METASTASIS

1. CA of tongue: jugulodigastric
2. CA of buccal mucosa: submental and submandibular
3. CA of gingival and hard palate: mandibular and
subdigastric
4. CA of lips: submental and submandibular
5. CA of floor of mouth: mandibular and subdigastric

1. epsteins pearl or bohns nodules: GINGIVAL CYST
2. rodent ulcer: BCC
3. large vessel type of hemangioma: cavernous hemangiomas
4. immature forms of capillary hemangioma: hypertrophic
hemangioma
5. with spindle-shaped cells surrounding capillaries:
hemangiopericytoma
6. bryces sign: laryngocoele
7. cold abscess: lymphadenitis
8. horner syndrome: laryngocoele
9. location of kochs nodule: posterior triangle

1. chorda tympani: CN VII
2. tensor tympani: CN V
3. tympanic plexus: CN IX
4. stapedius: CN VII

1. hypotympanium: floor
2. opening to tympanic membrane: medial wall
3. Eustachian tube opening: anterior wall
4. canal for tensor tympani muscle: anterior wall
5. epitympanium: roof
6. ossicles: medial wall
7. lateral semicircular
8. aditus: posterior wall

1. ampulla: crista ampullaris
2. macula: otoliths
3. organ of corti: hair cells for shearing

1. hot potato voice: PERITONSILLAR ABSCESS
2. chronic mouth breathing, snoring, hyponasal speech:
ADENOIDS
3. mesopharynx: OROPHARYNX
4. epipharynx: NASOPHARYNX
5. psueudomembrane: DIPHTHERIA
6. trench mouth: VINCENTs / PLAUTS ANGINA

1. below cricopharyngeus posteriorly where the longitudinal
esophageal fibers separate: LAIMER-HACKERMANN AREA
2. below lowest fibers of the cricopharyngeus and upper
circular fiber of the esophagus on lateral aspect :KILLIAN-
JAMIESON AREA
3. between alar and prevertebral sheaths: SPACE OF 4 or
DEGREE SPACE
4. space between the base of the skull and the superior
constrictor thru w/c the Eustachian tube passes: SINUS OF
MORGAGNI

1.
2.
3.

butterfly rash: LUPUS ERYTHEMATOSUS

encephalocoele: NASAL GLIOMA
failure of nasobuccal membrane to canalize: CHOANAL
ATRESIA
4. sebaceous gland hypertrophy: RHINOPHYMA
5. apple jelly nodules: LUPUS VULGARIS
6. pre-malignant lesion: SENILE KERATOSIS
7. excoriation and infection of vestivule: VESTIBULITIS
8. MC acute infection: FURUNCULOSIS
9. acute inflammation of skin and subcutaneous tissue:
ERYSIPELAS
10. esicupusular formation w/ yellow crust: IMPETIGO

1.
2.
3.
4.
5.
6.
7.
8.
9.

chemical-respiratory sensitizers: OCCUPATIONAL RHINITIS

greenish nasal secretion and crust: ATROPHIC RHINITIS
hallmark of inflammation: NASAL POLYPS
non-allergic rhinitis: IDIOPATHIC RHINITIS
CN II-VI: ORBITAL APEX SYNDROME
common cold: AINFECTIOUS RHINITIS
IgE-mediated inflammation: ALLERGIC RHINITIS
potts puffy tumor: OSTEOMYELITIS
pregnancy rhinitis: HORMONAL RHINITIS

1.
2.
3.
4.
5.

sphenopalatine vessels: POSTEROINFERIOR BLEEDING

jarjavay type: SEPTAL DEVIATION (LATERAL)
chevallet fracture: CLASS 1 FRACTURE
foster-kennedy syndrome: FRONTAL LOBE TUMOR
pig-nose appearance: CLASS 3 FRACTURE

FLAPS VS GRAFTS
1. can bridge defect: FLAPS
2. requires pressure dressing: FLAPS
3. more likely to contract: GRAFTS
4. depends on recipient site for nutrition: GRAFTS
5. less adaptable to weight bearing: GRAFTS

