Head and Neck Flashcards
What is stertor? How is it distinguished from stridor? What does stridor indicate?
Stertor ‘snoring’ / gasping noise originates in the pharynx. It is low-pitched, non-musical, and occurs during the inspiratory phase only
Stridor is an abnormal, high-pitched sound produced by turbulent airflow through a partially obstructed airway at the level of the supraglottis, glottis, subglottis, or trachea
What are the risk factors for H & N cancers?
Smoking Alcohol HPV Infection (partic tonsillar) Chemical/ dust exposure AIDS Presence of Premalignant Lesions e.g. Leukoplakia and erythroplakia
What is the significance of Leukoplakia and Erythroplakia?
Leukoplakia- white deposits on the tongue that cannot be removed by scraping (unlike candida). This is a premalignant dysplastic change with potential for malignant transformation.
Erythroplakia- red patch on the tongue that is a premalignant dysplastic change.
The significant clinical predictors of malignant transformation in oral dysplastic lesions are non-smoking status, sub-site (e.g., high risk in lateral tongue and low risk in floor of mouth), non-homogeneous appearance, size of lesion greater than 200 mm and higher histological grade (severe vs mild/moderate). Removal reduces risk of malignant transformation.
What are the important questions to cover for suspected malignancy in Head and Neck?
Stridor, Dysphagia, Hoarse Voice, Pain, odynophagia (painful swallowing), Neck Lump, Airway obstruction.
How do you manage obstructive sleep apnoea?
sleep study test
removal of adenoids and tonsils (in children)
What are the ddx for midline neck swellings?
Thyroglossal cyst (moves up with protrusion of tongue) - congenital Goitre (Autoimmune- Grave's/Hashimoto's, Neoplastic, Metabolic- Iodine deficiency)
What is the ddx for a lateral neck swelling?
Parotid/ submandibular- stones, abscess, inflammation, tumour
Carotid aneuyrsm
lymphadenopathy due to viral infection e.g. Glandular fever, HIV, malignancy (lymphoma/ ca from thyroid etc.)
Branchial cyst (congenital)
Where is the submandibular duct located?
just lateral to the frenulum
What divides the parotid gland?
the facial nerve, which splits into 5 branches in gland.
These are: temporal, zygomatic, buccal, marginal/mandibular, cervical.
What are the major salivary glands?
parotid, submandibular, sublingual.
When describing a swelling, what information do you relay?
site, size, shape, borders/margins, mobility, consistency, surface, attachments.
What are the key questions to ask in a history of salivary gland disease?
Pain and relationship to eating, swelling, PMH, Drugs, Surgery.
What would a midline scar just above the sternal notch suggest?
previous thyroidectomy, tracheostomy, if from mandible to mandible total laryngectomy
What would a lateral scar in the neck suggest?
endarterectomy, neck dissection, LN biopsy, thyroidectomy (hemi)
S shaped scar running from in front of pinna to post auricle - parotid gland surgery.
A patient presents with an inability to open their mouth. What is this called and what are the ddx?
trismus
quinsy bc of inflammation of the pterygoid muscles
