Head and neck

Head and neck

1. head and neck cancer

   • oral
   • nasopharynx
   • oropharynx
   • hypopharynx
   • larynx
   • trachea
   • signs/symps
     • mass in neck, neck pain, bleeding from mouth, bad greath, sinus congestion, sore tong, sores in mouth that don't heal, white/red/dark patches in mouth that will not go away, earache, unusual bleeding or numbness in mouth, lump in lip/mouth/gums, enlarged lymph glands in neck, slurring of speech, hoarse voice 6+w, sore throat 6+w, difficulty swallowing food, change in diet or weight loss
     • enlarged LN, sore throat, hoarse voice, lump or sore in throat/neck that doesn't go away, dysphagia, dysarthria, peristent earache, numb/paral of facial muscs
   • causes
     • alcohol + tobacco, diet (processed + red meat), betel nut
     • infection: HPV, EBV
     • GORD
     • Hematoopoietic stem cell transplantation
   • investig
     • needle biopsy -> histopathology
   • treat
     • surgery
     • radiation therapy
   • 50% present late

2. cataract

   • opacity in the lens
     • exam
       • red reflex- if immature, still occurs, if dense cataract, no red reflex
     • presentation
       • blurred vision
         • if unilateral, often unnoticed (but loss of steropsis affects distance judgement)
         • bilateral cuase gradual loss of vision (freq glasses changes) +/- dazzle, +/- monocular diplopia
     • treatment
       • surgery: if troubling, lifestyle restricted, or unable to read while driving
         • complics: capsule thickening i%, easily treated by capsulotomy   astigmatism, eye irritiaon, anterior uveitis
         • ideally day case, local anesthetic, small incision surg + phacoemulision + intraocular lens implant
   • major cause of blindness
   • found in 75% of 65+s, but only 20% of 45-65s

3. giant cell arteritis

   • see neurology

4. sinusitis

   • symps/signs
     • dull, constant, aching pain over frontal or maxillary sinus, with tender overlying skin +/- postnasal drip. pain worse on bending over.
     • ethmoid or sphenoid sinus pain: deep in midline at root of nose. common w/coryza.
     • pain lasts 1-2w
   • investig
     • CT can confirm diagnosis but is rarely needed
     • investig not recommend unless complications or chronic 12+ w
   • cause
     • viral or bact infect, or allergy or autoimmune
       • upper rest tract infect, usually virus, is most common cause of acute (incl rhinoviruses, coronaviruses, influenzaviruises)
       • <10 days usually viral; >10 days oft bacterial
     • inflamm of lining of sinuses
   • complications
     • abxcesses, meningitis, preseptal or orbital cellulitis -> abscess
   • treatment
     • gernally conservative: warm moist cloth, sufficient fluids, inhaling steam
     • if bacterial- antibiotics (amoxicillin) if don't resolve w/in 10 days. if don't resolve after 1 seven day course- co amoxiclav
     • surgery: if chronic or recurrening

5. TMJ syndrome

   • pain and dysfunct of muslces of mastic and TMJoint
     • is a symptom complex rather than a single condit.&nbsp; is multifactorial
     • symps/signs
       • dull/ache, poorly localised, usually intermitent pain on palp of musc or joint, restricted mandib move, noises from TMJ during jaw movement
         • usually aggravated by manip or funct eg chewing, yawning. often worse on waking
         • more oft unilat than bilat
       • often benign and self limiting
     • treat
       • splint, Cog behave therapy, analgesia
     • perhaps due to anterior disc displacement of articular disc
     • precipating factors
       • trauma, occlusal changes, parafunction, stress, (genetic hormonal and anatomical factors also predispose) psychosocial disorders big risk factors
     • exam: palpate of joint and musc of mastic, auscult over j?
     • epidemiology
       • very common. more F than M. 20-30% of adult pop?. Btw 20-40y
       • 2nd most common cause orofacial pain (behind toothache)

6. neck swelling

   • lymph gland enlargement [any cause]
     • complications: may cause difficulty breathing, sepsis
     • causes
       • Infection
         • strep throat, measles, ear infections, dental abscess, mono/glandular fever EBV, cellulitis or other skin/wound infects, HIV
       • Autoimmune
         • lupus
         • RA
       • Malignancies
         • lymphoma
         • leukemia
         • 2ndry mets
       • drugs
         • phenytoin (anti-seizure med), malaria prophylaxis
     • symps: depend on cause
     • signs
       • size
         • insignif if <2cm (in axilla and inguinal <3cm, in supraclavic fossa >1cm is signif)
       • consistency
         • soft
           • insignif
         • rubbery
           • classically lymphoma
         • hard
           • classically malignancy + granulomatous infection
       • tender
         • classically infection
         • non-tender: classically malignancy
   • thyroid disorder
     • see endocrine
   • salivary gland enlargement
     • parotid, submandibular, sublingual
     • causes
       • acute lymphoblastic leukemia
       • mumps
       • HIV
       • myxoedema
       • bulimia
     • hx: lumps; swelling related to food; pain; taste; dry eyes
     • exam: note sexternal swelling; look for secretions; bimanual palp for stones. examine CN VII and regional lyph nodes
     • test
       • cytology
         • Fine needle aspiration
     • symps/signs
       • acute swelling
         • mumps
         • HIV
       • recurrent unilat pain and swelling (partic on eating)
         • stone
           • 80% submandibular
           • +see red, tender, swollen, but uninfected gland
           • investig: plain xray or sialography
           • can remove by mouth or excision of gland
       • chronic bilat symps
         • + dry eyes and mouth and autoimmune disase
           • (eg hypothyroidism, mikulicz's or sjogren's, also bulimia)
       • fixed swelling
         • tumor, acute lymphoblastic leukemia, sarcoid, amyloid, wegener's syndrome, idopathic
           • 80% are parotid tumors
             • deflection of ear outwards is classic sign
             • remove any salivary gland swelling for assess if present for >1mo
             • VII nerve palsy means malignancy