MRCS ENT Flashcards
What is Pendred’s syndrome?
AR syndrome involving SNHL + thyroid goitre
What is Treacher Collin’s syndrome?
AD syndrome resulting in underdevelopment of maxilla and mandible, microtia, other ear abnormalities
What is Pierre Robin syndrome?
AD syndrome involving hypoplastic mandible with cleft palate and ear deformities
What is Crouzon’s syndrome?
AD syndrome with hypoplastic mandible and maxilla, craniostenosis, exophthalmos and ear abnormalities
What is Alpert’s syndrome?
AD syndrome with syndactyly, cleft palate, maxillary underdevelopment, stapes footplate fixatoin
Which congenital conditions increase the risk of glue ear?
Down’s syndrome
Cleft palate
CF
what is the CHARGE association
Coloboma
heart disease
atresia of choana
retarded growth
genital abnormalities
ear abnormalities
what is the pathophysiology of choanal atresia?
failure of breakdown of bucconasal membrane in utero - bilaterally leads to breathing difficulty at birth as neonates are nasal breathers
list 5 indications for adenoidectomy
nasal obstruction
glue ear
recurrent acute otitis media
rhinosinusitis
OSA
List 3 types of hearing aid (Minimum)
In the ear
in the canal
completely in the canal
Body worn
BAHA
CROS (contralateral routing of signal)
which side is the microphone worn on a CROS hearing aid
wear the microphone on the side of the dead ear, receiver on the better side
what is the purpose of a tracheooesophageal puncture?
initially feeding tube, later can accomodate artificial speaking valve. A tracheooesophageal puncture is a communication between the posterior tracheal wall and oesophagus
if a patient with a laryngectomy needs oxygen, where do you place the mask?
over the laryngectomy stoma
which hormones does the thyroid produce
list 5 risks of total thyroidectomy
hypocalcaemia
recurrent laryngeal nerve palsy
bleeding, neck haematoma
infection
hypothyroidism
tracheomalacia
reucrrence
5 signs of graves disease
lid lag/retraction
pretibial myxoedema
thyroid acropachy
palmar erythema
tachycardia/AF
tremor
treatment of severe hypocalcaemia following thyroidectomy?
10ml 10% calcium gluconate
then alpha calcidol and sandocal
How does alfacalcidol work
vitamin D supplement, requires only one conversion to active form (calcitriol) so provides rapid increase of vitamin D
5 features of hypocalcaemia
perioral numbness
weakness/lethargy
carpopedal spasm
chvosteks sign (tapping over parotid causes twitching of facial muscles)
what is trousseaus sign
spasm of hand following brachial artery occlusion with BP cuff on due to hypocalcaemia
Label
a - optic chiasm
b oculomotor nerve
c trochlear nerve
d abducens nerve
e ophthalmic division trigeminal nerve
f maxillary division trigeminal nerve
g pituitary gland
h ICA
i sphenoid sinus
j cavernous sinus
nerve passing through infraorbital foramen and where it comes from
infraorbital nerve from maxillary division of trigeminal nerve
Nerve passing through supraorbital foramen and its origin?
supraorbital nerve from frontal nerve from ophthalmic division of trigeminal nerve
nerve passing through mental foramen and where it comes from
mental nerve from inferior alveolar nerve from mandibular division of trigeminal nerve
Which muscles are the muscles of mastication?
masseter
temporalis
medial pterygoid
lateral pterygoid
Which nerve supplies the muscles of mastication
mandibular division of trigeminal nerve
list the muscles supplied by the mandibular division of trigeminal nerve
muscles of mastication
mylohyoid
anterior belly digastric
tensor tympani muscle
tensor veli palatini muscle
what are the axis of a tympanogram
x - pressure in daPa
y - complicance ml
Which hormones are produced by follicular cells of the thyroid?
