Head and Neck Flashcards
Where in the neck do thyroglossal duct cysts develop?
How are they made more visible?
In the midline
Move upwards when stick out tongue
Where do branchial cysts (/fistulae) develop?
Lump in neck on middle third of SCM
What are the 2 main symptoms of non-cancerous salivary disease?
Pain
Swelling
+poss also lacrimal involvement in systemic disease
What are the different types of non-cancerous salivary disease? (5)
Viral infection Sialadenitis Sialolithiasis Granulomatous disease Sjorgen's
What systemic viruses involved in salivary disease (2)
Mumps (paramyxovirus)
HIV
What is sialadenitis?
Which patient group may it affect?
Acute parotitis/submandibular
Older debilitated patients, dehydrated + poor oral hygiene
What are the S+S of sialadenitis? (6)
Treatment (4)
+ any complications (2)
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)
What is sialolithiasis/ how does it occur?
How does it present?
STONES
Occurs with chronic sialadenitis (of submandibular)
Postprandial swelling/pain (o/E tender/swollen + poss palp esp if calculi migrated)
Or
Repeat infection
How is sialolithiasis Dx?
How is it managed?
Dx by X-ray (radio-opaque dye into duct)
Initially: oral fluids + sialogogues (citrus)
Stones may pass by themselves
Or stone/gland surgically removed
How does granulomatous salivary disease occur?
How does it present?
TB/non-TB infection of submandibular/parotid
Cold abscess of LNs adjacent to gland
What are the characteristic features of Sjögren’s syndrome?
How is it Dx/Treated
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)
How may salivary malignancy present? (3)
Rapidly growing swelling / pain / involvement of other structures
Facial nn palsy
Local LN metastases
What are the 2 diff types of salivary malignancy?
What is the treatment (dependant on disease extent)
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
What is the commonest site for salivary gland cancers?
Salivary neoplasm relatively uncommon
80% in parotid + 80% benign pleomorphic adenoma
What types of benign salivary cancers are seen?
How do they present compared to malignants?
What is seen O/E?
Pleomorphic adenoma (commonest) (superficial lobe) Adenolymphoma
Slow growing painless masses
No facial nn palsy
O/E smooth subcutaneous swelling (no skin attachment)
How are benign salivary cancers Dx?
Fine needle aspiration EXcisional biopsy (not incisional as would spread tumour)
What type of gland (secretion) is the submandibular gland?
Where does it lie
Where does it open
Important related nerves (3)
Serous + mucous
Lies in triangular space (mylohyoid/mandible/deep cervical fascia)
Opens at frenulum
What type (secretion) is the sublingual gland? Where does it lie Where does it open?
Mucus
Lies along submandibular’s route
Opens into submandibular duct or directly into mouth
What type (secretion) is the parotid gland? Where does it anatomically lie? (B/wn + superficial to) Where does it drain?
Serous gland
B/wn mastoid process + mandible
Superficial to styloid process + attached muscles + carotid sheath
Opens at 2nd upper molar
What are some complications of parotid surgery? (4)
Facial nn damage
Haematology
Salivary fistula
Frey’s syndrome (sweat instead of salivate)
Describe the route of the carotid artery up to bifurcation
Common carotid at sternoclavicular joint
Along trachea/oesophagus in carotid sheath
Bifurcates at carotid triangle (sup. edge thyroid / C3)
What are the branches of the external carotid aa (7)
Superior thyroid Ascending pharyngeal Linguinal Facial Posterior auricular Superficial temporal Maxillary
How do brachial cysts occur? (Cellular pathology)
What is seen in FNA?
Due to epithelial inclusions within LN -> cystic degeneration
FNA shows pus-like aspirated in cholesterol crystals
What are the causes of diffuse (3) + nodular (1) goitre?
Diffuse: iodine defc / pregnancy / Graves** (TSH excess stimulation)
Nodular: ? Malignancy
