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Year 4 Neuro and Special Senses > Throat > Flashcards

Throat Flashcards

1
Q

Describe the borders of the anterior triangle

A

Midline
Mandible
SCM

Roof - Investing fascia
Floor - Visceral fascia

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2
Q

Name the four subdivisions of the anterior triangle

A

Carotid Triangle
Submental triangle
Submandibular triangle
Muscular triangle

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3
Q

What are the borders of the Carotid Triangle?

A

Medial border of SCM
Posterior belly of Diagastric
Superior border of Omohyoid

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4
Q

What are the contents of the Carotid Triangle?

A

Common Carotid (bifurcates within at C4)
IJV
Hypoglossal and Vagus
Baroreceptors

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5
Q

What is contained within the Submental triangle?

A

Submental lymph nodes

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6
Q

What is contained within the Submandibular triangle?

A

Submandibular salivary glands
Lymph nodes
Facial Artery and Veins

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7
Q

What is contained within the Muscular Triangle?

A

Infrahyoids
Pharynx
Thyroid
Parathyroid

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8
Q

Name the four Suprahyoid muscles

A

Stylohyoid
Digastric
Myelohyoid
Geniohyoid

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9
Q

Name the four infrahyoid muscles

A

Omohyoid
Sternohyoid
Thyrohyoid
Sternothyroid

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10
Q

What are the borders of the Posterior Triangle?

A

Posterior SCM
Anterior Trapezius
Clavicle

Roof - investing fascia
Floor - prevertebral fascia

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11
Q

Name three muscles in the Posterior Triangle

A

Omohyoid
Levator Scapulae
Scalenes

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12
Q

Name three vessels in the Posterior Triangle

A

EJV Superficially
Transverse Cervical
Suprascapular

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13
Q

Name the nerves in the Posterior Triangle

A

Accessory nerve
Cervical plexus
Trunks of Brachioplexus

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14
Q

Name three distinguishing features of the cervical spine

A
  • Triangular Vertebral Foramen
  • Bifid Spinous Process
  • Transverse Foramina

(spinal nerves exit above level)

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15
Q

Describe the anatomy of the Atlas (C1)

A

Articulates with the occiput and C2

No vertebral body or spinous process

Anterior arch has a facet for articulation with the dens

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16
Q

Describe the anatomy of the Axis (C2)

A

Has Dens (Odontoid Process) - medial atlanto-axial joint

Superior articular facets - lateral atlanto-axial joints

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17
Q

Name 6 ligaments of the Cervical Spine

A 
Anterior Longitudinal
Posterior Longitudinal
Ligamentum Flavum
Interspinous
Nuchal ligament
Transverse ligament of atlas
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18
Q

The Hyoid bone doesn’t articulate with any bones. Describe its anatomy

A

Greater Horn
Lesser Horn
Body

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19
Q

How is the Hyoid Bone damaged?

A

Strangulation

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20
Q

The Superficial Cervical Fascia lies between the dermis and Deep Cervical Fascia. Name the 5 contents

A 
Neurovascular supply to the skin
Superficial Veins
Superficial Lymph Nodes
Fat 
Platysma Muscle
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21
Q

Name the three Deep Cervical Fascial Layers

A

Investing
Pre Tracheal
Pre Vertebral

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22
Q

Describe the investing layer of Deep Cervical Fascia

A

Most superficial, surrounding all structures in the neck

Splits around trapezius and SCM

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23
Q

Describe the pre-tracheal layer of Deep Cervical Fascia

A

Spans between Hyoid and Thorax and fuses with Pericardium

Muscular part - encloses infrahyoids
Visceral part - encloses thyroid, trachea, oesophagus
Posterior Visceral - buccopharyngeal

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24
Q

Describe the pre-vertebral layer of the Deep Cervical Fascia

A

Surrounds vertebral column/scalenes/prevertebral muscles

Anterolateral portion forms floor of the Posterior Triangle

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25
Q

What is the Pharynx?