T3/T4
Which hormone is produced by parafollicular cells of the thyroid?
calcitonin
what is the emryological origin of the thyroid?
tongue base/thyroglossal duct
to what are thyroid hormones bound to in blood?
albumin/thyroglobulin
list one cause of a diffuse smooth goitre
graves disease
layers encountered in a thyroidectomy?
skin
fat
platysma
deep cervical fascia
strap muscles
pre tracheal fascia
structures at risk in a thyroidectomy
recurrent laryngeal nerve
superior laryngeal nerve
thyroid artery
commonest cause of a saddle deformity
septal trauma/perforation
systemic causes for saddle deformity (6)
GPA
Sarcoidosis
TB
syphilis
SLE
polyarteritis nodosa
ddx of unilateral high frequency SNHL
vestibular schwannoma
Risks of surgical management for CPA lesion
facial nerve injury
hearing loss (definitely if translabyrine approach)
intracranial haemorrhage
meningitis
6 nerves which pass through superior orbital fissure?
frontal nerve
nasociliary nerve
lacrimal nerve
CN 3 ocuclomotor
CN 4 trochlear
CN 6 abducens
2 muscles attached to mastoid tip
SCM
splenius capitis muscle
posterior belly of digastric muscle
5 structures attached to styloid process
stylohyoid ligament
stylomandibular ligament
styloglossus muscle
stylohyoid muscle
stylopharyngeus muscle
Innervation of styloglossus muscle
hypoglossal nerve
Innervation of stylohyoid muscle
facial nerve
innervation of stylopharyngeus muscle
glossopharyngeal nerve
6 structures which pass through internal auditory meatus
facial nerve
nervus intermedius
superior vestibular nerve
inferior vestibular nerve
cochlear nerve
labyrinthine artery
vestibular ganglion
describe the anatomy of a zenkers diverticulum
posterior diverticulum of the hypopharynx involving Killians dehiscence
5 symptoms of pharyngeal pouch
dysphagia
weight loss
regurgitation of undigested food
hallitosis
aspiration
cough
label
what is the helicotrema
the part where cochlear labyrunth where scala tympani and scala vestibule meet - the main component of the cochlear apex
which part of the cochlea does the oval window form
starting membrane of scala vestibuli
which part of the cochlea does the round window form
end of the scala tympani
label these neck levels
green - 1
orange - 2
purple - 3
red - 4
yellow - 5
white - 6
3 structures preserved in a modified radical neck dissection
spinal accessory
SCM
internal jugular
anatomical boundaries for level 3 neck dissection
middle internal jugular chain
hyoid to omohyoid
which nerves can be damaged in a level 3 neck dissection
greater auricular nerve
vagus nerve
hypoglossal nerve
symptoms of ramsay hunt syndrome
hearing loss
tinnitus
vertigo
pain in ear
signs of ramsay hunt syndrome
acute facial nerve palsy
loss of taste anterior 2/3 tongue
dry eyes/mouth
vesicular rash in ear canal/tongue/palate
CN at risk in ramsay hunt syndrome? (2)
7, 8 (hearing loss + disequilibrium)
treatment of ramsay hunt
pred
analgesia
eye care
+/- acyclovir
apart from ears, where else would you look for vesicles in ramsay hunt syndrome?
soft/hard palate
TM
list 4 causes of parotitis
sialadenitis
autoimmune - sjograns/sarcoid
infective - staph aureus, paramyxovirus
name the branches of the facial nerve BEFORE it leaves the stylomastoid foramen
nerve to stapedius
chorda tympani
greater petrosal nerve
what does the marginal mandibular nerve supply
depressor labii inferioris
depressor anguli oris
mentalis
why is the danger triangle of face significant?
can cause thrombophlebitis of facial vein - as no valves this can spread and cause cavernous sinus thrombosis
symptoms of cavernous sinus thrombosis?
what is a basal skull fracture?
which can involve temporal bone, occipital bone, sphenoid bone, ethmoid bone
what is the blood supply to the external ear?
posterior auricular and superficial temporal arteries
what is the nerve supply to the external ear?
posteromedial, posteriolateral and inferior auricle - greater auricular nerve which is a branch of cervical plexus C2 C3
anteriosuperior and anteromedial - auriculotemporal nerve which is branch of mandibular division of trigeminal nerve
EAC - branches of auriculotemporal, facial, vagus nerves
significance of auricular branch of vagus nerve?
referred pain from this nerve can indicate laryngeal cancer
can also cause cough when microsuctioning
what is the nerve responsible for cough during microsuctioning called?