1. proptosis and lateral rectus palsy: PTERYGOID / TEMPORAL
SPACE INFECTION
2. torticollis: CAROTID SPINE ABSCESS
3. horners syndrome: CAROTID SPINE ABSCESS
4. hot potato voice: RETROPHARYNGEAL SPACE ABSCESS
5. respiratory distress: PARAPHARYNGEAL SPACE INFECTION
6. osteomyelitits: MASSETER SPACE INFECTION

1. fissures of santorini: DEFICIENCY IN CARTILAGENOUS EAC
2. foramen of huschke: DEFICIENCY IN BONY EAC
3. pars flaccida: SHRAPNELLS MEMBRANE
4. notch of rivinus: AREA DEFICIENT OF ANNULUS FIBROSUS
5. otitis externa circumscripta: STAPHYLOCOCCUS
6. diffuse otitis externa: PSEUDOMONAS
7. epistaxis: KIESSELBACHS PLEXUS
8. tripod fracture: ZYGOMA
9. blow out fracture of orbit: FORCED DUCTION TEST
10. temporal bone fracture: BATTLES SIGN

1.
2.
3.
4.
5.
6.

bactidol: HEXITIDINE
docusate: OTOSOL
nystatin, gramicidin: POSTOTOC, APLOSYN OTIC
lidocaine, benzoxonium: OROFAR-L
antipyrine: AURALGAN OTIC
neomycin, polymyxin: KENACOMB OTIC

1.
2.
3.
4.
5.

syphilis: PENICILLIN
ludwigs angina: INCISION AND DRAINAGE
salpingitis: PENICILLIN
herpes: ACYCLOVIR
candida: NYSTATIN

1.
2.
3.
4.

aerotitis media: BAROTRAUMA

apical petrositis: GRADENIGO SYNDROME
lateral sinus thrombophlebitis: PICKET FENCE SYNDROME
otitic hydrocephalus: QUECKENSTEDT

11.
12.
13.
14.
15.
16.
17.
18.

RHINITIS
1. IgE mediated : ALLERGIC RHINITIS
2. tuberculosis: CHRONIC RHINITIS
3. prolonged use of decongestant: RHINITIS
MEDICAMENTOSA
4. pregnancy-related: NOTA
5. with dryness: ATROPHIC RHINITIS
6. emotional stress: VASOMOTOR RHINITIS
7. infectious/inflammation: ACUTE RHINITIS

1. unilateral hearing loss: NOTA
2. bilateral hearing loss: NOTA
3. benign paroxysmal positional vertigo: CULPOLITHIASIS
4. menieres dse: TINNITUS

1. staphylococcus: CLOXACILLIN
2. streptococcus: AMOXICILLIN
3. herpes ACYCLOVIR
4. candida: NYSTATIN
5. psueomonas: OFLOXACIN

GRADENIGO VS MENIERE
1. diplopia: GRADENIGO
2. hearing loss: MENIERE
3. ear fullness: MENIERE
4. dizziness: MENIERE
5. tinnitus: MENIERE
6. ear discharge: GRADENIGO

1. frontal sinus MIDDLE MEATUS
2. anterior ethmoid sinus MIDDLE MEATUS
3. posterior ethmoid sinus SUPERIOR MEATUS
4. sphenoid sinus SPHENOETHMOIDAL RECESS
5. mastoid ADITUS AD ANTRUM
6. maxillary sinus MIDDLE MEATUS
7. cavernous sins OPHTHALMIC VEIN
8. middle meningeal sinus FORAMEN SPINOSUM
9. highmore of antrum AD IC ANTRUM
10. middle ear EUSTACHIAN TUBE

nasolacrimal duct INFERIOR MEATUS

tensor tympani - ROOF
bony ear canal EXTERNAL CAROTID
jugular vein - FLOOR
CN VII - AICA
Eustachian tube: MIDDLE EAR
lacrimal gland: INFERIOR MEATUS
ethmoid hair cells

1.