A

Muscular tube connecting oronasal cavity to larynx and oesophagus
Begins at base of skull and descends to C6

Split into Nasopharynx, Oropharynx and Laryngopharynx

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26
Q

Describe the structure of the Nasopharynx

A
  • Base of skull to the soft palate
  • Lined with ciliated pseudostratified columnar epithelium with goblet cells
  • Contains Adenoids
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27
Q

Describe the structure of the Oropharynx

A

From soft palate to superior border of epiglottis

Contains posterior 1/3 tongue, lingual tonsils, palantine tonsils and superior constrictor muscles

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28
Q

Describe the structure of the Laryngopharynx

A

Between superior border of epiglottis and inferior border of cricoid

Contains Piriform Fossae and Middle/Inferior constrictors

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29
Q

The muscles of the Pharynx include Circular and Longitudinal. Describe the circular muscles

A

Superior, Middle and Inferior constrictors

Contract sequentially for Peristalsis

Inferior splits into two parts so if inferior part doesn’t relax - diverticulum

Innervated by Vagus

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30
Q

The muscles of the Pharynx include Circular and Longitudinal. Describe the longitudinal muscles

A

Stylopharyngeus, Palatopharyngeus, Salpingopharyngeus

Shorten and widen pharynx, and elevate larynx in swallowing

All Vagus innervation (except Stylopharyngeus - CNIX)

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31
Q

Describe the blood supply to the Pharynx

A

Branches of the ECA

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32
Q

Name the four roles of the Larynx

A

Phonation, Ventilation, Coughing, Protection of LRT

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33
Q

Describe the anatomy of the Larynx

A

Spans C3-C6
Covered anteriorly by infrahyoids
Anterior to Oesophagus
3 Subsections (Supra, Glottis, Infra)

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34
Q

Describe the blood supply to the Larynx

A 
Superior Laryngeal (Branch of Superior Thyroid)
Inferior Laryngeal (Branch of Inferior Thyroid)
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35
Q

Describe the innervation of the Larynx

A

RLN - Sensory to Infraglottis and Motor to all except Cricothyroid

Superior Laryngeal - Sensory to Supraglottis and Motor to Cricothyroid

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36
Q

Name the three unpaired cartilages of the Larynx

A

Thyroid Cartilage (Laryngeal Prominence)
Cricoid (complete ring)
Epiglottis

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37
Q

Why is the fact that the Cricoid is a complete ring relevant?

A

Pressure can be applied to occlude the oesophagus and prevent regurgitation of contents during Emergency Intubation

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38
Q

Name the three paired cartilages of the Larynx

A

Arytenoid
Corniculate
Cuneiform

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39
Q

There are extrinsic and intrinsic Laryngeal ligaments. Name the two main intrinsic ligaments

A

Cricothyroid (upper margin is free edge - vocal ligament)

Quadrangular (lower margin is thickened to become vestibular)

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40
Q

Describe the histology of vocal cords

A

Stratified Squamous Epithelium
Reinke’s Space (Watery GAG layer vibrates to make sound)
Vocal Ligament
Vocal Muscle

Relatively avascular

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41
Q

What is the Vestibular Ligament?

A

AKA False Vocal Cord

Lies above true vocal cord

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42
Q

What is the role of the extrinsic laryngeal muscles?

A

Suprahyoids - laryngeal elevation

Infrahyoids - laryngeal depression

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43
Q

What do the intrinsic muscles of the larynx do (except Cricothyroid)?

A

Control Rima Glottidis, and length/tension of vocal cords

Innervated by inferior laryngeal nerve (from RLN)

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44
Q

What does the Cricothyroid Muscle do?

A

Stretches and tenses vocal ligament

Innervated by External Branch of Superior Laryngeal

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45
Q

Why is the Posterior Cricoarytenoid Muscle so important?

