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MRCS (ENT) > Anatomy + Other > Flashcards

Anatomy + Other Flashcards

1
Q

What meets at the helicotrema and what is it?

A

The Scala Vestibuli and Scala Tympani
It is the most apical part of the cochlea

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2
Q

What is the modiolus?

A

Modiolus = the conical shaped central axis of the cochlea

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3
Q

What are the major cations of perilymph and endolymph

A

Perilymph - Sodium
Endolymph - Potassium

PS EP

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4
Q

What is found in (fluid):
Scala vestibuli
Scala media
Scala tympani

A

Scala vestibuli - Perilymph
Scala media - Endolymph
Scala tympani - Perilymph

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5
Q

What separates the scala vestibuli from the scala media?

A

Reissner’s membrane

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6
Q

What area of the cochlea is involved in Ménière’s disease?

A

Scala media …. Endolymphatic hydrops

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7
Q

What does the organ of corti sit on?

A

The basilar membrane

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8
Q

What compartments do the oval and round windows open into

A

Oval = Scala vestibuli
Round = Scala tympani

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9
Q

What membrane sits within the scala media?

A

Tectorial membrane

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10
Q

Skull Foramina - Look at table

A

Cribiform foramina of Cribriform plate
CN1 - Olfactory nerve
Anterior Ethmoidal nerves

Optic canal
CN2 - Optic nerve
Opthalmic Artery
Central retinal vein

Superior orbital fissue
CN3 - Occulomotor nerve (superior and inferior divisions)
CN4 - Abducens nerve
CNV1 - Opthalmioc division of trigeminal nerve (Lacrimal / Frontal / Nasociliary branches)
CN6 - Trochlear Nerve

Superior ophthalmic vein
Branch of inferior ophthalmic vein

Recurrent meningeal artery (passes backward through fissure, is branch of lacrimal artery, anastomisis with MMA)

Sympathetic nerves

8 things:
4 proper nerves
2 veins
1 artery
Sympathetic nerves

Inferior orbital fissue
CNV2 - Zygomatic branch

Branch of inferior ophthalmic vein
Infraorbital artery
Ascending branches of pterygopalatine ganglion

4 things (half of SOF)

Nerve, Ganglion, Vein, Artery

Foramen rotundum
CNV2 (Maxillary division of the trigeminal nerve)
Artery of foramen rotundum
Emissary veins

Foramen Ovale
CNV3 (Mandibular division of the trigeminal nerve)
Lesser petrosal nerve

Accesory meningeal artery
Emissary veins
Ortice ganglion just below foramen

Foramen spinosum
CNV3 - Meningeal branch

Middle meningeal artery
Middle meningeal vein
MMA fighter bust someones SPINE

Foramen Lacerum
Is closed by cartilage in life so nothing
Associated:
Greater petrosal nerve (on top of fora- men)
Internal carotid artery (on top of foramen)
Internal auditory meatus
CN7 - Facial Nerve
CN8 - Vestibulocochlear nerve
Labrythine artery
Vestibular ganglion

Jugular foramen
CN9 - Glossopharyngeal
CN10 - Vagus
CN11 - Accessory

Meningeal branches of occipital and ascending pharyngeal arteries
Superior bulb of internal jugular vein
inferior petrosal sinus
Sigmoid sinus

Hypoglossal canal
CN12 - Hypoglossal nerve

Foramen magnum
CN11 - Spinal part of accessory nerv

Spinal cord (medulla)
Meninges
Vertebral arteries
Anterior and posterior spinal arteries
Dural veins

MS VADA eating a MAGNUM

Stylomastoid foramen
CN7 - Facial nerve
Stylomastoid artery

**Condylar canal **
Emmissary vein from sigmoid sinus to vertebral veins in neck

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11
Q

Pharyngeal clefts / arches / pouches… see table

A

Pouches

1 - Eustachian tube + middle ear
2 - Lining of palatine tonsils
3 - INFERIOR parathyroid glands + Thymus (descend together)
4 - SUPERIOR parathyroid glands + C cells (parafollicular of thyroid)

Clefts
Pharyngeal clefts (ectodermal) are small sinuses between arches - all obliterated except:
1st Pharyngeal cleft = EAM! External Acoustic Meatus
IF 2nd 3rs 4th NOT obliterated (failure of fusion of 2nd pharyngeal arch and epicardial ridge) = BRANCHIAL CYST

