ORAL CAVITY; FLOOR OF MOUTH; SUBLINGUAL SPACE; ORO- AND HYPOPHARYNX; LARYNX; TRACHEA

Question 1

one of the most common head and neck infections in adolescents and young adults.

Answer 1

Tonsilitis

Question 2

the most common deep neck infection, almost always secondary to acute or recurrent tonsillitis.

Answer 2

Peritonsillar abscess or quinsy

Question 3

What are the complications of peritonsillar abscess?

Answer 3

retropharyngeal effusion

retropharyngeal abscess

septic thrombophlebitis of the internal jugular vein (Lemierre syndrome)

Question 4

life-threatening condition caused by inflammation of the epiglottis and aryepiglottic folds, which can lead to acute airway obstruction.

Answer 4

Epiglottitis

Question 5

? is due to viral infection of the upper airway by parainfluenza virus or respiratory syncytial virus (RSV).

Answer 5

Croup

6 months up to 15 years old, but most commonly between 6 months to 3 years with a peak at 18 months

Question 6

Imaging features to suggest croup

Answer 6

steeple sign - AP radiographs of the neck or chest and neck demonstrates uniform narrowing of the subglottic airway

distension of the hypopharynx is also seen due to the patient’s attempt at decreasing airway resistance.

while this can be a sign of upper airway obstruction, note that it also normally occurs at end inspiratory phase in a crying child

lateral radiograph of the upper airway will show a normal epiglottis and narrowing of the subglottic region

Question 7

Complications of retropharyngeal abscess?

Answer 7

posterior extension to pre-vertebral space, discitis osteomyelitis, epidural abscess

lateral extension involving carotid artery (haemorrhage, pseudoaneurysm, thrombosis, stenosis) and jugular vein (thrombosis)

anterior compression and compromise of the airway

inferior extension into the mediastinum resulting in mediastinitis (e.g. via involvement of the danger space, carotid sheath or visceral space)

systemic dissemination and development of sepsis

Grisel syndrome

Lemierre syndrome

Question 8

Tracheobronchial abnormalities that also spare the posterior wall

Answer 8

tracheobronchopathia osteochondroplastica - thickening is irregular and nodular

Question 9

Tracheobronchial abnormalities that involve the posterior wall:

Answer 9

granulomatosis with polyangiitis (GPA) - circumferential involvement
the subglottic trachea is the most commonly affected area (involvement down to the main bronchi is possible)

tracheobronchial amyloidosis - circumferential involvement
may appear as focal or diffuse narrowing
calcifications of the tracheal wall can be seen

post-intubation tracheal stenosis - focal involvement
irregular and concentric stenosis

Question 10

? is a posterior outpouching of the hypopharynx, just proximal to the upper oesophageal sphincter through a weakness in the muscle layer called the Killian dehiscence.

Answer 10

Zenker diverticulum, also known as a pharyngeal pouch

More than 50% of the affected patients present in 60-80 years of life. It is rarely found in individuals less than 40 years of age

Question 11

Imaging findings of inhaled foreign body

Answer 11

the patient should be radiographed on expiration: this will exaggerate the differences between the lungs

the normal lung should appear smaller and denser than the affected lung

due to the check valve mechanism, air enters the bronchus around the foreign body but cannot exit, the affected lung will usually appear overinflated and hyperlucent, with concomitant rib flaring and a depressed ipsilateral hemidiaphragm

the chest x-ray will be normal in ~35% (range 30-40%) of patients 1-2

the majority of foreign bodies are radiolucent

unilateral emphysema or atelectasis are the most common findings

Question 12

? are rare, benign, acquired, cystic lesions that occur at the floor of the mouth as sublingual or minor salivary gland retention cysts.

Answer 12

Ranula

reasons that are unclear, they appear to be more common in the Maori of New Zealand and Pacific Island Polynesians

Question 13

Location of ranula vs plunging ranula

Answer 13

Simple ranula is within the sublingual space above the mylohyoid muscle but plunging ranula dives into the submandibular space with a collapsed sublingual portion called the “tail”

Question 14

Presents as a cricopharyngeal bar, which is seen as a relatively constant impression on the posterior aspect of oesophagus at C5-6 level. ……can be diagnosed with manometry.

Answer 14

Cricopharyngeal muscle spasm is also known as cricopharyngeal achalasia

Question 15

refers to the impaired mobility of the true vocal cord or fold due to neurologic dysfunction.

Answer 15

Vocal cord paralysis/paresis (VCP), also known as vocal fold paralysis/paresis

Question 16

The imaging features of vocal cord paralysis include

Answer 16

enlarged pyriform sinus

medialization and thickening of the aryepiglottic fold

enlarged laryngeal ventricle (sail sign)

abducted vocal cord during breath-hold imaging with compensatory medial bowing of the contralateral cord

Question 17

a condition characterised by narrowing of the subglottic airway (region below the vocal cords). It can be congenital or acquired

Answer 17

Subglottic stenosis

Question 18

? is the dilatation of the saccule of the laryngeal ventricle and is unilateral in the vast majority of cases.

Answer 18

Laryngocele

Almost all laryngoceles are unilateral,

Question 19

Risk factors for laryngocele?

Answer 19

Raised intralaryngeal pressure secondary to:

excessive cough

playing woodwind/brass instruments

glass blowing

obstructing lesion, e.g. a tumour

childbirth: rarely reported

Question 20

refers to a rare, often lethal, congenital laryngotracheal condition and is primarily characterised by obstruction to the fetal upper airway.

Answer 20

Congenital high airway obstruction syndrome or sequence (CHAOS)

Question 21

What are the three possible types of CHAOS?

Answer 21

complete laryngeal atresia without an oesophageal fistula

complete laryngeal atresia with a tracheo-oesophageal fistula

near-complete high upper airway obstruction

Question 22

A congenital granular cell myoblastoma (also known as congenital epulis) is a very rare benign tumour which classically presents in the fetal-neonatal population.

occurs almost exclusively in females

where does it occur?

Answer 22

most commonly occurs along the alveolar ridge of the maxilla although less commonly, it can also occur in relation to the mandible.

Question 23

is a term given to a very rare form of teratoid tumour that arises from the oropharyngeal region.

Typical location of tumour?

Answer 23

Epignathus

The tumour typically arises from the palato-pharyngeal region around the basisphenoid (Rathke’s pouch) and with progressive growth fills the buccal cavity and finally protrudes out of the mouth