Sheehan syndrome: ISCHEMIC NECROSIS OF THE

ANTERIOR PITUITARY
2. cavernous sinus syndrome: MC CAUSE IS ETHMOIDITIS
3. charcots triad: NYSTAGMUS, SCANNING SPEECH AND
INTENTION TREMOR SEEN IN MULTIPLE SCLEROSIS
4. digeorge syndrome: THYMUS AGENESIS
5. freys syndrome: AURICULOTEMPORAL NERVE SENDS ITS
PARASYMPATHETIC FIBERS TO INNERVATE THE SWEAT
GLANDS
6. carotid sinus syndrome: NOTA
7. gilles de la tourettes syndrome: CHOREA, COPROLALIA,
TICS
8. markus-gunn syndrome JAW WINKING
9. campomelic syndrome: DWARFISM, CRANIOFACIAL
ANOMALIES, BOWING OF TIBIA AND FEMUR
10. zaufals syndrome: SADDLE NOSE
11. ortners syndrome: CARDIOMEGALY ASSOCIATED W/
LARYNGEAL PARALYSIS SECONDARY TO COMPRESSION
12. bezolds abscess: SECONDARY TO PERFORATION OF THE
TIP OF THE MASTIOD BY INFECTION
13. carcinoid syndrome: TUMOR SECRETES SEROTONIN
14. semons law: PARALYSIS OF THE CRICOARYTENOID
POSTICUS BEFORE PARALYSIS OF THE ADDUCTORS
15. ondines curse: FAILURE OF RESPIRATORY CENTER
AUTOMATICITY W/ APNEA ESPECIALLY EVIDENT DURING
SLEEP

SALIVARY GLANDS
1. U-shaped bend on mylohyoid: SUBMANDIBULAR GLAND
2. Wharton duct: SUBMANDIBULAR GLAND
3. rivinus duct: SUBLINGUAL GLAND
nd
4. stensen duct: PAROTID GLAND drains opposite/upper 2
molar
5. MC tumor occur: PAROTID GLAND
6. most sialolithiasis occur: SUBMANDIBULAR GLAND
7. mixed glands: PAROTID and SUBMANDIBULAR
8. serous glands: PAROTID
9. mucous glands: SUBLINGUAL

AREAS OF INJURY
1. I: intracranial penetration
2. II: orbital and globe injury
3. III: head and neck injuries

EPITHELIAL COVERING
1. lips: NONKERATINIZING SQUAMOUS
2. cheeks: NONKERATINIZING SQUAMOUS
3. nasopharynx: CILIATED

4.
5.
6.
7.
8.
9.
10.

oropharynx: NONKERATINIZING SQUAMOUS

hypopharynx: NONKERATINIZING SQUAMOUS
pharyngeal tonsil: CILIATED
palatine tonsil: NONKERATINIZING SQUAMOUS
lingual tonsil: NONKERATINIZING SQUAMOUS
middle ear: CILIATED
external ear: KERATINIZING SQUAMOUS

LYMPHATIC DRAINAGE
1. lips: LEVEL I
2. cheeks: LEVEL I
3. tongue: LEVEL I
4. palatine tonsil: LEVEL II
5. middle: LEVEL II

ORAL MANIFESTATION OF SYSTEMIC DSE
1. syphilis: GUMMAS and ENANTHEMS
2. melkersson-rosenthal syndrome: FISSURED TONGUE
3. anaphylaxis: ANGIOEDEMA
4. pernicious anemia: HUNTERS GLOSSITIS

NOTES

EXTERNAL EAR
1. auricle/pinna
2. external auditory canal
3. tympanic membrane
MIDDLE EAR
1. tympanum/middle cavity
2. antrum and mastoid air cells
3. eustachian tube
INNER EAR
1. bony labyrinth
2. membranous labyrinth

MIDDLE EAR BOUNDARIES

roof tegmen tympani

lateral tympanic membrane

anterior eustachain tube opening

posterior aditus / opening into tympanic membrane

floor hypotympoanum

medial promontory, labyrinthine windows, horizontal

part of CN VII, lateral semicircular canal

BOUNDARIES

superior tegmen antri

posterior sigmoid sinus

anterior posterior wall of external auditory canal

inferior digastrics ridge

CENTRAL PATHWAY

dorsal and ventral cochlear nucleus

i.
superior olivary complex
ii.
lateral lemniscus
iii.
inferior quadrigeminal body
iv.
medial geniculate
v.
auditory complex

