Lecture 11: Face and Neck Flashcards
What are the 3 subtypes of TMJ dysfunction?
- Myofascial pain and dysfunction (MC) (muscles of mastication)
- Internal derangement (Disc dislocation)
- Osteoarthritis (Degeneration of cartilage)
Who is TMJ dysfunction MC in?
Adult females
What is TMD often associated with?
- Mood disorders
- Rheumatoid arthritis
- Bruxism
What clinical findings are common in TMD?
- Joint pain and noise
- Abnormal jaw movement
- Muscle tenderness
- HA
- Dizziness/vertigo with associated otalgia or aural fullness
What historical findings might suggest TMD?
- Habits of biting, chewing, or clenching their jaw.
- Bruxism
- Ear symptoms
- HEENT pain
- Hx of TMJ surgery
What PE should we do for evaluating TMD?
- Bite on a tongue blade
- Evaluate postural asymmetry
- Neuromuscular exam
- Palpation for tenderness of crepitus
- Abnormal jaw movements
How do we treat TMD?
- Joint rest
- Soft diet
- PT
- Intra-oral devices
- Botox (temporary)
When is a specialist referral indicated for TMD?
- No improvement after 6m
- Progressive difficulty in opening mouth
- Inability to eat normal diet
- Recurrent dislocation of joint.
Where do head and neck cancers typically arise from?
Epithelial cell origin, forming squamous cell carcinomas.
What are the primary risk factors for head and neck cancer?
- Alcohol
- Tobacco (esp. smokeless)
Who typically gets head and neck cancer more?
Males
What finding in the oral cavity might suggest cancer?
Painful lesions
Erythoplakia most likely condition to cause cancer.
What is the first step in evaluating a neck mass?
- H&P to differentiate into 3 categories
- Possible infectious
- Possible malignant
- Possible non-malignant
What suggests an infectious etiology for a Head/Neck mass?
- Recent URI
- Dental infection
- Trauma
- Travel
- Rapidly growing
What finding suggests neoplasm over infectious etiology for a head/neck mass?
- Firm, slowly growing mass.
- Ulceration of overlying skin
What is the initial imaging of choice for a suspected malignancy of the head/neck?
CT w/ contrast
What additional diagnostic studies can be performed for a suspected malignancy of the head/neck?
- FNAB (preferred)
- Core biopsy
- US/CT guided FNA
- Incisional biopsy
How do we stage a head/neck tumor?
Standard TNM staging.
At what stage is a squamous cell carcinoma concerning for recurrence and metastasis?
- Starting at stage 3, which is a locoregionally advanced disease.
- Surgery, chemo, and radiation to prevent mets.
What is the MC virus to cause oropharyngeal cancer?
HPV (16 specifically)
What is the most concerning finding for pts with HPV in regards to oropharyngeal cancer?
- Patients with HPV that does not go away. HPV will cause damage if it persists, allowing a tumor to grow.
- High-risk HPV IS NOT likely to cause cancer.
