Oropharyngeal and Laryngeal Disorders - Heywood Flashcards
Identify this condition:
pt presents with a collar of edema and infection of the submandibular, sublingual and submental compartments bilaterally, tongue is pushed superiorly and posteriorly
Ludwig’s Angina
tx: manage airway, I&D may be required
Identify and describe the management:
pt is a 22 yo acapella singer
Larygnoscope shows: bilateral distinct masses on the anterior vocal cords involving the mucosa and submucosa
Nodules
- bilateral can occur in children and young adults
- no sex predilection
- biphasic, early and mature
- occur at the “striking zone”
TX: voice therapy
Identify and describe the management:
Larygnoscope shows: a sessile mass on the mid anterior cord
Unilateral Polyp
can be pendunculated or sessile
tx: voice therapy or surgery
Grade these tonsils:
Grade 4
Identify this condition:
pt reports recurrent oral apthous ulcers, gential ulcers, and uveitis
Bechet’s
rare immune-mediated small vessel systemic vasculitis
Grade these tonsils:
Grade 2
Identify this condition:
20 yo pt presents with small, round circumscribed ulcers that has a gray floor with an erythmatous halo in her mouth
pt reports prior history and that these typically occur 3-6 times a year and only last a week or so
pt says her brother has something similar
Aphthous Stomatitis
- restricted to the mouth
- typically resolves in the third decade of life
- affects 20% of population
- ulcers last 7-10 days
- 3-6 episodes a year
- result of T cell mediated immune response
associated conditions with: Aphthous-Like Stomatitis
- Behcet’s Disease
- Celiac Disease
- Cyclic Neutropenia (every 21 days)
- Nutritional Deficiencies (B12, folic acid, & iron)
- IgA deficiency
- Immunocompromised States
- IBD - Chron’s
- MAGIC Syndrome (Mouth & Genital Ulcers with inflammed cartilage)
- PFAPA Syndrome (Periodic Fever, Aphthas, Pharyngitis, Adenopathy)
- Reiter’s Disease
- Erythema Multiforme
- Toothpastes - Sodium Lauryl Sulfate
Recurrent Respiratory Papillomatosis
- affects mucous membrane of the respiratory tract
- infection only in keratinocytes of the skin or mucous membrane
- viral etiology: HPV 6, 11
- vertical transmission
- juvenile and adult onset
Identify this condition and describe the management:
pt presents with an occluded salivary gland on the mucosa
Mucocele
tx: drainage and excision
Identify this condition and describe the management:
pt presents with a midline anterior neck mass
examination reveals the mass elevates when the patient swallows and sticks out her tongue
Thyroglossal Duct Cyst
remnant of connection between foramen cecum and thyroid
tx: surgical excision
Identify this condition:
pt presents with a lace like pattern in her oral cavity
Lichen planus
- not contagious
- unknown triggers
- maybe autoimmune
TX: steroids helpful, no known cure
Identify this condition:
lateral neck mass, anterior to the SCM
exam reveals the mass opens into the tonsillar fossa
Branchiogenic Cyst - second arch
Superficial to CN IX and XII
Superficial to Cartoid Sheath
Granulomas
Contact - posterior glottis
- auctioneers, bass singers, throat clearing/coughing
- GERD
TX:
- steroids, proton pump inhibitors
- surgical management
Identify this condition:
pt is an adolescent with a sore throat, fever, malasie,
exam: lymphadenopathy over the posterior cervical and occipital nodes, elevated AST/ALT (liver tests)
Infectious Mononucleosis
Primary cause: Epstein Barr Virus
Can be detected with the monospot test
Identify this condition and describe the management:
pt presents with a mass in the floor of his mouth, it extends inferiorly into the neck
Ranula
occlusion of sublingual gland
simple type: lies in the mouth floor
plunging or diving type: pierces mylohyoid muscle and presents as a neck mass
Identify this condition:
neck mass, anterior to the SCM
Branchiogenic Cyst - first arch
Type 1 - duplication of EAC
Type 2 - intimate association with facial nerve
Identify and describe the management:
pt is a female smoker with a very raspy voice
Larygnoscope shows: bilateral masses spread across the cord
Bilateral Diffuse Polyposis
common with vocal abuse - leads to edema, vascular congestion and stasis
Grade these tonsils:
Grade 1
Identify this condition:
pt complains of trismus, dysphagia, odynophagia
exam: see below, temp: 100 F
CBC: increased WBC
Peritonsillar Abscess
Identify this condition:
pt presents with painful, ulcerated, bleeding gums
culture shows polymicrobial anaerobic infection (Borrelia vinventii)
Acute Necrotizing Ulcerative Gingivitis (aka Trench Mouth, Vincen’ts Angina)
more common in young adults
predisposing factors: poor nutrition, debilitating disease
tx: antibiotics, surgical debridement
Identify this condition:
pt complains of mouth pain, exam shows a cheesy appearance with an ulcerative base
Fungal Infection
Candida most common
Identify this condition:
pt presents with vesicles in her mouth
exam findings: ulcerated lesions on a hyperemic rim (see below)
Herpes Virus
type 1 primarily oral
tx: antivirals
other presentations see below:
Leukoplakia
- white patch
- pre-cancerous lesion
- need biopsy to rule out carcinoma
- 0-20% turn into cancer (see image of vocal cord carcinoma below)
Grade these tonsils:
Grade 3
Identify this condition:
5 yo pt presents in the ER, he is bent forward and drooling with stridor
Acute Epiglottitis/Supraglottitis
often pediatric presentation
H. flu
examine in O.R. with intubation equipment readily available
Identify this condition:
pt presents with a candidal infection at the corner of her mouth
Angular Chelitis
associated with decreased vertical height between the mandible and maxilla
tx: restore height, use antifungals
