Head and neck 2 Flashcards
What constitutes the oral cavity?
Oral vestible (area between lips/teeth) Oral cavity proper
What are the boundaries of the oral cavity?
Lips to palatoglossaI arch (anterior pillar)
Palate to floor of mouth/tongue
buccal mucosa
What are the functions of the oral cavity?
Taste Mastication >Teeth, tongue Speech >Tongue, cheek, lips Digestion >Salivary enzymes Swallowing >Tongue, hard and soft palate
What ducts enter the oral cavity?
Parotid
Submandibular duct
Describe the course of the parotid duct
duct pierces buccinator muscle,
then opening up into the oral cavity on the inner surface of the cheek
Opens opposite second molar
Describe the course of the submandibular duct
Lying superior to thedigastric muscle,
Both submandibular gland is divided into superficial and deep lobes,
separated by themylohyoid muscle.
How is the anterior 2/3rds of the tongue innervated?
From 1st branchial arch
Sensation - lingual nerve
>branch of mandibular divisionof theCN V
Taste
>Chorda tympani
How is the posterior 1/3rd of the tongue innervated?
Arises from 3rd brachial arch
Supplied by glossopharyngeal nerve (CN IX)
What are the functions of the tongue?
Taste
Mastication
Swallowing
Speech
What are the papillae of the tongue?
Fulliform
Gungiform
Folliate (very rudimentary)
Circumvallate
Describe the fulliform papillae
Most numerous
No taste buds
Describe the location of fungiform papillae
Scattered throughout dorsum of tongue
Describe the location of Circumvalate papillae
placed in a row just anterior to the sulcus terminalis
>(“V” shaped groove that demarcates the junction of the oral and pharyngeal portions of the tongue base)
What is teh innervation of the motor (muscle) aspect of tongue?
Everything innervated hy hypoglossal nerve (CN XII)
EXCEPT palatoglossus
>Innervated by pharyngeal plexus (CN IX/X)
What is the function of the intrinisic muscles of tongue?
Alter shape
What is the function of the extrinsic muscles of tongue?
Alter position
What are the main extrinsic muscles of the tongue?
Genioglossus,
styloglossus,
hyoglossus and palatoglossus
What muscles control mastication?
Lateral pterygoid
Medial pterygoid
Temporalis
Masseter
What is the innervation of the muscles of mastication?
CN V3
Mandibular division of trigemial nerve
Where do the muscles of mastication act?
Temporal-mandibular joint
>Grind food between teeth
What is the anterior/posterior boundaries of the orophaynx?
Palatoglossal arch to posterior pharyngeal wall
What is the inferior/superior boundaries of the orophaynx?
Lower border of soft palate to upper margin of epiglottis
What is the lateral boundary of the oropharynx?
faucial pillars & palatine tonsils
What is the nerve supply of the oropharynx?
Pharyngeal plexus- CN IX & X
What are the subsites of the hypopharynx?
Pyriform sinus
Post-cricoid area
Posterior pharyngeal wall
What is the innervation of the hypopharynx?
Pharyngeal plexus- CN IX & X
What is the blood supply of the hypopharynx?
Superior Thyroid Artery
Lingual Artery
Ascending Pharyngeal Artery.
What are superior/inferior boundaries of the hypopharynx?
Epiglottis To lower border of cricoid cartilage
What is the anterior boundary of the hypopharynx?
Back of larynx
What is the oral phase of swallowing?
Tongue propels food (bolus) into pharynx
Triggering swallowing reflex (afferent: CN V, IX, X – swallowing centre in medulla – efferent: CN VII, X, XII)
What is the pharyngeal phase of swallowing?
Soft palate pulled upwards
Epiglottis covers the larynx, vocal cord approximate, larynx moves upward
Upper oesophageal sphincter (UOS) relaxes
Respiration is reflex inhibited
What is the oesophageal phase of swallowing?
Once bolus passed UOS, the sphinter constricts
Bolus propelled downwards by peristaltic motion, reflex via myenteric plexus
Auerbach’s plexus(ormyenteric plexus) provides motor innervation to both layers of the tunica muscularis, having both parasympathetic and sympathetic input
What are the three phases of swallowing?
Oral
Pharyngeal
Oesophageal
What is the function of the larynx?
