Throat Flashcards
1
Q
Describe the borders of the anterior triangle
A
Midline
Mandible
SCM
Roof - Investing fascia
Floor - Visceral fascia
2
Q
Name the four subdivisions of the anterior triangle
A
Carotid Triangle
Submental triangle
Submandibular triangle
Muscular triangle
3
Q
What are the borders of the Carotid Triangle?
A
Medial border of SCM
Posterior belly of Diagastric
Superior border of Omohyoid
4
Q
What are the contents of the Carotid Triangle?
A
Common Carotid (bifurcates within at C4)
IJV
Hypoglossal and Vagus
Baroreceptors
5
Q
What is contained within the Submental triangle?
A
Submental lymph nodes
6
Q
What is contained within the Submandibular triangle?
A
Submandibular salivary glands
Lymph nodes
Facial Artery and Veins
7
Q
What is contained within the Muscular Triangle?
A
Infrahyoids
Pharynx
Thyroid
Parathyroid
8
Q
Name the four Suprahyoid muscles
A
Stylohyoid
Digastric
Myelohyoid
Geniohyoid
9
Q
Name the four infrahyoid muscles
A
Omohyoid
Sternohyoid
Thyrohyoid
Sternothyroid
10
Q
What are the borders of the Posterior Triangle?
A
Posterior SCM
Anterior Trapezius
Clavicle
Roof - investing fascia
Floor - prevertebral fascia
11
Q
Name three muscles in the Posterior Triangle
A
Omohyoid
Levator Scapulae
Scalenes
12
Q
Name three vessels in the Posterior Triangle
A
EJV Superficially
Transverse Cervical
Suprascapular
13
Q
Name the nerves in the Posterior Triangle
A
Accessory nerve
Cervical plexus
Trunks of Brachioplexus
14
Q
Name three distinguishing features of the cervical spine
A
- Triangular Vertebral Foramen
- Bifid Spinous Process
- Transverse Foramina
(spinal nerves exit above level)
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
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
17
Q
Name 6 ligaments of the Cervical Spine
A
Anterior Longitudinal Posterior Longitudinal Ligamentum Flavum Interspinous Nuchal ligament Transverse ligament of atlas
18
Q
The Hyoid bone doesn’t articulate with any bones. Describe its anatomy
A
Greater Horn
Lesser Horn
Body
19
Q
How is the Hyoid Bone damaged?
A
Strangulation
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
21
Q
Name the three Deep Cervical Fascial Layers
A
Investing
Pre Tracheal
Pre Vertebral
22
Q
Describe the investing layer of Deep Cervical Fascia
A
Most superficial, surrounding all structures in the neck
Splits around trapezius and SCM
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
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
25
What is the Pharynx?
Muscular tube connecting oronasal cavity to larynx and oesophagus
Begins at base of skull and descends to C6
Split into Nasopharynx, Oropharynx and Laryngopharynx
26
Describe the structure of the Nasopharynx
- Base of skull to the soft palate
- Lined with ciliated pseudostratified columnar epithelium with goblet cells
- Contains Adenoids
27
Describe the structure of the Oropharynx
From soft palate to superior border of epiglottis
Contains posterior 1/3 tongue, lingual tonsils, palantine tonsils and superior constrictor muscles
28
Describe the structure of the Laryngopharynx
Between superior border of epiglottis and inferior border of cricoid
Contains Piriform Fossae and Middle/Inferior constrictors
29
The muscles of the Pharynx include Circular and Longitudinal. Describe the circular muscles
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
30
The muscles of the Pharynx include Circular and Longitudinal. Describe the longitudinal muscles
Stylopharyngeus, Palatopharyngeus, Salpingopharyngeus
Shorten and widen pharynx, and elevate larynx in swallowing
All Vagus innervation (except Stylopharyngeus - CNIX)
31
Describe the blood supply to the Pharynx
Branches of the ECA
32
Name the four roles of the Larynx
Phonation, Ventilation, Coughing, Protection of LRT
33
Describe the anatomy of the Larynx
Spans C3-C6
Covered anteriorly by infrahyoids
Anterior to Oesophagus
3 Subsections (Supra, Glottis, Infra)
34
Describe the blood supply to the Larynx
```
Superior Laryngeal (Branch of Superior Thyroid)
Inferior Laryngeal (Branch of Inferior Thyroid)
```
35
Describe the innervation of the Larynx
RLN - Sensory to Infraglottis and Motor to all except Cricothyroid
Superior Laryngeal - Sensory to Supraglottis and Motor to Cricothyroid
36
Name the three unpaired cartilages of the Larynx
Thyroid Cartilage (Laryngeal Prominence)
Cricoid (complete ring)
Epiglottis
37
Why is the fact that the Cricoid is a complete ring relevant?
