Chapter 16 - Head and Neck
Mark W. Lingen DDS, PhD
Vinay Kumar MD
Diseases of the head and neck range from the common cold to uncommon neoplasms of the nose. Those selected for discussion are assigned, sometimes arbitrarily, to one of the following
anatomic sites: (1) oral cavity; (2) upper airways, including the nose, pharynx, larynx, and nasal sinuses; (3) ears; (4) neck; and (5) salivary glands.
The oral cavity is a fearsome orifice guarded by ranks of upper and lower "horns" (lamentably, quite subject to erosion), demanding constant gratification, and teeming with
microorganisms, some of which are potentially harmful. Among the many disorders that affect its various parts, only the more important or frequent conditions involving the teeth and
supporting structures, oral mucous membranes, lips, and tongue are considered.
Teeth and Supporting Structures
Teeth contribute to a number of important functions, including mastication and proper speech. It is useful to briefly review normal dental anatomy before we delve into the common
pathologic conditions affecting teeth. As is well known, teeth are firmly implanted in the jaw and are surrounded by the gingival mucosa ( Fig. 16-1 ). The anatomic crown of the tooth
projects into the mouth and is covered by
Figure 16-1Schematic representation of the normal dental anatomy and surrounding supporting tissues.
Figure 16-2Fibroma. Smooth, pink, exophytic nodule on the buccal mucosa.
Figure 16-3Pyogenic granuloma. Erythematous, hemorrhagic, and exophytic mass arising from the gingival mucosa.
Figure 16-4Aphthous ulcer. Single ulceration with an erythematous halo surrounding a yellowish fibrinopurulent membrane.
TABLE 16-1-- Oral Manifestations of Some Systemic Diseases
Scarlet fever Fiery red tongue with prominent papillae (raspberry tongue); white coated tongue through which hyperemic papillae project (strawberry
Measles A spotty enanthema in the oral cavity often precedes the rash; ulcerations on the buccal mucosa about Stensen duct produce Koplik spots
Infectious mononucleosis An acute pharyngitis and tonsillitis that may cause coating with a gray-white exudative membrane; enlargement of lymph nodes in the neck
Diphtheria A characteristic dirty white, fibrinosuppurative, tough, inflammatory membrane over the tonsils and retropharynx
Human immunodeficiency virus
Predisposition to opportunistic oral infections, particularly with herpesvirus, Candida, and other fungi; sometimes oral lesions of Kaposi
sarcoma and hairy leukoplakia (described in text)
Dermatologic Conditions *
Lichen planus Reticulate, lacelike, white keratotic lesions that rarely become bullous and ulcerated; seen in more than 50% of patients with cutaneous lichen
planus; rarely, is the sole manifestation
Pemphigus Usually vulgaris; vesicles and bullae prone to rupture, leaving hyperemic erosions covered with exudate
Bullous pemphigoid Oral lesions resemble macroscopically those of pemphigus but can be differentiated histologically
Erythema multiforme A maculopapular, vesiculobullous eruption that sometimes follows an infection elsewhere, ingestion of drugs, development of cancer, or a
collagen vascular disease; when it involves the lips and oral mucosa, it is referred to as Stevens-Johnson syndrome
Date: 2016-04-22; view: 857