Surgery Clinical Demonstration: Head & Neck

Question 1

Common presenting complaints in head and neck

Answer 1

1. Lump / Swelling / Mass
2. Pain
3. Ulcer / Growth in mucosal lining of oral cavity / oropharynx
4. Discharge / Bleeding from nose, ear, skin surface
5. Deafness
6. Dysphagia
7. Difficulty in breathing
8. Harness / Change of voice

Question 2

Neck examination

Answer 2

Inspection (In front of patient):

• Asymmetry
• Mass (size, shape, site, discolouration etc.)
• Posture of head and neck
• Swallow (mass move?) —> Thyroid enlargement
• Protrusion of tongue (mass move?) —> Thyroglossal cyst

Palpation:

• Cervical LN
• Salivary glands (Parotid, Submandibular)
• Thyroid
• Triangles of neck
• Tracheal deviation

Auscultation:
- Bruit —> Toxic thyroid gland

Question 3

Oral cavity and Oropharynx

Answer 3

Gloves + Torch + Spatula

Inspection of Mucosal lining:

• Buccal surface
• Tongue
• Floor of mouth

Palpation:

• Consistency
• Lesion
• Regional LN

Question 4

Ear examination

Answer 4

Inspection:

1. External ear / Auricle
2. External auditory canal
3. Posterior auricular area
   - Skin changes
   - Growth
   - Symmetry

Otoscopy:
Pull ear posteriorly + superiorly —> straighten external auditory canal

Cartilaginous part of ear canal

• Inflammation
• Skin changes

Bony part of ear canal
- Tympanic membrane
—> Cone of light
—> Handle of malleus
—> Long process of incus
—> Pars tensa
—> Pars flaccida

Tuning fork test (256 / 512 Hz)

• Rinne’s test
• Weber’s test