A

It is the sole Abductor of the larynx/vocal cords, allowing breathing

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46
Q

Describe the anatomical relations of the Thyroid Gland

A

Anterior - Infrahyoids
Lateral - Carotid Sheath
Medially - larynx/pharynx/RLN/External branch

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47
Q

Describe the blood supply of the Thyroid Gland

A
  • Superior Thyroid (first branch of ECA)
  • Inferior Thyroid (From thyrocervical trunk - branch of subclavian)
  • 10% have additional Thyroid IMA artery from Braciocephalic trunk
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48
Q

Describe the venous drainage of the Thyroid Gland

A

Superior Middle and Inferior Thyroid Veins form a plexus

Superior and Middle drain into IJV and Inferior drains into braciocephalic

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49
Q

Describe the lymphatic drainage of the Thyroid Gland

A

Paratracheal

Deep cervical

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50
Q

What are the Parathyroid Glands?

A

Located on posterior aspect of thyroid gland (between 2 and 6 in number)
Superior from fourth pharyngeal arch
Inferior from third pharyngeal arch

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51
Q

What is the Cervical Plexus?

A

Anterior Rami of C1-C4

Clinically relevant for sensory nerve block at Erb’s Point (middle of posterior SCM)

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52
Q

Name the four tonsils in Waldeyer’s Ring

A

Lingual
Palantine
Tubal
Adenoid

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53
Q

Describe the pathway of the Carotid Arteries

A

Right - Braciocephalic
Left - Aortic Arch

Ascend until C4 where they split in Carotid Triangle

External branches - Superior Thyroid, Ascending Pharyngeal, Lingual, Facial, Occipital, Posterior Auricular, Maxillary, Superficial Temporal

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54
Q

Describe the anatomy of the Thyrocervical Trunk

A

Branch of the Subclavian Artery

Inferior Thyroid, Ascending Cervical, Transverse Cervical, Suprascapular Artery

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55
Q

Retropharyngeal Abscesses are often seen in young children, describe the aetiology

A

URTI causes adenitis in retropharyngeal nodes with then causes an abscess

Normally polymicrobial (S.Aureus, H.Parainfluenza)

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56
Q

How do Retropharyngeal Abscesses present?

A 
Severe sore throat
Dysphagia
Trismus
Stridor
Neck stiffness and head tilted back
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57
Q

Give three differentials for a Retropharyngeal Abscess

A

Angio-oedema
Epiglottitis
Foreign Body

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58
Q

Name four investigations for Retropharyngeal Abscess

A
  • Bloods (WCC and CRP very high)
  • Blood Cultures (often negative)
  • Pus Culture (after drainage)
  • Lateral Neck Xray (prevertebral soft tissue swelling and widening of retropharyngeal space)

If above is not diagnostic - CT with IV Contrast

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59
Q

What would a CT of Retropharyngeal Abscess show?

A

Hypodense lesion in retropharyngeal space with peripheral ring enhancement

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60
Q

How would you manage a Retropharyngeal Abscess?

A

?Surgical Airway
IV Fluids
Per Oral drainage under anaesthetic
IV Co-Amoxiclav

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61
Q

Name three complications of Retropharyngeal Abscesses

A

Airway Obstruction
Mediastinitis
Pericarditis

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62
Q

Parapharyngeal Abscesses are the second most common (after Peritonsillar). Where is the Parapharyngeal Space?

A

Lateral to superior pharyngeal constrictor and medial to pterygoids

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63
Q

How does a Parapharyngeal Abscess present?

A

Fever
Sore Throat
Neck Swelling

Anterior - Lock jaw and hard mass along mandible
Posterior - minimal lock jaw but can involve carotid sheath (rigors, high fever, carotid rupture)

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64
Q

How are Parapharyngeal Abscesses investigated?

A

CT

FNE

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65
Q

How are Parapharyngeal Abscesses managed?

A 
IV Co-Amoxiclav
Surgical Drainage (usually through submaxillary fossa)

This may have to be repeated if reaccumulations

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66
Q

What is Ludwig’s Angina?