Pressure can be applied to occlude the oesophagus and prevent regurgitation of contents during Emergency Intubation
38
Name the three paired cartilages of the Larynx
Arytenoid
Corniculate
Cuneiform
39
There are extrinsic and intrinsic Laryngeal ligaments. Name the two main intrinsic ligaments
Cricothyroid (upper margin is free edge - vocal ligament)
Quadrangular (lower margin is thickened to become vestibular)
40
Describe the histology of vocal cords
Stratified Squamous Epithelium
Reinke's Space (Watery GAG layer vibrates to make sound)
Vocal Ligament
Vocal Muscle
Relatively avascular
41
What is the Vestibular Ligament?
AKA False Vocal Cord
Lies above true vocal cord
42
What is the role of the extrinsic laryngeal muscles?
Suprahyoids - laryngeal elevation
| Infrahyoids - laryngeal depression
43
What do the intrinsic muscles of the larynx do (except Cricothyroid)?
Control Rima Glottidis, and length/tension of vocal cords
Innervated by inferior laryngeal nerve (from RLN)
44
What does the Cricothyroid Muscle do?
Stretches and tenses vocal ligament
Innervated by External Branch of Superior Laryngeal
45
Why is the Posterior Cricoarytenoid Muscle so important?
It is the sole Abductor of the larynx/vocal cords, allowing breathing
46
Describe the anatomical relations of the Thyroid Gland
Anterior - Infrahyoids
Lateral - Carotid Sheath
Medially - larynx/pharynx/RLN/External branch
47
Describe the blood supply of the Thyroid Gland
- Superior Thyroid (first branch of ECA)
- Inferior Thyroid (From thyrocervical trunk - branch of subclavian)
- 10% have additional Thyroid IMA artery from Braciocephalic trunk
48
Describe the venous drainage of the Thyroid Gland
Superior Middle and Inferior Thyroid Veins form a plexus
Superior and Middle drain into IJV and Inferior drains into braciocephalic
49
Describe the lymphatic drainage of the Thyroid Gland
Paratracheal
| Deep cervical
50
What are the Parathyroid Glands?
Located on posterior aspect of thyroid gland (between 2 and 6 in number)
Superior from fourth pharyngeal arch
Inferior from third pharyngeal arch
51
What is the Cervical Plexus?
Anterior Rami of C1-C4
Clinically relevant for sensory nerve block at Erb's Point (middle of posterior SCM)
52
Name the four tonsils in Waldeyer's Ring
Lingual
Palantine
Tubal
Adenoid
53
Describe the pathway of the Carotid Arteries
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
54
Describe the anatomy of the Thyrocervical Trunk
Branch of the Subclavian Artery
Inferior Thyroid, Ascending Cervical, Transverse Cervical, Suprascapular Artery
55
Retropharyngeal Abscesses are often seen in young children, describe the aetiology
URTI causes adenitis in retropharyngeal nodes with then causes an abscess
Normally polymicrobial (S.Aureus, H.Parainfluenza)
56
How do Retropharyngeal Abscesses present?
```
Severe sore throat
Dysphagia
Trismus
Stridor
Neck stiffness and head tilted back
```
57
Give three differentials for a Retropharyngeal Abscess
Angio-oedema
Epiglottitis
Foreign Body
58
Name four investigations for Retropharyngeal Abscess
- 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
59
What would a CT of Retropharyngeal Abscess show?
Hypodense lesion in retropharyngeal space with peripheral ring enhancement
60
How would you manage a Retropharyngeal Abscess?
?Surgical Airway
IV Fluids
Per Oral drainage under anaesthetic
IV Co-Amoxiclav
61
Name three complications of Retropharyngeal Abscesses
Airway Obstruction
Mediastinitis
Pericarditis
62
Parapharyngeal Abscesses are the second most common (after Peritonsillar). Where is the Parapharyngeal Space?
