Face and Neck - Exam 4

Question 1

The TMJ joint is a hinge joint between what 2 structures?

Answer 1

is the articulation between the mandibular condyle and the glenoid fossa of the temporal bone

Question 2

What are the 3 subtypes of TMJ? Which one is MC?

Answer 2

**Myofascial pain and dysfunction- MC

Internal derangement

Osteoarthritis

Question 3

Which type of TMJ: Affects the muscles of mastication (masseter, temporal, pterygoids)

Answer 3

Myofascial pain and dysfunction

Question 4

Which type of TMJ: Dislocation of the articular disc in the glenoid fossa

Answer 4

Internal derangement

Question 5

Which type of TMJ: Degeneration of the articular cartilage

Answer 5

Osteoarthritis

Question 6

TMJ is MC in ______. What age range is the greatest risk of onset? What is their an association with another condition? What has the highest rate of prevalence?

Answer 6

Females

18-44

associated with mood disorders, other psych conditions and bruxism

increased prevalence with RA

Question 7

Joint pain
Joint noise
Abnormal mandibular movement
Masticatory muscle tenderness
Patients may complain of pain using their jaw, their jaw locking, or their bite not feeling right
HEADACHE- frontal, temporal, occipital
Dizziness or vertigo that is associated with aural fullness or otalgia

What am I?
What is the tx?
How do you dx it?

Answer 7

TMJ

joint rest
Avoid chewing gum, biting nails, excessive talking
Eat a soft diet
Reduce stress
Physical therapy
intra-oral devices

clinically!!!!

Question 8

Can give ____ injections to help with muscle relaxation for TMJ

Answer 8

botox injections

every 3-4 months

Question 9

Name 6 components of a TMJ PE

Answer 9

check for abnormal jaw movements
palpate for jaw tenderness or crepitus
pain with dynamic loading
evaluate for bruxism
evaluate postural asymmetry
neuromuscular exam-> check cranial nerves especially CN V and VII

Question 10

When do you refer out for TMJ?

Answer 10

Symptoms do not improve after 6 months of joint rest
Progressive difficulty in opening the mouth
Inability to eat a normal diet
Recurrent dislocation of the temporomandibular joint

Question 11

Epithelial carcinomas arise from the mucosal surfaces and are typically ______ cell in origin

Answer 11

squamous

salivary gland tumors are different from cancers of the head and neck

Question 12

What are the 3 highlighted risk factors for head and neck cancers?

Answer 12

alcohol
tobacco
smokeless tobacco

Question 13

When do head and neck cancers normally present if they are tobacco related? HPV related?

Answer 13

tobacco: usually less than 60

HPV: usually younger 40-50 in males for often

Question 14

Unilateral serous otitis media / otalgia
Unilateral or bilateral nasal obstruction
Epistaxis
Advanced carcinoma may cause CN neuropathies

What am I?

Answer 14

nasopharynx cancer

Question 15

Persistent hoarseness

What am I?

Answer 15

larynx cancer

Question 16

Non-healing ulcers
Changes in the fit of dentures
Painful lesions

What am I?

Answer 16

oral cavity cancer

Question 17

Changes in tongue mobility
Alterations in speech

What am I?

Answer 17

tongue cancer

Question 18

Sore throat

What am I?

Answer 18

Oropharynx and hypopharynx

Question 19

**What do you need to be able to differentiate between for neck masses? What are some s/s to point that it is infectious?

Answer 19

possible infectious
possible malignant
possible nonmalignant

Infectious etiologies are suspected based on a hx of the mass developing within a few days/weeks of an upper respiratory infection, dental infection, trauma, travel

Question 20

What are some hx features that point to malignancy?

Answer 20

Lack of infectious etiology
Duration of greater than 2 weeks or unknown

Question 21

What are the PE findings that point towards malignancy?

Answer 21

size > 1.5cm
Firm texture/fixed mobility
ulceration of overlying skin

Rapid growing usually infectious cause, while firm, slowly enlarging masses are usually neoplastic***

Question 22

**If you suspect a malignancy of the head/neck, what are the diagnostic TOC? (2)

Answer 22

Contrast CT initial study of choice

Fine Needle Aspiration (FNA): preferred option

Question 23

What is the staging system used for head and neck masses?

Answer 23

TNM stages

Tumor
size and extent of main tumor

Nodes
number of nearby lymph nodes that have cancer

Metastasized
spread to other areas: from primary tumor to other sites/parts of the body

Question 24

What is the tx for stage 1 and 2 head/neck squamous cell carcinomas?

Answer 24

Surgery (removal of tumor/cancerous lesion) or Radiation Therapy

Question 25

What is the tx for stage 3 and 4 head/neck squamous cell carcinomas? What do they have a high risk for?

Answer 25

Combined modalities
Surgery, Radiation Therapy and or chemotherapy

high risk of recurrence and metastasis

Question 26

What is the tx for metastatic head/neck squamous cell carcinomas?

Answer 26

Palliative chemotherapy, supportive care

Question 27

______ is a causative agent for many head and neck squamous cell carcinomas arising in the oropharynx (tonsils and base of tongue)
70% in US

Answer 27

HPV related oropharyngeal cancer

Question 28

Most people who have high-risk HPV won’t get _____. However, some people aren’t able to ____ of their HPV infection. When this happens, the virus can cause damage that makes ______

Answer 28

cancer

get rid

a tumor grow

Question 29

What does a HPV positive cancer present like? What pt population?

Answer 29

younger : 30-55 male
location: tonsil, base of tongue, soft palate

increased number of sexual partners

asymptomatic neck mass. pts will LACK symptoms such as odynophagia or otalgia

Question 30

What strain of HPV is associated with squamous cell carcinoma of the oral cavity?

Answer 30

HPV type 16

oropharyngeal HPV infection may be acquired in the health care setting through exposure to HPV in aerosols produced during surgical excision or ablation of HPV-associated lesions