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ENT > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

Where in the neck do thyroglossal duct cysts develop?

How are they made more visible?

A

In the midline

Move upwards when stick out tongue

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2
Q

Where do branchial cysts (/fistulae) develop?

A

Lump in neck on middle third of SCM

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3
Q

What are the 2 main symptoms of non-cancerous salivary disease?

A

Pain
Swelling
+poss also lacrimal involvement in systemic disease

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4
Q

What are the different types of non-cancerous salivary disease? (5)

A 
Viral infection
Sialadenitis
Sialolithiasis
Granulomatous disease
Sjorgen's
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5
Q

What systemic viruses involved in salivary disease (2)

A

Mumps (paramyxovirus)

HIV

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6
Q

What is sialadenitis?

Which patient group may it affect?

A

Acute parotitis/submandibular

Older debilitated patients, dehydrated + poor oral hygiene

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7
Q

What are the S+S of sialadenitis? (6)
Treatment (4)
+ any complications (2)

A

Parotid pain/swelling
Pyrexia / Systemic upset
Visible pus from parotid opening
Submandibular (mouth floor) pain/swelling

High-dose Abx, rehydration, oral hygiene, citrus mouthwashes (increase saliva flow)

Comps: parotid abscess + chronic (sialolithiasis)

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8
Q

What is sialolithiasis/ how does it occur?

How does it present?

A

STONES
Occurs with chronic sialadenitis (of submandibular)

Postprandial swelling/pain (o/E tender/swollen + poss palp esp if calculi migrated)
Or
Repeat infection

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9
Q

How is sialolithiasis Dx?

How is it managed?

A

Dx by X-ray (radio-opaque dye into duct)

Initially: oral fluids + sialogogues (citrus)
Stones may pass by themselves
Or stone/gland surgically removed

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10
Q

How does granulomatous salivary disease occur?

How does it present?

A

TB/non-TB infection of submandibular/parotid

Cold abscess of LNs adjacent to gland

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11
Q

What are the characteristic features of Sjögren’s syndrome?

How is it Dx/Treated

A 
AFFECTS MOISTURE PRODUCING GLANDS
Dry eyes (keratoconjunctivitis)
Dry mouth (xerostomia)
Diffuse parotid enlargement 
Reduced salivary flow

Dx - biopsy (lymphocyte in gland)
Tx - symptomatic (eg artificial tears etc)

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12
Q

How may salivary malignancy present? (3)

A

Rapidly growing swelling / pain / involvement of other structures
Facial nn palsy
Local LN metastases

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13
Q

What are the 2 diff types of salivary malignancy?

What is the treatment (dependant on disease extent)

A

Muco-epidermoid (less common)
Low grade -> excise
High grade -> radical resection + radio

Adenoid cystic carcinoma (commoner)
Usually extensive/ nerve infiltration -> radical excision + radio but poor long-term prognosis

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14
Q

What is the commonest site for salivary gland cancers?

A

Salivary neoplasm relatively uncommon

80% in parotid + 80% benign pleomorphic adenoma

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15
Q

What types of benign salivary cancers are seen?

How do they present compared to malignants?
What is seen O/E?

A 
Pleomorphic adenoma (commonest) (superficial lobe)
Adenolymphoma

Slow growing painless masses
No facial nn palsy
O/E smooth subcutaneous swelling (no skin attachment)

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16
Q

How are benign salivary cancers Dx?

A 
Fine needle aspiration
EXcisional biopsy (not incisional as would spread tumour)
17
Q

What type of gland (secretion) is the submandibular gland?
Where does it lie
Where does it open
Important related nerves (3)

A

Serous + mucous

Lies in triangular space (mylohyoid/mandible/deep cervical fascia)

Opens at frenulum

18
Q 
What type (secretion) is the sublingual gland?
Where does it lie
Where does it open?
A

Mucus
Lies along submandibular’s route
Opens into submandibular duct or directly into mouth

19
Q 
What type (secretion) is the parotid gland?
Where does it anatomically lie? (B/wn + superficial to)
Where does it drain?
A

Serous gland
B/wn mastoid process + mandible
Superficial to styloid process + attached muscles + carotid sheath
Opens at 2nd upper molar

20
Q

What are some complications of parotid surgery? (4)

A

Facial nn damage
Haematology
Salivary fistula
Frey’s syndrome (sweat instead of salivate)

21
Q

Describe the route of the carotid artery up to bifurcation

A

Common carotid at sternoclavicular joint
Along trachea/oesophagus in carotid sheath
Bifurcates at carotid triangle (sup. edge thyroid / C3)

22
Q

What are the branches of the external carotid aa (7)

A 
Superior thyroid
Ascending pharyngeal
Linguinal 
Facial
Posterior auricular
Superficial temporal
Maxillary
23
Q

How do brachial cysts occur? (Cellular pathology)

What is seen in FNA?

A

Due to epithelial inclusions within LN -> cystic degeneration

FNA shows pus-like aspirated in cholesterol crystals

24
Q

What are the causes of diffuse (3) + nodular (1) goitre?

A

Diffuse: iodine defc / pregnancy / Graves** (TSH excess stimulation)
Nodular: ? Malignancy

25
Q

What are the different types of thyroid tumours? (5)

A

Malignant:
Follicular cells: papillary / follicular / anaplastic
Parafollicular cells: medullary carcinoma

Benign: adenoma

26
Q

What are the relative incidences / prognoses / treatments of the 4 different thyroid malignancies

A

Papillary (50%) + Follicular (25%)
Both good prognosis (worse if unconfined/haem spread)
Tx: total thyroidectomy + neck dissection + radioactive iodine ablation

Anaplastic (20%)
V bad prognosis - 92% die within 1yr despite treatment
Radical radiotherapy

Medullary (5%)
Regional LNs affected in 30% (medium prognosis)
Total thyroidectomy + radiotherapy

27
Q

How does a thyroid anaplastic malignancy present? (4)

How does a thyroid medullary malignancy present (bloods)?

A 
Anaplastic:
Rapidly enlarging mass
Pain
Referred otalgia
Invasion symps (trachea/oesophagus)
Medullary:
Raised calcitonin (parafollicular cells secrete) but normal calcium levels
28
Q

What are the investigations used in thyroid disease? (3)

+ What does each determine?

A

USS - type of swelling (diffuse/multinodular/solitary)
FNAC - malignant/benign
Radioisotope scan - malignant (cold nodules) / benign (hot)

29
Q

What are some red flag symptoms of head + neck malignancy (10)

A 
Pain 
Parasthesia
Dysphagia
Local invasion/compression
Nerve palsies
Trismus (lockjaw)
Halitosis
Otalgia (referred)
Wt loss
Ulceration
30
Q

What is leukoplakia?

What is the incidence / change they will turn malignant?

A

White hyperkeratotic plaques on oral mucosa
<1% incidence
3% these malignant in 5yrs

31
Q

Describe the features of leukoplakia (4)

A

Asymp
Raised patches
Well-defined edges
Erosions /ulceration (sign of malignant change)

32
Q

How are leukoplakia managed? (3)

A

General - stop smoking/drinking
Medical - retinoids
Surgical - excision

33
Q

What are some important related nerves with the (run in close proximity to) the submandibular gland (3)

A

Hypoglossal + linguinal nn (deep lobe/duct)

Marginal mandibular nn (CN7) (overlying skin)

ENT (6 decks)

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