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12
Q

What attaches to the styloid process? (5 things)

A

Styloglossus muscle
Stylopharyngeus muscle
Stylohyoid muscle
Stylomandibular ligament
Stylohyoid ligament

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13
Q

Openings into the nasal cavity and location

A

Frontal
Maxillary
Anterior ethmoidal sinuses
> open into the middle meatus via the semilunar hiatus
(bounded inferiorly and anteriorly by the sharp concave margin of the uncinate process of the ethmoid bone) (The opening of this all is the osteomeatal complex)

Middle ethmoidal sinuses empty out onto
> The ethmoidal bulla in the middle meatus

The posterior ethmoidal sinuses open out at the level of the
> superior meatus

Sphenoid sinus opens into the > posterior nasal roof

Nasolacrimal duct – opens into the
> inferior meatus.

Auditory (Eustachian) tube – opens into the nasopharynx at the level of
> inferior meatus

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14
Q

Advantages / Disadvantages of CT

A

Advantages

Painless
Non-invasive
Good evaluation of boney structures
More information than plain XR
Good for use in surgical plannning and image guidance techniques (e.g. CT guided biopsy)
Quicker (and cheaper than MRI)
Can be performed with implanted medical devices

Disadvantages

Uses ionising radiation
Poor evaluation of soft tissue (vs MRI)
Slower and more expensive than plan XR
Patientsa must lie flat and still

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15
Q

Unilateral nasal obstruction, facial pain, foul odour, and left upper dental pain

CT shows complete opacification of unilateral (left) maxillary sinus + ? tooth infection

Possible Dx (2)

A

Fungal ball / Fungal sinusitis
Malignancy

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16
Q

Fungal ball

Symptoms
& Investigations

A

Nasal obstruction, facial pain, foul odour, and left upper dental pain

Maxillary sinus most commonly affected

FNE
Orthopantomogam (OPG)
CT Paranasal sinuses

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17
Q

Treatment of fungal ball (mycetoma)

A

Online it looks like for fungal ball - Surgery is generally used to clear out the sinus - FESS

Then antifungals

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18
Q

Excluding the superior orbital and inferior orbital fissure there are 3 other foramen in the orbit

What are they?
What runs through them?
How far apart are they?

A

Foramen anterior and posterior ethmoidal arteries

Optic canal
- CN2 - Optic nerve
- Opthalmic Artery
- Central retinal vein

The rule of halves:

Anterior ethmoidal artery is 24 mm from anterior edge of the lacrimal
crest

Posterior ethmoidal artery is 12 mm behind the anterior ethmoidal artery

Optic nerve is 6 mm behind the posterior ethmoidal artery

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19
Q

Mechanism for referred otalgia in laryngeal malignancy

A

Stimulation of the auricular branch of the vagus nerve (Arnold’s nerve) when the sensory branches of the vagus nerve supplying the larynx (internal branch of superior la- ryngeal nerve) are stimulated by laryngeal malignancy.

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20
Q

Which artery can cause bleeding into the orbit after a FESS

A

Anterior ethmoidal artery

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21
Q

Intrinsic muscles of larynx (5)

And nerve supply

A

Intrinsic laryngeal muscles are:

Thyroarytenoid (vocalis) (paired)
Transverse arytenoid (unpaired).
Lateral cricoarytenoid (paired)
Posterior cricoarytenoid (paired)

= recurrent laryngeal nerve.

Cricothyroid muscle.

= external branch of the superior laryngeal nerve supplies

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22
Q

Sensaory supply to the larynx?

A

The internal branch of the superior laryngeal nerve of the vagus is responsible for sensation to the the vocal cords / glottis and above

Recurrent laryngeal nerve
supplies sensation to the SUBglottis and below

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23
Q

The 4 laryngeal cartilages are:

A

Thyroid cartilage
Cricoid cartilage
Arytenoid cartilage
Epiglottis.

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24
Q

Damage to external branch of superior laryngeal nerve - symptoms and why?

A

Cricothyroid muscle = This muscle tenses the vocal cords to increase the pitch of voice.

Damage = unable to hit high pitch / high notes

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25
Q

Type of joint: arytenoid > cricoid cartilage

A

The arytenoid moves on the cricoid cartilage by means of a synovial joint. It is susceptible to all the disorders that affect the larger synovial joints elsewhere in the body.

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26
Q

Explain why some patients cough when their ear is microsuctioned (specific nerve)?