A

Bilateral aggressive cellulitis involving the sub mandibular space. Rapidly spreading and normally without abscess formation

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67
Q

What is the cause of Ludwig’s Angina?

A

Usually dental infections
Oral Ulcerations
Malignancy
Penetrating Injuries

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68
Q

How does Ludwig’s Angina present?

A 
Swelling on the floor of mouth
Painful mouth
Protruding tongue
Airway compromise
Drooling
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69
Q

How is Ludwig’s Angina investigated?

A

CT Neck
Orthopanomogram (wide view XRay of lower face)
Culture

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70
Q

How is Ludwig’s Angina managed?

A

Airway management (upright with O2 supplementation - unless surgery where nasal intubation is required)

IV Benzylpenicillin and IV Metronidazole

Surgical debridement if failing to respond to abx within 24h or if severe

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71
Q

Name three investigations for Hoarse Voice

A

Flexible Nasal Endoscopy

Microlaryngobronchoscopy (similar to FNE but under GA)

Stroboscopy (synchronised flashing lights makes vocal cord movement appear slower)

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72
Q

Name 5 benign causes of Hoarse Voice

A 
Vocal Cord Nodules
Muscle Tension Dysphonia
Vocal Cord Polyps
Larygneal Papilloma
Reinke's Oedema
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73
Q

What are Vocal Cord Nodules?

A

Commonly secondary to Phonotrauma
Frequently bilateral
Breathy and Husky with low pitch

Managed by SALT team, rarely requires microlaryngoscopic surgery

74
Q

What is Muscle Tension Dysphonia?

A

Often caused by stress/anxiety
Hoarse voice towards EOD or after extended use
Confirmed by Stroboscopy
Managed by SALT

75
Q

What are Vocal Cord Polyps?

A

Caused by acute injury/GORD/smoke inhalation

Typically benign but unilateral so requires excision to rule out malignancy

76
Q

What is a Laryngeal Papilloma?

A

Benign lesion of the larynx, commonly caused by HPV6 and HPV11
Confirmed by histology
Requires excision as they can cause airway obstruction

77
Q

What is Reinke’s Oedema?

A

Oedema of vocal cords strongly linked to female smokers

Managed by smoking cessation and voice therapy

78
Q

Name two infective causes of Hoarse Voice

A

Larygnitis

Epiglottitis

79
Q

What is Laryngitis?

A
  • Inflammation of the vocal cords, normally following ——–Respiratory Tract Infection
  • May be associated with pain
  • Normal clinical assessment
  • FNE - inflamed larynx with dilated vessels
  • Self limiting
80
Q

Name a neurological cause of Hoarse Voice

A

RLN palsy (stroke, MS, Thyroidectomy, malignancy)

81
Q

Name three malignant causes of Hoarse Voice

A

Laryngeal Ca
Lung Ca
Thyroid Ca

82
Q

What is Stridor?

A

Noise made by forced air through a narrow upper airway

Narrowing occurs below Supraglottis (Stertor) but above Bronchioles (wheeze)

83
Q

What is the Bernculli Principle?

A

As airway begins to narrow, velocity increases and linear pressure exerted decreases, causing airway collapse

84
Q

How can the characteristics of the Stridor help to determine the location?

A

Inspiratory - Laryngeal
Expiratory - Tracheobronchial
Biphasic - Subglottic or Glottic

85
Q

Name three red flags associated with Stridor (other than Stridor itself)

A

Quiet
Trismus
Drooling

86
Q

Management should be initiated before definitive cause is found. Name three possible investigations

A

FNE
Bronchoscopy
CT

87
Q

Describe Acute Stridor management

A

1) Stabilise, Start O2, Contact specialists
2) Suction any secretions
3) Adrenaline or Steroids as necessary
4) Take bloods

88
Q

Give four acute causes of Stridor

A

FB Inhalation
Epiglottitis
Croup
Anaphylaxis

89
Q

State four chronic causes of Stridor

A

Laryngomalacia
Subglottic Stenosis
Vocal Cord Paralysis
Subglottic Haemangioma

90
Q

What is Laryngomalacia?

