Head and neck 2 Flashcards
Complications of DNSI
Airway compromise
Rupture
Mediastinitis
Lemierre’s syndrome
Carotid artery erosion
What can a rupture of DNSI lead to
Pneumonia, empyema, lung abscess
Symptoms and treatment of mediastinitis
SOB, chest pain, wide mediastinum
IV abx, surgery
What is Lemierre’s syndrome and its management
Internal Jugular Vein thrombosis and oropharynx infection
IV abx, heparin, excision?
What is carotid artery erosion
Presentation?
Management
Internal carotid artery most commonly eroded. Then external most likely, then common carotid.
Sentinel bleeds: mouth, nose, ear
Surgery
What is parotitis
Treatment
Can be mumps or bacterial parotitis
Mumps: children, bilateral ‘hamster face’. Watch for complications
Bacterial parotitis: occurs in elderly, debilitated and those with poor oral hygiene. Parotid swollen, tender, pus at duct opposite second upper molar. Treatment: PO/IV abx, rehydrate, oral care
Typical history of those with salivary gland stones
Pain after eating which settles an hour or so afterwards.
Symptoms of Sjogren’s syndrome
Dry eyes/mouth, arthralgia (joint pain)
Imaging for salivary stones
USS/ FNA/ Xray/ MRI
Difference between stertor and stridor
Stertor- noise breathing caused by partial obstruction of the airway above the larynx (tonsils, adenoids, tongue obstruction). Sounds like snoring
Stridor-NOisy breathing caused by partial obstruction of airway at or below the larynx
Signs of severe airway obstruction and what to do
Tracheal tug, recession, accessory muscle use, complete obstruction with quiet breathing, tachycardia, hypoxia, confusion
URGENT ent input
Causes of stridor
Supraglottitis/ epiglottitis
Malignancy
Vocal cord palsy
Angioedema
Foreign body
Causes of stertor
Tonsillitis
NAsal obstruction
Foreign body
Angioedema
Management of stridor
ABCDE
Resus
Anaesthetics
ENT
COnsider
Adrenaline nebuliser
Dexamethasons for inflammation
Theatre
Awake tracheostomy
If a sore throat looks unusual what is it
Tonsillitis
If a sore throat has a normal looking pharynx what is i
Supraglottitis
What is supraglottitis
Infection of the supra glottis (larynx above the true cords)
Management of supraglottitis
Consider airway compromise needing intubation or trache
Most settle with IV dexamethasone and IV abx
Can adrenaline be given in supraglottitis?
IF so what should you be wary of
YEs. Nebulised adrenaline may buy time in extremis. But rebound tightening of airway is possible so if you need adrenaline you should consider securing the airway
Symptoms of an impacted foreign body
Felt something stick at time of eating
Unable to finish meal
Unable to eat or drink since or swallow own saliva
Sharp pain
fever/surgical emphysema. abnormal physiology if progression
Symptoms of an ingested foreign body which has just caused a scratch
OK at time of eating, pain later. Able to finish meal. Able to eat and drink subsequently. Able to swallow own saliva. Dull pain. Normal physiology
Tests to do if ingested foreign body
Lateral neck xray. However not always seen.
CXR if think has gone down
ENT can do Flexi scope and remove it under anaesthetic. If no foreign body is seen, advise pt to return if worse/ persisting, fever or neck lump
What does surgical emphysema indicate on a neck Xray
perforation
how to manage a patient who has swallowed a large food bolus and presents with complete dysphagia
CXR and neck Xray to look for opaque bones as these won’t pass. Consider buscopan and diazepam to relax muscle. Oesophagoscopy and removal in ENT if doesn’t pass and food bolus is either pushed down or brought up
What cancers arise from glands
Adenoid cystic carcinoma
Mucoepidermoid carcinoma
What cancers arise from upper aerodigestive tract mucosa
squamous cell carcinoma
Risk factors for H&N cancer
Tobacco and alcohol
HPV
Occupation: nickel refining, woodworking, exposure to textile fibres
Plummer-VInson syndrome: iron deficiency in older women. Develop hypo pharyngeal carcinoma
Risk factors for H&N cancers in younger patients
HPV infevtion
Smokeless Tobacco
Marijauna
How does head and neck cancer present
Visible lesions
Neck lump
Hoarse voice
Dysphagia
Referred otalgia