AUDIOGRAM KEY / AUDIOMETRY

right
left
AC unmasked
O
X
AC masked
triangle square
BC mastoid unmasked <
>
BC mastoid masked
[
]

red
blue

DEGREE OF HEARING LOSS

0-25 dB normal hearing threshold

26-40 mild hearing loss

41-60 moderate hearing loss

56-70 - moderately severe hearing loss

71-90 severe hearing loss

>90 profound hearing loss

BERKESY TEST
TYPE FINDINGS
INTERPRETATION
I
pulsed and continuous across all
normal or middle ear
frequencies
dse
II
pulsed and continuous
cochlear dse
interweave in low and mid
(menieres)
frequencies but at 1000Hz
continuous drop but no more
than 20 dB
III
similar to type II, but the drop is
retrocochlear
more than 20 dB
pathology (acoustic
schwannoma
IV
pulsed and continuous tones do
retrocochlear
not interweave
pathology
V
pulsed drops below the
non-organic hearing
continuous ones
loss

WAVES

I distal portion of auditory nerve

II proximal portion of auditory nerve

III cochlear nucleus

IV superior olivary complex

V lateral lemniscus as it teminates at interior colliculus

OTITIS MEDIA VS OTITIS EXTERNA

OTITIS EXTERNA
OTITIS
MEDIA
pain
very severe
not severe
tenderness on pinna
(+)
(-)
manipulation
fever
usually (-)
usually (+)
hx of URTI
usually (-)
usually (+)
hx of scratching or
(+)
usually (-)
cleaning of ear
hearing
not impaired unless
impaired
canal obliterated
matoid xray
normal
mastoiditis

COMPLICATIONS OF OTITIS MEDIA AND MASTOIDITIS

extracranial
o facial nerve paralysis
o labyrinthitis
o subperiosteal abscess
o apical petrositis (gradenigo)

o sensorineural hearing loss

intracranial
o extradural abscess
o subdural abscess
o lateral sinus thrombophlebitis
o meningitis
o brain abscess
o otitic hydrocephalus

LABYRINTHITIS
TYPE
VERTIGO
circumscribed mild

HEARING LOSS
conductive

serous

moderate

mixed

suppurative

severe

sensorineural
then total

COCHLEAR DISEASES

ONSET
presbycussis
infection
noise-
induced
ototoxicity
trauma
barotrauma
systemic dse
menieres

LATERALITY

gradual
sudden
gradual

bilateral
uni or bi
uni or bi

sudden
sudden
sudden
gradual
fluctuant

bilateral
unilateral
unilateral
bilateral
unilateral
(bilateral 30%)

VESTIBULAR DISORDERS

VERTIGO
(DURATION)
menieres
episodic
(20mins-hour)
vestibular
neuronitis

acute
labyrinthitis
benign positional

acoustic
neuroma or
vestibular
schwannoma
vertebrobasilar
insufficiency

PATHOLOGY
erosion w/o actual
erosion of the
labyrinth w/ a
fistula
localized invasion to
severe w/ toxins of
the organism
actual penetration
and invasion by the
organisms

VESTIBULAR
SYMPTOMS
-
+
-
+/-
+
+
-
+

HEARING
LOSS
fluctuant
(low freq in
early stage)
no loss

VESTIBULAR
STATUS
decreased

severe SNHL

decreased

recurrent;
related to
position and
aggravated by
head movt
(seconds)
progressive

no loss

normal

progressive
SNHL

decreased

acute and
aggravated by
head movt
(variable)

compatible

normal

acute;
aggravated by
head movt
(>24hrs)
acute (>24hrs)

decreased

PERMISSIBLE NOISE EXPOSURE
DURATION/DAY SOUND LEVEL
8 hrs/day
90 dBA
6
92
4
95
3
97

2
100
1.5
102
1
105
0.5
110
<0.25
115

DEGREE OF ATTENUATION OF SOUND BY PROTECTORS
PROTECTION TYPE ATTENUATION AT LOW FREQUENCIES
cotton (pain)
0
waxed cotton
3.8
ear plugs
30
ear muff
40
ear muss w/ insert 70

CENTRAL AND PERIPHERAL CAUSES OF VERTIGO

PERIPHERAL
CENTRAL
duration
may be intermittent,
may be persistent,
usually hrs to days w/
usually wks to mos w/
normal periods
no normal periods
s/sx CNS
(-)
usually (+)
fixation
suppresses nystagmus
no effect
spontaneous
fatigue, jerk or rotator
non-fatigable, does not
nystagmus
and occurs in one
change w/ different
particular direction
plane of gaze; oblique
or vertical types usually
central in origin
nystagmus enhanced
nystagmus decreases w/
by eye closure
eye closure
induced
fatigable duration <1
non-fatigable>1 min.
nystagmus
min. follows COWS
doesnt follow COWS
(cold opposite warm
same)
causes
menieres, vestibular
tumors, multiple
neuronitis, benign
sclerosis, epilepsy,
paroxysmal positional
vascular problems
vertigo, acoustic
neuroma