A

Congenital abnormality where larynx collapses in breathing

Types: 1) Tight Aryepiglottic Folds

        2) Redundant soft tissue in Supraglottis
        3) NMD/GORD

Normally self resolves

91
Q

What is Subglottic Stenosis?

A

Can be congenital, idiopathic, or acquired (eg post intubation)
Graded using Cotton Myer classification

Managed with daily prednisolone

92
Q

What is a Subglottic Haemangioma?

A

Most common head and neck tumour in children

Nasal breathing but normal cry

Diagnosed with microlaryngoscopy/bronchoscopy

Treated with Steroids/Propanolol/Excision

93
Q

Give three causes of Acute Throat Pain

A

Pharyngitis
Tonsillitis
Peritonsillar Abscess

94
Q

Give three causes of Chronic Throat Pain

A

Pharyngitis (Tobacco, Alcohol)
Gastric Reflux
Vitamin Deficiency (D,B12, Folate)

95
Q

Peritonsillar Abscesses are a complication of Tonsillitis. Describe the pathophysiology

A

Usually starts with acute follicular tonsillitis, then peritonsillitis
Pus then becomes trapped between tonsillar capsule and lateral pharyngeal wall
Normally S.Pyogenes/S.Aureus/H.Influenza

96
Q

How do Peritonsillar Abscesses present?

A 
Severe throat pain which may become unilateral
Fever
Drooling
Foul Breath
Hot Potato voice 
Trismus
97
Q

Peritonsillar Abscesses should be treated as a clinical diagnosis and referred to ENT that day. Describe the management

A

Fluids and Analgesia

Initial IV Benzylpenicillin and Metronidazole, before switching the Oral Pen V and Metronidazole

Needle aspiration and incision drainage

98
Q

Name three risk factors for Oral Candidiasis

A

Broad Spectrum Antibiotics
Immunocompromised
Steroid Inhalers

99
Q

Name three types of Oral Candidiasis

A

Oral Thrush (curd like white patches that can be rubbed off)
Erythematous (Marked erythema and soreness after oral abx)
Median Rhomboid

100
Q

How is Oral Candidiasis managed?

A

Children - Muconazole gel
Immunocompetent - Muconazole gel or Nystatin
Immunosupressive - Fluconazole

101
Q

Name four red flags associated with Neck Lumps

A

Hard and Fixed
Epistaxis
Constitutional Symptoms
Cranial Nerve Palsy

102
Q

Name two infective causes of Neck Lumps

A

Reactive Lymphadenopathy

Sialadenitis

103
Q

Name two Neoplastic causes of Neck Lumps

A

Lymphoma

H and N Cancer

104
Q

Name two Inflammatory causes of Neck Lumps

A

Sarcoidosis

Thyroid Nodule

105
Q

Name two congenital causes of Neck Lumps

A

Cystic Hygroma

Branchial Cyst

106
Q

Name a vascular cause of Neck Lumps

A

Carotid Body Tumour

107
Q

How are neck lumps investigated?

A

USS +/- FNA
Excisional Biopsy if Lymphoma
CT/MRI

108
Q

What is a Cystic Hygroma?

A

Benign fluid filled sac caused by malformation of the lymphatic system
Can be anywhere but classically posterior triangle

109
Q

How does a Cystic Hygroma present?

A

Soft painless fluctuant mass that transilluminates

Can grow large enough to cause airway compression/dyphagia

Can be associated with clinical syndromes (eg Turners)

110
Q

How are Cystic Hygromas managed?

A

Only required if symptomatic

Surgical excision or Lymphatic Sclerotherapy

111
Q

Carotid Body tumours are neuroendocrine tumours arising from Paraganglion cells. How do they present?

A

Pulsatile Painless Neck Lump

Typically can move side to side but not up and down

112
Q

How are Carotid Body Tumours managed?

