ENT Flashcards
Name of of the triangles in the neck and important structures within
Submental: Bilateral anterior digastrics and hyoid bone
- submental lymph nodes
- myohyoid muscle
Submandibular: anterior and posterior digastric and mandible
- submandibular gland
- facial artery and vein
- mandibular branch of facial nerve
- hypoglossal nerve
Muscular: Median line, omohyoid, sternocleidomastoid
- thyroid gland
- larynx
- strap muscles
Carotid: omohyoid, sternocleidomastoid, posterior digastric
- Carotid artery and its division into the internal and external carotid
- internal jugular vein
- Vagus nerve
- Ansa cervicalis
Posterior cervical: sternocleidomastoid, trapezius, clavicle
- External jugular vein
- Phrenic nerve
- Accessory nerve
- Roots of brachial plexus
- ansa cervicalis
Name the divisions of the External Carotid Artery
Some Anatomists Like Freaking Out Poor Medical Students Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial temporal
Name the Levels of the neck
Submental - I (Ia and Ib) Submandibular - II (IIa and IIb) Middle sternocleidomastoid - III Inferior sternocleidomastoid - IV Posterior cervical - V Muscular - VI Supraclavicular
List the differential for a midline neck mass
Congenital: - Thyroglossal duct cyst - Dermoid - Teratoma - Thymic cyst - Vascular tumours and malformations Inflammatory/Infectious: - lymphadenitis - thyroiditis Neoplastic - thyroid
List the differential for a lateral neck mass
Congenital: - Brachial cleft cyst - pre-auricular pit/sinus/cyst - vascular malformation - pseudotumour of infancy - thymic cyst Infectious: - lymphadenitis: viral, bacterial, infectious mononucleosis, atypical mycobacterium, cat-scratch disease - infection of congenital mass - deep neck space infection - parotitis Inflammatory: - Kawasaki - Sarcoidosis Neoplastic: Benign: vascular tumour, teratoma, dermoid, lipoma, nerve tumour Malignant: lymphoma, rhabdomyosarcoma, thyroid
List the most common brachial cleft cyst?
Second brachial cleft
Discuss the presentation and treatment of a first brachial cleft cyst
Presentation:
- Cyst or draining sinus that is anterior to the ear
- can extend over parotid or angle of mandible
- tract can extend into external auditory canal
Treatment:
- surgical excision with careful dissection of facial nerve
Discuss the presentation and management of a second brachial cleft cyst
Location: - Cyst located along anterior border of middle to lower third of SCM - tract extends along carotid sheath -> between divisions of carotid -> terminating in tonsillar fossa Presentation: - cyst with clear or mucoid drainage Investigations: - ultrasound and then CT Treatment: - surgical excision
Discuss the presentation and management of pseudotumour of infancy
- Intra-uterine trauma to the neck resulting in hematoma and subsequent fibrosis Presentation: - firm, round mass along SCM that presents in 2-3 weeks of life - possible torticollis Investigations: - ultrasound - FNA Treatment: - physiotherapy
Discuss the presentation and management of a lymphatic malformation of the neck
Presentation: soft, mobile, painless, cystic mass in posterior triangle. Grow with infant growth
Investigations: MRI
Treatment: bleomycin
Discuss the presentation and management of infantile hemangioma
Presentation: soft, mobile, bluish/red masses. Must discuss risk of airway hemangioma. Most improve within 5-7 years
Treatment: Propanolol
What are the risks of propanolol therapy for infantile hemangioma?
Cardiac: hypotension, arrhythmia, bradycardia
Hypoglycaemia
Respiratory: worsening of asthma, bronchospasm
What are the most likely organisms for acute suppurative lymphadenitis?
Staph aureus
Group A beta-hemolytic strep
What inflammatory neck lesion presents in an asymptomatic child in the submandibular region of the neck?
Atypical mycobacterium
Concern with surgery is mandibular branch of facial nerve
Discuss the presentation and management of a thyroglossal duct cyst
Demographics:
- Children 2-10 years old
Presentation:
- soft, smooth, painless cyst at the level of the hyoid
- Elevates with swallowing
Investigations:
- ultrasound (must ensure normal thyroid is present)
Treatment:
- Sistrunk procedure (remove cyst and hyoid bone)
What are the most common neck masses by age group?
0-15: Infectious Congenital Malignant Benign 16-40 Infectious Congenital Benign Malignant >40: Malignant/Benign mass (SCC common) Infectious Congenital
What are the red flags for a child presenting with stridor?
Hypoxemia Tachypnea Tripod positioning Respiratory distress Decreased level of consciousness Drooling Agitation
List the clinical findings and possible cause of a child with stridor?
Inspiratory stridor and snoring:
- Nasal problems (polyps, choanal atresia)
- foreign body
- neoplasm
Gurgling with muffled voice -> pharyngeal problem:
- afebrile: macroglossia, neoplasm, adenotonsillar hypertrophy
- febrile: epiglotittis, acute tonsillitis, infectious mononucleosis, abscess
High pitched inspiratory stridor with voice change and hoarseness -> laryngeal problem:
- afebrile: laryngeal mass, subglottic stenosis, vocal cord paralysis
- febrile: epiglotittis, croup
Inspiratory and expiratory wheezes -> tracheal problem:
- acute: foreign body
- chronic: tracheal mass
Expiratory wheeze -> bronchial pathology
- symmetric breath sounds: asthma, foreign body
- asymmetric breath sounds: foreign body, asthma
Discuss the presentation and management of laryngeomalacia
Pathophysiology:
- collapse of tissue above airway from short aryepiglotic folds
- arternoid prolapse
- omega-shaped epiglottis
Symptoms:
- Presents 2 weeks after birth
- inspiratory stridor that is intermittent and increases with feeding, normal cry, noisy sleep
Treatment:
- surveillance
- surgical if apnea, failure to thrive, difficulty feeding
Discuss the presentation and management of unilateral and bilateral vocal cord paralysis
Unilateral:
- no stridor and able to maintain airway, voice changes
Bilateral:
- significant inspiratory stridor and respiratory distress resulting in tracheostomy
