Throat 2 Flashcards
Hypopharyngeal cancer - definition:
Pathology?
Most likely area to arise?
Cancer of the piriform sinuses, posterior pharyngeal wall or post cricoid area
95% SCC
Piriform sinus most common area
Management of hypopharyngeal cancer
Investigations:
- CT head / neck / chest (staging)
- MRI primary in advanced disease
- +/- PET for distant mets
- EUA & Biopsy AFTER IMAGING so that post biopsy oedema doesnt result in overstaging of primary on imaging
MDT
Nutritional optimisation
NON SURGICAL:
* Palliation with best supportive care (+/- radiotherapy / chemotherapy / tracheostomy / gastrostomy)
* Chemotherapy for less fit patients
* Radiotherapy (in early disease)
SURGICAL:
Surgical resection (can be transoral in early disease)
+/- reconsruction (e.g. free Jej / ALT) + neck dissection +/- adjuvant radiotherapy
Vocal cord nodule - most common area for them to arise and why?
Junction between the proximal and middle 1/3 of the vocal cord
As this is the area where contact is most forceful
Vocal cord nodules - management
Conservative - voice rest and voice rehabilitation
Surgical excision
Reinke’s oedema - managment:
Conservative - avoid irritant> smoking, trate acid reflux
Surgical excision of oedematous mucosa
Post tonsillectomy bleed types:
Primary (reactive) haemorrhage <24 hours
Secondary
Management of post tonsillectomy bleed
A-E Approach and resuscitate accordingly
A
- Sit patient up, encouage spitting blood out into bowl
- Suction if required
B
C
- Ensure large bore IV access
- FBC / Coag / G&S / Crossmatch
- Fluids
- Analgesia
Medical management:
- IV TXA
Topical
- Hydrogen peroxide gargles (1%, so 3% diluted with 3 parts water)
- Silver nitrate cautery
- Ice pack to back of neck
- Pressure with adrenaline soaked gauze or dental roll 1:10,000 if severe and awaiting theatre
Management:
- NBM
- Contact anaesthetics / ENT senior / theatre co-ordinater
Theatre for arrest of post tonsillectomy haemorrhage