Lateral to superior pharyngeal constrictor and medial to pterygoids
63
How does a Parapharyngeal Abscess present?
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)
64
How are Parapharyngeal Abscesses investigated?
CT
| FNE
65
How are Parapharyngeal Abscesses managed?
```
IV Co-Amoxiclav
Surgical Drainage (usually through submaxillary fossa)
```
This may have to be repeated if reaccumulations
66
What is Ludwig's Angina?
Bilateral aggressive cellulitis involving the sub mandibular space. Rapidly spreading and normally without abscess formation
67
What is the cause of Ludwig's Angina?
Usually dental infections
Oral Ulcerations
Malignancy
Penetrating Injuries
68
How does Ludwig's Angina present?
```
Swelling on the floor of mouth
Painful mouth
Protruding tongue
Airway compromise
Drooling
```
69
How is Ludwig's Angina investigated?
CT Neck
Orthopanomogram (wide view XRay of lower face)
Culture
70
How is Ludwig's Angina managed?
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
71
Name three investigations for Hoarse Voice
Flexible Nasal Endoscopy
Microlaryngobronchoscopy (similar to FNE but under GA)
Stroboscopy (synchronised flashing lights makes vocal cord movement appear slower)
72
Name 5 benign causes of Hoarse Voice
```
Vocal Cord Nodules
Muscle Tension Dysphonia
Vocal Cord Polyps
Larygneal Papilloma
Reinke's Oedema
```
73
What are Vocal Cord Nodules?
Commonly secondary to Phonotrauma
Frequently bilateral
Breathy and Husky with low pitch
Managed by SALT team, rarely requires microlaryngoscopic surgery
74
What is Muscle Tension Dysphonia?
Often caused by stress/anxiety
Hoarse voice towards EOD or after extended use
Confirmed by Stroboscopy
Managed by SALT
75
What are Vocal Cord Polyps?
Caused by acute injury/GORD/smoke inhalation
Typically benign but unilateral so requires excision to rule out malignancy
76
What is a Laryngeal Papilloma?
Benign lesion of the larynx, commonly caused by HPV6 and HPV11
Confirmed by histology
Requires excision as they can cause airway obstruction
77
What is Reinke's Oedema?
Oedema of vocal cords strongly linked to female smokers
Managed by smoking cessation and voice therapy
78
Name two infective causes of Hoarse Voice
Larygnitis
| Epiglottitis
79
What is Laryngitis?
- 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
Name a neurological cause of Hoarse Voice
RLN palsy (stroke, MS, Thyroidectomy, malignancy)
81
Name three malignant causes of Hoarse Voice
Laryngeal Ca
Lung Ca
Thyroid Ca
82
What is Stridor?
Noise made by forced air through a narrow upper airway
Narrowing occurs below Supraglottis (Stertor) but above Bronchioles (wheeze)
83
What is the Bernculli Principle?
As airway begins to narrow, velocity increases and linear pressure exerted decreases, causing airway collapse
84
How can the characteristics of the Stridor help to determine the location?
Inspiratory - Laryngeal
Expiratory - Tracheobronchial
Biphasic - Subglottic or Glottic
85
Name three red flags associated with Stridor (other than Stridor itself)
Quiet
Trismus
Drooling
86
Management should be initiated before definitive cause is found. Name three possible investigations
FNE
Bronchoscopy
CT
87
Describe Acute Stridor management
1) Stabilise, Start O2, Contact specialists
2) Suction any secretions
3) Adrenaline or Steroids as necessary
4) Take bloods
88
Give four acute causes of Stridor
FB Inhalation
Epiglottitis
Croup
Anaphylaxis
89
State four chronic causes of Stridor
Laryngomalacia
Subglottic Stenosis
Vocal Cord Paralysis
Subglottic Haemangioma
90
What is Laryngomalacia?
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
What is Subglottic Stenosis?
Can be congenital, idiopathic, or acquired (eg post intubation)
Graded using Cotton Myer classification
Managed with daily prednisolone
92
What is a Subglottic Haemangioma?