A

Can be managed conservatively with active monitoring via serial imaging
May require surgical excision
Radiotherapy for unresectable tumours

113
Q

What is a Thyroglossal Cyst?

A

Congenital fluid filled sac due to remnant of Thyroglossal Duct
Painless midline cyst that moves up and down on tongue protrusion

114
Q

How are Thyroglossal Cysts managed?

A

Surgical intervention with Sistrunk Procedure

Central body of Hyoid is removed to allow complete removal of tract

115
Q

What are Branchial Cysts?

A

Congenital masses arising in the lateral aspect of the neck due to incomplete obliteration of branchial clefts (typically anterior to SCM)
If large can compress

116
Q

How are Branchial Cysts managed?

A

FNA to exclude cystic metastases of SCC

Surgical Excision +/- Sclerotherapy

117
Q

How does Oral Cavity SCC present?

A

Painless mass
Bleeding
May have preceding Leukoplakia/Erythroplakia

118
Q

How does Pharyngeal Cavity SCC present?

A

Odynophagia
Dysphagia
Stertor

Often metastasise early due to extensive lymphatics

119
Q

How does Nasopharyngeal SCC present?

A

Trotter’s Triad

Unilateral conductive deafness
Trigeminal Neuralgia
Defective Soft Palate Motility

120
Q

How does Laryngeal SCC present?

A

Hoarse voice
Dysphagia
Persistent Cough

Glottis has could prognosis due to poor lymphatic drainage

121
Q

How are Head and Neck SCCs investigated?

A

Examination under anaesthesia (+laryngopharyngooesophagoscopy)
Biopsy
CT
FNA Neck metastases

122
Q

How is SCC of the Oral Cavity managed?

A

Small - Wide local excision +/- Neck dissection

Large- Resection, Neck Dissection, Flap Reconstruction, Radio/Chemo

123
Q

How is SCC of the Oropharynx managed?

A

Small Tonsil - Resection
Large Tonsil - Solely chemoradio
Small Tongue Base - Resection
Large Tongue base - Chemoradio

124
Q

Name 5 subtypes of Thyroid Cancer

A 
Papillary
Follicular
Medullary
Anaplastic 
Lymphoma
125
Q

Describe Papillary Thyroid Cancer

A

Commonest type, usually in 40-50y
Papillary and Colloid filled follicles

May have hx of irradiation to the neck

126
Q

Describe Follicular Thyroid Cancer

A

Second most common
Microscopic capsular invasion
Usually Haematogenous spread

127
Q

Describe Medullary Thyroid Cancer

A

Arise in Parafollicular (C) cells therefore cause a rise in Calcitonin
Associated with MEN2 Syndrome

128
Q

Describe Anaplastic Thyroid Cancer

A

Rare, Aggressive and normally in elderly

Poor Prognosis

129
Q

Describe Lymphoma Thyroid Cancer

A

Rare

Grow Rapidly with marked compressive and B symptoms

130
Q

Name four risk factors for Thyroid Cancer

A

Female
FH (MEN)
Childhood Radiation
Hashimotos

131
Q

Thyroid Cancer normally presents as palpable lump (S). Describe some red flags

A

Rapid growth and pain
Cough/Hoarse Voice
Lump Tethering

132
Q

Name three differentials for Thyroid Cancer

A

Benign Thyroid Adenoma
Toxic Multinodular Goitre
Thyroglossal Duct Cyst

133
Q

How is Thyroid Cancer investigated?