Arnold’s nerve or the auricular branch of vagus nerve
describe the pathophysiology of cauliflower ear
collection of blood between perichondrium and auricular cartilage which compromises blood supply to cartilage > cartilage necrosis > fibrous tissue forms in overlying skin
List which nerves can be affected in NOE
VII, IX, X, XI, XII
list 4 complications of NOE
CN palsies
lateral and cavernous sinus thrombosis
meningitis
death
list blood supply of nasal cavity
SPA
anterior ethmoidal
posterior ethmoidal
greater palatine
superior labial
what is the innervation of the nasal cavity?
anterior-superior - anterior + posterior ethmoidal nerves (V1)
posterior-inferior -
maxillary nerve (v2)
Olfactory area - olfactory nerve
list the extrinsic muscles of the tongue
genioglossus
hypoglossus
styloglossus
palatoglossus
sensory supply to the tongue?
anterior 2/3 -
general sensation is via lingual nerve which is branch of V3
taste is via chorda tympani which is branch of 7
posterior 1/3 -
both general sensation and taste are from glossopharyngeal nerve
what are the 4 taste sensations of the tongue
sweetness (tip)
salty (lateral margins)
sour (posterior)
bitter (posterior)
motor supply of muscles of tongue?
all hypoglossal nerve except palatoglossus which is pharyngeal plexus
blood supply to tongue?
lingual artery from ECA
what are the four types of papillae on the tongue?
circumvallate papillae - anterior to terminal sulcus
foliate papillae - on lingual mucosa
filiform papillae - parallel to terminal sulcus
fungiform papillae - apex of tongue
where does the temporalis muscle originate
temporal fossa
where does temporalis insert
coronoid process of mandible
where does masseter originate
zygomatic arch
where does masseter insert
ramus of mandible
where does lateral pterygoid originate
skull and lateral surface of lateral pterygoid
where does lateral pterygoid insert
TMJ capsule
where does medial pterygoid originate
maxillar tuberosity/palatine process/medial surface of lateral pterygoif
where does medial pterygoid insert
TMJ angle of mandible
what are the branches of the facial artery
NECK
ascending palatine
tonsillar
submental
glandular
FACE
inferior labial
superior labial
lateral nasal
angular
describe a radical neck dissection
lymph nodes 1-5
sacrifice of spinal accessory, internal jugular vein, SCM
describe a modified radical neck dissection
lymph node dissection from 1-5
preservation of one or more of spinal accessory, internal jugular or SCM
describe a selective neck dissection
removal of 1 or more lymph node groups
describe an extended neck dissection
refers to removal of additional lymphatic or non lymphatic structures not routinely included in traditional neck dissections
name the different layers of deep cervical fascia
superficial
middle
deeper
name the subdivisions of the deep layer of the deep cervical fascia
pretracheal and prevertebral
describe the retropharyngeal space
space posterior to pharynx and oesophagus
clinical significance of retropharyngeal space?
can extend from skull to T1-T2 so can cause mediastinitis
what is the danger space
lies posteriorly to retropharyngeal space - spread of infection in this space tends to occur rapidly due to presence of loose areolar tissue
zone 1 neck injury?
thoracic inlet up to cricothyroid membrane
zone 2 neck injury?
between cricothyroid membrane and angle of mandible
zone 3 neck injury
above angle of mandible
signs of accessory nerve damage
limitation of abduction of shoulder
how can carotid body tumours present?
usually asymptomatic palpable neck mass
may also have CN palsy or involvement of sympathetic chain
fever of unknown origin is an uncommon sign
describe the cervical plexus
plexus of first 4 cervical spinal nerves C1-4
what are 4 cutaneous branches of cervical plexus
C2 - lesser occipital nerve - lateral part of occipital region
C2 + C3 - greater auricular nerve - innervates skin near concha auricle, EAM, partoid region, post auricular region
C2 + C3 - transverse cervical nerve - anterior region of neck
C3 + C4 - supraclavicular nerves - innervate shoulder, upper thoracic region
name 4 muscular branches of the cervical plexus
ansa cervicalis - from C1-3 - innervates sternohyoid, sternothyroid and omohyoid
phrenic - C3-5 but primarily C4, supplies diaphragm and pericardium
communicating branches C1 - supplies geniohyoid and thyrohyoid
segmental branches - C1-4 - supplying anterior and middle scalene muscles
what is erb’s point and its significance?