*What else is explained by this?

A

Arnold nerve reflex (Auricular branch of the Vagus nerve)

Innervates -
- Inferior boney canal
- Posteriorsuperior cartilaginous canal
- Adjacent tympanic membrane
- Conchal bowl

When touched stimulates vagus nerve cough reflex

Also explain referred pain from laryngeal cancer to the ear/ear canal

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27
Q

Innervation of the pinna?

A

Facial nerve
vagus nerve
Trigeminal nerve
Greater auricular nerve (via C2 C3)

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28
Q

Innervation of conchal bowl?

A

Auricular branch of vagus
Facial nerve (intermediate branch)

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29
Q

Greater auricular nerve supplies what part of Pinna?

A

The pinna is innervated
- laterally
- inferiorly
- posteriorly by the greater auricular nerve (derived from the cervi-
cal plexus).

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30
Q

What supplies the anterior portion of the Pinna?

A

Auriculotemporal branch of the mandibular division of the trigeminal nerve supplies the anterior portion of the pinna

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31
Q

Greater auricular nerve innervates what areas?

A

Greater auricular nerve runs from Erbs point at the midpoint of the posterior border of sternocleidomastoid
muscle to the parotid gland.

It divides into anterior branch and posterior branches.

Anterior branch supplies skin over the angle of the mandible

Posterior branch supplies the ear lobe and mastoidf process?

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32
Q

What innervates the earlobe?

And what else does it innervate?

A

Posterior branch of the grater auricular nerve

Mastoid process

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33
Q

Innervation of lateral surface of TM and EAM

A

Auriculotemporal branch of Mandibular branch of Trigeminal (CNV3)
Intermediate branch of Facial nerve
Auricular branch of Vagus nerve

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34
Q

Innervation of medial surface of TM & middle ear?

A

Tympanic branch of the Glossopharyngeal nerve

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35
Q

Innervation of EAM?

A

Auriculotemporal branch of Mandibular branch of Trigeminal (CNV3)
Intermediate branch of Facial nerve
Auricular branch of Vagus nerve

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36
Q

Skin behind the ear innervated by?

A

Innervates the skin and the scalp posterosuperior to the auricle (C2)

Greater auricular nerve (C1-C2)

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37
Q

Axial
Coronal
Sagittal

A

Axial > Horizontal slices (e.g. head to toe)
Coronal > Vertical slices (front to back)
Sagittal > Side (left to right)

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38
Q

How do you describe colours on MRI scan and what are the two types and differences?

A

Low signal is black, High signal is white

What = high signal changes depending on T1 vs T2 MRI

  • T2 Water White (WW) i.e high signal
  • T1 Water Black, i.e. Low signal

Fat is high on both T1 + T2

Contrast (gadolinium) is only given in T1

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39
Q

How to describe and MRI

A

PCAP -
- Plane
- Contrast given
- Anatomical location
- Pathology demonstrated

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40
Q

How to describe and CT

A

PwCAP -
- Plane
- WIndow (soft tissue or bone)
- Contrast given
- Anatomical location
- Pathology demonstrated

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41
Q

What becomes of the pharyngeal pouches?

A

Pharyngeal Pouches =
Outpocketings on LATERAL wall (endodermal)

Separate the arches = (5 pairs, 4 survive) “P”ouch for “P”arathyroids and “P”alatine tonsils

1 - Eustachian tube + middle ear
2 - Lining of palatine tonsils
3 - INFERIOR parathyroid glands + Thymus (descend together)
4 - SUPERIOR parathyroid glands + C cells (parafollicular of thyroid

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42
Q

What becomes of the pharyngeal clefts?

What pathology is associated with them, explain how it occurs?

A

Pharyngeal clefts (ectodermal) are small sinuses between arches - all obliterated except:

1st Pharyngeal cleft = EAM! External Acoustic Meatus

IF 2nd 3rs 4th NOT obliterated (failure of fusion of 2nd pharyngeal arch and epicardial ridge) = BRANCHIAL CYST

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43
Q

1st Pharyngeal Arch
- Nerve
- Bone
- Artery
- Muscles
- Sensation

A

Nerve
* V: Trigeminal

Bone
* Maxillary prominence – maxilla, zygomatic bone, part of temporal bone - associated with:
* Maxillary cartilage = Incus
* Mandibular prominence - mandible, associated with:
* Meckel’s cartilage = malleus, mandible

