Face and Neck - Exam 4 Flashcards
The TMJ joint is a hinge joint between what 2 structures?
is the articulation between the mandibular condyle and the glenoid fossa of the temporal bone
What are the 3 subtypes of TMJ? Which one is MC?
**Myofascial pain and dysfunction- MC
Internal derangement
Osteoarthritis
Which type of TMJ: Affects the muscles of mastication (masseter, temporal, pterygoids)
Myofascial pain and dysfunction
Which type of TMJ: Dislocation of the articular disc in the glenoid fossa
Internal derangement
Which type of TMJ: Degeneration of the articular cartilage
Osteoarthritis
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?
Females
18-44
associated with mood disorders, other psych conditions and bruxism
increased prevalence with RA
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?
TMJ
joint rest
Avoid chewing gum, biting nails, excessive talking
Eat a soft diet
Reduce stress
Physical therapy
intra-oral devices
clinically!!!!
Can give ____ injections to help with muscle relaxation for TMJ
botox injections
every 3-4 months
Name 6 components of a TMJ PE
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
When do you refer out for TMJ?
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
Epithelial carcinomas arise from the mucosal surfaces and are typically ______ cell in origin
squamous
salivary gland tumors are different from cancers of the head and neck
What are the 3 highlighted risk factors for head and neck cancers?
alcohol
tobacco
smokeless tobacco
When do head and neck cancers normally present if they are tobacco related? HPV related?
tobacco: usually less than 60
HPV: usually younger 40-50 in males for often
Unilateral serous otitis media / otalgia
Unilateral or bilateral nasal obstruction
Epistaxis
Advanced carcinoma may cause CN neuropathies
What am I?
nasopharynx cancer
Persistent hoarseness
What am I?
larynx cancer
Non-healing ulcers
Changes in the fit of dentures
Painful lesions
What am I?
oral cavity cancer
Changes in tongue mobility
Alterations in speech
What am I?
tongue cancer
Sore throat
What am I?
Oropharynx and hypopharynx
**What do you need to be able to differentiate between for neck masses? What are some s/s to point that it is infectious?
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
What are some hx features that point to malignancy?
Lack of infectious etiology
Duration of greater than 2 weeks or unknown
What are the PE findings that point towards malignancy?
size > 1.5cm
Firm texture/fixed mobility
ulceration of overlying skin
Rapid growing usually infectious cause, while firm, slowly enlarging masses are usually neoplastic***
**If you suspect a malignancy of the head/neck, what are the diagnostic TOC? (2)
Contrast CT initial study of choice
Fine Needle Aspiration (FNA): preferred option
What is the staging system used for head and neck masses?
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
What is the tx for stage 1 and 2 head/neck squamous cell carcinomas?
Surgery (removal of tumor/cancerous lesion) or Radiation Therapy
What is the tx for stage 3 and 4 head/neck squamous cell carcinomas? What do they have a high risk for?
Combined modalities
Surgery, Radiation Therapy and or chemotherapy
high risk of recurrence and metastasis
What is the tx for metastatic head/neck squamous cell carcinomas?
Palliative chemotherapy, supportive care
______ is a causative agent for many head and neck squamous cell carcinomas arising in the oropharynx (tonsils and base of tongue)
70% in US
HPV related oropharyngeal cancer
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 ______
cancer
get rid
a tumor grow
What does a HPV positive cancer present like? What pt population?
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
What strain of HPV is associated with squamous cell carcinoma of the oral cavity?
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
