Otolaryngology Flashcards
Cauliflower deformity
Boxer
Repeated trauma
Perichondritis
Painful vesicles on ear
Neuropathic pain
Herpes zoster
Painful ear infection
External otitis
Painless ear infection
Otitis media
Most common organism that causes otitis externa
Pseudomonas aeruginosa
Causes swimmer’s ear
Pseudomonas aeruginosa
Herpes zoster oticus complication
Ramsay Hunt Syndrome
Facial paralysis
Obstructed apopilosebaceous unit ob lateral 1/3 of posterosuperior canal by Staph aureus
Furunculosis
Otomycosis is caused by
Aspergillus flavus, nigra (immunocompetent)
Candida (immunocompromised DM, steroids)
Cottonball appearance on otoscopy
Otomycosis
Perichondritis is caused by
Necrosis of ear cartilage
Atresia of external auditory canal
Complete absence of middle ear cleft and profound sensorineural deafness
Microtia
Hereditary Deafness
Glomerular Nephritis
defect in Type IV Collagen (Basement membrane)
Alport syndrome
Ears which stand out from side of head due to inc angle from posterior auricle and skull
Loss of antihelical fold
Lop Ear deformity
Most common inherited syndrome causing hearloss
Branchio-oto-renal Syndrome
Bilateral in 25-50%
5x risk of general population for permanent hearing impairment
Pre auricular sinus/pits
Tensor tympani In
Trigeminal V
Stapedius in
Seventh Facial
Hyperacusis in Bell’s is bec of
Involvement of Facial n that supply stapedius. Foot plate of stapes communicates with oval window
Ruptured tympanic membrane
Otorrhea
Stage 3 Suppuration OM
Mastoid
Decalcification, osteoclastic reaction
Mastoid coalescence
Mastoiditis
Stage 4 Coalescence OM
OM Complications
Mastoiditis
Choleastoma
Meningitis
Stage 5 OM
Resolution
Coalescence
Extra or intracranial complication
Temporal brain abscess
Stage 6 Complication OM
Frontal lobe abscess
Recurrent sinusitis
COM etiologic agent
Pseudomonas
Proteus
Strep
Waldeyer’s ring (6)
Paired
Palatine/Faucial
Tubal/Gerlach
Unpaired
Adenoids
Lingual
Protrusion of both sides of tongue
Depression of tongue
Genioglossus
Retraction of tongue
Styloglossus
Hyoglossus
Epithelium in oral cavity
Stratified squamous
Tongue of men
90% of oral cavity cancer
SCC of tongue
In tongue SCC assess
Mobilitt
Ability to cross midline
Location (base)
Tonsils virtually in contact with each other
Kissing tonsils
Brodsky Grade 4
Airway obstruction
Pathogen causing 20% of common colds
Rhinovirus
Causes 5% of colds
Coronavirus
Bacterial pathogen tonsilltis 15-30%
Group A Beta Hemolytic Streptococcus pyogenes
Group A Beta Hemolytic Strep causes
Rheumatic fever
Causes 5% of most bacterial pathogenic tonsillitis
Streptococcus Group C
Dangerous Triangle of Face
Arteries
Superior labial mouth
Angular
Facial
Infection arising from danger triangle of face
Cavernous sinus thrombosis
Trigeminal nerve V1
Ophthalmic:
Nasociliary - tip of nose
External nasal
Infratrochlear
Nerve for facial nerve grafting
Sural nerve
Dangerous space in pharynx
Retropharyngeal space
Fracture of walls of floor of orbit
Blow out fracture
Pathognomonic of orbital floor fracture
Tear drop sign
Orbital fat or muscle that herniates into maxillary sinus
Lefort I
Horizontal
Maxillary
Guerin fracture
Lefort II
Pryamidal fracture
Lefort III
Crosses orbital sockets
Craniofacial dysfunction
Calvarium separates from facial bone
Pan face deformity
Tripod Malar Fracture (3)
Orbital floor fx
Fx of lateral wall of maxillary antrum
Zygomatic arch fx
Most common site of mandibular fracture
Condylar fracture (36%)
Most common fractured facial bone
Nasal
Deviated septum
Epistaxis
Nasal fracture
Cavernous sinus content (5)
CN III CN IV CN V1, V2 CN VI ICA
Cavernous sinus thrombosis pathway
Inferior ophthalmic/Labial vein
Facial vein
Dangerous area of face
CVS
V1 exits on
Superior orbital foramen
V2 exits on
Foramen Rotundum
V3 exits on
Foramen ovale
Blood supply of nose
Sphenopalatine artery
Sphenopalatine artery gives rise to
Kiesselbach’s plexus Anterior
Woodruff’s plexus Posterior
Site of bleeding during epistaxis
Kiesselbach’s plexus
Most common site of nasopharyngeal CA
Fossa of Rosenmuller
Fossa of Rosenmueller is also
Posterolateral recess
Innervation of Parotid Gland
CN IX
Parotid gland secretion
serous
Koplik’s spots
Stensen’s duct of parotid gland
Paranasal sinuses (4)
Sphenoidal
Ethmoidal
Frontal
Maxillary
Sinus at birth
Maxillary
Ethmoid
Largest sinus
Maxillary
Paranasal sinus fxn (2)
Resonance of sound
To make bones of skull lighter
Drainage of tears
Nasolacrimal duct
Inferior nasal and meatus
Removes levels I to V CLN
Spinal Accessory
IJV
SCM
Radical Neck Dissection
Removes same level of lymphatics as in radical
Preserves CN XI, IJV and SCM
Modified Radical Neck dissection
Most common benign salivary tumor
Pleorphic adenoma