Artery
* Maxillary

Muscles (ATTM)
Trigeminal “all the Tensors!”
* Temporalis, Masseter, Pterygoids
* Mylohyoid, Anterior belly digastric
* Tensory tympani, Tensor veli palatini

Sensation
* Face
* General sensation anterior 2/3 tongue
* Oral cavity lining and nose

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44
Q

2nd Pharyngeal Arch
- Nerve
- Bone
- Artery
- Muscles
- Sensation

A

Nerve
* VII: Facial

Bone
Reichart’s cartilage =
* Stapes
* Styloid
* Stylohyoid ligament
* Upper body + lesser horn of Hyoid

Artery
* Stapedial: Regresses before birth.
* Hyoid artery – gives rise to the corticotympanic artery in the adult

Muscles
* Muscles facial expression,
* Stapedius
* Stylohyoid
* Platysma
* Posterior belly of digastric

Sensation
* Taste sensation anterior 2/3 tongue
* Part of EAM & lateral TM

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45
Q

3rd Pharyngeal Arch
- Nerve
- Bone
- Artery
- Muscles
- Sensation

A

Nerve
* IX: Glossopharyngeal

Bone
* Lower hyoid

Artery
* Common carotid artery

Muscles
* Stylopharyngeus
StylopharanGeous

Sensation
* Taste + general sensation posterior 1/3 tongue

46
Q

4th Pharyngeal Arch
- Nerve
- Bone
- Artery
- Muscles
- Sensation

A

Nerve
* X: Superior laryngeal

Bone
* Laryngeal cartilages: Thyroid, Corniculate and Cuneiforme

Artery
* Left - Aortic arch
* Right - proximal portion of the subclavian artery

Muscles
Cricothyroid and the PLP
* Pharyngal constricters
* ? Palatopharyngeous
* Levator palatini
* Palatoglosus
* Cricothyroid

Sensation
* Root of tongue / lower pharynx / upper larynx

47
Q

5th Pharyngeal Arch
- Nerve
- Bone
- Artery
- Muscles
- Sensation

A

Nothing in life - regresses before birth

48
Q

6th Pharyngeal Arch
- Nerve
- Bone
- Artery
- Muscles
- Sensation

A

Nerve
* X: Recurrent laryngeal

Bone
- None

Artery
* Left – ductus arteriosus
* Right – proximal portion of the pulmonary arteries

Muscles
Intrinsic muscles of the larynx (with the exception of cricothyroid)
* Thyroarytenoid
* Transverse arytenoid
* Lateral cricoarytenoid
* Posterior cricoarytenoid

Sensation
* General sensation below the vocal cords

49
Q

Uses for BIPP and what is it?

A

Bismuth Iodoform Paraffin Paste and ribbon gauze.

BIPP is an astringent and antiseptic dressing which slowly releases iodine over time

Ear surgery:
- myringoplasty
- mastoid surgery

  • Pack the nasal cavity, especially in cases of posterior epistaxis
50
Q

Bismuth Iodoform Paraffin Paste - main ingredient?

A

Iodine

51
Q

Bismuth Iodoform Paraffin Paste - what can happen with some patients when it is used?

A

Type IV hypersensitivity reaction

Generally 48-72 hours post
Remove and can use plain ribbon gauze instead

52
Q

Why must BIPP be removed prior to embolisation?

A

The strip down the middle of it is radiopaque, indestiguishable from a vessel

53
Q

Name the extrinsic tongue muscles (4)

A

Genioglossus
Hyoglossus
Styloglossus
Palatoglossus

54
Q

Where is the superior laryngeal nerve found and what are it’s landmarks?

A

‘Jolly Joll because he’s superior in every way’

Jolly because he likes “Ss & M”

Joll’s triangle:

Midline
Superior thyroid pedicle
Strap muscle - sterenothyroid

55
Q

Where is the recurrent laryngeal nerve found and what are it’s landmarks?

A

Beahr’s triangle:

Common carotid artery Trachea
Inferior thyroid artery

“Beahr has a TIC”

56
Q

Where is the Fossa of Rosenmuller?

What else is nearby and what’s it’s clinical significance?

A

Behind the ostium of the eustachian tube is a deep recess, the pharyngeal recess (fossa of Rosenmüller)

At the base of this recess is the retropharyngeal lymph node (the Node of Rouvier).

