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SpC ENT > Facial palsy, lumps in neck and salivary glands > Flashcards

Facial palsy, lumps in neck and salivary glands Flashcards

1
Q

Where in the brain does the facial nerve arise?

A

rises in the medulla and emerges between the pons and the medulla

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2
Q

What are the intracranial causes of facial palsy?

A 
Brainstem tumours
Strokes
polio
MS
acoustic neuroma
meningitis
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3
Q

What are the intratemporal causes of facial palsy?

A

They are otitis media
Ramsay hunt syndrome (herpes zoster oticus)
Cholesteatoma

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4
Q

What are the infratemporal causes of facial palsy?

A

Parotid tumours

Trauma leading to complete palsy indicates urgent CT as surgical exploration may be required

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5
Q

How do you differentiate between an upper and lower motor neurone facial palsy?

A

In upper the forehead is spared because it is bilaterally innervated

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6
Q

What tests should be done for facial palsy?

A

Should do ESR, Glucose and lyme disease serology
examine the parotid for lumps
Ears to excluse cholesteatoma and ramsay hunt syndrome
Do MRI for space occupying lesions, cerebrovascular accident, MS, temporal bone fracture

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7
Q

How do you diagnose bells palsy?

A

This is an idiopathic palsy of the LMN and is partly a diagnosis of exclusion

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8
Q

What is the pathophysiology behind bells palsy?

A

Thought to be due to odema causing entrapment of the facial nerve in the narrow bony canal

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9
Q

How fast is the onset of idiopathic facial palsy?

A

Onset is abrupt (overnight)

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10
Q

What is the treatment of idiopathic facial palsy?

A

Prednisolone helps improve the rate of revovery

Help protect the eye with moistening drops

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11
Q

When should bells palsy be referred?

A

When it has lasted over 1 month
If there is recurrence
If there is doubt about the diagnosis

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12
Q

What is the prognosis for bells palsy?

A

Most have full recoery in 3 months (85%)

Some will have no recovery (5%) - refer to plastics if > 6 months

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13
Q

When diagnosing neck lumps what sort of time period requires investigation?

A

If the lump has been present for less than 3 weeks then it is likely to be a reactive lymphadenopathy and investigation is unwise

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14
Q

What tests should be done for a neck lump?

A

Should US lumps to guide fine needle aspiration
CT can help define masses in relation to their anatomical neighbours
Do virology and mantoux test (TB)

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15
Q

What can a chest x ray show in patinets with neck lumps?

A

Can show malignancy or bilateral hilar lymphadenopathy in sarcoid

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16
Q

What are possible differentials for midline lumps?

A

If the patient is <20 then it is likely a dermoid cyst
If it moves up on tongue potrusion then it is likely to be a thyroglossal cyst
If older than 20 then it could be a thyroid mass

17
Q

What are the possible differentials for lumps in the submandibular triangle?

A

They could be self limiting reactive lymphadenopathy if <20
If greater than 20 need to exclude malignant lymphadenopathy - firm, non tender, weight loss, fever, night sweats
Is TB likely?
If it is not a node think submandibular salivary stone or tumour

18
Q

What are differentials for lumps in the anterior triange?

A

Lymphadenopathy is common
Is the spleen enlarged with symptoms such as weight loss (lymphoma)
Branchial cysts - where upper third of SCM meets middle third - contain cholesterol crystals
If superoposterior could be parotid tumour
Pulsatile lumps:
-carotid aneurysm
-Tortuous carotid artery
-Carotid body tumour

19
Q

What are the differentials for a lump in the posterior triangle of the neck?

A

Cervical ribs can intrude into this area, can cause neuro symptoms by compressing brachial plexus
Pharyngeal pouches can protrude into the posterior triangle on swallowing
Cystic hygromas are macrocystic lymphatic malformations - transilluminate brightly
Any small lumps think lymphadenopathy (TB or viruses) or metastases

20
Q

What are the possible differentials if fine needle aspiration is positive?

A 
SCC -MRI/CT
Adenocarcinoma- MRI/CT
Melanoma - skin cancer MDT
Thyroid carcinoma - US thyroid
Lymphoma - excision
Merkel cell carcinoma - skin cancer MDT
21
Q

How do you examine the salivary glands?

A

Look for any swellings, palpate for stones, test facial nerve function
Note the size, mobility and extend of any mass

22
Q

What is Sialadenitis?

A

This is an acute infection of the submandibular or parotid glands, usually occurs in elderly dehydrated patients

23
Q

What is the presentation of sialadenitis?

A

Painful diffuse swelling of the gland with fever

Pressure on the gland may lead to puss leaking out of the duct

24
Q

What is the treatment of sialadenitis?

A

Treated with antibiotics and good oral hygiene
Sialogogues are helpful e.g. lemon drops that stimulate salivation
Surgical drainage may be required
Recurrent infection can occur with salivary duct stenosis

25
Q

How do salivary stones (sialolithiasis) present?

A

With pain and tense swelling of the gland during/after meals

Stone may be palpable in the floor of the mouth

26
Q

How are salivary stones investigated and treated?

A

With plain x ray or sialogram

Treated with surgical removal for bigger stones

27
Q

What inflammatory conditions cause the salivary galnds to enlarge?

A

Sjogrens syndrome - parotid
Viral infections e.g. mumps or HIV
Granulomatous disease e.g. TB or sarcoidosis

28
Q

Where do most salivary galnd tumours form and what type are they?

A

80% of salivary gland tumours form in the parotid and 80% of these are benign pleomorphic adenomas

29
Q

What gland tumour for salivary tumours have the highest percentage malignancy?

A

50% submandibular gland tumours are malignant

30
Q

What are some of the symptoms of salivary gland tumours?

A

A hard fixed mass with or without pain
There may be overlying skin ulceration but tumours do not vary in size when eating as seen with inflammation and salivary stones

31
Q

What does a facial nerve palsy with salivary gland swelli g suggest?

A

Malignancy

32
Q

What is the grading for facial nerve weakness?

A

House brackmann scoring system

33
Q

What is bells phenomenon?

A

This is upward and outward movement of the eye in an attempt to close it

34
Q

What is ramsay hunt syndrome?

A

This is herpes zoster oticus
It causes facial nerve palsy and vesicular rash on the skin of the auricle
After primary infection from the varicella zoster virus (chicken pox) the virus remains latent in the ganglia and can become reactivated

35
Q

What is the treatment of ramsay hunt syndrome?

A

Treat with steroids and antivirals

Post herpetic pain can persist for months

SpC ENT (7 decks)

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