FACIAL NERVE TESTS FOR LOCALIZATION

schirmers hearing test - test for lacrimation

stapedial reflex - test of loudness tolerance

taste test

test for salivation

differentiating upper vs lower motor neuron cause


FACIAL NERVE TEST INTERPRETATION
SITE
UM VESTIBU
SCHIRM SALIVATI STAPED TAS
N
LAR
ER
ON
IAL
TE
CNS
+
+
+
+
+
+
CPA
-
+
+
+
+
+
IAC
-
-/+
+
+
+
+
middle -
-
-
-
+
+
ear
betwe
-
-
-
-

+
en
chorda
&
stapedi -
-
-
-
+

us
SMF
-
-
-
-
-


OPERATIONS ON THE EXTERNAL EAR

surgery for perichondritis for perichondritis in fluctuant

stage

meatoplasty canalplasty for meatal atresia

myringotomy for serous otitis media ; pus in middle ear;

to insert ventilation tube

OPERATIONS ON THE MIDDLE EAR

simple or cortical mastoidectomy of schwartze - for

coalescent mastoidectomy; as preliminary exposure of
facial nerve, labyrinthine or internal auditory canal
surgeries

radical mastoidectomy for complication of middle ear

dse; no cochlear reserve

modified radical mastectomy for good cochlear nerve;

preliminary surgery for reconstructive surgery; ears not
responsive to medical treatment

tympanoplasty for reconstruction of middle ear

o types: I graft on malleus
II incus
III stapes
IV footplate
V fenestration operation

OPERATIONS OF THE INNER EAR

labyrinthine surgery for vertigo

conservative preserve hearing

surgery of the internal auditory canal removal of acoustic

neuromas/vestibular schwannomas; sectioning of
vestibular nerve for severe vertigo; facial nerve
decompression in tumors

transotic extension for petrous apex lesion

CONGENITAL HEARING LOSS

GENETIC
NON-GENETIC
alport synd
rubella synd
treacher-collins synd
kernicterus & neonatal
hyperbiliruinemia
waardenburgs synd
congenital syphilis
jervel-lange synds
premturity
pendreds synd
anoxia at birth
kearns-sayne synd
teratogens - drugs
GJB2 or connexin 26

mutation

EXTERNAL NOSE

bony framework
o nasal bone
o frontal process of maxilla
o nasal process of frontal bone

cartilaginous framework
o lower lateral (greater alar) cartilage
o quadrilateral cartilage
o upper lateral (lateral nasal) cartilage
o lesser alar cartilage
o sesamoid cartilage

constrictors
o nasalis
o depressor septi
o depressor alaque nasi

dilators
o procerus
o dilator nasi
o angular head of quadratus labii superioris
INTERNAL NOSE

BOUNDARIES
o superior cribriform plate of ethmoid
o inferior maxillary bone
o medial septum
o lateral maxillary bone
o posterior sphenoid sinus

nasal septum
o septal cartilage
o vomer
o perpendicular plate of ethmoid
o maxillary crest
o premaxilla

turbinates
o inferior turbinate largest
o middle turbinate part of ethmoid bone
o superior turbinate - part of ethmoid bone
o supreme turbinate occasionally found

meatuses
o inferior meatus drains nasolacrimal duct
o middle meatus drains frontal, maxillary,
anterior ethmoid sinus
o superior meatus
o supreme meatus
o sphenoethmoid recess


NASAL BONE FRACTURES
class 1 (chevallet
along quadrilateral cartilage & distal thin
fracture)
portion of nasal bone
due to low-velocity trauma
class 2
nasal bones, frontal process of maxilla,
structures / iin class 1
due to medium-velocity trauma
w/ jarjavay cartilaginous fracture
class 3
extends thru ethmoid labyrinth w/ inward
telescoping nasal skeleton
pig-nose