Most common head and neck tumour in children
Nasal breathing but normal cry
Diagnosed with microlaryngoscopy/bronchoscopy
Treated with Steroids/Propanolol/Excision
93
Give three causes of Acute Throat Pain
Pharyngitis
Tonsillitis
Peritonsillar Abscess
94
Give three causes of Chronic Throat Pain
Pharyngitis (Tobacco, Alcohol)
Gastric Reflux
Vitamin Deficiency (D,B12, Folate)
95
Peritonsillar Abscesses are a complication of Tonsillitis. Describe the pathophysiology
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
How do Peritonsillar Abscesses present?
```
Severe throat pain which may become unilateral
Fever
Drooling
Foul Breath
Hot Potato voice
Trismus
```
97
Peritonsillar Abscesses should be treated as a clinical diagnosis and referred to ENT that day. Describe the management
Fluids and Analgesia
Initial IV Benzylpenicillin and Metronidazole, before switching the Oral Pen V and Metronidazole
Needle aspiration and incision drainage
98
Name three risk factors for Oral Candidiasis
Broad Spectrum Antibiotics
Immunocompromised
Steroid Inhalers
99
Name three types of Oral Candidiasis
Oral Thrush (curd like white patches that can be rubbed off)
Erythematous (Marked erythema and soreness after oral abx)
Median Rhomboid
100
How is Oral Candidiasis managed?
Children - Muconazole gel
Immunocompetent - Muconazole gel or Nystatin
Immunosupressive - Fluconazole
101
Name four red flags associated with Neck Lumps
Hard and Fixed
Epistaxis
Constitutional Symptoms
Cranial Nerve Palsy
102
Name two infective causes of Neck Lumps
Reactive Lymphadenopathy
| Sialadenitis
103
Name two Neoplastic causes of Neck Lumps
Lymphoma
| H and N Cancer
104
Name two Inflammatory causes of Neck Lumps
Sarcoidosis
| Thyroid Nodule
105
Name two congenital causes of Neck Lumps
Cystic Hygroma
| Branchial Cyst
106
Name a vascular cause of Neck Lumps
Carotid Body Tumour
107
How are neck lumps investigated?
USS +/- FNA
Excisional Biopsy if Lymphoma
CT/MRI
108
What is a Cystic Hygroma?
Benign fluid filled sac caused by malformation of the lymphatic system
Can be anywhere but classically posterior triangle
109
How does a Cystic Hygroma present?
Soft painless fluctuant mass that transilluminates
Can grow large enough to cause airway compression/dyphagia
Can be associated with clinical syndromes (eg Turners)
110
How are Cystic Hygromas managed?
Only required if symptomatic
| Surgical excision or Lymphatic Sclerotherapy
111
Carotid Body tumours are neuroendocrine tumours arising from Paraganglion cells. How do they present?
Pulsatile Painless Neck Lump
| Typically can move side to side but not up and down
112
How are Carotid Body Tumours managed?
Can be managed conservatively with active monitoring via serial imaging
May require surgical excision
Radiotherapy for unresectable tumours
113
What is a Thyroglossal Cyst?
Congenital fluid filled sac due to remnant of Thyroglossal Duct
Painless midline cyst that moves up and down on tongue protrusion
114
How are Thyroglossal Cysts managed?
Surgical intervention with Sistrunk Procedure
Central body of Hyoid is removed to allow complete removal of tract
115
What are Branchial Cysts?
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
How are Branchial Cysts managed?
FNA to exclude cystic metastases of SCC
Surgical Excision +/- Sclerotherapy
117
How does Oral Cavity SCC present?
Painless mass
Bleeding
May have preceding Leukoplakia/Erythroplakia
118
How does Pharyngeal Cavity SCC present?
Odynophagia
Dysphagia
Stertor
Often metastasise early due to extensive lymphatics
119
How does Nasopharyngeal SCC present?
Trotter's Triad
Unilateral conductive deafness
Trigeminal Neuralgia
Defective Soft Palate Motility
120
How does Laryngeal SCC present?
Hoarse voice
Dysphagia
Persistent Cough
Glottis has could prognosis due to poor lymphatic drainage
121
How are Head and Neck SCCs investigated?
Examination under anaesthesia (+laryngopharyngooesophagoscopy)
Biopsy
CT
FNA Neck metastases
122
How is SCC of the Oral Cavity managed?
