Summary
Summary ENT Revision Posters
- Module
- Medicine
- Institution
- The University Of Sheffield (TUOS)
Revision posters for ENT Diseases
[Show more]
1 review
By: physician786 • 6 year ago
Content preview
Deep swellings of anterior triangleSwellings which move on swallowing
Scalp Swellings: Scalp swellings: sebaceous cysts, lipomas, papillomas, squamous cell and basal cell • Thyroid gland swellings
carcinomas, melanoma. • Thyroglossal cyst
Cephalhaematoma: Cephalhaematoma: subperiosteal haematoma; occurs following birth trauma/ direct injury • Embryological remnant of thyroid; may present as fluct
in babies. Heamatoma occurs beneath periosteum; limited by suture lines; usually resolves spontaneously occur along line of thyroid descent; most commonly oc
Ivory Osteoma: Osteoma of outer table of skull = smooth hard swelling; skin moves over it freely. Confirmed by hyoid bone. S&S : usually painless, cystic swelling in mid
radiograph. Asymptomatic; should be left or excised if it enlarges. swallowing/tongue protrusion. Occasionally become in
Cock’s peculiar tumour: Supporting sebaceous cyst with granulation tissue. May be mistaken for squamous cell inc swelling. Rx: excision. Lymph node: occasionally atta
carcinoma swallowing
Swellings which DO NOT move on swallowing
Facial Swellings: Boils, sebaceous cysts, dermoid cysts, squamous cell carcinoma, basal cell carcinoma, • Salivary glands: inflammatory. Parotid gland included b
malignant melanoma neck under normal conditions. In pathological condition
largely in neck
• Acute sialadenitis: Most common in parotid gland; due
Neck Swellings mumps. Bilateral. Occasionally sialadenitis of both paro
Swellings in neck: Assessment and dg of neck swellings: hx, examination of site/ size/ nature of swelling be caused by poor oral hygiene, dehydration or duct ob
(soft/firm, mobile/fixed, transilluminates, presence of bruit); Fine needle bx indicated for non-pulsatile masses. bacterial sialadenitis is often unilateral. S&S: sudden on
If cytology not definitive, US core bx may be indicated if imaging suggests it. Definitive investigation for soft salivary gland. Worsens with eating. General malaise. E
tissue swelling = MRI. In general, if pt>45, assume metastatic malignant disease until proven otherwise. swelling in region of gland. Rx: viral parotitis – treat sym
Superficial Swellings bacterial sialadenitis is treated by Abx e.g. Dlucloxacillin
Superficial: Sebaceous cyst, lipoma, dermoid cyst, abscess parotitis investigated by sialography to exlude sialectas
• Superficial lumps: sebaceous cysts, lipomas, dermoids and infective lesions (boils and abscesses); common Chronic Sialadenitis: Usually due to calculus in duct or duct
site for lipomas = midline posteriorly at level of collar line of calcium or magnesium phosphate; usually opaque. S&S: P
Lymph Nodes when eating/drinking. Can reproduce swelling in clinic by ap
• Majority of neck swellings, especially in children, due to LN. LN of H&N arranged in two circles: stone becomes impacted, gland remains swollen. Infection a
• 1) Outer superficial circle: submental, submandibular, preauricular, occipital nodes Inspect duct orifice: in case of submandibular calculi, swellin
• 2) Inner circle: surrounds trachea and oesophagus; includes paratracheal and retropharyngeal nodes mouth. Feel along duct in floor of mouth, palpating bimanu
• Both superficial and deep groups drain into chain of deep cervical LN which surround the IJV. Lymph from may feel calculus. Investigations: plain radiograph, ‘floor of
here drains into: a) thoracic duct on left, b) lymphatic duct on right calculi; of no stone seen, arrange sialogram. Treatment: Sto
• Causes of cervical lymphadenopathy: by incising directly over stone into floor of mouth; stone ext
• Infection: local lesions on H&N, URTI, Tonsillitis, Glandular fever, Toxoplasmosis, TB, HIV, With duct stenosis, a ductoplasty (widening of duct orifice)
cat-scratch disease itself, total (submandibular) or partial (parotid) removal of g
• Malignancy: primary (lymphoma, lymphosarcoma, leukaemia); secondary (almost
anywhere in body, breast, lung, testis)
• Sarcoidosis
• Investigation of Cervical Lymphadenopathy: Clinical examination: Look for local lesions: scalp, face, neck, Obstruction: Obstructive Disease Sialolithiasis (Sa
mouth, tonsil. Full examination: chest, breast, abdomen, testes, lower limb. Check for axillary, inguinal Common in submandibular gland; uncommon in parotid. Ae
lymphadenopathy and hepatosplenomegaly. ductal debris, calcium phosphate coalesce, due to inflamma
• Investigations: Hb, FBC, ESR, Paul-Bunnell, Toxoplasma screen, viral antibodies, HIV; CXR: hilar nodes, S&S: Submandibular stones may be palpable in floor of mou
primary lung tumour. Laryngoscopy and examination of post-nasal space. FNAC. US guided core biopsy of enlargement and pain on eating, with return to normal as s
node. Excisional biopsy of node (if suspect lymphoma). MRI/CT of H&N to examine nodes and look for chronic enlargement and often infection.
possible primary lesion. Examine under anaesthetic by panendoscopy of nasopharynx, oropharynx, Treatment: Stones near orifice can be removed intraorally.
