PANCE Blueprint EENT (7%)

Gingival Hyperplasia: Overgrowing of gums so that it blocks the teeth, commonly caused by medications. phenytoin, CCB's and cyclosporine

Vincent's Angina: “Trench Mouth” necrotizing gingivitis: characterized by the “punched-out” appearance of the gingival papillae

Dental abscess: Poor dental health is a risk factor for a dental abscess or facial cellulitis, treat with IM ceftriaxone and amoxicillin

Single or multiple small, shallow ulcers with a yellow-gray fibrinoid center with red halos, a biopsy should be considered for ulcers lasting more than 3 weeks

TX: viscous lidocaine 2–5% applied to ulcer QID after meals until healed

Immunocompromised, young patients

• Painful, white fluffy patches that can be scraped off and may bleed when scraped (candidiasis can "come off") leaving an erythematous, friable base
• Potassium Hydroxide (KOH) prep for diagnosis

TX: Antifungals, which are available in several forms (i.e., ketoconazole or fluconazole orally, clotrimazole troches, nystatin liquid rinses)

• Classic manifestations of these infections include high fever, systemic toxicity, and local signs of erythema, edema, and fluctuance
• Computed tomography (CT) is the imaging modality of choice for the diagnosis of deep neck space infection
• The most common organisms isolated from deep neck space infections are viridans streptococci

TX: Antibiotics, aspiration or surgical drainage should be performed

Unvaccinated patient leaning forward, drooling, stridor and distress (tripod position, muffled voice)

• H. influenza type B (Hib)
• Lateral radiograph: Thumbprint sign

TX: Secure airway, admit, IV Ceftriaxone, and IV fluids

HSV type 1, vesicular lesions all in the same stage of development, a prodromal period of tingling discomfort or itching

TX: Symptomatic treatment with antipyretics and analgesia is recommended. IV hydration is sometimes needed in cases of decreased oral intake

• Oral acyclovir (15 mg/kg/dose five times per day for 7–10 days; max 200 mg per dose) may decrease the duration of illness if started within 72 hours at the onset of symptoms

• Consider squamous cell carcinoma if hoarseness persists > 2 weeks, history of ETOH and or smoking, laryngoscopy is required for symptoms persisting > 3 weeks

TX: Relax voice, supportive

• Oral or IM corticosteroids may also hasten recovery for performers but requires vocal fold evaluation before starting therapy

Presents with a severe sore throat, lateral uvula displacement, bulging tonsillar pillar

• Hot potato (muffled) voice and deviation of the uvula to one side
• + Streptococcus pyogenes

TX: Aspiration, incision and drainage, and/or antibiotics

• Parenteral amoxicillin, amoxicillin-sulbactam, and clindamycin
• In less severe cases, oral antibiotics can be used for 7 to 10 days (i.e., amoxicillin, amoxicillin-clavulanate, clindamycin)
• Tonsillectomy may also be considered in about 10% of patients

• Mononucleosis: Epstein Barr virus, fever, sore throat, lymphadenopathy, splenomegaly, atypical lymphocytes, + heterophile agglutination test (monospot)
• Consider gonorrhea pharyngitis in patients with recent sexual encounters, or with non-resolving pharyngitis
• Fungal in patients using inhaled steroids
• Group A Streptococcal pharyngitis: S. pyogenes. Centor Criteria: Absence of a cough, exudates, fever, cervical lymphadenopathy. Throat culture is the gold standard

TX:

• Viral: supportive
• Mononucleosis: Symptomatic and avoid contact sports, antibiotics such as amoxicillin or ampicillin may cause a rash
• Fungal: clotrimazole, miconazole, or nystatin
• Group A Strep: Penicillin is first line, Azithromycin if Pen allergic. Complications: Rheumatic fever and post-strep glomerulonephritis
• Gonorrhea pharyngitis: follows the same principles for the approach to therapy of uncomplicated urogenital gonococcal infections, with a preferred regimen of intramuscular ceftriaxone (250 mg) and azithromycin as a second agent

Sialadenitis is a bacterial infection of a salivary gland usually caused by sialolithiasis which is an obstructing stone in the salivary gland

• Acute swelling of the cheek which worsens with meals
• etiology: S. aureus
• Diagnose with CT, ultrasonography, or MRI

TX: Dicloxacillin, 1st gen cephalosporin, or clindamycin, symptomatic: hydration, sialogogues

Parotitis is an inflammation of one or both parotid glands, the major salivary glands located on either side of the face, in humans

• Patients present with fever and chills, periauricular, mandibular pain, and swelling; trismus, dysphagia; purulent drainage
• Viral ⇒ No discharge, prodrome followed by swelling lasting 5–10 days

Causes:

• Bacterial: S. aureus, most common
• Viral: mumps, influenza, coxsackie, Epstein–Barr virus (EBV)
• Autoinflammatory: sarcoidosis as part of Mikulicz syndrome

Mumps parotitis

• Mumps is caused by a paramyxovirus. Likely in a child without a complete vaccination series. Transmitted via airborne droplets
• Typically, it begins with a few days of fever, headache, myalgia, fatigue, and anorexia, followed by parotitis
• In adult males look for an associated orchitis

Diagnosis is often clinical

• Sample purulent exudate, ultrasound-guided needle aspiration; culture, Gram stain
• Ultrasound ⇒ increased blood flow through gland, enlargement, nodules
• CT scan ⇒ extension of inflammation to surrounding tissue
• Complete blood count (CBC)
• Serum and urinary amylase rise during the first week of parotitis without underlying pancreatitis
• Viral shows leukocytosis, increased IgM against mumps

TX: Self-limiting treat with hydration and rest

• Vaccination is effective for prevention
• Contagious for 9 days after onset of parotid swelling

Oral leukoplakia is an oral potentially malignant disorder that presents as white patches of the oral mucosa that cannot be wiped off with a gauze

• Tobacco use (smoked and especially smokeless), alcohol abuse, HPV infections
• Leukoplakia is in itself a benign and asymptomatic condition. However, some patients will eventually develop squamous cell carcinoma (SCC)

TX: Biopsy and surgical excision,  destructive therapies (eg, laser ablation, cryosurgery), medical therapies (eg, retinoids, vitamin A, carotenoids, NSAIDs), and watchful waiting with close clinical and histologic follow-up

Oral hairy leukoplakia is a separate disorder that is not premalignant. It is an Epstein-Barr virus-induced lesion that occurs almost entirely in HIV-infected patients.

• Generally affects the lateral portions of the tongue, although the floor of the mouth, the palate, or the buccal mucosa may also be involved

TX: Unlikely to progress to squamous cell carcinoma

• Treatment with zidovudine, acyclovir, ganciclovir, foscarnet, and topical podophyllin or isotretinoin. Therapy is usually not indicated