Part of resp tract
Voice
Swallowing
What forms the supraglottis?
extends from the superior tip of the epiglottis to the floor of the ventricular fold (junction of respiratory and squamous epithelium).
What forms the glottis?
superiorly: true vocal fold To inferior: a horizontal plane 5 mm inferior to the vocal cord.
What forms the subglottis?
begins 5 mm below the free edge of the true vocal cord and proceeds to the inferior border of the cricoid cartilage.
What are the three parts of the larynx?
Supraglottis
Glottis
Subglottis
What are the seven segments of cartilage?
Cricoid cartilage Thyroid cartilage Epiglottis Paired arytenoid cartilages (>corniculate >cuneiform > two of each)
What are the extrinsic muscles of the larynx?
Infrahyoid
Suprahyoid
Thyrohyoid
What is the function of the extrinsic muscles of the larynx?
Move the entire laryngeal complex
What gives the motor innervation of the larynx?
CN X
All intrinsic muscles supplied by the recurrent laryngeal nerve
> Exception cricothyroid muscle (external laryngeal nerve)
What nerve innervates the cricothyroid muscle?
External laryngeal nerve
What is the function of the posterior circo-artenoid?
Abducts cords
Opens cords
What is the function of the oblique artyenoids?
Close cords by drawing artyneoids together
What is the function of the transverse arytenoid?
Closes cords by drawing arytenoids together
What is the function of the lateral circoarytenoids?
Adduct/close cords by rotating arytenoids medially
What is the function of the thyroarytenoids/vocalis?
Loosen cords by drawing thyroid cartilage and arytenoids together
What is the resporatory phase of speech?
Air flow
Inhalation and exhalation
What is the phonation phase of speech?
Flow of air through different vocal cord features: >Position >Tension >Vibration >length
What is the resonation phase of speech?
Oral/nasal speech balance Depends on >nasopharynx >Nasal cavity >Oral cavity
What is the articulation phase of speech?
Production of speech determined by action of:
>Lips
>Tongue
>Jaw
What is the prosody (nasal) phase of speech?
Production of syllable stress and emphasis
Provides effective speech tone
What are common complaints in otology?
Hearing loss Otalgia (ear pain) Otorrhoea (discharge) Tinnitus Vertigo Facial weakness
Who (paeds) is at risk for sensioneural hearing loss?
Family history Meningitis Perinatal sepsis >Toxoplasmosis >Rubella >CMV >Herpes
What tests can be used to test hearing in children?
Distraction tests - distraction bell whilst looking at person. Testing to see if they turn head Visually reinforced audiometry Play audiometry Pure tone audiometry Tympanometry
What tests can be used to test hearing in neonates?
Objective tests - otoacoustic emissions
Auditory brainstem response
What are the (child) risk factors for ottis media with infusion?
M>F Day care Older sibilngs Parental smoking Cleft palate Down's syndrome
When are children likely to get ottis media with effision?
80% before 10 yrs
Peaks at 12/18 months and 4 years
What are the symptoms of ottis media with effusion?
Hearing loss
Speech delay
Behavioral problems
Academic decline
What are the signs of Ottis media with effusion?
Dull TM
Fluid levels
Bubbles
What are the treatment options for ottis media with effusion?
General advice
>Stop parental smoking
>Seasonal variation
>Breast feeding reduces risk
Autoinflation
Hearing aids
Surgery (grommet +/- adenoidectomy)
What are they symptoms of acute ottis media?
Short history Lots of pain Fever Systemic upset Ear discharge
What bacteria can cause acute ottis media?
Haemophiluus influenzae
Strep. pneumonia
Moraxella catarrhalis
How do you manage acute ottis media?
Analgesia (capol/ibuprofen)
Anti-biotics
What are the antibiotics taken for acute ottis media?
5-7 days of:
1st line: Amoxycilling/co-amoxiclav
2nd line: eythromycin/clarthromycin
How do you treat recurrent acute ottis media?
With a long course (4-6 weeks) of antibiotics
Low dosage
Consider a grommit
What are the extracranial complications of acute ottis media?
Acute mastoiditis Mastoid abcess Facial nerve palsy Ossicular/cochlear damage Labrinthitis Chronic perforation
What are the intracranial complications of acute ottis media?
Febrile convulsion
Brain abscess
Meningitis
Subdural/extradural empyema
What are the management options for hearing loss?
