Lecture 11: Face and Neck Flashcards

1
Q

What are the 3 subtypes of TMJ dysfunction?

A
  • Myofascial pain and dysfunction (MC) (muscles of mastication)
  • Internal derangement (Disc dislocation)
  • Osteoarthritis (Degeneration of cartilage)
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2
Q

Who is TMJ dysfunction MC in?

A

Adult females

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3
Q

What is TMD often associated with?

A
  • Mood disorders
  • Rheumatoid arthritis
  • Bruxism
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4
Q

What clinical findings are common in TMD?

A
  • Joint pain and noise
  • Abnormal jaw movement
  • Muscle tenderness
  • HA
  • Dizziness/vertigo with associated otalgia or aural fullness
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5
Q

What historical findings might suggest TMD?

A
  • Habits of biting, chewing, or clenching their jaw.
  • Bruxism
  • Ear symptoms
  • HEENT pain
  • Hx of TMJ surgery
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6
Q

What PE should we do for evaluating TMD?

A
  • Bite on a tongue blade
  • Evaluate postural asymmetry
  • Neuromuscular exam
  • Palpation for tenderness of crepitus
  • Abnormal jaw movements
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7
Q

How do we treat TMD?

A
  • Joint rest
  • Soft diet
  • PT
  • Intra-oral devices
  • Botox (temporary)
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8
Q

When is a specialist referral indicated for TMD?

A
  • No improvement after 6m
  • Progressive difficulty in opening mouth
  • Inability to eat normal diet
  • Recurrent dislocation of joint.
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9
Q

Where do head and neck cancers typically arise from?

A

Epithelial cell origin, forming squamous cell carcinomas.

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10
Q

What are the primary risk factors for head and neck cancer?

A
  • Alcohol
  • Tobacco (esp. smokeless)
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11
Q

Who typically gets head and neck cancer more?

A

Males

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12
Q

What finding in the oral cavity might suggest cancer?

A

Painful lesions

Erythoplakia most likely condition to cause cancer.

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13
Q

What is the first step in evaluating a neck mass?

A
  • H&P to differentiate into 3 categories
  • Possible infectious
  • Possible malignant
  • Possible non-malignant
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14
Q

What suggests an infectious etiology for a Head/Neck mass?

A
  • Recent URI
  • Dental infection
  • Trauma
  • Travel
  • Rapidly growing
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15
Q

What finding suggests neoplasm over infectious etiology for a head/neck mass?

A
  • Firm, slowly growing mass.
  • Ulceration of overlying skin
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16
Q

What is the initial imaging of choice for a suspected malignancy of the head/neck?

A

CT w/ contrast

17
Q

What additional diagnostic studies can be performed for a suspected malignancy of the head/neck?

A
  • FNAB (preferred)
  • Core biopsy
  • US/CT guided FNA
  • Incisional biopsy
18
Q

How do we stage a head/neck tumor?

A

Standard TNM staging.

19
Q

At what stage is a squamous cell carcinoma concerning for recurrence and metastasis?

A
  • Starting at stage 3, which is a locoregionally advanced disease.
  • Surgery, chemo, and radiation to prevent mets.
20
Q

What is the MC virus to cause oropharyngeal cancer?

A

HPV (16 specifically)

21
Q

What is the most concerning finding for pts with HPV in regards to oropharyngeal cancer?

A
  • 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.