Fossa of Rosenmuller is where nasopharyngeal carcioma (SCC) commonly arises

57
Q

What / where is the sinus of Morgagni?

Clinical significance

A

= defect in the anterior aspect of the pharyngobasilar fascia.

Enclosed space between the superior pharyngeal constrictor muscle, the base of the skull and the pharyngeal aponeurosis / pharyngobasilar fascia

Transmits the Eustachian tube and levator veli palatini muscle

= allows communication between the nasopharynx and middle ear

Trotter’s syndrome of cancer arises / invades here

58
Q

Imaging modality of choice for imaging the primary cancer in most head and neck CAs?

A

MRI with contrast
- T1 with gadolinium enhancement

CT of head / neck / throax for staging (nodes & mets)

59
Q

Facial layers of the neck

A

**Superficial cervical fascia **- skin, subcutaneous tissue and the platysma

Deep cervical fascia

Superficial layer of deep fascia = the Investing layer, encloses

  • SCM / traps /Straps / Parotids

Middle = Pretracheal layer, encloses
* Organs of the neck: thyroid, parathyroid glands, larynx, trachea, pharynx,oesophagus.

Deep = Pre vertebral layer
* Vertebral column and the paravertebral muscles

Space between the middle and deep layers anteriorly = retropharyngeal space, which is subdivided by a thin membrane called the alar fascia.

Danger space = posterior to the alar fascia, which extends from the oropharyngeal region inferiorly into the posterior mediastinum (to the level of the diaphragm)

60
Q

What is the danger space in the neck

A

Space between the middle and deep layers anteriorly = retropharyngeal space, which is subdivided by a thin membrane called the alar fascia.

Danger space = posterior to the alar fascia, which extends from the oropharyngeal region inferiorly into the posterior mediastinum (to the level of the diaphragm)

61
Q

Where is the retropharyngeal space?

Clinical relevance?

A

Space between the middle (pretracheal) and deep layers of the neck (prevertebral) anteriorly = retropharyngeal space, which is subdivided by a thin membrane called the alar fascia.

Extends from skull base to lower border of pharynx, but there is an extension posterior to the alar fascia ….

Danger space = posterior to the alar fascia, which extends from the oropharyngeal region inferiorly into the posterior mediastinum (to the level of the diaphragm)

62
Q

Where is the parapharyngeal space?

Clinical relevance?

A

Parapharyngeal space is a potential space, shaped like an inverted pyramid - extends from the skull base to the hyoid bone.

Carotid sheath is Lateral and inferior to it

Communicates with the retropharyngeal space so a parapharyngeal abscess can also lead to mediastinial spread.

63
Q

LASER stands for:

A

Light amplification by stimulated emission of radiation

64
Q

What precautions should be taken in ORs when LASERs are in use? (min 5)

A
  • Skin of sedated or anaesthetised patients must be shielded
  • Patients eyes must be protected
  • Theatre staff should wear eye protection
  • Doors should be locked
  • Windows covered
  • Warning signs / lamps at entrance to theatres
65
Q

What does KTP laser stand for?

A

Potassium Titanyl Phosphate

66
Q

Differences between KTP (what stand for) and C02 lasers?

A

Potassium Titanyl Phosphate

Wavelength
Target Chromophore

67
Q

Explainwhat determines wavelength and taregt chromophore in LASER

A

The laser medium (gas / liquid / solid ) determines wavelength

Different substances have different targets (chromophores) which selectively uptake that laser

C02 - water (Cutting / ablating)
KTP Potassium Titanyl Phosphate - Haemoglobin (photoangiolytic)

68
Q

Indications for LASER I.e what can you use it on?

A

Leukoplakia
Laryngeal stenosis
Laryngomalacia
Pharyngeal pouch surgery
Laryngeal pappilomatosiis
HHT
Oropharyngeal cancer resection
Vocal cord nodules

69
Q

How to ventiolate pt during laser

A

Laser Safe ET tube
Jet ventilation

70
Q

Advantages and disadvantages of LASER

A

Advs:
* Precision
* Better haemostasis
* Cost effective
* Minimal tissue manipulation
* Increased sterility

Disadvs
* Increased staff no.s
* Increased training
* Safety aspects
* Cost of equiptment

71
Q

Compression of superiornorbital fissure structures - symptoms:

A

Superior orbital fissure syndrome:

Diplopia
Opthalmoplegia
Exophthalmos (Proptosis)
Ptosis
Eyelid & forehead anaesthesia