SEPTAL DEVIATION
lateral (jarjavay)
lateral nasal fracture w/ displacement of
type
septum from vomerian groove & maxillary
crest
depressed
frontal nasal fracture w/ twisting, buckling,
(chevallet) type
reduplication & fibrosis of quadrilateral
septum
laterofrontal type combination of lateral & depressed types

NASAL BONE FRACTURE

MC fracture in the body

assault MC cause
MANDIBLE FRACTURE
nd

2 to nasal bone fracture

th

10 most fractured in the whole body

angle 35%, symphysis

case: primary assault

FRONTAL BONE FRACTURE

least common of all fractures

5-15%

MAXILLARY FRACTURE CLASSIFICATION

dishpan or panface
le fort I: GUERIN
- horizontal separation
(horizontal separation) - palate separated from the rest of maxilla

- interdental & intermaxillary fixation, 4-
6wks
lefort II: PYRAMIDAL
- MC of maxillary fracture
(midfacial fracture)
- palate w/ maxilla is separated from

zygoma and the ethmoid
- as above fixation from zygomatic suture
or orbital rim
lefort III:
- nasofrontal suture
CRANIOFACIAL
- across floor of orbit
DYSJUNCTION
- maxilla and zygoma are separated from

the cranium
- interdental & intermaxillary fixation,
suspension from zygomatic suture &
wiring from infraorbital rim

BENIGN PEMPHIGUS

site
lesions

BULLOUS
PEMPHIGUS
oral mucosa
small & w/ bleeding
on rupture

histopath
no acantholysis
immunoflourescence fluorescence at
basement
membrane
prognosis
benign

OBSTRUCTIVE SLEEP APNEA

ADULT
etiology
multiple
sleep
manifestations
daytime
manifestation
sleep study
findings

management

potential
morbidity of
untreated

snoring, restless
sleep, frequent
awakening
excessive daytime
sleepiness
decreased
oxygenation, sleep
fragmentation

often medical
(positive airway
pressure therapy)
vehicular accidents,
cognitive
impairment,
medical conditions

ACUTE EPIGLOTTITIS VS CROUP

ACUTE
EPIGLOTTITIS
area

PEMPHIGUS
VULGARIS
nasal, oral
larger, may leave
denuded area on
rupture
massive acantholysis
at area of
acantholysis
high mortality if
untreated

PEDIATRIC
usually enlarged tonsils &
adenoids
snoring, restless sleep,
odd sleeping positions
hyperactivity, inattention,
sleepiness
oxygenation usually
maintained, CO2
retention &
hyperventilation, sleep
architecture maintained
often surgical
(tonsillectomy &
adenoidectomy)
medical, neuroanatomic
& cognitive

CROUP (ACUTE
LARYNGOTRACHEOBRONCHITIS)

laryngeal
area just below vocal cords
surface of
epiglottis
etiology
H.influenza,
viral - parainfluenza type I-IV
type B
peak age
3-6yrs
6mos-3yrs
s & s/x
sit up w/
tends to lie down
mouth open &

chin forward
hoarse
not hoarse
very croupy cough
cough not
no dysphagia
croupy
may have
dysphagia
course
rapid, can be
less rapid
fatal w/in hrs
w/o treatment
recurrence
rare
more common
laryngoscopy cherry-
subglottic swelling seen thru
red,markedly
glottis
swollen
epiglottis
treatment
penicillin, ampicillin, sulbactam

UNILATERAL MIDLINE PARALYSIS VS BILATERAL MIDLINE PARALYSIS

UNILATERAL
BILATERAL
paralysis of abductor & adductors,
initially both cords are
except cricothyroid
intermediate breathy
voice
initially paralyzed cord assumes
tracheostomy to relieve
intermediate or cadaveric position
obstruction
hoarse voice
cricothyroid still functions to lengthen
can do arytenoidectomy
paralyzed cord
& arytenoidopexy
6wks after onset paralyzed cord

assumes paramedia (adducted) position
if paralyzed cord is slighty lateral to

midline (paramedia) the normal cord
can still coaptate w/ paralyzed cord by
compensating
no airway obstruction in any stage

