ORAL CAVITY AND PHARYNX

What are the possible

Acute or delayed hemorrhage

complications?

PERITONSILLAR ABSCESS

What is the clinical setting?

Inadequately treated recurrent acute or

chronic tonsillitis

What is the associated

Mixed aerobes and anaerobes (which

microbiology?

may be PCN resistant)

What is the site of formation?

Begins at the superior pole of the tonsil

What are the symptoms?

Severe throat pain, drooling dysphagia,

odynophagia, trismus, cervical adenopathy,

fever, chills, malaise

What is the classic

“Hot-potato voice”

description of voice?

What are the signs?

Bulging, erythematous, edematous

tonsillar pillar; swelling of uvula and

displacement to contralateral side

What is the treatment?

IV antibiotics and surgical evacuation

by incision and drainage; most experts

recommend tonsillectomy after

resolution of inflammatory changes

LUDWIG ANGINA

What is it?

Infection and inflammation of the floor of

the mouth (sublingual and submandibular)

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What is the prognosis?

Depends on stage and site:

Tongue: 20% to 70% survival

Floor of mouth: 30% to 80% survival

Most common cause of death in

successfully treated head and neck

cancer is development of a second

primary (occurs in 20%–40% of cases)

SALIVARY GLAND TUMORS

What is the most common

Mucoepidermoid carcinoma (10% of

malignant salivary tumor?

all salivary gland neoplasms) Think:

Mucoepidermoid Malignant

Most common parotid malignancy

Second most common submandibular

gland malignancy

What is the second most

Adenoid cystic carcinoma; most common

common malignant salivary

malignancy in submandibular and minor

tumor in adults?

salivary glands

LARYNX ANATOMY

Define the three parts.

1. Glottis: begins halfway between the

true and false cords (in the ventricle)

and extends inferiorly 1.0 cm below

the edge of the vocal folds

2. Supraglottis: extends from superior

glottis to superior border of hyoid and

tip of epiglottis

3. Subglottis: extends from lower border

of glottis to inferior edge of cricoid

cartilage

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Innervation?

Vagus nerve: superior laryngeal and

recurrent laryngeal nerves; superior

laryngeal supplies sensory to supraglottis

and motor to inferior constrictor and

cricothyroid muscle; recurrent laryngeal

supplies sensory to glottis and subglottis

and motor to all remaining intrinsic

laryngeal muscles

What is the differential

Epiglottitis, bacterial tracheitis, foreign

diagnosis?

body, diphtheria, retropharyngeal

abscess, peritonsillar abscess, asthma

How is the diagnosis made?

A-P neck x-ray shows classic “steeple sign,”

indicating subglottic narrowing; ABG

may show hypoxemia plus hypercapnia

What is the treatment?

Keep child calm (agitation only worsens

obstruction); cool mist; steroids; aerosolized

racemic EPI may be administered to

reduce edema/airway obstruction

What are the indications for

If airway obstruction is severe or child

intubation?

becomes exhausted

What is the usual course?

Resolves in 3 to 4 days

What type of secondary

Secondary bacterial infection

infection occurs?

(streptococcal, staphylococcal)

EPIGLOTTITIS

What is it?

Severe, rapidly progressive infection of

the epiglottis

What is the usual causative

Haemophilus influenzae type B

agent?

What age group is affected?

Children 2 to 5 years of age

What are the signs/

Sudden onset, high fever (40 C);

symptoms?

“hot-potato” voice; dysphagia

(S drooling); no cough; patient prefers

to sit upright, lean forward; patient

appears toxic and stridulous

How is the diagnosis made?

Can usually be made clinically and does

not involve direct observation of the

epiglottis (which may worsen obstruction

by causing laryngospasm)

What is the treatment?

Involves immediate airway support in the

O.R.: intubation or possibly tracheostomy,

medical treatment is comprised of steroids

and IV antibiotics against H. influenzae

What is the usual location?

Laryngeal surface of epiglottis

What area is often involved?

Pre-epiglottic space

Extension?

Tend to remain confined to supraglottic

region, though may extend to vallecula or

base of tongue

What is the associated type

High propensity for nodal metastasis

of metastasis?

What is the treatment?

Early stage XRT

Late stage laryngectomy

GLOTTIC LESIONS

What is the usual location?

Anterior part of true cords

Extension?

May invade thyroid cartilage, cross

midline to invade contralateral cord, or

invade paraglottic space

What is the associated type

Rare nodal metastasis

of metastasis?

What is the treatment?

Early stage XRT

Late stage laryngectomy

What comprises the workup?

Full head and neck examination, indirect

laryngoscopy, CT scan and MRI, FNA for

tissue diagnosis; biopsy contraindicated

because it may adversely affect survival if

malignant

What is the differential

Inflammatory: cervical lymphadenitis,

diagnosis?

cat-scratch disease, infectious

mononucleosis, infection in neck

spaces

Congenital: thyroglossal duct cyst (midline,

elevates with tongue protrusion),

branchial cleft cysts (lateral), dermoid

cysts (midline submental), hemangioma,

cystic hygroma

Neoplastic: primary or metastatic