Head and neck Flashcards
Swallowing stages
1) Oral
2) Pharyngeal
3) Oesophageal
Stages of voice production
Column of air pressure moves up. Causes vocal ford vibration. This causes resonance. Then you articulate sounds
Differentials for 20yo with a 5 day history of sore throat, temp, difficulty swallowing, painful swallowing, swollen glands
Tonsillitis
Glandular fever
Quinsy
Supra/epiglottitis
Deep neck space infection (DNSI)
What should you be wary of in someone with significant sore throat but normal pharynx exam
Supraglottitis
Management of tonsillitis
Analgesia, PO abx, drink plenty, soft foods or soups
When would a tonsillectomy be required
More than 7 episodes per year in 1 year
5/year for 2 years
2/year for 3 years or more
Management of post tonsillectomy
Painful for 1-2 weeks so advise regular analgesia and normal diet
Bleeds are common. Primary bleeds may need theatre but secondary bleeds settle conservatively on admission
Are swabs used for tonsillitis
No
Symptoms of tonsillitis
White pus on tonsils
Painful
Fever
Unwell
What is glandular fever
Viral infection affecting tonsils and lymph nodes caused by EBV
Symptoms of glandular fever
IT is a prodromal illness therefore:
-Cervical lymphadenopathy
-Abdominal pain
-HEpatosplenomegaly
-Check: FBC, LFTs, mono spot-glandular fever test
Management glandular fever
-symptomatic: oral rehydration, analgesia (soluble)
-Abx if presenting with possible tonsillitis
-LFT monitoring if abnormal
-Avoid contact sport/ alcohol: hepatosplenomegaly-rupture
-Warn may feel washed out
Do not give ampicillin/amoxicillin- rash
What is quinsy
Peritonsillar abscess
Symptoms of quinsy
-Shorter history
-Dysphagia (maybe absolute)
-Trismus (can’t open mouth fully)
-Unilateral swelling: above and lateral to tonsil
-Tonsil and uvula pushed to opposite side
Management of quinsy
Involve ENT
IV fluids and abx
Needle aspiration or formal insertion and drainage
If an older person who is a smoker, and who is otherwise well but has progressive symptoms consider a neoplastic lesion
How do complications of throat infections arise
Throat infection leads to lymphadenitis (inflammation in lymph nodes). This leads to suppuration (pus in lymph nodes). This leads to Neck abscess so a Deep Neck Space Infection [parapharyngeal or retropharyngeal]
What is parapharyngeal DNSI
Lateral to pharynx
What is retropharyngeal DNSI
Behind pharynx
Symptoms and signs of DNSI
Difficulty moving head from left to right as extremely painful !!!
Sore throat
Odynophagia (painful swallow)
Dysphagia
Trismus
Drooling
Fever
Muffled voice
Septic
Neck mass
Airway compromise
Displaced pharynx
Tongue swelling
Brawny induration
Imaging for DNSI
CT
USS to check for abscess vs cellulitis when there is a superficial mass
Who does retropharyngeal infections mostly affect
Children
How does a retropharyngeal infection develop
Adenitis of ROuviere’s nodes which leads to suppuration.
trauma, foreign body ingestion may also cause this
Complications of retropharyngeal infection
Mediastinitis
Spread to other deep neck spaces
Where is the parapharyngeal space
Mandible is lateral to it
