Overview on Anatomy of Human Respiratory System
Sunit K. Singh in Human Respiratory Viral Infections, 2014
It is posterior to oral cavity from uvula up to the level of hyoid bone. The opening of the oral cavity in the oropharynx is known as the fauces. A pair each of palatine tonsils and lingual tonsils are located in the oropharynx. The lining of the oropharynx is formed by stratified squamous epithelium. The oropharynx is a common passage for air, food, and drinks; so, it serves both respiratory and digestive functions.
The Head and Neck
E. George Elias in CRC Handbook of Surgical Oncology, 2020
The lymphatic drainage of the floor of the mouth is to the submandible and the internal jugular chain. Lymph node metastases usually develop during the course of the disease, and bilateral cervical lymph node metastases are not infrequent. The hard palate carcinomas are rare with an incidence of 0.5% of oral cavity cancers. The lymphatic drainage is behind the dental arch to the retropharyngeal, internal jugular, and submandibular lymph nodes. Primary tumors of the hard palate can be salivary gland in origin such as cylindromas, epidermoid carcinomas, or bone tumors. These can easily invade the maxillary sinus and/or the upper gingiva. Such tumors should be differentiated from other conditions such as torus palatinus, papillomata, dentigerous cysts, and very rarely now the syphilic gumma. The mandible can be the site of various primary lesions including the multiloculated fibro-osteoma, giant cell tumor, and ameloblastoma, which is a multiloculated cystic tumor that arise from the epithelium that gives the enamel. These three tumors are characterized by local invasion and no lymphatic or systemic metastasis. On the other hand, the malignant varieties, that have a great potential for systemic metastases, include Ewing’s sarcoma, osteogenic sarcoma, and Burkitt’s lymphoma. The oropharynx includes the soft palate and the tonsillar pillars, the tonsils, the base of the tongue, and the periepiglottic area. The soft palate and the anterior tonsillar pillars can be the site of primary epidermoid carcinomas. The posterior tonsillar pillars are very rarely the primary site. Soft palate and tonsillar pillar carcinomas do not metastasize early, but the chances of cervical lymph node metastases increase as they get bigger. Tonsillar tumors constitute 1.5 to 3% of all cancers, and these include epidermoid carcinoma and lymphoma (usually non-Hodgkin’s). These lesions must be differentiated from tuberculous and syphilitic lesions. Early cervical lymph node metastases is common. The base of the tongue is the posterior one third, and it is the part of the tongue that is located behind the circumvallate papillae. It extends laterally to the glossopharyngeal sulcus, and posteriorly it forms the anterior wall of the valleculae (which is part of the periepiglottic area). The base of the tongue is extremely rich in lymphatics that penetrate the pharyngeal wall. The most common tumor is epidermoid carcinoma.
Tumours of the oral cavity and pharynx
Anju Sahdev, Sarah J. Vinnicombe in Husband & Reznek's Imaging in Oncology, 2020
The nasopharynx lies behind the nasal cavity and above the oropharynx, the soft palate forming the inferior wall. NPC is confined to the nasopharynx when it involves the roof (containing the centrally placed adenoid), posterior wall, and lateral walls, including the pharyngeal recesses, eustachian tube entrance, torus tubarius, and levator palatini muscle attached to the tube (Figure 1.17a and b ). The pharyngeal recess is a common site for NPC (Figure 1.17a), and small tumours deep in the recess can be identified easily on MRI but may be undetectable on nasoendoscopy because of angulation of the recess and the fact that the walls of the recess are often collapsed.