Small - Wide local excision +/- Neck dissection
Large- Resection, Neck Dissection, Flap Reconstruction, Radio/Chemo
123
How is SCC of the Oropharynx managed?
Small Tonsil - Resection
Large Tonsil - Solely chemoradio
Small Tongue Base - Resection
Large Tongue base - Chemoradio
124
Name 5 subtypes of Thyroid Cancer
```
Papillary
Follicular
Medullary
Anaplastic
Lymphoma
```
125
Describe Papillary Thyroid Cancer
Commonest type, usually in 40-50y
Papillary and Colloid filled follicles
May have hx of irradiation to the neck
126
Describe Follicular Thyroid Cancer
Second most common
Microscopic capsular invasion
Usually Haematogenous spread
127
Describe Medullary Thyroid Cancer
Arise in Parafollicular (C) cells therefore cause a rise in Calcitonin
Associated with MEN2 Syndrome
128
Describe Anaplastic Thyroid Cancer
Rare, Aggressive and normally in elderly
Poor Prognosis
129
Describe Lymphoma Thyroid Cancer
Rare
| Grow Rapidly with marked compressive and B symptoms
130
Name four risk factors for Thyroid Cancer
Female
FH (MEN)
Childhood Radiation
Hashimotos
131
Thyroid Cancer normally presents as palpable lump (S). Describe some red flags
Rapid growth and pain
Cough/Hoarse Voice
Lump Tethering
132
Name three differentials for Thyroid Cancer
Benign Thyroid Adenoma
Toxic Multinodular Goitre
Thyroglossal Duct Cyst
133
How is Thyroid Cancer investigated?
TFTs
Ultrasound Thyroid
FNA
134
Describe the Ultrasound features of Thyroid Cancer
Microcalcification
Hypoechogenicity
Irregular Margin
Allocated a score U1-U5 (U3-U5 requiring FNA)
135
Describe the FNA classification of Thyroid Cancer
```
Thy1 - Inconclusive
Thy2 - Non Malignant
Thy3 - Follicular, excision and histology
Thy4 - Suspicious, Hemithyroidectomy
Thy5 - Malignant
```
136
Describe the surgical management of Thyroid Cancer
Hemithyroidectomy
Total Thyroidectomy
Neck Dissection
137
Describe the non surgical management of Thyroid Cancer
Radioiodine Theraoy (Papillary or Follicular)
External Beam Radiotherapy
Chemotherapy
138
Name three complications of Thyroidectomy
Haematoma
RLN Damage
Hypocalcaemia
139
Describe the anatomy of the Parotid Salivary Gland
- 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
Describe the anatomy of the Submandibular Salivary Gland
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
Describe the anatomy of the Sublingual Salivary Gland
Located on the floor of the mouth
Secretes into Rivinus Duct
142
What is Sialoadenitis? Give five causes
Inflammation of the Salivary Gland (can be acute or chronic)
Infective (eg mumps), Stones, Malignancy, Autoimmune, Idiopathic
143
What is Heerfordt's Syndrome?
A form of Sarcoidosis
Parotid Enlargement, Anterior Uveitis, Facial Nerve Palsy
144
How does Sialoadenitis present?
Painful swelling and tenderness of gland
Pyrexia
Lymphadenopathy
Purulent discharge from ducts
145
How is Sialoadenitis investigated?
- Routine bloods (inc ESR if autoimmune suspicious)
- Blood/Pus swabs
- FNA if suspecting malignancy
- USS
146
How is simple Sialoadenitis managed?
- Initially conservative with hydration, analgesia and artificial saliva
- Use Sialogogues
- Abx if suspecting bacterial
147
What are Sialogogues
Lemon Juice
Massage Gland
Promoting salivation
148
How is a Sialoadenitis Abscess managed?
Incision and drainage
| Abx
149
What is Sialolithiasis?
Presence of calculi in the salivary glands or ducts
150
Describe the pathophysiology of Sialolithiasis
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
Give three risk factors for Sialolithiasis
Medication
Dehydration
Smoking
152
How does Sialolithiasis present?