no intervention needed except when no
compensation occurs

LARYNGEAL TUMORS

BENIGN NEOPLASM
MALIGNANT NEOPLASM
types
polyps, cysts, l
SCC or epidermoid
ipomas, chondromas, carcinoma;
papillomas
adenocarcinoma
etiologic
vocal abuse (polyps,
smoke >1 pack/day x 15-
factor
nodules)
20yrs
sex
female
male
predilection
s & s/x
hoarseness,
hoarseness, neck mass,
discomfort, no
cervical lymphadenopathy,
bleeding, no cervical
bleeding, stridor,
lymphadenopathy
respiratory distress,
sensation of rawness
management surgery; remove only surgery radical
the tumor; preserve
laryngectomy w/ neck
all normal tissues &
node dissection,
laryngeal function
reconstruct w/
trachaeoesophageal shunt
to restore speech; RT,
chemo

NASAL POLYPS GRADING
0 - no polyps
I polyps do not prolapse beyond middle turbinate & may require
endoscopy for visualization
II polyps extend below middle turbinate. visible w/ nasal
speculum
III polyps touch nasal floor. may occlude entire nasal cavity. seen
thru vestibule w/o aid of nasal speculum

NASAL POLYP VS TURBINATES

NASAL POLYP
TURBINATES
color
skinned/seedless
pink to red
grapes
decongestant
(-)
(+)
effect
mobility
mobile
fixed
sensation
(-)
(+)
location
osteomeatal complex along entire lateral
nasal wall
consistency
soft
hard

TRIANGLES OF THE NECK

POSTERIOR TRIANGLE:
o supraclavicular
o occipital

ANTERIOR TRIANGLE
o muscular
o digastrics/submandibular/submaxillary
o submental/suprahyoid
o carotid

FLAP VS GRAFT
pp
FLAP
limited to transplantation of skin
can carry other tissues
depends on recipient site for
has own blood supply
nutrition
may discolour; likely to contract
better color; less likely to
contract
less adaptable to weight bearing
more adaptable to weight
bearing
less able to survive on a bed w/
can be used on a bed w/
questionable nutrition
questionable nutrition
requires pressure dressing
not require pressure dressing
cannot bridge defect
can bridge defect

HEMOLYTIC STREP / S.AUREUS - MC pathogenic organism of the
head and neck
POTTS DSE - retropharyngeal space infection in adults


OROPHARYNX

soft palate to dorsum of tongue inferiorly

lateral palatine arches (fauces)

waldeyers ring:
o lingual tonsils base of tongue
o faucial tonsils paired and w/in palatine fauces
o adenoids
o lateral pharyngeal bands
o tonsils of gerlach w/in tip of fossa of
rosenmuller

NASOPHARYNX

boundaries:
o superior base of skul
o anterior nasal cavity
o inferior oropharynx and soft palate
o lateral opening of Eustachian tubes
o posterior cervical vertebrae

pharyngeal bursa
o saclike depression in posterior wall
o remnant of notochord
o site of thornwaldts cyst

DIFFERENTIATION
S & S/X
ANGIOFIBROM
A JUVENILE
TYPE
age
1-18yrs
sex
male
bleeding
profuse

NASOPHARYNGEA
L MALIGNANCY
30-60yrs
more male
scanty to mild

nasal
passage
obstructio
n
neck nodes

minimal to
severe

minimal to the
beginning

(-)

cranial
nerve

Nil

early, bilateral &

large
CN VI initially,
then V, IX, X

ear

occasional

treatment

surgery

can be an early
sign
radiation /che&
mo

NASAL
MALIGNANC
Y
40-70yrs
female
minimal to
moderate
moderate to
severe

late
CN V for
advanced
cases
(-)
surgery & RT
and/or
chemo

ACUTE TONSILLITIS CAUSES

GABHS, H.influenza, S.pneumonia

tx: penicillin

CHRONIC TONSILITTIS

tx: tonsillectomy

tonsillitis occurrence to be candidate for tonsillectomy:

o 3/yr for 3yrs
o 5/yr for 2yrs
o 7 or more for 1yr
o >2wks school/work missed in 1 yr

INDICATIONS FOR TONSILLECTOMY

ABSOLUTE
o obstruction causing dysphagia, airway
obstruction
o pharyngeal or peritonsillar abscess
o suspected mignancy

RELATIVE
o recurrent GABHS infection
o tonsil hyperplasia w/ functional obstruction,
such as dysphagia or sleep apnea
o rheumatic fever w/ heart damage w/ recurrent
tonsillitis & poor antibiotic control

