment - during direct - Smooth red swelling
1. Radiotherapy laryngoscopy - Crust covering
(T1No & T2No) - Nasal obstruction
2. Surgery 3. Vertical / - Hoarseness
3. Chemotherapy Horizontal Partial - Wheezing
laryngectomies - Stridor
Complication Of - unsuitable cordectomy
Radiotherapy but unnecessary total Diagnosis
1. Persistent edema laryngectomy 1. Biopsy
2. Dysphagia - preserve vocal fn & - plasmas cell
3. Ageusia airway - hyaline bodies
4. Xerostomia - granulation tissue
5. Sicca syndrome 4. Total - Mikulicz cells
6. Recurrent tumor laryngectomy
7. Lymph node - tumors that cant be Treatment
metastasis removed by - Streptomycin
cordectomy / partial - Steroids
Prognosis laryngectomy
If untreated - Death - tumors spreading to SYPHILIS
within 12 months due neighboring structures Laryngeal Syphillis
to: - recurred tumor after Symptoms
- Asphyxia radiotherapy / partial - Mucous plaques
- Bleeding procedures - Hazy, smoke color
- Metastasis mucosal lesion
- Infection SCLEROMA - Hoarseness
- Cachexia Scleroma Of Nose - Mucosal swelling 
Etiology airway obstruction
- Klebsiella - Destroyed cartilage in
rhinoscleromatosis gumma III

Clinics Diagnosis
- Hard rubbery nodular - Biopsy
infiltration of mucous - Serological
membrane
- Red-brown color  Nasal Syphillis
pale pink Inherited Syphillis
- Nasal obstruction - Snuffles fr 3 mo old
- Crusted discharge - Obstinate nasal
- Painless nasal cavity discharge
stenosis - Crust
- Fissures at anterior
nares
 - Tonsillar enlargement - Perichondritis /
Gumma Stage - Mucous patch: round/ monocorditis danger
- Gummatous ulceration oval + bluish-grey +
- Atrophy congestion zone Diagnosis /
- Scarring - Multile symmetrical Microlaryngoscopy
- Depressed nose bridge patches Fresh
- Foetid crust in nasal - Confluent patches - Reddish brown
cavity - Ulceration – dirty grey submucus nodules
- Defect teeth & cornea color - Ulceration /
- Enlarged cervical granulation
Acquired Syphillis glands
Secondary - Skin eruption Monocarditis
- Mucous patches - Redness & thickening
Tertiary - Small ulceration on
Tertiary / Gumma - Hard purplish swelling one vocal cord
- Irregular mamillated - Center punched out
infiltration ulcer Differential Diagnosis
- Dark red - Greenish yellow base - Vasomotor
- Perforated septum - Red indurated edges monocorditis
- Destruction of external - Nonspecific hcornic
nose Symptoms laryngitis
- Nasal obstruction Secondary - Carcinoma
- Head ache - Slight pain in throat
- Nose pain - Dysphagia Treatment
- Swollen and tender - Anti TB
nose Tertiary - Blocking of SLN to
- Ulceration - Nasal speech treat pain
- Purulent discharge - Food enter nose while - Isolation & contact
- Crusts eating investigation
- Stench/odor
Diagnosis Course & Prognosis
Diagnosis - Ulceration / membrane - Infectious
- Granular lesion formation - Lesion heal wo
- Foedtid crust - Gumma permanent fn effect
- Serological - Serological - Good
- Biopsy
Treatment TB Of Pharynx
- Penicillin Treatment Acute military TB
- Douching nose - Local hygiene Symptoms
- Remove all loose TUBERCULOSIS - grey/yellow tubercles
sequestra Laryngeal on fauces/ palate
Tuberculosis - shallow ulcers
Syphilis Of Pharynx Symptoms - pain on swallowing
Primary - Hoarseness - excess salivation
- Unilateral chancre - Coughing for motnhs - throaty voice
- Enlarged cervical - Pain on - rapid emaciation
glands swallowing,radiate to
- Cartilaginous hardness ear Diagnosis
- T. pallidum - pain (if syphilis no
Pathogenesis pain)
Secondary - 2 infection from - Biopsy (to DD
- + Spirhochetes pulmonary TB diptheria)
- congestion of palate - go to larynx by bacillae - Throat swab
and fauces in sputum
Treatment
- Anti TB therapy
Tuberculosis Of The
Tonsil
- No characteristic
features
- Diagnosis of TB
cervical glands
- Histological
examination
- TX: antitb tgeraot

Lupus Vulgaris & TB

Of Nose
Etiology
- Mycobacterium
tuberculosis
- Affect nasal vestibule,
septum & ala
- Female > male

Symptoms
- Granulation tissue
- Ulceration
- Sanguinesou
mucopurulent
discharge

Diagnosis
- Granulomatous lesion
- Histological
- Heaf test

Treatment
- Streptomycin
- PAS
- Isoniazid
- Riampicin
- Ethambutol