hypopharynx, larynx, trachea and upper bronchi, oesophagus and stomach. Biopsy of suspicious areas and Stones at tip of duct can be removed whereas if further bac
likely primary site (nasopharynx, tongue base, pyriform and tonsillar fossae) Ductal Stenosis
Deep Swellings Aetiology: Trauma, neoplasm or chronic inflammatory proce
Deep: Anterior Triangle - Move on swallowing: thyroid, thyroglossal cyst, LN. Do not move on swallowing: Neoplasm usually palpable. Treatment: dilatation or glandu
salivary glands, branchial cyst, carotid body tumour, carotid aneurysm, sternomastoid ‘tumour’ Cystic Disease
Posterior Triangle - Cervical rib, subclavian artery aneurysm, pharyngeal pouch, cystic hygroma Ranula (A sialocele of the Cloor of the mouth)
Obstruction of salivary gland with build up of saliva; often a
bluish – due to fluid in ranula itself. Benign condition
Types of Ranula
Salivary Gland Tumours • Circumscribed: obstruction and cystic dilatation of subl
Salivary gland tumours rare: 85% parotid gland; 8-15% submandibular gland; 5-8% sublingual gland • Plunging: extravasation of saliva into tissues of floor of
Majority of salivary tumors are benign and in parotid; usually pleomorphic adenomas. Minor salivary glands are floor of the mouth
submucosal around oral cavity. Generally, smaller gland, more likely neoplasm is malignant. S&S: cystic submucosal mass in floor of mouth; may periodi
Salivary Gland Swellings contents into mouth
Inflammatory and infective: Acute sialadenitis, eg. mumps, parotitis. Chronic sialadenitis Treatment: Circumscribed cyst may be excised, along with in
Neoplastic: Benign – adenolymphoma, pleomorphic adenoma; Malignant- adenocarcinoma ranulas cannot be excised; should be marsupialized.
AI: Mikulicz’s syndrome, Sjogren’s syndrome
Benign:
Pleomorphic Adenoma: 90% occur in parotid gland. ‘Mixed parotid tumour’: histological appearance of mixed Branchial Cyst
element: epithelial, fibrous, myxomatous, ‘pseudocartilaginous’ (pseudocartilaginous = mucus). Slow growing Branchial cyst = remnant of second branchial cyst; may be a
and may enlarge over many years. Tumour sends processes into surrounding parotid tissue: shelling out S&S: Appears in early adult life, usually with soft swelling; co
(enucleation) of these lesions may leave tumour behind with high recurrence rate. After many years (10-30y cyst; some may be firm. Occurs at level of junction of upper
slow growth), some pleomorphic adenomas develop into invasive malignant tumours. sternomastoid, appearing from under anterior border of SC
S&S: Early and middle adult life; painless swelling on side of face; slow growing. sinus, that opens over anterior border of SCM at junction of
O/E: non-tender, diffuse swelling in angle between mandible and mastoid process. May extend down into neck Sinus may extend up between internal and external carotid
and forward on to cheek overlying masseter. Test integrity of facial nerve. Dg: clinical history and examination. side-wall of the pharynx.
DD: Parotitis, sebaceous cyst, lipoma, preauricular lymph node, tumour of ramus of mandible. Differential diagnosis of branchial cyst = lymph node
Rx: Superficial parotidectomy- removal of gland superficial to CN7. Enucleation associated with high reccurence Dg can be confirmed by aspirating cyst, and examining the f
Complications (warn pt prior to consent, esp of facial nerve palsy): Facial nerve palsy either temporary or cholesterol crystals will be seen.
permanent; Salivary fistula – usually dries up spontaneously; Frey’s syndrome: facial flushing and sweating on Treatment: surgical excision of cyst, sinus or Cistula tract.
eating, occurs in areas supplied by auriculotemporal nerve
Benign: Adenolymphoma (Warthin’s tumour): Adenolymphoma = cystic tumour containing epithelial and Carotid Body Tumour
Carotid body tumour = chemodectoma; slow-growing tumo
lymphoid elements; benign. S&S: Middle and old age; M>F; Slow-growing, painless swelling over jaw angle; Soft
carotid bifurcation; usually benign but rarely becomes malig
and well defined. Rx: Surgical excision; If pt elderly and dg is certain, these can be left alone. Recurrence rare
‘potato’ tumour due to shape and consistency when cut.
Malignant tumour: usually affects parotid; may arise in longstanding pleomorphic adenoma. Mucoepidermoid
S&S: age 40-60 years; painless, slow-growing lump + transm
tumours are primary squamous cell tumours of parotid gland and are of variable grade.
with fainting attacks from pressure on carotid sinus.
Adenoid cystic carcinoma: Associated with early perineural spread and skip lesions; usually req adjuvant
Investigations: CT scan, angiography: shows tumour blush a
radiotherapy following removal of gland and nerve branch. Pt may have a long latency period before
of bifurcation. Treatment: surgical excision. Large tumours m
haematogenous lung, liver or bone metastasis become clinically evident. Rx: Radical parotidectomy with
sacrifice of facial nerve. Neck dissection may be req. Radiotherapy of limited value. Prognosis poor. Carotid Aneurysm
True carotid aneurysm is extremely rare. False aneurysm ma
Secondary squamous cell carcinoma/ melanoma of head and upper aerodigestive tract may present with a
trauma of neck Tortuous carotid artery appearing from und
lump in the parotid gland; treated with total parotidectomy and ipsilateral neck dissection
may give impression of aneurysm
Lymphomas: May arise in parotid gland; Surgery confined to incisional bx prior to oncological therapy.
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller siobhan01. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for £6.49. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
60904 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy revision notes and other study material for 14 years now