The Neck, Glands of the Face, and H&N Cancers Flashcards
What kind of cancer makes up the majority of head and neck cancers?
Squamous cell carcinoma
What are cancers of the head and neck most associated with epidemiologically?
Tobacco use
Aside from heavy smoking, what other risk factors are there for head and neck cancers?
Heavy alcohol consumption Poor dentition Socially disadvantaged groups Poor diet (low fibre) GORD HPV
Is smoking the only way someone can use tobacco?
No, it can be chewed too.
How might a pt with a head and neck tumour present?
- Persistent hoarse voice
- Sore throat
- Cough
- Earache
- Neck lump
- Mouth lesion
- Recurrent unilateral nosebleeds
- Systemic features e.g. weight loss
How are early-stage H+N cancers usually managed?
Surgery or radiotherapy
What supportive Rx might a pt with a H+N tumour need?
Nutritional support
Communication support
Dentition support
Psychological support - for cancer and for possible cosmetic effect.
What are the salivary glands called?
- Parotid gland
- Submandibular
- Sublingual
Where do the parotid glands:
a) lie?
b) open?
a) below the external auditory meatus
b) on the buccal membrane opposite second upper molar
Where do the submandibular glands:
a) lie?
b) open?
a) beneath and infront of angle of the jaw
b) floor of the mouth lateral to frenulum
Where do the sublingual glands:
a) lie?
b) open?
a) below the tongue
b) through several ducts on the floor of the mouth
How much saliva is produced in one day?
1-1.5 Litres
What are the functions of saliva?
Lubrication
Facilitate speech, swallowing, digestion, and mastication.
Protect oral mucosa and teeth.
What symptoms might a pt have relating to salivary gland pathology?
Swelling
Pain (gland or ear or throat)
Difficulty eating
Dry mouth
How can we examine the parotid gland?
Ask pt to clench jaw - palpate parotid gland overlying the masseter muscle.
Which nerve may be affected by parotid gland pathology?
Facial nerve
What other swelling can salivary gland swellings be confused with?
Lymph node swelling
What might cause parotid gland swelling?
- Viral - mumps
- Bacterial infection
- Stone
- Sjögren’s syndrome
- Sarcoidosis
- Granulomatosis
- HIV-related lymphocytic infiltration
- Benign or malignant tumour
What might cause submandibular gland swelling?
- Stone in duct
- Benign or malignant tumour
- Sjögrens
What is the most common cause of salivary gland infection?
Mumps
A pt presents with a painful swelling on the side of their face. They have experienced a dry mouth and temperature along with this.
What might this be, and what other symptoms might they have?
Infection of parotid gland.
- Abnormal or foul taste
- Discharge from ducts
- Mouth pain especially when eating
- Difficulty talking
- Other signs of systemic unwellness
How should mumps or other salivary gland infections be managed?
Supportively - it is self-limiting and not serious.
It is however notifiable.
Encourage salivary flow.
Abx may be necessary.
Remove stones or strictures if appropriate.
How can salivary glands become obstructed?
- Calculi or stones form from mucus, cellular debris, calcium, and magnesium phosphates.
- Duct stenosis (post-inflamm, chronic)
- Obstructing tumour
How does an obstructed salivry gland present?
Pain and swelling in region of gland, particularly at meal times (when saliva production is stimulated)