Detail:

Ophthalmoplegia: compression / damage to oculomotor, trochlear and abducens nerves

Ptosis: due to loss of oculomotor motor supply to the levator palpebrae superioris and loss of sympathetic input

Proptosis: decreased tension in extraocular muscles due to loss of innervation

Fixed dilated pupil: due to loss of parasympathetic supply to the pupil by the oculomotor nerve

Lacrimal hyposecretion and eyelid or forehead anaesthesia: due to damage to branches of the ophthalmic division of the trigeminal nerve

Loss of corneal reflex

72
Q

Superior orbital fissure syndrome - causes:

A

Trauma e.g. orbital blow out fracture
Infection
Inflammatory condition
Neoplasia (benign or malignant).

73
Q

What is orbital apex syndrome (signs / symptoms)?

A

Blindness / Visual loss + Cranial neuropathies
e.g.
Opthalmoplegia
Hypoasthesia of eyelid / upper face
Diplopia
Ptosis
etc.

= SOF Syndrome + decreased visual acuity

74
Q

Orbital apex syndrome - causes

A

Commonly a middle cranial fossa tumour involving the orbital apex

Also
- Trauma
- Inflammatory e.g. Sarcoid, GPA
- Infection
- Vascular e.g. cavernous sinus thrombosis

75
Q

Types of melanoma

A

Superfical Spreading
Nodular
Acral lentiginous
Lentigo maligna
Regressed

76
Q

What are the warning features for a mole / melanoma

A

ABCD
* Asymmetry
* Border irregular
* Colour
* Diameter greater than 6mm

Other:
* Itching, burning
* Swelling,
* Pain in a pre-existing mole, Development of a raised area in a previously flat mole
* Change in the consistency of the mole
* Change in the surface characteristics
* such as bleeding, scaling, ulceration or crusting
* Development of satellite lesions.
* New moles on an elderly person

77
Q

Most common site of malignant melanoma

A

Trunk

78
Q

Histological staging systems for malignant melanoma (2)

A

Breslow
Clark

79
Q

What makes up a salivary unit in a slivary gland? (5)

A

Cells which make up salivary unit
MAISE:
* Myoepithelial
* Accinic
* Intercalated duct
* Secretory
* Excretory.

Tumours of one of these cell types = Monomorphic

Tumours of >1 = Pleomorphic

80
Q

Differential diagnosis for red marks/lesions on face:

A

Vascular tumours
Benign:
- Haemagiomas
- Pyogenic granuloma

Malignant: Angiosarcoma

Vascular malformations:

High flow: Arteriovenous
e.g. Arterial malformation, Arteriovenous fistula, Arteriovenous malformation

Low flow:
— Venous malformation (most common ~40%)
— Lymphatic malformations
e.g. Cystic hygroma / lymphangioma
—-Capillary malformations / Portwine stain

Malignant neoplasm

Note: Vascular anomilies is the blanket term for vascular tumours + vascular malformations

81
Q

Vascular malformations, types and presentations

A

LOW FLOW

**Venous malformations (most common) **
* Bluish lesion
* Compressible on palpation
* Enlarge with physical activity or if in a dependent position.
* Painful in the morning due to stasis
Rx: Camouflauge makeaup, laser therapy, sclerotherapy, resection

Capillary malformation / Port wine stain
* Flat, reddish lesions
* Mostly around the head and neck
Rx: … same as above

Lymphatic malformation/Lymphangioma
Fluid-filled cysts that form in children, often on the head and neck e.g. cystic hygroma
Rx: Surgical excision

HIGH FLOW

Arteriovenous malformations
Most commonly in the CNS and asymptomatic or general symptoms e,.g. hadaches, seizures, focal neurology etc.

82
Q

Vascular tumours types

A

**Benign: **

Infantile haemagioma / Strawberry naevus
- Develop after birth
- Grow rapidly involute over several years by apoptosis
- Complications: stridor due to obstruction, ulceration, bleeding, infection

Rx
- Conservative mostly
- Beta blockers + corticosteroids can be used

**Pyogenic granuloma **

Common on: Gums, skin, nasal septum
Proliferation capillaries due to trauma, hormones, drugs
Rapidly grow over weks

Rx:
Topical: Imiquimod cream 5% /
topical (or oral) beta-blockers
Surgical excision / curretage

Malignant: Angiosarcoma

83
Q

Difference between haemagioma and vascular malformation?