May be asymptomatic
Intermittent facial swelling associated with eating (can be painful or painless)
Stones may feel palpable or glands may feel tender
153
What three investigations could be done for Sialolithiasis?
USS - normally first line
XRay - as most stones are radio-opaque
Sialography - not routinely performed as invasive
154
Sialolithiasis is initially managed conservatively. How could recurrent/persistent disease managed?
- Sialoendoscopy and removal
- Transoral surgical removal
- Extracorporeal Shock Wave Lithotripsy
- Gland removal
155
Give two examples of benign salivary tumours
```
Pleomorphic Adenoma (can undergo malignant change)
Warthin's Tumour
```
156
Give four examples of malignant salivary tumours
Mucoepidermoid Carcinoma
Acinic Cell Carcinoma
Adenoid Cystic Carcinoma
SCC
157
Give three risk factors for Salivary Gland Malignancy
Radiation
EBV
Smoking
158
How can a Salivary Gland Malignancy present?
Slowly enlarging painless mass (maybe associated facial nerve palsy)
Large - airway obstruction, dysphagia
159
How are Salivary Gland Malignancies investigated?
USS and FNA
CT Staging
160
Describe the management of Salivary Gland Malignancies
- Surgical Excision (may have to sacrifice facial nerve if parotid)
- Selective neck dissection
- Radiotherapy
DO NOT RESPOND WELL TO CHEMOTHERAPY
161
Describe three early complications of Salivary Gland Malignancy management
Haematoma
Facial Nerve Injury
Marginal Mandibular/Hypoglossal/Lingual damage
162
Describe three late complications of Salivary Gland Malignancy management
Frey's Syndrome (Post parotidectomy - autonomic fibres reform inappropriately, causing inappropriate redness and sweating)
Salivary Fistula
163
What is Sjogren's Syndrome?
Autoimmune inflammatory disorder characterised by diminished lacrimal and salivary excretion (due to lymphocytic infiltration of glands)
164
Describe the clinical features of Sjogren's
MAD FRED
Myalgia, Arthralgia, Dry mouth, Fatigue, Raynauds, Enlarged Parotids, Dry Eyes
165
How is Sjogren's investigated?
Autoantibodies - Anti Ro
Schirmers tear volume (reduced)
Salivary gland biopsy (lymphocytic infiltration)
166
How is Sjogren's managed?
Avoid dry/smoky atmosphere
Hypermellose tears/artificial saliva
Beware of neonatal HB
167
Define OSA
Obstructive Sleep Apnoea
Upper airway narrowing, provoked by sleep causing daytime sleepiness
168
Describe some causes of OSA
Small Pharyngeal Size - Neck Fat, Large Tonsils, Craniofacial abnormalities
Excess narrowing - Obesity, NMD, Muscle relaxants
169
How does OSA present?
Excessive snoring
Daytime sleepiness
Nocturia
170
How is OSA investigated?
Epworth Sleepiness Scale
Overnight Oximetry
Sleep Study EEG
171
Describe the management options for OSA
Conservative - lose weight
Surgical - Pharyngeal surgery to remove excess tissue from soft palate and pharynx, and removes tonsils
CPAP/BiPAP
172
How can Post Tonsillectomy Bleeds present?
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
Give 6 Structural Causes of Dysphagia
```
FB
Benign Stricture (eg GORD)
Pharyngeal Pouch
Scleroderma (CREST)
Plummer Vinson Syndrome
Tumour
```
174
What is a Pharyngeal Pouch?
- 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
What is Plummer Vinson Syndrome?
Long term iron deficiency leading to tissue growth
176
Name 5 structural causes of Dysphagia
```
Achalasia
Presbyoesophagus
Myasthenia Gravis
Bulbar Palsy
ALS (Motor Neurone Disease)
```
177
Describe the pathophysiology of Achalasia
Impaired peristalsis and increased lower oesophageal sphincter pressure (with inadequate relaxation on swallowing)
178
Name three presenting features of Achalasia
Dysphagia
Retrosternal Chest Pain
Bolus Impaction
179
How is Achalasia investigated? What would they show?
Barium Swallow (dilation of oesophagus behind heart - bird's beak)
Oesophageal Manometry (abnormal peristalsis and high LOS pressure)
180
How is Achalasia managed?
Heller Myotomy
| Pneumatic Dilation
