Head and Neck 2

Question 1

Presentation of a dermoid cyst?

Answer 1

They are cystic teratomas which are almost always benign.
Presents as a midline ass which will not move with protrusion of the tongue. Hard in consistency and limited to skin.
Rx - complete surgial removal.

Question 2

What is a Ranula?

Answer 2

Cystic swelling on the floor of the mouth which is from sublinguial salivary gland.

A plunging ranula is when it extends through muscles in the floor of the mouth into the neck

Question 3

Benign tumours of salivary glands?

Answer 3

Pleomorphic adenomas - most common.
Warthin’s tumour - strongly associated with smoking.

Question 4

Explain features of carotid body tumour

Answer 4

Located at the common carotid artery bifurcation (baro and chemo-recptors)
Presents as a pulsatile, compressible mass that refills rapidly on release of pressure

Question 5

Investigations for dysphagia?

Answer 5

Ward assessment,
Speech and language therapist,
Nasopharyngeal laryngoscopy,
FEES,
Barium swallow,
Videofluroscopy,
OGD,
Oesophageal manometry

Question 6

Risk factors and presentation and treatment of oral cavity cancer

Answer 6

Risk factors: Smoking, alcohol, betel nut, chronic dental issue, immunosuppresion.
Presentation: Painless lump, non healing ulcer, erythroplakia, speckles leukoplakia, lichen planus. Late symptoms include pain, bleeding and obstructive symptoms.
Rx - surgery +/- post op radiotherapy +/- reconstruction

Question 7

Risk factors, presentation and treatment of nasopharyngeal cancer?

Answer 7

RFs: South asian population and EBV.
Presentation; Cervical lymphadenopathy, ear pain, secretory otitis media, CN palsies, epitaxis/discharge, nasal obstruction.
Rx - Chemo and radiotherapy. Surgery is last ditch effort.

Question 8

Risk factors, presentation and treatment of oropharyngeal cancer

Answer 8

RFs: Smoking, alcohol, HPV 16/18
Presentation: Painless unilateral tonsillar swelling, unilateral throat pain with worsening dysphagia, otalgia, neck lump.
Rx - radiotherapy or endoscopic surgery. Later on chemorads and open surgery + reconstruction.

Question 9

Explain features of pleomorphic adenomas?

Answer 9

Most common benign tumour of the parotid gland which presents between ages 40-60.
Presents with gradual onset painless swelling of parotid gland. Mobile > fixed.
Rx - surgical removement because risk of malignant transformation.

Question 10

Features of stertor vs stridor

Answer 10

Stertor - Snoring which occurs with partial obstruction above the larynx.
Stridor - Noise due to partial obstruction at level/below larynx (ENT emergency)

Question 11

Causes of airway problems?

Answer 11

Infective - tonsillitis (stertor), epiglottitis/supraglottitis (stridor).
Hypersensitivity - angioedema,
Trauma,
Neurological - bilateral vocal cord palsy.
Malignancy,
External compression,
Foreign body

Question 12

Neck lump Ix?

Answer 12

Ultrasound +/- FNA or core biopsy.
CT/MRI if concerned about malignancy - if find lesion then biopsy under general anesthetics.

Question 13

Management of acute ENT airway issue

Answer 13

A-E
If stridor - nebulised adrenaline, steroids and refer urgently to ENT.
Antibiotics +/- aspiration of abscess
IV fluids

Question 15

Indications for tracheostomy?

Answer 15

Upper airway management,
Trauma,
Long term ventilation,
Head and neck surgery

Question 16

Features of tracheostomy

Answer 16

Opening of trachea below the larynx, must always were tube.
Can be temporary or permanent.
Still have anatomically intact airway - can still breath through mouth.

Question 17

Features of laryngectomyEm

Answer 17

Normally only done for cancer.
Larynx is removed +/- other structures.
It is an end stoma so only airway, permanent and cannot be reversed.
Doesn’t always need tube.
No communication between mouth and lungs so if patient comes in cyanosed then put oxygen mask over the neck.

Question 18

Urgent suspicion of cancer referral for head and neck cancer?

Answer 18

Emergency - Stridor.

Unexplained neck lump > 3 weeks.
Unexplained ulceration/swelling in mouth for > 3 weeks.
All unexplained red/mixed red or white patched in mouth for > 3 weeks.
Persistnet (not intermittent) hoarseness for > 3 weeks.
Persistent pain in throat or pain on swallowing for > 3 weeks