A

haemagiomas are vascular tumours and unlike vascualr malformations they are:
- absent at birth
- grow fast
- Involute spontaneously around 2 years of age

84
Q

Oesophageal levels from incisors (cm / vertebra)

A
  • C6: Cricopharyngeal sphincter / cricoid / cricophjaryngeous 15cm
  • T4: Aortic arch crosses / Trachea bifurcates / Bronchoaortic constriction 22-24cm
  • T5: Left main bronchus 27cm
  • T10: Entrance to abdomen 38cm
  • T10: Incisors > OG junction 40cm
85
Q

Structures and distances from the anterior edge of the lacrimal crest

A

Rule of halves:
* 24mm behind: Anterior ethmoidal artery
* 12mm behind that: posterior ethmoidal artery
* 6mm behind that: Optic nerve

86
Q

What is vidians nerve, location/route/function

A

= Nerve of the pterygoid canal (Vidian nerve) formed by junction of:

  • Greater petrosal nerve: parasymp to lacrimal / mucous of nose
  • Deep petrosal nerve: symp to blood vessels

Passes from the foramen lacerum to the pterygopalatine fossa through the pterygoid canal

87
Q

Where is the Pharyngeal tubercle, what attaches to it?

A

Pharyngeal tubercle = just anterior to foramen magnum (part of basialrt part of occipital bone)

Attachement = fibrous raphe of the pharynx, also known as the pharyngeal raphe

= connects with the superior pharyngeal constrictor muscle.

88
Q

Explain the embryological origin of the external ear

A

External ear develops from the first two pharyngeal arches

They form six hillocks of His in the five weeks of development.

1st Arch forms first three hillocks
= fuse together to =
- tragus
- helix
- Crus of helix
(Innervated by the Trigeminal nerve… 1st Arch)

2nd arch forms the last 3, fuse to =
- antihelix
- antitragus
- lobule
(Areas innervated by the cervical plexus and the facial nerve ..2nd Arch)
… also explains why in Ramsey Hunt vesicles occur on the pinna

89
Q

What part of the external ear is formed by the first three hillocks of his?

A

1st Arch forms first three hillocks
= fuse together to =
- tragus
- helix
- crus of helix
(Innervated by the Trigeminal nerve… 1st Arch)

2nd arch forms the last 3, fuse to =
- antihelix
- antitragus
- lobule
(Areas innervated by the cervical plexus and the facial nerve ..2nd Arch)
… also explains why in Ramsey Hunt vesicles occur on the pinna

90
Q

What can happen if the hillocks of His fail to fuse?

A

Pre auricular sinus

91
Q

Benefits of mono and braided sutures

A

Braided:
* Greater tensile strength
* Better pliability and flexibility
* Handles and ties well
* Less likely than monofilament to be crushed/crimped which weakens suture

Mono:
* More resistant to harboring microorganisms
* Exhibits less resistance to passage through tissue than multifilament suture does

92
Q

True Vocal Cord (Vocal Folds)

Layers (Medial to lateral / superficial to deep) (7)

A
  • (Non keratenised stratified) Squamous epithelium
  • Basement membrane
  • Superficial lamina propria
  • –.. this layer = Reinke’s space (watery, amorphous layer is rich in glycosaminoglycans. Due to its fluidity, the epithelium is able to vibrate freely above it to create sound)
  • Intermediate lamina propria
  • Deep lamina propria
  • ….. = these two layers = the Vocal ligament - Lies at the free upper edge of the cricothryoid ligament
  • Muscle > Thyroarytenoid muscle (Vocalis muscle)
93
Q

False vocal cords (Vestibular folds ) - Consist of (2)
Function (1)

A

Consist of the
* vestibular ligament (free lower edge of the quadrangular membrane)
* Covered by a mucous membrane

Fixed folds, which act to provide protection to the larynx

94
Q

What are Agger Nasi cells and where are they?

A

Agger nasi air cells are the most anterior ethmoidal air cells

  • Anterolateral and inferior to the frontal recess

‘A’gger for ‘A’nterior

95
Q

What is concha bullosa?
Associated with? (1)

A

Concha bullosa (middle turbinate pneumatisation) is a common finding and although associated with deviation of the nasal septum,

96
Q

What is an Onodi air cell?
Significance?

