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Medicine Year 2 > HNN Topic 19 - Mouth > Flashcards

HNN Topic 19 - Mouth Flashcards

1
Q

List the causes of mouth ulcers

A
  • Traumatic ulcers
  • Recurrent aphthous stomatitis
  • Infection
    • Viral - chickenpox, herpetic stomatis, HIV
    • Bacterial - syphillis, tuberculosis
    • Fungal
    • Parasitic
  • Drug induced - alendronate (bisphosphonate for osteoporosis), cytotoxic drugs (methotrexate, chemotherapy), NSAIDs, cocaine
  • Malignancy
  • Allergy
  • Haematological e.g. anaemia
  • GI e.g. coeliac, Crohn’s disease, ulcerative collitis
  • Nutritional e.g. iron, folate, B12 deficiency
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2
Q

Describe the location of the deep cervical nodes

A

Vertical chain, close to internal jugular vein within carotid sheath

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3
Q

Where are the intrinsic muscles of the tongue and what is their function?

A

Within tongue, change tongue shape/size for speaking, chewing and eating

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4
Q

Describe the organisation of lymph nodes and vessels in the head/neck

A
  • Superficial and deep vessels
    • Superficial drain to superficial ring of lymph nodes at junction of head and neck
    • Deep vessels arise from deep cervical nodes, converge to form the left and right jugular lymphatic trunks
  • Superficial and deep cervical nodes
    • Superficial in ring arrangement, drain into deep
    • Deep in vertical column, drain to deep lymphatic vessels
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5
Q

Describe the pharyngeal phase of swallowing

A
  • Bolus moved to pharynx, pressure receptors activated in the palate and anterior pharynx, signals to swallowing centre in brainstem
  • Respiration inhibited, larynx raised, glottis closed, oesophageal sphincter opened
  • Soft palate elevated to close nasopharynx and allow passage of food
  • Vocal cords close to prevent aspiration
  • Bolus moved towards oesophagus via peristalsis of pharyngeal constrictor muscles
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6
Q

What is the function of styloglossus muscle?

A

Retracts and elevates the tongue

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7
Q

Describe the complications of oral cancers and how these are overcome

A
  1. Dysphagia - risk of malnutrition, aspiration, pneumonia
  2. Speech

Managed by a speech and language therapist - exercises to improve speech and swallowing function

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8
Q

Describe the attachments of palatoglossus muscle

A

From palatine aponeurosis to attach broadly across tongue

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9
Q

Describe the innervation of the intrinsic muscles of the tongue

A

Hypoglossal nerve

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10
Q

List the intrinsic muscles of the tongue

A
  • 4 paired muscles, named for direction of travel
    • Superior longitudinal
    • Inferior longitudinal
    • Transverse
    • Verticle
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11
Q

Describe the location and function of the submandibular nodes

A

3-6 nodes below the mandible in the submandibular triangle, collect lymph from cheeks, lateral nose, upper lip, lateral lower lip and gums/anterior tongue. Submental and facial nodes also drain into submandibular nodes.

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12
Q

Describe the location and function of occipital nodes

A

1-3 nodes on back of head, drain the occipital areas of the scalp

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13
Q

Describe the diagnosis of oral cancer

A
  • Forceps biopsy of lesion - local anaesthesia
    • Assess histology
  • PET-CT of head and neck
    • Shows size, presence/absence of neck nodes, distant metastases
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14
Q

Describe the treatment of mouth ulcers

A
  • Cause-related treatment
  • Usually heal without intervention
  • Maintain good oral hygiene, use antiseptic mouthwash to prevent secondary infection
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15
Q

Describe the attachments of the genioglossus muscle

A

Mental symphysis of the mandible to the dorsum of the tongue

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16
Q

Describe the vasculature of the tongue

A
  • Mostly lingual artery (branch of external carotid artery)
  • Tonsillar artery (branch of facial artery) - collateral circulation
  • Drainage - lingual vein, drains into internal jugular vein
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17
Q

Where do the deep cervical nodes drain to?

A
  • Deep cervical vessels arise from the deep cervical nodes, converge to form the left and right jugular lymphatic trunks
  • Left lymphatic trunk joins thoracic duct at root of neck
  • Right lymphatic trunk empties into R lymphatic duct at root of neck
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18
Q

Describe the location and function of the superior cervical nodes

A
  • Superficial anterior cervical lymph nodes and posterior lateral superficial nodes
  • Anterior close to anterior jugular vein, drains superficial anterior neck
  • Posterior close to external jugular vein, drain superficial neck
19
Q

What is the function of the superficial cervical nodes?