cutaneous branches of cervical plexus emerge at middle of posterior border of SCM here
Can do a cervical plexus block here
organism commonly implicated in orbital cellulitis?
staph aureus, strep penumoniae, haemophilus infulenzae
components of eye examination to examine in orbital cellulitis
colour vision
visual acuity
eye movements
pupil reflexes
complications of surgery for orbital abscess (orbital cellulitis)
enophthalmos
brain abscess
haemorrhage
diplopia
swelling
ddx of a child in respiratory distress
laryngomalacia
infective - adenotonsillitis severe, epiglottitis, laryngotracheobronchitis (croup)
subglottic stenosis
symptoms of AOM
fever
otalgia
irritability
reduced feeding
bacteria associated with AOM
strep pneumonia
haemophilus influenza
moraxella catarrhalis
strep pyogenes
staph aureus
complications of AOM
hearing loss
vertigo
facial nerve palsy
TM perf
mastoiditis
brain abscess
sigmoid sinus thrombosis
meningism
subdural empyema
bezold, citelli, luc abscess
classification for pars tensa retraction
sade classification
classification for pars flaccida retraction
tos’s classification
level of hearing loss you would expect in chronic otitis media
20-60db
describe sade classification
1 - retracted
2- retracted onto incus
3 - retraction onto promontory but not adherent
4 - adhesion onto promontory
5 - atelectatic TM with perf
tos classification describe
1 - mild retraction, air is still present between pocket and malleus neck
2- retraction pocket touches malleus neck +/- erosion of neck
3 - retraction pocket causes erosion of outer attic wall
4 - depth of retraction pocket difficult to see
4 blood tests for septal perforation
FBC
ESR
cANCA
pANCA
ACE
what is special about septal perf due to syphilis
usually affects bony septum rather than cartilage
how to test for syphilis
VDRL - venereal disease research laboratory
types of flaps to fix septal perf
local nasal mucosa
buccal mucosa
composite septal cartilage and mucosa
type of nystagmus with disorders affecting lateral SCC
horizontal nystagmus
when do you see pendular/see-saw nystagmus
congenitally blind people
what does HHT stand for and alternative name
hereditary haemorrhagic telangiectasia or rendu-osler-weber disease
inheritance pattern of HHT
AD
presentation of HHT
epistaxis
GI bleed
haemoptysis
2 associated abnormalities with hht
AV malformations
aneurysms
management of HHT epistaxis
conservative - monitioring, follow up
medical - oestrogens/progesterone
surgical - laser, septodermoplasty, modified young’s procedure
which gene mutations associated with HHT?
endoglin ENG
activin like receptor kinase ALK-1
SMAD4
management of pharyngeal pouch
conservative
medical - botox injection to cricopharyngeus
surgical - endoscopic stapling, open
complications of surgery for pharyngeal pouch
oesophageal perforation
hoarseness
bleeding
infection
recurrence
injury to teeth
what is boyce’s sign
seen in pharyngeal pouch, neck mass which gurgles on palpation
investigations for VC palsy
CT skullbase to mediatinum
CXR
bloods for systemic disease
why wait 6 months before attempting surgery to medialise vc in vc palsy
voice rehab can be trialled in the meanwhile and the contralateral cord may compensate so surgery might not be needed
layers of VC superficial to deep
squamous epithelium
superficial lamina propria (reinkes space)
intermediate lamina propria
deep lamina propria
thyroarytenoid muscle complex
organisms involved in acute rhinosinusitis
rhinovirus
parainfluenza virus
pneumococcus
haemophilus influenzae
4 medical options to arrest post tonsillectomy bleeding
Resuscitation – ABCDE
Hydrogen peroxide gargles
Silver nitrate cautery to bleeding point using local anaesthetic spray
Application of adrenaline soaked gauze to the area
antibiotics to avoid in EBV why
amoxicillin
ampicillin
type 4 hypersensitivity reaction
3 other indications for tonsillectomy than recurrent tonsillitis
More than one quinsy/peritonsillar abscess
Suspected cancer
Obstructive sleep apnoea
As part of another procedure e.g. uvulopalatoplasty
tonsillitis organisms
group A beta haemolytic strep
methods of identifying facial nerve intraoperatively
Tragal pointer- triangular extension of cartilage inferiorly off the tragus and location of the facial nerve is approximately 1cm antero-inferiorly
Superior border of posterior belly of digastric, facial nerve runs superiorly and parallel
Root of styloid process: nerve lies laterally
Tympanomastoid suture 6-8mm deep to the nerve
complications of tonsillitis
quinsy, retropharyngeal/parapharyngeal abscess, sepsis, endocarditis, mediastinitis, vincents angina
complications of parotidectomy
freys syndromw
ear numbness due to greater auricular nerve injury
seroma
salivary fistula
blood supply and drainage of parotid gland and lymphatic drainage
Arterial– external carotid branches (facial artery)
Vein– retromandibular vein
Lymphatic drainage– deep cervical nodes
types of incision for parotidectomy
modified blair
facelift incision
treatments for freys syndrome
Aluminium based deodorant
Topical glycopyrrolate
Botox
Jacobson nerve neurectomy
what is semons law?