Tumor of only the Parotid Gland
Warthin’s tumor
Most common malignant salivary gland tumor
Mucoepidermoid carcinoma
Most common submandibular and minor salivary gland malignancy
Adenoid cystic carcinoma
Kiesselbach’s plexus
Great palatine
Anterior ethmoidal
Sphenopalatine
Superior labial
Woodruff’s plexus
Ascending pharyngeal
Sphenopalatine
Posterior nasal
Common to Kiesselbach’s and Woodruff’s
Sphenopalatine
Most common site of nasopharyngeal tumor
Fossa of Rosenmuller
Poserolateral recess
MC presentation of NPCA
Rf
Epistaxis
Smoking
EBV
Troublesome bleeding after tonsillectomy is caused by
damage of external palatine vein lateral to tonsils at tonsillar fossa
Rima Glottidis
Opening between true vocal cord and arytenoid
Paired tonsils
Adenoid
Lingual
Infection from deep neck space enters mediastinum through
substernal space of Burns
between superficial and deep fascia
Nerve supply of parotid gland
CN IX
Nerve that dissects parotid gland to superficial and deep lobes
CN VII
Sinuses present at birth
Ethmoid
Maxillary
Sphenoid sinus forms at
5 y/o
Frontal sinus forms at
7-8 y/o
Nasolacrimal duct drains at the
Inferior nasal conchae
Largest sinus
present at birth
Maxillary
Paired brachial arches and clefts form at
4 weeks
From second arch
Reichart’s cartilage
Reichart’s cartilage differentiates into
Stapes Styloid p Stylohyoid ligament Lesser horn of the hyoid Superior part of body of hyoid
Second arch muscular derivative
Muscles of scalp and face Platysma Stylohyoid Stapedius Posterior belly of digastric
Vascular element of second arch
Stapedial artery
Arch 1
Meckel’s cartilage
Arch 2
Reichert’s cartilage
Precancerous whitish patch
Leukoplakia
Precancerous biopsy finding of oral lesion
Dysplasia
Most oral cavity CA are
epidermal in origin
Most common type of oral cavity cancer
squamous cell carcinoma
Leukoplakia is strongly assoc with
smoking
Virus that causes oral hairy leukoplakia
EBV
Factors to predispose oral cavity CA
Cigarette Betel nut chewing Alcohol Poor oral hygiene Ill fitting denture
Oral cavity cancer sx
Pain LOM of tongue Bleeding Lump in neck Dysphagia or odynophagia Leukoplakia Tumor w or w/o ulcerarion Cervical LAD Neuro signs: CN XII (motor) Mental nerve (sensory)
Anterior 2/3 sensory innervation
Facial nerve
Mental nerve
Oral cavity cancer dx
Panoramic radiograph - sockets, teeth, mandibular border
CT scan
Biopsy
Oral cavity cancer Surgery tx
1-2cm margin
Neck dissection
Oral cavity cancer chemotherapt
Cisplatin
5-FU
Cisplatin causes
Ototoxicity
Nephrotoxicity
5-FU inhibits
thymidilate synthase
M>F
75% occur after 50
85% SCC
Nasal ca
M>F
95% after 40
80% SCC
Paranasal sinus ca
Nasal ca sx
Nasal obstruction Foul smelling Nasal d/c Lymph node metastasis Epistaxis Bulging cheek
Nasal ca risk factor
Smoking
Occupational (woodworker, learher tanning and mining)
Chronic sinusitis - metaplasia
Bacteria for pretanning of leather
Bacillus
Nasal ca dx
CT scan
biopsy
Nasal ca tx
Maxillectomy
Orbital exenterartion
Lymphatic metastasis
Nasal ca poor prognosis
Advance stage
Complex anatomy
Spread beyond the sinus
Angiomas are found in
septum
inferior turbinate
Nasal polyp with interstitial fluid, connective and vascular tissue
Hemangiomatous polyp
Benign tumor un adolescent males
Juvenile nasopharyngeal angiofibroma
Vascular tumor tx
Surgical excision Radiation Cryosurgery Hormonal therapy Selective thromboembolism
Largest salivary gland
Serous
Duct: Stensen’s
Opens into oral vestibule opposite upper second molar tooth
Parotid gland
Post gustatory sweating due to damage to auriculotemporal and great auricular nerve from trauma
Frey syndrome
Frey syndrome nerve
Auriculotemporal
Great auricular nerve
Arnold’s nerve is auricular branch of the
Vagus
Stimulus intended for saliva production results to sweating
Frey syndrome
Floor of the mouth
Serous> mucous
Duct: Wharton’s
Submandibular gland
Smallest
Mixed secrerion mucous>serous
Ducts: rivinu and bartholin
Sublingual
Throughout oral cavity, nasopharynx, sinus, trachea and bronchi
Minor salivary
Anterior to tongue
Gland of blandin
Connected to circumvalate papillae
Gustatory glands of Ebner
75-85% of Parotid tumors are
benign
Malignant salivary tumors occur in
Minor (46%)
Sublingual (85%)
Most common benign salivary gland tumor (85%) of parotid gland
Pleomorphic
Warthin (10)
Most common malignant salivary tumor (33%)
Mucoepidermoid
Adenoid cystic
Stigma of malignant salivary tumor
Facial nerve paralysis
Rapid growth
Lymphadenopathy
Induration/fixation
Second most common benign salivary gland tumor
95% parotid, 3% bilateral
Warthin’s tumor
The more the lens bends light rays the greater the
Measured in
refractive power
diopters
Total refractive power
2/3 cornea
1/3 lens