ENT - 2 Flashcards
What 3 structures does the parotid gland have close proximity to?
Facial nerve
External carotid artery
Greater auricular nerve
Where does the parotid duct exit into the mouth?
Through Stenson’s duct - Opposite the 2nd molar
What kind of fluid does the parotid secrete
Watery serous saliva
What supplies the parasympathetic innervation the parotid gland?
The Glossopharyngeal nerve - parasympathetic innervation - increase saliva production
Where does the submandibular duct enter the mouth?
Wharton’s duct - floor of the mouth
What kind of fluid does the submandibular secrete
Thick, mucoid saliva
What supplies the parasympathetic innervation to the submandibular gland?
Chorda tympani (branch of facial nerve) and the lingual nerve (branch of the mandibular nerve - division of the trigeminal nerve)
Presentation of Acute Silolithiasis ( Salivary Stasis)
Pain, firm swelling, pus discharge
Treatment of AS
Fluids, Abx if infection, warm compress
Where is the most common gland for AS
Submandibular gland
What is Sjorgen’s syndrome
Autoimmune destruction of acinar and ductal cells in the moisture producing glands of the body
2 main symptoms of Sjorgens syndrome
Dry eyes and mouth
2 disease Sjorgens syndrome is associated with
Non-hodgkin lymphoma and RA/SLE
Treatment of SS
Oral hygiene and salivary substitutes
Most common site and type of salivary gland tumour?
80% Parotid
80% of those are benign
80% of those are pleomorphic adenoma
Red flags of Laryngeal Cancer
Hoarse voice, stridor, dysphagia, lump in neck, unilateral otalgia
Where are most nose bleeds located
Keiselbach’s plexus (95%) - anterior nasopharynx
Symptoms of anterior and posterior epistaxis
Anterior = blood coming out of nose - usually 1 nostril Posterior = blood going down throat/ out both nostrils
Epistaxis treatment
Stop the bleeding - Pressure, nasal pack, cautery or surgery
What causes Glue Ear?
Narrow or blocked Eustachian tube stops air flow leading to fluid build up in the middle ear
Symptoms of glue ear
Hearing loss, pain and behaivior changes in children
What 4 things make up the Centor Criteria
Tonsillar exudate
Tender anterior cervical lymph nodes
Absence of cough
History of fever
Symptoms of pharyngitis
Sore throat, cough, coryzal, otalgia
Symptoms of tonsilitis
Sore throat, low grade temo, otalgia, reduced oral intake, cervical lymphadenopathy, exudate on tonsils
Causes of tonisilitis
70% viral - 10% EBV
Bacterial - Group a B-haemolytic strep (Exudate)
What is a Quinsy
Peritonsillar abscess
Symptoms of a quinsy?
Increasing sore throat, dysphagia, reduced oral intake, hot potato voice, temperature, cervical lymphadenopathy, deviated uvula away from swelling
Causes of quinsy
Usually a complication of untreated tonsillitis
Treatment of quinsy
Admit to hosp
Analgesia, IV fluids, Benzylpenicillin, needle aspiration + dranage
Cause of glandular fever
Epstein Barr Virus- Infectious Mononucleosis
Symtoms of GF
2wk history of sore throat, general malaise, cervical lymphadenopathy, soft palate petechiae, exudative tonsils and hepatosplenomegaly
Treatment of GF
Depends on severity - may need admission, IV fluids and Benzylpenicillin
Who gets supraglottisis and epiglottisis
Children = Epiglottitis Adults = Supraglottitis
Symptoms of epi/supra
1wk sore throat, odynophagia, hoarse voice, SoB
Treatment of epi/supra
Airway assessment - ambulance to A+E
Urgent ENT assessment - secure airway, adrenaline nebs and IV dexamethasone
Treat cause - IV cefetaxime + ITU admission
What is Rhinosinusitis?
Inflammation of the lining of the nose and sinuses
Presentation of Rhinosinusitis?
Nasal obstruction/ congestion, Rhinorrhoea
Post nasal drip + reduced sense of smell
Red flag - Unilateral obstruction and bleeding
Usual cause of acute Rhinosinusitis?
Viral URTI with secondary bacterial infection
Viral and bacterial causes
Viral - Rhinovirus, influenza and RSV
Bacterial - Pneumococcus, Streptococcus and H.flu
Causes of chronic Rhinosinusitis
Allergic - Atopy, aspirin allergy
Non-allergic - Idiopathic, ciliary dysfunction.
Treatment of Rhinosinusitis
Stepwise:
1) Topical steroid spray
2) Topical steroid drops
3) Oral steroids
4) Surgery