A

TFTs
Ultrasound Thyroid
FNA

134
Q

Describe the Ultrasound features of Thyroid Cancer

A

Microcalcification
Hypoechogenicity
Irregular Margin

Allocated a score U1-U5 (U3-U5 requiring FNA)

135
Q

Describe the FNA classification of Thyroid Cancer

A 
Thy1 - Inconclusive
Thy2 - Non Malignant
Thy3 - Follicular, excision and histology
Thy4 - Suspicious, Hemithyroidectomy
Thy5 - Malignant
136
Q

Describe the surgical management of Thyroid Cancer

A

Hemithyroidectomy
Total Thyroidectomy
Neck Dissection

137
Q

Describe the non surgical management of Thyroid Cancer

A

Radioiodine Theraoy (Papillary or Follicular)
External Beam Radiotherapy
Chemotherapy

138
Q

Name three complications of Thyroidectomy

A

Haematoma
RLN Damage
Hypocalcaemia

139
Q

Describe the anatomy of the Parotid Salivary Gland

A
  • Anterior to Pinna and Lateral to Mandibular Ramus
  • Split into deep and superficial lobes by the facial nerve
  • Opens into Stensons duct
  • 80% Salivary Gland Neoplasms are here
140
Q

Describe the anatomy of the Submandibular Salivary Gland

A

Inferior to body of mandible and superior to Digastric

Duct opens up into Wharton’s Duct (close to tongue frenulum)

Mixed mucous and serous secretions

141
Q

Describe the anatomy of the Sublingual Salivary Gland

A

Located on the floor of the mouth

Secretes into Rivinus Duct

142
Q

What is Sialoadenitis? Give five causes

A

Inflammation of the Salivary Gland (can be acute or chronic)

Infective (eg mumps), Stones, Malignancy, Autoimmune, Idiopathic

143
Q

What is Heerfordt’s Syndrome?

A

A form of Sarcoidosis

Parotid Enlargement, Anterior Uveitis, Facial Nerve Palsy

144
Q

How does Sialoadenitis present?

A

Painful swelling and tenderness of gland
Pyrexia
Lymphadenopathy
Purulent discharge from ducts

145
Q

How is Sialoadenitis investigated?

A
  • Routine bloods (inc ESR if autoimmune suspicious)
  • Blood/Pus swabs
  • FNA if suspecting malignancy
  • USS
146
Q

How is simple Sialoadenitis managed?

A
  • Initially conservative with hydration, analgesia and artificial saliva
  • Use Sialogogues
  • Abx if suspecting bacterial
147
Q

What are Sialogogues

A

Lemon Juice
Massage Gland

Promoting salivation

148
Q

How is a Sialoadenitis Abscess managed?

A

Incision and drainage

Abx

149
Q

What is Sialolithiasis?

A

Presence of calculi in the salivary glands or ducts

150
Q

Describe the pathophysiology of Sialolithiasis

A

Typically following stagnation of saliva, and is composed of calcium phosphate and hydroxyapatite (as saliva is calcium rich)

Usually in the Submandibular gland as it has a long duct and secretions are more mucoid

151
Q

Give three risk factors for Sialolithiasis

A

Medication
Dehydration
Smoking

152
Q

How does Sialolithiasis present?

A

May be asymptomatic

Intermittent facial swelling associated with eating (can be painful or painless)

Stones may feel palpable or glands may feel tender

153
Q

What three investigations could be done for Sialolithiasis?

A

USS - normally first line
XRay - as most stones are radio-opaque
Sialography - not routinely performed as invasive

154
Q

Sialolithiasis is initially managed conservatively. How could recurrent/persistent disease managed?

A
  • Sialoendoscopy and removal
  • Transoral surgical removal
  • Extracorporeal Shock Wave Lithotripsy
  • Gland removal
155
Q

Give two examples of benign salivary tumours

A 
Pleomorphic Adenoma (can undergo malignant change)
Warthin's Tumour
156
Q

Give four examples of malignant salivary tumours

A

Mucoepidermoid Carcinoma
Acinic Cell Carcinoma
Adenoid Cystic Carcinoma
SCC

157
Q

Give three risk factors for Salivary Gland Malignancy

A

Radiation
EBV
Smoking

158
Q

How can a Salivary Gland Malignancy present?

A

Slowly enlarging painless mass (maybe associated facial nerve palsy)

Large - airway obstruction, dysphagia

159
Q

How are Salivary Gland Malignancies investigated?