A combination of naso- and oropharyngeal swabs improves the diagnostic yield of respiratory viruses in adult emergency department patients
Published in Infectious Diseases, 2019
Peter Ek, Blenda Böttiger, Disa Dahlman, Karin B. Hansen, Mattias Nyman, Anna C. Nilsson
Background: Along with the current development of molecular diagnostic methods of respiratory viruses, the bedside patient sampling techniques need to be evaluated. We here asked the question whether the addition of an oropharynx swab to the traditional nasopharynx swab might improve the diagnostic yield of multiplex PCR analysis. Ct values from the two sampling sites were compared as well as patient tolerability. Methods: In an emergency department in Malmö, Sweden, 98 adult patients with respiratory disease were sampled both from the nasopharynx and oropharynx for virus diagnostics by PCR. Results: Influenza (AH1, AH3, B), human metapneumovirus (hMPV) or respiratory syncytial virus (RSV) were detected by PCR in 58 subjects. The diagnostic yield was improved by combining nasopharyngeal and oropharyngeal sampling – a virus was detected in another 6 patients compared to traditional nasopharyngeal sampling (p = .031, McNemar’s test). In 38/55 subjects viral load was higher in the nasopharynx than in the oropharynx. Self-reported discomfort was significantly lower from oropharyngeal sampling than from nasopharyngeal sampling. Conclusions: Adding an oropharynx sample to a nasopharynx sample increased the diagnostic yield of respiratory viruses. Oropharyngeal sampling was well tolerated.
Evolving role of human papillomavirus as a clinically significant biomarker in head and neck squamous cell carcinoma
Published in Expert Review of Molecular Diagnostics, 2019
Caitlin McMullen, Christine H. Chung, Juan C. Hernandez-Prera
Introduction: The majority of squamous cell carcinoma (SCC) of the oropharynx, one of the sites within the head and neck region, is now associated with high-risk human papillomavirus (HPV) in North America. Several modalities are available to determine the HPV status, however, the understanding of each assay in its application and limitations is essential for accurate interpretation and appropriate utilization of results in management of these patients. Areas covered: This expert review will cover the role of HPV in head and neck squamous cell carcinoma (HNSCC), indications for HPV testing, HPV detection methods in tumors, saliva and serum, and exploiting HPV status as a prognostic biomarker of clinical outcome in HNSCC. Expert commentary: The HPV status is the most significant diagnostic and prognostic biomarker in HNSCC, specifically in the oropharynx. Research underway is currently delineating the role of HPV and p16 testing in non-oropharyngeal sites. While the feasibility of non-invasive serum and saliva testing for HPV detection has been established, the clinical application of these assays is still evolving.
Critical Weight Loss in Patients With Oropharynx Cancer During Radiotherapy (± Chemotherapy)
Published in Nutrition and Cancer, 2017
Belinda Vangelov, Rebecca L. Venchiarutti, Robert I. Smee
Critical weight loss (CWL) defined as ≥5% in one month, is common in patients with oropharynx cancer and identification of patients at risk is challenging. We aimed to investigate if predictors of CWL in this population exist to guide nutritional intervention. Data were collected retrospectively on 134 patients who had radiotherapy (RT) ± concurrent chemotherapy (CRT) ± surgery. Body weights were collected pre-RT and during RT, with percentage weight change measured against baseline. Logistic regression was used to analyze chosen predictors. The incidence of CWL was 67% (26% of these patients experiencing ≥10% loss). Patients who had CRT experienced significantly higher weight loss (7.1% versus 4.7%; p = 0.001). Tube feeding was used in 64% of patients with CWL, the majority of tubes inserted reactively. These patients had a mean weight change of −8.8% (versus −7.1% in those with no tube) (p = 0.004). Multivariate models identified increased risk of CWL in tonsil origin tumors (p < 0.05), with CRT being the only predictor of weight loss ≥10% (p < 0.05). These patients are particularly vulnerable to CWL and the majority experience significant nutritional issues during RT, regardless of nutritional status at diagnosis. Nutritional intervention should be targeted accordingly.
Related Knowledge Centers
- Cricoid Cartilage
- Hypopharynx
- Lungs
- Pharynx
- Oral Cavity
- Soft Palate
- Epiglottis