A

Onodi air cell (above)- Sphenoethmoidal air cell - anatomical variant
I
mportant due to its close proximity to the optic nerve and internal carotid artery

97
Q

What are Haller cells and where are they found?
WHat problems can occur due to them ?

A

Haller cells( infraorbital ethmoidal air cells)
= ethmoid air cells located lateral to the maxillo-ethmoidal suture along the inferomedial orbital floor

  • Generally asymptomatic
  • Can get infected > track to orbit
  • Surgeons may enter orbit via them if not recognised during FESS
  • If large can block osteomeatl complex
98
Q

Attachements to mastoid process

A

Posterior belly of digastric muscle
Sternocleidomastoid
Splenius capitus
Longissimus capitus

99
Q

What is the difference between monospot abd Paul-Bunnel test (and what is similiar - other than they both test for EBV)

A

Both heterophile antibody tests:

Paul-Bunnell test uses sheep erythrocytes
Monospot test, horse red cells

100
Q

Contents of neck levels

A

Contents of Neck Levels:

1
* Submandibular gland
* Hypoglossal nerve
* Facial, submental and mylohyoid vessels
* Anterior jugular veins
* Mylohyoid nerve
* ? Lingual nerve
? Marginal mandibular

2
* Accessory nerve
* Hypoglossal nerve
* Greater auricular nerve
* Internal and external laryngeal nerves
* IJV
* External carotid artery and number of branches e.g. superior thyroid ?
* Internal carotid artery
* Superior root of the ansa cervicalis

3
* IJV
* Common carotid artery
* Internal and external laryngeal nerves
* Superior thyroid vein

4
* Common carotid artery
* IJV
* Phrenic nerve
* Thoracic duct or Right lymphatic trunk
* ? Lung apices

5
* Accessory nerve
* Brachial plexus trunks
* Cervical plexus branches
* External jugular, Transverse cervical, suprascapular veins
* Subclavian, Transverse cervical, Suprascapular, Occipital arteries
* Inferior belly of omohyoid
* ? Lung apices

6
* Trachea
* Larynx
* Thyroid gland
* Parathyroid glands
* Vagus nerve
* Glossopharyngeal nerve
* Superior, middle and inferior thyroid vessels

101
Q

Level 6 neck contents

A

6
* Trachea
* Larynx
* Thyroid gland
* Parathyroid glands
* Vagus nerve (Recurrent laryngeal nerve)
* Glossopharyngeal nerve
* Superior, middle and inferior thyroid vessels

102
Q

Level 5 neck contents

A

5
* Accessory nerve
* Brachial plexus trunks
* Cervical plexus branches
* External jugular, Transverse cervical, suprascapular veins
* Subclavian, Transverse cervical, Suprascapular, Occipital arteries
* Inferior belly of omohyoid
* ? Lung apices

103
Q

Level 4 neck contents

A

4
* Common carotid artery
* IJV
* Phrenic nerve
* Thoracic duct or Right lymphatic trunk
* Lung apices
* Transverse cervical artery

104
Q

Level 3 neck contents

A

3
* IJV
* Common carotid artery
* Vagus nerve
* Superior thyroid vein

105
Q

Level 2 neck contents

A

2
* Accessory nerve
* Hypoglossal nerve
* Greater auricular nerve
* Internal and external laryngeal nerves
* IJV
* External carotid artery and number of branches e.g. superior thyroid ?
* Internal carotid artery
* Superior root of the ansa cervicalis

106
Q

Level 1 neck contents

A

1
* Submandibular gland
* Hypoglossal nerve
* Facial, submental and mylohyoid vessels
* Anterior jugular veins
* Mylohyoid nerve
* ? Lingual nerve

107
Q

Submucous cleft & bifid uvula embryology

A

Submucous cleft palate = failure of fusion of the maxillary processes / palatine shelves

Bifid uvular is related to this and = failure of fusion of the uvula - so also failure of fusion of the maxillary processes / palatine shelves

108
Q

Cleft palate embryology

A

Palatal shelves fail to fuse in the midline

109
Q

Cleft lip embryology

A

Failure of fusion from the incisive foramen to the alveolus and the lip

– occurs when the medial nasal prominence and maxillary prominence fail to fuse.

(failed merging of the maxillary and medial nasal elevations on one or both sides due to the inadequate migration of neural crest cells.)

110
Q

Three structures preserved in modified radical neck dissection

A

Accessory
IJV
SCM

MRCS (ENT) (14 decks)

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