Neck Disorders Flashcards
Which nerves are connected with the taste buds?
CN VII
CN XI
Factors Leading to Flavor
Smell Taste Irritation Texture Temperature
Hypogeusia
Diminished taste to 1 or more tastants
Ageusia
Absent taste function
Dysgeusia
Persistent sweet, sour, salty, bitter or metallic taste
Allegeusia
Unpleasant taste of food or drink that is usually pleasant
Phantogeusia
Unpleasant taste produced indigenously due to gustatory hallucination
Etiology of Taste Disorders
Aging Infections Gastric reflux Drugs Xerostomia
Reasons for Xerostomia
Diseases Radiation Infections Drugs- TCA's Toxins
Treatment of Dysgeusia
Treat underlying problem when possible
Clonazepam (Klonopin)
Treatment for Burning Mouth
TCA’s
Clonazepam
Reasons for Halitosis
Good oral hygiene Dentures Mouth breather Snores Excess nasal discharge Excess nasal obstruction DM Immunosuppresed
Define Halitophobics
People who are afraid they have bad breath but don’t actually have bad breath
PE for Halitosis
Smell patients breath through mouth
Smell patients breath through nose
Scrape tongue and smell the scrapings
Etiology of Halitosis in the Oral Cavity
Breakdown of amino acids producing sulfur
Poor dental hygiene
Accumulation & putrefaction of postnasal drip
Dental Abscess
Gingivitis
Unclean Dentures
Etiology of Halitosis in the Nasal Passages
Nasal infection
Polyps
FB in children
Etiology of Halitosis in the Tonsils
Tonsilloliths
Treatment of Halitosis in the Oral Cavity
Proper dental care/hygiene Cleaning of posterior tongue Rinsing/deep gargling with mouthwash Brief gum chewing Sufficient water intake
Stomatitis- Oral Infections
Candida HSV VAV HIV Recurrent apthous stomatitis (RAS) RULE OUT CA
Treatment for Aphthous Ulcers
Symptomatic Relief
Chemical cautery
Intralesional or oral cortison
Symptomatic Relief for Aphthous Ulcers
Triamcinolone acetonide
Oragel
Anbesol
Stomatitis due to Varicella-zoster Virus
Grouped vesicles unilaterally on the hard palate
Stomatitis due to HIV
Painful mucocutaneous ulceration one of the most distinctive manifestation of primary HIV-1
Complications of Xerostomia
Severe dental caries Gum disease Halitosis Salivary gland calculi Dysphagia
Etiology of Xerostomia
Autoimmune
Radiation treatment
Medication SE
Treatment of Xerostomia
Artificial saliva
Odynophagia Differential Diagnosis
Severe stomatitis
Candida involving the esophagus
GERD
Stomatitis in immunosuppressed patients
Treatment of Odynophagia
Treat the underlying cause
Indirect Laryngoscopy Indications
Hoarseness >2 weeks Odynophagia Voice change Dysphagia Hemoptysis FB sensation
Contraindications for Indirect Laryngoscopy
Uncooperative patient
Patient with strong gag reflex
Compromised airway
Supplies Needed for Indirect Laryngoscopy
Light source
Warmed mirror
Gauze
Topical anesthetic
Keys in History in Hoarseness
Duration & onset Triggers Better/worse H&N symptoms Hx of neck surgery Hx of smoking or alcohol abuse Hx of reflex Hx of trauma or ET intubation Occupation Hobbies Habits impacting voice
Etiologies of Hoarseness
Acute laryngitis Chronic laryngitis Benign vocal fold lesions Malignancy involving the larynx Neurologic dysfunction Functional issues Systemic conditions
Treatment for Hoarseness due to Acute Laryngitis
Self-limited
Secondary to URI
Voice rest
Fluids
Treatment for Hoarseness due to Chronic Laryngitis
Chronic irritants Toxins GERD Chronic sinusitis Postnasal drip Chronic alcohol use Chronic vocal strain Tobacco smoke Treat underlying etiology
Types of Benign Vocal Cord Lesions
Polyps
Nodules
Polyps
Chronic vocal cord irritation
Etiologies: smoking, reflux, muscle tension dysphonia
Nodules
Bilateral, symmetric
Singers/screamers nodes
More common in women & children
Laryngeal CA
Primarily SCC
Risk Factors: smoking/alcohol abuse
Metastasizes to regional lymph nodes
3 Phases of Swallowing
Oral preparatory
Pharyngeal
Esophageal
Disorders of Oral Preparatory Phase
Inadequate mastication
Xerostomia
Neurologic disorders
Disruption of oropharyngeal mucosa
Disorders of the Pharyngeal Phase
Neuromuscular discordination
Obstructions within oropharynx
Poor compliance of upper esophageal sphincter
Key History to Oropharyngeal Dysphagia
Symptoms occur immediately after swallowing
Hx of neurologic symptoms
Dry mouth & eyes
Complaints with Oropharyngeal Dysphagia
Coughing Choking Drooling Odynophagia Changes in speech Weight loss Aspiration
Diagnostic Tests of Oropharyngeal Dysphagia
Barium Studies (piece of bread) Fiberoptic endosopic evaluation Nasopharyngeal laryngoscopy Manometry
Differential of Acute Pharyngitis in Adults
Viruses (HSV, EBV, HIV, Diptheria)
10%- Group A strep
Acute Pharyngitis Management
Throat, nasopharyngeal specimens Rapid strep culture Monospot Influenza Hx of HIV risk factors
Group A Strep Acute Pharyngitis Treatment
Penicillin/Amoxacillin
Cephalosporin
Macrolide
Symptomatic Treatment
Analgesics (acetaminophen, NSAIDS, aspirin) Topical analgesics (lozenges, sprays, fluids)
What is Tonsillopharyngitis caused by?
Group A strep
Presentation of Tonsillopharyngitis
Severe sore throat
Difficulty swallowing
Fever
Signs of Tonsillopharyngitis
Enlarged, erythematous tonsils with exudate
Lymphadenopathy
Treatment goals in Group A Strep Tonsillopharyngitis
Reduce duration & severity of symptoms
Reduce nonsuppurative complications
Reduce transmission to close contacts
What is a Peritonsillar Abscess?
Complication of tonsillitis
Presentation of Peritonsillar Abscess
Sore throat Odynophagia Fever Trismus Develop dysphagia, drooling, & voice changes Ipsilateral ear pain
Differential Diagnosis of Peritonsillar Abscess
Unilateral tonsillitis
Peritonsilar cellulitis
Mono
Neoplasm
Treatment of Peritonsillar Abscess
I&D then antibiotics
Sometimes tonsillectomy
Diptheria
Corynbacterium diphtheriae
Spread by respiratory droplets or cutaneously
Characteristic Sign of Diptheria
Grayish/white exudate
Pseudomembrane
Diagnostic Test for Diphtheria
Culture
Test for toxin
Treatment for Diphtheria
Erythromycin
PCN
Antitoxin
Treat contacts
