Common Conditions of the Head, Neck and Throat Flashcards
What is the basic arrangement of the lympho-reticular system of the head and neck?
Inner ring = Waldeyer's ring - Adenoids - Tubal tonsils - Palatine tonsils - Lingual tonsils - Pharnygeal bands Other ring = lymph node groups - Pre-auricular - Post-auricular - Submandibular - Submental - Occipital Lymphatic chain associated with great vessels of neck and thoracic duct - Anterior triangle - Posterior triangle
What are the likely sites of origin of a cancer of the head and neck?
External = skin - SCC - Melanoma Internal = upper aero-digestive tract - Oral cavity - Tonsils - Larynx - Pharynx - Nasopharynx, esp if Cantones/SE Asian Primary salivary gland pathology Thyroid differentiated tumours Lymphoma Supraclavicular LN associated with visceral malignancy
What is Virchow’s node?
Also called signal node
In left supraclavicular fossa
Abdominal cavity drains to it
What is Troisier’s sign?
Enlarged Virchow’s node
Strongly associated with GI cancer
What are the initial investigations for a neck lump?
Fine needle aspiration cytology CT scan of - Neck - Oral cavity - Nasopharynx CXR Open neck biopsy rarely needed
What are common oral pathologies?
Leukoplakia Persistent mouth ulceration Quinsy/peritonsillar abscess Tonsillitis Tongue base and floor of mouth swelling
What is leukoplakia?
Pre-cancerous for SCC
Stays for >6 weeks
Why is persistent mouth ulceration a worry?
Suspicion of maligancy, especially with other factors like
- Smoking
- Sun exposure
- Presence of neck lump
What are the signs of quinsy/peri-tonsillar abscess?
Displaced uvula
Unilateral swelling
What is worrying about quinsy/peri-tonsillar abscess?
Point of drainage
Relationship to local structures
Potential spread to other fascial spaces
What are the potentially fatal sequelae of quinsy/per-tonisllar abscess?
Spread to tongue base > spread to mediastinum > mediastinitis
What is the appearance of bacterial tonsillitis?
Follicular = strawberries and cream
When should you consider tonsillectomy?
Recurrent bacterial tonsillitis
- 6 in 12 months
- Obstructive sleep apnoea
- Especially in children
What is the appearance of infectious mononucleosis tonsillitis?
More diffuse coating on tonsils, compared with bacterial infection
Hepatosplenomegaly
Diffuse lymphadenopathy
Impaired liver function
What are the possible causes of tongue base and floor of mouth swelling?
Infective
- Spread from other head and neck fascial space
Malignancy
Haematoma
From where can infection spread to cause swelling at the tongue base and floor of mouth?
Quinsy
Neglected jaw fracture
Mandibular molar tooth rot abscess
Why is tongue base and floor of mouth swelling important?
Possibly fatal airway obstruction
What can be the source of ear pain?
Otitis externa
Otitis media
Referred pain to ear
From where can pain often be referred to the ear?
Temporomandibular joint, due to
- Anxiety
- Teeth clenching
- Poor molar support
- Bruxism
What is bruxism?
Involuntary habitual grinding of teeth, especially during sleep
What can otalgia with persistent hoarseness indicate?
GORD
Laryngeal cancer
What can otalgia with haemoptysis indicate?
Any cancers along airway
What can otalgia with a neck lump just lateral to the larynx on the same side indicate?
Laryngeal cancer
What can cause hoarseness?
SCC of larynx
Paralysed vocal cord
Reflux of pepsin and acid
Vocal nodules
How can rapid airway patency be established in an emergency?
Piercing relatively bloodless crico-thyroid membrane
Where is it preferable to perform a tracheostomy?
Below 2nd tracheal ring
