ENT Part 2 Flashcards
1
Q
Describe the anatomy of the parotid gland?
A
- Serous salivary gland located anterior to the pinna and lateral to the ramus of the mandible.
- It is superficial to the masseter and drains via the stensen’s duct opposite the upper second molar after piercing the buccinator muscle and the buccal mucosa.
- It is split into deep and superficial lobes by the facial nerve which passes through the gland.
- The majority of the gland lies superficial to the facial nerve.
- Facial palsy is one of the most serious risks from parotid surgery and can also be caused by a parotid malignancy
2
Q
Describe the types of lumps found in the parotid gland?
A
- Most neoplasms - in the parotid gland (80%)
- Most are benign (80%) – off these, 80 are pleomorphic adenomas
- Infections less common in the parotid gland
3
Q
Describe the anatomy of the submandibular gland?
A
- Located inferior to the body of the mandible and superior to the digastric muscle.
- Drains via Wharton’s duct which opens into the mouth close to the frenulum of the tongue.
- The hypoglossal and lingual nerves run medial to the gland and are at risk during submandibular gland surgery.
- Submandibular gland - mixed mucous and serous secretions
- Sublingual glands - entirely mucous and located in the floor of the mouth.
4
Q
How common are infections in the submandibular + sublingual infections:?
A
- Submandibular - Half the neoplasms are malignant.
-
Sublingual - 80% of sublingual gland neoplasms are malignant
- Infections are more common (than parotid) - 9x
5
Q
What is acute sialadenitis? How is it ixd + mxd?
A
- Cause: infective (bacterial or viral)
- Bacterial: staph infection in dehydrated of immunocompromised individuals
- Viral: Paramyxovirus – Mumps, Coxsackievirus, Echovirus, HIV
- Chronic: rare. Sometimes seen in TB, sarcoidosis, HIV, syphilis, sjogrens. Can be caused by strictures and salivary gland stones
- Autoimmune: sarcoidosis, sjogrens, wegeners granulomatosis
- Sx: pain, gland swelling, pressure over gland can cause leaking of pus
- Ix: routine bloods, pus swabs, cultures, USS imaging. CT scan (if deep neck space infection suspected)
- Mx: abx, good oral hygiene, sialologues (e.g. lemon drops stimulating salivation). Surgical drainage sometimes required.
6
Q
Where does sialolithiasis most common?
A
Submandibular gland where secretions are richer in calcium and thicker
7
Q
What is sialolithiasis?
A
- Stones in the salivary duct cause obstruction and subsequently lead to pain and swelling which is worse during meals
- RFs: medication, dehydration, gout, smoking, chronic periodontal disease, hyperparathyroidism
- Sx: pain and tense swelling of the gland, during and after meals, palpable stone on the flow of the mouth
8
Q
How is sialolithiasis mxd?
A
- Mx: conservative – small stones will pass spontaneously
- Medical: analgesia, hydration, sialogogues (lemon drops)
- Surgery: for larger stones, endoscopic removal
- Surgery - Intraoral removal of palpable stones; Removal of salivary gland
9
Q
What is sjogrens disease?
A
- Autoimmune disease causing lymphocytic infiltration into the ductal tissue of secretary glands.
- Classical presentation: dry eyes, dry mouth and enlarged salivary glands (bilateral)
- Increased risk of developing lymphoma.
- The disease may be
- Primary: Xerostomia and xerophthalmia without connective tissue abnormality.
- Or secondary: As primary disease, with connective tissue disease, most commonly RA
10
Q
What are some of sx of head + neck tumours?
A
- Dysphonia (esp laryngeal malignancy which may cause hoarseness)
- Dysphagia/odynaphagia
- Dyspnoea –stridor from narrowing of airway, especially laryngeal tumours
- Neck Mass
- Pain from site of pathology or referred e.g. to ear
- Bleeding from nose or mouth depending on site of primary(rare presentation)
- Nasal blockage –normally unilateral progressive for nasal/nasopharyngeal pathology
11
Q
What sx of H+N tumours warrant an urgent 2WW referral?
A
- Ear ache/ effusion
- Lumps (lip mouth and gum)
- Speech change
- Hoarse voice > 6 weeks
- Sore throat > 6 weeks
12
Q
What are some pre malignant conditions seen in H+N cancers?
A
- Leukoplakia (white patches)
- Erythroplakia (red patches)
- Erythroleukoplakia (mixed red and white patches)
- Oral lichen planus
- Actinic cheilitis
13
Q
What are the sx of oral cavity cancer?
A
- painless mass, felt on the inner lip, tongue, floor of the mouth or the hard palate.
- Less common (non-specific): oral cavity bleeding, localised pain in oral cavity and jaw swelling
- Persistent, painful ulcers; white/ red patches on tongue
- Otalgia, odonyphagia, lymphadenopathy
14
Q
What are some sx of Pharyngeal cancer?
A
odynophagia, dysphagia, stertor, referrered otalgia
15
Q
How does nasopharyngeal cancer present?
A
- Cervical lymphadenopathy
- Otalgia
- Unilateral serous otitis media
- Nasal obstruction, discharge and/ or epistaxis
- Cranial nerve palsies e.g. III-VI
*
