Head and Neck Head and Neck

Manifestations of Manifestations of
HV/ADS HV/ADS
Adam Ray, MD
SIU Division oI Otolaryngology-
Head and Neck Surgery
-ectives -ectives
asic Science
Incidence
Pathogenesis in the Head and Neck
Evaluation and Treatment
Case study review
Case Report: Case Report:
year old male with known HIV and history
oI lymphadenopathy in the neck returns to clinic
with complaints oI an increasing neck mass on the
right side. Previous FNA as shown benign
Iollicular hyperplasia. Patient`s complaints
include general malaise and examination reveals a
large level II lymph node on the right that is much
larger than the adenopathy palpated on the
remainder oI the neck exam. the patient is on anti-
retroviral medication. Laboratory evaluation
reveals increased sed rate and CD4 counts oI 400.
Case Report: Case Report:
hat is the next step in this patients
workup?
hat is the criteria Ior open bx vs
observation only?
asic Science: asic Science:
Structure oI the HIV particle:
a. lipid bilayer capsule
b. viral core
c. RNA strands
d. reverse transcriptase
asic Science: asic Science:
HIV liIe cycle
inding with the host cell (CD4)
Synthesis oI DNA
Incorporation into the host cell DNA-provirus
Latent period
Synthesis oI new HIV particles
ncidence: ncidence:
) 4 million adults and million children are inIected with HIV
worldwide.
) ,000 new inIections per day.
3) 40 oI inIected adults are women.
4) vertical transmission mother-child.
5) children:
a. most common cause oI immunodeIiciency.
b. one oI the top 0 leading cause oI death in U.S.
) 50 oI HIV inIected people will develop AIDS within 0 years.
7) occupational risks and prevention:
a. risk oI seroconversion aIter percutaneous exposure is 0.3.
b. universal precautions.
ncidence: ncidence:
AIDS
Opportunistic inIections
Absolute CD4 counts less than 00
!athogenesis !athogenesis
Dermatologic
Otologic
Nose and Paranasal Sinuses
Oral Cavity and Pharynx
Larynx
Neck
!athogenesis: !athogenesis: Dermatologic Dermatologic
candidiasis
molluscom contagiosum
bacillary angiomatosis
seborrheic dermatitis
herpes zoster
Idiopathic multiple sarcoma
(Kaposi`s Sarcoma)
Molluscom
Contagiosum
Kaposi`s
Sarcoma
!athogenesis: !athogenesis: Dermatologic Dermatologic
Kaposi`s Sarcoma
pink to purplish in color, raised or
nodular
histopathology
mucosal and skin lesion
adenopathy
!athogenesis: !athogenesis: tologic tologic
otitis externa
otitis media
serous otitis
Iacial paresis/paralysis
SNHL
HIV labyrinthitis
!athogenesis: !athogenesis:
Nose and Paranasal Sinuses Nose and Paranasal Sinuses
herpetic lesions
neoplasms
allergies
chronic sinusitis
invasive Iungal sinusitis
Erosion oI medial orbital wall
!athogenesis: !athogenesis:
ral Cavity and Pharynx ral Cavity and Pharynx
oral candidiasis: most common
herpetic stomatitis
apthous ulcers
hairy leukoplakia
Kaposi`s Sarcoma
Non-Hodgkin`s Lymphoma
peridontal disease
candidiasis
mucomycosis
hairy leukoplakia
Kaposi`s Sarcoma
Kaposi`s Sarcoma
lymphoma
!athogenesis: !athogenesis: arynx arynx
inIections
neoplasms
recurrent respiratory papillomatosis
!athogenesis: !athogenesis: Neck Neck
salivary glands
lymphocytic inIiltrates
Parotid masses
!athogenesis: !athogenesis: Neck Neck
Lymphadenopathy
Iollicular hyperplasia
Kaposi`s Sarcoma, NHL
T
atypical mycobacteria
histoplasmosis, toxoplasmosis
Cat scratch disease
;aIuation: ;aIuation:
PMHx
Social Hx
Complete Head and Neck exam (nasal
endoscopy/ Ilexable laryngoscopy)
FNA
Imaging (CT or MRI )
Pathology
;aIuation: ;aIuation:
Laboratory Dx:
estern blot
Viral titer
CD4 counts
Monitor anti-viral Rx
%reatments: %reatments:
Medical:
Antiviral, anti-retroviral drugs
Chemo/RT Ior Kaposi`s and NHL
Antibiotics
Post-exposure: zidovudine prophylaxsis
%reatments: %reatments: Surgical Surgical
Dermatologic: excison and curettage,
cryotherapy
Otologic: myringotomy and tube,
mastoidectomy
Sinus: surgical drainage
Larynx: mucosal bx, intervention Ior
obstruction
%reatments: %reatments: Surgical Surgical
Neck: FNA, excisional bx
Criteria Ior open excisional bx:
Constitutional symptoms
Localized adenopathy
Disproportionately large node in a patient with
persistent generalized LAD
Cytopenia or elevated SED rate
Case Study Re;isited: Case Study Re;isited:
This patient meets the criteria Ior open bx
general malaise
New large lymph node in a patient with known
generalized LAD
increased SED rate
Patient does not have AIDS as CD4 count is
400
Summary: Summary:
All aspects oI society are aIIected by the
disease including children and heterosexual
women.
50 oI those inIected with the virus will
develop head and neck maneIestations.
Understanding symptoms and surgical
treatments is crucial in the proper
management oI these patients.
References: References:
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