In a progressive lesion of the recurrent laryngeal nerve, the abductors are paralysed before the adductors. Therefore incomplete paralysis of the vocal cord results in the vocal cord being brought to the midline, but in complete paralysis the cord will be in the paramedian position.
treatments for VC palsy
Speech and language – voice therapy
Surgery to medialise the affected vocal cord
Bulk injection e.g. bioplastique, collagen, fat
Thyroplasty
treatment for pharyngeal pouch
Conservative- if small and asymptomatic
Medical– botox to cricopharyngeus
Surgical– endoscopic stapling (Weerda diverticuloscope and endoscopic stapler) or open procedure- risks, oesophageal perforation, infection, stricture, bleeding, mediastinitis, recurrence, hoarseness, damage to teeth, lips and gums.
2 US features of U3 thyroid nodule
Homogenous, hyper-echoic (markedly), solid, halo (follicular lesion)#
hypo-echoic, equivocal echogenic foci, cystic change
mixed/central vascularity.
which U scores need FNA
3-5
which condition associated with raised TPO antibodies
hashimotos
when should thyroid reach final position in utero?
7 weeks
Joll’s triangle
midline, superior thyroid pedicle and straps- superior laryngeal nerve
Beahr’s triangle
common carotid, trachea and inferior thyroid artery- RLN
2 causes of primary hyperparathyroidism
parathyroid adenoma
parathyroid hyperplasia
3 imaging modalities to help localise parathyroid lesions
Ultrasound scan neck
Technetium Tc 99m sestamibi parathyroid scintigraphy
SPECT (Single Photon Emission Computerized Tomography)
4 indications for parathyroidectomy
Symptoms of hypercalcaemia such as thirst, frequent or excessive urination, or constipation
End-organ disease (renal stones, fragility fractures or osteoporosis)
An albumin-adjusted serum calcium level of 2.85 mmol/litre or above.
Age 50 years or younger
Suspicion of parathyroid carcinoma
What is the embryological origin for the superior and inferior parathyroid glands?
Inferior parathyroid glands derive from third branchial arch
Superior parathyroid glands derive from fourth branchial arch
genetic association with parathyroid adenomas
Multiple endocrine neoplasia (MEN) type 1 and 2b
mumps virus name
paramyxovirus
Investigations for salivary gland conditions
ESR, FBC, RF, ANA, electrophoresis, anti Ro and soluble liver antibodies, TFTs, BM, LFTs, urate, plain film, sialogram, CT/MRI if malignant disease suspected. FNA (don’t do incisional/trucut biopsy due to seeding)
TNM staging for laryngeal ca - t component
T1 – Tumour confined to vocal cords and they are movile
T2 – Tumour extending beyond glottic larynx with or without mobile cords
T3 – Tumour limited to larynx with fixed cords and/or minor cartilage destruction and/or paraglottic space
T4- Tumour involves tissues boyond larynx
presenting complaints of laryngeal cancer
Hoarseness
Shortness of breath
Stridor
Sore throat
investigations for laryngeal cancer
Microlaryngoscopy and biopsy
CT neck and thorax
management of laryngeal ca
mdt
laser resection
radiotherapy
Name the different subsites for an oropharyngeal tumour.
