ENT Pathology 5 - Nasopharyngeal Ca, Bell's palsy, Ramsay hunt, Croup, Epiglottis, laryngitis Flashcards
What are two common viral causes of nasopahryngeal carcinoma?
HPV (human papilloma virus) and EBV (Epsteinn Barr virus)
What is the most common site of origin for nasopharyngeal carcinoma?
Fossa of rosenmuller - pharyngeal recess (located posterior to the eustachian tube opening
What are risk factors for NPC?
Smoking and alcohol
How many weeks of hoarseness is a red flag for NPC?
Hoarseness for greater than 6weeks
Local spread may involve CN’s via jugular foramen in nasopharyngeal carcinoma (NPC) What is the mainstay of treatment?
Radiotherpy
What is the most common type of carcinoma? (Of the head and neck)
Squamous cell carcinoma
• Often advanced at presentation • M>F • Most are squamous • Usually older patient who is a smoker This is an orophraryngeal carcinoma What is the main treatment in oropharngeal carcinoma?
usually radiotherapy
Where can the pain in oropharngeal carcinoma arise?
The pain can arise in the in the ear due to referred pain
What innervates the eustachian tube with sensory innervation therefore can have referred pain?
CN IX - glossopharyngeal nerve
Is a stridor suggestive of an upper or lower respiratory tract pathology?
Suggest of an upper respiratory tract pathology -eg in croup (laryngeotracheobronchitis) - you can have a stridor
Patient presents with a stridor, hoarseness of voice, dysphagia and haemoptysis What do you think?
Laryngeal carcinoma
What is the cause of unilateral facial nerve palsy causing facial weakness unilaterally?
Bell’s palsy
What is the most probable cause of Bell’s palsy causing the unilateral facial paralysis?
Most likely to be of viral aetiology
Describe the features of Bell’s palsy?
Can present with a variety of features due to the muscles of facial expression supplied by the facial nerve Can have - drooling, dry eyes, loss of taste on anterior 2/3rds of the tongue Drooping eyelid
What is the sensory and motor innervation of the lacrimal gland?
Sesnory - lacrimal nerve branch of opthalmic nerve (CN V1) Motor - greater petrosal nerve branch of the facial nerve (CN VII) - therefore decreased tear production and dry eyes
Which muscle moves the tears across the eyes due to the closure of the eyelids? Which muscle prevents drooling? What nerve supplies taste to the anterior 2.3rds of the tongue? (what fissure does it exit the skull via)
Closure of the eylids - orbicularis oculi muscle Prevents drooling - orbicularis oris muscle Taste to anterior 2/3rds of tongue - chorda tympani branch of the facial nerve - exits via the petrotympanic fissure Glossopharyngeal supplies the posterior 1/3rd of the tongue with sensory innervation
What is the name for dry eyes in Bell’s palsy?
Keratoconjunctivitis sicca - just means dry eyes
What is the first line treatment used in all cases of Bell’s palsy?
Corticosteroid - prednisolone and eye protection eg eye drops
What may be given if there is severe paralysis of the facial muscles?
An antiviral such as aciclovir - refer to specialist help for consideration
How is bell’s palsy differentiated from ramsay hunt syndrome?
Bell’s palsy is unilateral facial palsy (can have pain) Ramsay hunt syndrome presents with unilateral facial palsy with vesicles in auditory canal or face/tongue/hard palate
How is ramsay hunt syndrome treated?
Treated with antivirals (acyclovir) + steroids (prednisolone)
• Leading cause of stridor (high pitched inspiratory noise) with a barking cough What is this?
Croup (laryngeotracheobronchitis) - cough and no drooling is usually croup
What is the cause of croup?
usually caused by parainfluenza virus
What may be the sign on xray for croup and what is the usual treatment?
Sign is a steeple sign on xray usually NICE recommend giving a single dose of oral dexamethasone (0.15mg/kg) to all children regardless of severity
