HEAD NECK 19 Short notes Epulis -Ludwig's angina

Chapter 14 page 1

Epulis

This  is an abnormal hyperplasia of the gums and is  produced  by

any  cause of chronic irritation (sharp edge of tooth cavity)  or

infection giant cell epulis is also because of inflammation.

Chapter 14 after 2.3

Torticollis

This  is the abnormal position of the head and neck caused  by  a

spasm  of  the  neck muscles. It can be  caused  by  an  abnormal

position while sleeping or an injury at birth. Treatment is  with

physiotherapy  and ultrasound. In the birth injury stretching  of

the muscles can also help.

Chapter 14 after 7.2

Adamantinoma

This is a multilocular cystic swelling usually seen in the  lower

jaw. It causes a bony expansion which can be seen on Xray. It  is

a slow growing tumour but invades tissue locally. The patient  is

20-30 years. Treatment is by local Excision.

Chapter 14 after 4.6

Ameloblastomar

This  tumour takes origen from the enamel organ of the teeth  and

can be seen in the upper or lower jaw also called admantinoma.  A

slow growing low-grade malignat tumour expands the jaw. X-ray  is

a  "soap  bubfle"  multiloculated cystic expansion  of  jaw.  The

lesion has to be excised and replaced with a bone graft.

Chapter 14 after 4.6

Odontoma

There are cysts that origen from ectodermal and mesodermal  teeth

producing tissue in the mouth. These cysts expend the jaw and are

usually benign.

Chapter 14 after 4.2

Ludwig's Angina

This  is  a severe cellulite of the submandibidor region  due  to

tooth  abscess  due to anaerobes and spirochetes the  ocdena  can

cause  respiratory obstruction. The patient needs  admission  and

 hugh dose of antibiotic and metronidazole.

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HEAD NECK 18 malignant parotid

8.6.1 MALIGNANT MIXED TUMOURS

Malignant mixed tumours arise from a neoplastic transformation of

a  benign mixed tumour.  Patients are generally older,  malignant

lesions  are  usually  larger and any mixed  tumour  may  contain

within  it malignant elements and may result in  adeno-carcinomas,

squamous cell carcinoma or malignant spindle cell alternation.

With  the exception of mixed tumours; benign lesions of  salivary

tissues have no malignant potential.

CLINICAL PRESENTATION

Mixed  tumour may grow for years at a slow pace.   The  malignant

component  suddenly develops and there is a marked change in  its

course.

Fixation  of  glands to skin or underlying  structures,  palpable

nodes and involvement of the VIIth nerve are all diagnostic.

Excision of the mass and histologic examination are indicated  in

every case.

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HEAD NECK 17 Parotid tumors

8.5 TUMOURS

8.5.1 MIXED TUMORS

A  common  lesion  of the salivary gland  is  the  mixed  tumours

(pleomorphic adenoma).

*  Eighty  percent of all benign tumours probably originate  from

   the myoepeithelial cells of the ducts.

*  Microscopic examination shows a network of strands of  spindle

   shaped and stellete cells.

*  In  one-third  of  cases loose  myxoid  pattern  predominates. 

   Half, in addition, have pseudocartilaginous structures.

Treatment  is  superficial  Parotidectomy  with  conservation  of

branches of the facial nerve.

8.5.2 PAILLARY CYSTADENOMA LYMPHOMATOSUM (WHARTHIN'S TUMOUR)

The lesion feels firm on examination and represent parotid tissue

sequestered in a lymphnodes.  It is the second most common benign

tumour of salivary tisse

The Histogenesis is unceertain

Treatment is surgical excision.

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HEAD NECK 16 Sialolithisis sialoadenitis

8.4 SIALOLITHIASIS (STONES)

Calculi  sometimes form within the ducts of salivary  glands  and

this occurs because of poor drainage and change of pH.

The symptoms are those of obstruction and distension of the gland

following  the  taking of food.  The gland may  enlarge  and  may

become palpable.

The  stone may be felt in the cheek in the parotid duct  and  the

floor of the mouth in the case of Submandibular duct symptoms are

of pain and swelling.

Treatment is by removal of the stone .

SIALOADENITIS

This occurs most often with invasion by bacteria.

Acute  parotitis occurs, with the symptoms of pain, swelling  and

fever progress is rapidly in these cases .

Obstruction  of the duct plays a causative role  dehydration  and

malnutrition also contribute.

Treatment  is  removal  of  causitive  factors  and  antibiotics. 

Drainage of abscess may be required.

Recurrent sialoadenitis also occur with repeated episodes of pain

and swelling with fever and its complication of orchitis has been

discussed elsewhere.

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