Tonsils
Soft palate
Base of tongue
Posterior pharyngeal wall
presenting complaints of oropharyngeal ca
Neck lump
Sore throat
Dysphagia
Referred otalgia
what is p16 testing
Overexpression of p16 protein is a useful screening method for HPV infection as HPV-associated carcinomas show strong nuclear and cytoplasmic expression of p16 in over 70% of malignant cells.
cause of referred otalgia in oropharyngeal tumours
Occurs due to irritations of glossopharyngeal sensory nerve fibres which connect to the middle ear via Jacobson’s nerve.
What is the most common histological type of laryngeal cancer?
scc
What is the male to female ratio for laryngeal cancer?
5:1 (Male: Female).
What are the major risk factors for laryngeal cancer?
Smoking, alcohol, HPV types 16 and 18.
What percentage of patients with laryngeal cancer have synchronous tumors?
5%`
What are the typical presenting symptoms of laryngeal cancer?
Hoarseness, dysphagia or odynophagia, and dyspnoea.
What simple tests are used in the investigation of laryngeal cancer?
Chest X-ray (CXR), full blood count (FBC), urea and electrolytes (U&E), liver function tests (LFTs).
What advanced imaging is used in diagnosing laryngeal cancer?
MRI or CT of the thorax, abdomen, and pelvis (TAP).
What endoscopic procedures are performed for laryngeal cancer?
Panendoscopy and microlaryngoscopy.
How is early-stage laryngeal cancer (T1/T2) managed?
Radiotherapy (RT) or partial laryngectomy.
What is the treatment for T3 laryngeal cancer
Total laryngectomy +/- postoperative radiotherapy.
How is T4 laryngeal cancer treated?
A: Total laryngectomy + neck dissection.
What post-surgical interventions may be needed after laryngectomy?
Voice restoration procedures, speech therapy, and thyroid and parathyroid hormone replacement.
What characterizes a T1 tumor in laryngeal cancer?
Tumor confined to one site.
What characterizes a T2 tumor in laryngeal cancer?
Tumor involving more than one site.
What characterizes a T3 tumor in laryngeal cancer?
Fixed vocal cord or postcricoid invasion.
What characterizes a T4 tumor in laryngeal cancer?
Tumor extending beyond the larynx.
What is a cordectomy and when is it typically performed?
Cordectomy involves the removal of vocal cords, either open or endoscopic, often for benign tumors.
What is hemilaryngectomy and when is it performed?
Hemilaryngectomy is the removal of half the thyroid cartilage and half the cricoid cartilage, often for tumors confined to the vocal fold.
What is a supraglottic laryngectomy?
A procedure where the glottis is joined to the base of the tongue, leaving the vocal cords intact.
What structures are removed in a total laryngectomy?
Thyroid, hyoid bone, cricoid cartilage, proximal trachea, and thyroid gland.
What is required post-operatively after a total laryngectomy?
A tracheostomy with a speech valve.
What are the histological subtypes of nasopharyngeal carcinoma?
Squamous cell, squamous keratinizing, non-keratinizing, or undifferentiated carcinoma.
What dietary habit is associated with an increased risk of nasopharyngeal carcinoma, particularly in Hong Kong?
Consumption of salted fish.
what is the fossa or rosenmuller also called
posterolateral recess
What are common presenting symptoms of nasopharyngeal carcinoma?
Neck lump, otalgia, epistaxis.
What characterizes a T1 tumor in nasopharyngeal carcinoma?
Tumor confined to the nasopharynx.
What characterizes a T3 tumor in nasopharyngeal carcinoma?
Tumor invading bone or sinuses.
What characterizes a T4 tumor in nasopharyngeal carcinoma?
Tumor extending into the cranial fossa, hypopharynx, orbit, or infratemporal fossa.
What is the primary treatment for nasopharyngeal carcinoma?
Local radiotherapy (RT) +/- bilateral neck RT +/- radical neck dissections.
What is an angiofibroma, and where does it commonly occur?
Angiofibroma is a benign tumor consisting of fibrous and vascular tissue, commonly involving the sphenopalatine foramen.
What symptoms may indicate the presence of an angiofibroma?
Epistaxis, nasal obstruction, and bone erosion.
What is the most common histological type of oropharyngeal cancer?
scc
What are the risk factors for oropharyngeal cancer?