Bone anchored hearing aid
cochlear implant
Remove foreign body if present
What investigations are indicated in a child with nasal symptoms?
Allergy tests (RAST/Skin prick) Plain x-ray (adenoids) CT scan (choanal atresia)
What can cause nasal obstruction in children?
Rhitinits
Adenoidal hypertrophy
Foreign body
How do you treat nasal obstruction in children?
Decongestants Steroids (not under 4) Nasa hygiene (douching) Surgery Diathermy (reduce turbinates) Adenoidectomy Correct choanal atresia
What is periorbital cellulitis?
Complicated ethmoid sinusitis
Potentially sight threatening
Risk of intracranial sepsis
What are the differentials of a neck lump in children?
Thyroglossal cyst
Branchial cyst
Lymph node enlargement
What is the medical treatment of acute tonsillitis?
Penicillin V +/- anaerboic cover
AVOID amoxycillin/ampicillin
Antiseptic gargle
Analgesia
What is the surgical treatment of acute tonsillitis?
Drain tonsillar abscess
Stop airway obstriction
What tests can be used to gather more information in acute tonsilitis?
EBV serology
FBC
U&Es
CRP
What are the anatomical differences in the H&N region between children and adults?
Relative macroglossia Tonsiller hypertrophy Large epiglottis Short neck High larynx Subglottis is norrowest point
What is stertor?
Noisy breathing due to obstruction above larynx
What is ronchi?
Noisy breathing due to narrowing of the lower respiratory airways
What is a silogram?
Dye injection into salivary glands
Allows identification of stones/narrowing
What is a sinogram?
Injection into a hole (dye) to see where it goes
How do you treat a laryngeal pouch?
Laser endoscopy to help hypertonic muscle release tension
What is a blom-singer valve?
Allows for speech after laryngectomy
When is a barium swallow used?
When suspected leak in GI tract
If in doubt use iodine water based contrast
What is siboeristeal?
Pus gathering behind eye
Must decompress eitherwise sight loss due to optic nerve impingement
What is an allergy?
A hypersensitive disorder of the immune system
Occur to normally harmless environmental substances known as allergens; the reactions are acquired
Exaggerated or inappropriate immune reaction, causing damage to the host
What is an allergen?
Antigen that causes allergic reactions
Usually proteins
Depending on the individual, allergen, and mode of introduction the symptoms can vary from systemic or localised
Asthma localised to resp system, eczema to dermis
What are the common symptoms of an allaergy?
Sneezing Nasal congestion Runny nose Swelling and tenderness of mouth Difficulty breathing Flushing or rash Burning/itching of skin Hives Nausea/vomitting Abdominal cramps Diarrhoea
What mechanism is behind an allergy?
IgE triggers mast cells
Results in a subsequent accumulation of inflammatory cells at sites of antigen deposition
How do allergies develop?
First allergen exposure - response with T/B cells producing IgE
IgE circulates in blood and binds to IgE-specific receptors
Mast cells and basophils
Describe an acute allergic response
Exposure of allergen
specific IgE
Leads to degranulation with release of contents
What contents are released in degranulation in an allergy?
histamine, cytokines, interleukins, leukotrienes, and prostaglandins
What are the systemic effects caused by degranulation in an allergy?
vasodilation,
mucous secretion,
nerve stimulation
and smooth muscle contraction.
What is the late phase response to an allergen?
2-4 hours after inital exposure Due to migration of other leukocytes to initial site >Neutrophils, >lymphocytes, >eosinophils, >macrophages all migrate
What is immunotherapy?
Controlled exposure to known allergens to reduce the severity of allergy
>Useful for allergic rhinitis, allergic asthma, allergic conjunctivitis etc
>Not for food allergy, urticaria, atopic dermatitis
What is desensitisation therapy?
Desensitization - vaccinated with progressively larger doses of allergen
>Increasing IgG antibody production blocks excessive IgE production.
>The person builds up immunity to increasing amounts of the allergen in question.
How do you treat allergies?
Allergen avoidance
Pharmaotherapy (reduce effets when exposed to allergen)
Immunotherpay
What is allergic rhinitis?
Allergic inflammation of nasal airways
Occures when allergen inhaled by someone sensistised to allergen
Seasonal or perienial
How do you diagnose allergies?
Skin tests
RAST test