A

Receive lymph from scalp, face and neck

20
Q

Describe the voluntary phase of swallowing

A
  • Mastication produces bolus of food
  • Back of tongue elevated and soft palate pulled anteriorly - keeps food within oral cavity, allows airway to remain open
21
Q

Describe the treatment of oral cancers

A
  • Radiotherapy
  • Surgery
  • Chemotherapy
22
Q

List the important deep cervical nodes

A

Jugulo-omohyoid, jugulodigastric, supraclavicular nodes

23
Q

Describe the epidemiology of oral cancers

A
  • Oral cancer - 6th most common malignancy worldwide, 3rd most common in developing countries
  • Squamous cell carcinoma most common form
  • Men > women
  • Age of occurrence typically >40 years
  • Usually identified in late stage, overall 5 year survival rate <60%
24
Q

What is the function of the deep cervical nodes?

A

Receive all lymph from the head and neck - directly or indirectly

25
Q

Describe the location and function of the facial nodes

A

Maxillary, infraorbital, buccinator and supramandibular nodes. Drain mucous membranes of nose and cheeks, eyelids and conjunctiva.

26
Q

List the symptoms of oral cancer

A
  • Red/white patches, lumps, ulcers
  • Persistent pain in mouth
  • Dysphagia
  • Changes in voice/speech problems
  • Swollen lymph nodes in neck
  • Weight loss
  • Bleeding/numbness in mouth
  • Teeth becoming loose
  • Difficulty moving jaw - trismus
27
Q

Describe the lymphatic drainage of the tongue

A
  • Anterior 2/3 - submental and submandibular nodes (drain to deep cervical nodes)
  • Posterior 1/3 - deep cervical nodes
28
Q

List the phases of swallowing

A
  1. Voluntary phase
  2. Pharyngeal phase
  3. Oesophageal phase
29
Q

In what situation is it important that mouth ulcers are examined?

A

Mouth ulcers which don’t head in 2-3 weeks should be examined (by a dentist, oral specialist/surgeon or maxillofacial surgeon) to rule out oral cancer

30
Q

What is the function of the genioglossus muscle?

A
  • Inferior fibres - protrude tongue
  • Middle fibres - depress tongue
  • Superior fibres - draw tip of tongue back and down
31
Q

Describe the attachments of styloglossus muscle

A

Styloid process (temporal bone) to side of tongue

32
Q

Describe the location and function of the pre-auricular nodes

A

1-3 nodes anterior to auricle, drain superficial face and temporal region

33
Q

What is the function of hyoglossus muscle?

A

Depresses and retract tongue

34
Q

Describe the location and function of the postauricular nodes

A

2 nodes behind ear, drain posterior neck, upper ear and back of external acoustic meatus

35
Q

Describe the attachments of hyoglossus muscle

A

Hyoid bone to side of tongue

36
Q

List the causes of oral cancers

A
  • Tobacco and alcohol use
  • HPV infection
  • Immunosuppression
  • Diet low in fruit/vegetables
  • Betel nut chewing - common in developing countries
37
Q

Describe the sensory innervation of the tongue

A
  • Anterior 2/3
    • General sensation - lingual nerve (from mandibular)
    • Taste - facial nerve (chorda tympani)
  • Posterior 1/3
    • General sensation + taste = glossopharyngeal nerve
38
Q

Describe the location and function of the submental nodes

A

Superficial to mylohyoid muscle, drain centre of lower lip, floor of mouth and apex of tongue

39
Q

List the superficial cervical lymph nodes

A
  1. Occipital
  2. Mastoid/post-auricular/retro-auricular
  3. Pre-auricular/parotid
  4. Submental
  5. Submandibular
  6. Facial (group)
  7. Superficial cervical
40
Q

What is the clinical importance of the supraclavicular nodes?

A
  • Virchow’s node - L supraclavicular node
  • Enlarged - Troisier’s sign, indicates gastric cancer
41
Q

Describe the innervation of the extrinsic muscles of the tongue

A

All innervated by the hypoglossal nerve, except palatoglossus which is innervated by the vagus nerve

42
Q

List the extrinsic muscles of the tongue

A
  1. Genioglossus
  2. Hyoglossus
  3. Styloglossus
  4. Palatoglossus
43
Q

What is the function of palatoglossus muscle?

A

Elevates posterior part of tongue

44
Q

Describe the oesophageal phase of swallowing

A
  • Upper 1/3 of oesophagus is voluntary skeletal muscle, lower 2/3 is involuntary smooth muscle
  • Larynx lowers, returning to normal position
  • Cricopharyngeal muscle contracts to prevent reflux and respiration begins again
  • Bolus move down into oesophagus via peristalsis, coordinated by extrinsic nerves

Medicine Year 2 (41 decks)

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