Smoking, alcohol, betel nut chewing, HPV (types 6, 11, 16, 18).
What are the common presenting symptoms of oropharyngeal cancer?
Neck lump, sore throat, odynophagia, muffled speech, trismus (if pterygoid involvement).
What premalignant lesion is associated with oropharyngeal cancer and is more common in smokers?
Leukoplakia (hyperkeratosis).
What imaging techniques are used to assess oropharyngeal cancer?
MRI (for soft tissue definition), CXR, and liver ultrasound.
What invasive investigations are performed for oropharyngeal cancer?
Fine needle aspiration (FNA) of the lump, panendoscopy + biopsy, and sometimes a blind biopsy of the tonsil and tongue base.
How is early-stage (T1/T2) oropharyngeal cancer managed?
rt
What surgical procedures may be required for T3/T4 oropharyngeal cancer?
Excision with a 1-2 cm margin, +/- neoadjuvant chemoradiotherapy, depending on size and site.
What reconstruction options are available after excision for oropharyngeal cancer?
Anterolateral thigh (ALT) flap, pectoralis major (pec maj) flap, or forearm flap.
What is the most common histological type of hypopharyngeal carcinoma?
Squamous cell carcinoma (90%)
What are the common locations of hypopharyngeal carcinoma?
Postcricoid area, pyriform fossa, posterior pharyngeal wall.
What are common presenting symptoms of hypopharyngeal carcinoma?
Neck lump, hoarseness, dysphagia, pneumonia.
What characterizes a T1 tumor in hypopharyngeal carcinoma?
Tumor in one site and <2 cm.
What characterizes a T3 tumor in hypopharyngeal carcinoma?
Tumor >4 cm or fixation of the hemilarynx.
What is the treatment for early hypopharyngeal carcinoma?
rt
What surgical procedures may be required for larger hypopharyngeal tumors?
Laryngectomy, pharyngectomy, and reconstruction.
t2 hypopharyngeal ca
T2 – more than one site or 2-4cm
t4 hypopharyngeal ca
invasion of adjacent structures
name causes of grisel syndrome
lots of buzzing in adenoidectomy
alternative infection - e.g. retropharyngeal abscess
level 1 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes
level 2 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes
level 3 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes
level 4 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes
level 5 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes
level 6 neck lump - differential and primary tumour site for which nodes at this level are the first echelon nodes
why should hyoid bone be removed in sistrunk procedure
recurrence rate 85% if not removed
5 systemic causes of saddle nose deformity
granulomatosis with polyangiitis
sarcoidosis
relapsing polychondritis
leprosy
syphilis
ectodermal dysplasia
2 management options for saddle nose deformity
control systemic disease
SRP with reconstruction using autograft
9 causes of saddle nose deformity
untreated septal haematoma/abscess
rhinoplasty
granulomatosis with polyangiitis
sarcoidosis
relapsing polychondritis
leprosy
syphilis
intranasal cocaine
T cell lymphoma
examination of saddle nose deformity
loss of nasal dorsal height
loss of nasal tip support and definition
overrotation of nasal tip
where does disease of the 2nd and 3rd molars spread to
submandibular space first because roots are below mylohyoid
where does disease of teeth other than 2nd and 3rd molars spread to first
sublingual space first because roots are above mylohyoid
conservative measures for a CSF leak
bed rest
head up bed 15-30 degrees
stool softeners
LD
where is the thinnest part of the anterior skull base
lateral lamella of cribriform plate
which fluid in the body contains beta2 transferrin
CSF ,perilymph, aqueous humour
4 signs or symptoms which would be concerning for serious pathology in child with orbital cellulitis
visual loss
proptosis
ophthalmoplegia
meningism
what is the orbital septum
in the upper eyelid - the fascia from the orbital rim periosteum to levator aponeurosis
in the lower eyelid - fascia from orbital rim periosteum to the inferior border of the tarsal plate
when to perform urgent out of hours CT for orbital cellulitis
all paeds cases
suspicion of underlying abscess
suspicion of cavernous sinus thrombosis
evidence of meningism or intracranial abscess
Submental triangle boundaries
inferiorly - hyoid
medially - midline of neck
laterally - anterior belly digastric
