Head, ENT, Face and Oral cavity

Question 1

Plagiocephaly (flat head syndrome)

Answer 1

Asymmetry of skull affects 1 in 5 infants

Congenital or acquired by sleeping in one position, usually on back

Skull X-ray performed if any doubt

Treat by changing sleeping sides

Question 2

Prominent bat/shell ears

Answer 2

Optimal time for surgical correction is after 5–6 yrs

Possible to correct by moulding ear with tape within first 6 mths

Question 3

Facial deformity

Answer 3

Refer as soon as it is detected.

Question 4

External angular dermoid

Answer 4

Lies in outer aspect of eyebrow.

Progressively enlarges. Best excised.

Question 5

Cleft lip and cleft palate

Answer 5

Be careful of the ‘hidden’ sub-mucus cleft

• —bifid uvula and deep groove in midline of palate.

Ideal age for repair of (before the child begins to speak:

• cleft lip is <3 mths
• the palate 6–12 mths

Question 6

Nasal disorders

Answer 6

Rhinoplasty is best deferred to late adolescence

Choanal atresia can lead to asphyxia if bilateral

• the thin membrane can be perforated with a urethral sound as an emergency procedure

Question 7

Tongue tie

Answer 7

Consider with breastfeeding problems and an inability to protrude the tongue beyond the lips.

Often a strong family history.

Surgery is usu. recommended in first 4 months or later at 2–6 yrs.

Question 8

Pre-auricular sinus

Answer 8

If infected, discharges pus from tiny opening at level of meatus in front of the upper crus of the helix.

Refer for surgical excision but it can be left if unproblematic.

Question 9

Branchial sinus/cyst/fistula

Answer 9

Located inferior to the external auditory meatus or anterior to the sternomastoid muscle.

Refer for excision.