A

USS and FNA

CT Staging

160
Q

Describe the management of Salivary Gland Malignancies

A
  • Surgical Excision (may have to sacrifice facial nerve if parotid)
  • Selective neck dissection
  • Radiotherapy

DO NOT RESPOND WELL TO CHEMOTHERAPY

161
Q

Describe three early complications of Salivary Gland Malignancy management

A

Haematoma
Facial Nerve Injury
Marginal Mandibular/Hypoglossal/Lingual damage

162
Q

Describe three late complications of Salivary Gland Malignancy management

A

Frey’s Syndrome (Post parotidectomy - autonomic fibres reform inappropriately, causing inappropriate redness and sweating)

Salivary Fistula

163
Q

What is Sjogren’s Syndrome?

A

Autoimmune inflammatory disorder characterised by diminished lacrimal and salivary excretion (due to lymphocytic infiltration of glands)

164
Q

Describe the clinical features of Sjogren’s

A

MAD FRED

Myalgia, Arthralgia, Dry mouth, Fatigue, Raynauds, Enlarged Parotids, Dry Eyes

165
Q

How is Sjogren’s investigated?

A

Autoantibodies - Anti Ro

Schirmers tear volume (reduced)

Salivary gland biopsy (lymphocytic infiltration)

166
Q

How is Sjogren’s managed?

A

Avoid dry/smoky atmosphere
Hypermellose tears/artificial saliva

Beware of neonatal HB

167
Q

Define OSA

A

Obstructive Sleep Apnoea

Upper airway narrowing, provoked by sleep causing daytime sleepiness

168
Q

Describe some causes of OSA

A

Small Pharyngeal Size - Neck Fat, Large Tonsils, Craniofacial abnormalities

Excess narrowing - Obesity, NMD, Muscle relaxants

169
Q

How does OSA present?

A

Excessive snoring
Daytime sleepiness
Nocturia

170
Q

How is OSA investigated?

A

Epworth Sleepiness Scale
Overnight Oximetry
Sleep Study EEG

171
Q

Describe the management options for OSA

A

Conservative - lose weight

Surgical - Pharyngeal surgery to remove excess tissue from soft palate and pharynx, and removes tonsils

CPAP/BiPAP

172
Q

How can Post Tonsillectomy Bleeds present?

A

Can occur in surgery or secondary (after 24h)

Herald bleed (small and stops itself) signals an incoming larger haemorrhage so should be treated as an emergency

173
Q

Give 6 Structural Causes of Dysphagia

A 
FB
Benign Stricture (eg GORD)
Pharyngeal Pouch 
Scleroderma (CREST)
Plummer Vinson Syndrome
Tumour
174
Q

What is a Pharyngeal Pouch?

A
  • Inferior pharyngeal constrictor is split into two parts (thyropharyngeus and cricopharyngeus)
  • Normally in swallowing cricopharyngeus will relax when thyropharyngeus contracts (if not then high pressure and diverticulum forms)
  • Halitosis, Regurgitiation, Palpable lump

Req surgery

175
Q

What is Plummer Vinson Syndrome?

A

Long term iron deficiency leading to tissue growth

176
Q

Name 5 neuromuscular causes of Dysphagia

A 
Achalasia
Presbyoesophagus
Myasthenia Gravis
Bulbar Palsy 
ALS (Motor Neurone Disease)
177
Q

Describe the pathophysiology of Achalasia

A

Impaired peristalsis and increased lower oesophageal sphincter pressure (with inadequate relaxation on swallowing)

178
Q

Name three presenting features of Achalasia

A

Dysphagia
Retrosternal Chest Pain
Bolus Impaction

179
Q

How is Achalasia investigated? What would they show?

A

Barium Swallow (dilation of oesophagus behind heart - bird’s beak)

Oesophageal Manometry (abnormal peristalsis and high LOS pressure)

180
Q

How is Achalasia managed?

A

Heller Myotomy

Pneumatic Dilation

Year 4 Neuro and Special Senses (8 decks)

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