INDICATIONS FOR ADENOIDECTOMY

obstruction dse nasal obstruction

middle ear dse due to adenoid hypertrophy

suspicion of malignancy

CONTRINDICATIONS TO TONSILLECTOMY & ADENOIDECTOMY

cleft palate

blood dyscrasias

medical contraindications

LARYNGEAL CARTILAGES

thyroid - biggest

cricoids only complete cartilaginous ring

arytenoids paired; hitching posts for vocal cords

corniculate paired; on top of arytenoids

cuneiform paired; lateral to corniculate on aryepiglottic

folds

epiglottis

EXTRINSIC MUSCLES OF LARYNX

depressors: omohyoid, sternohyoid, sternothyroid

elevators: mylohyoid, geniohyoid, genioglossus,

hyoglossus, digastrics stylohyoid

pharyngeal constrictor, inferior pharyngeal constrictor

INTRINSIC MUSCLES OF LARYNX

adductors: lateral cricoarytenoid, thyroarytenoid,

transverse arytenoid, oblique arytenoid

abductors: posterior cricoarytenoid

tensors: cricothyroid, thyroarytenoid, vocalis

INFERIOR LARYNGEAL NERVE motor supply of all intrinsic laryngeal
muscles except cricothyroid
SUBMANDIBULAR NODES

most significant and largest

6-12 nodes
SUBMANDIBULAR INFECTION

haemolytic streptococci MC pathologic organism

ludwigs angina MC etiology is from dental cries

MANDIBULOTOMY cutting thru the mandible temporarily
JUVENILE NASOPHARYNGEAL ANGIOFIBROMA

benign

male; adolescent
EBV - viral etiology of nasopharyngeal carcinomas

MOST COMMON TUMORS
a) BCC
o MC epidermal tumor of the head and neck
o rodent ulcer
b) SCC
o MC malignancy in the oral cavity
o lip: lower lip = 95%; upper lip = 5%
o tonue
o MC malignancy in the phrynx
o MC malignancy in the larynx
o MC malignancy in the esophagus
o MC carcinoma of the pranasal sinuses
o followed by adenocarcinoma
c) papillary carcinoma
o MC thyroid carcinoma
o psamomma bodies
o orphan annie eye
o adenocarcinoma
o MC benign tumor of larynx HPV 16 (18)
d) follicular carcinoma
o pericapsular vascular invasion

o hurthle cell cord-like

pleomorphic adenoma
o benign mixed tumor
o MC benign tumor of salivary glands
o orphan annie eye

f) warthins tumor
o papillary cystadenoma lymphomatosum
o MC bilateral parotid gland tumor
g) acinic carcinoma parotid (MC at tail)
h) medullary carcinoma
o C-cells
o pheochromocytoma
i) adenoma MC thyroid neoplasm
j) hemangioma - MC benign tumor of salivary glands in
children
k) adenoid cystic carcinoma
o MC tumor of submandibular gland
o MC minor salivary gland malignancy
l) nodal type / reed Sternberg Hodgkin lymphoma
m) extranodal / nodal dse non-hodgkin
n) mucoepidermoid carcinoma
o MC malignancy of salivary gland in children
o MC malignant tumor of salivary glands
o MC malignancy in the parotid gland/hard palate
nd
o 2 MC of the submandibular gland
o) neurofibroma von Recklinghausen
ANAPLASTIC CA rapid growth and fixation to underlying structures
MIXED follicular tumors behave like papillary tumors
BENIGN TUMORS IN THE PAROTID GLAND 80%
e)

PAROTID - MC site of all salivary gland tumor

nd
MINOR SALIVARY GLANDS - 2 MC site of all salivary gland tumor
rd
SUBMANDIBULAR GLAND - 3 MC site of all salivary gland tumor
nd

LATERAL BORDERS OF TONGUE 2 MC tumor of the oral cavity

rd
CARCINOMA OF FLOOR OF MOUTH 3 MC oral cavity tumor
PERIAPICAL CYST MC odontogenic cyst
RETROPHARYNGEAL NODES/NODES OF RANVIER first nodes
affected in nasopharyngeal and maxillary carcinoma
NASOPALATINE FISSURAL CYST MC fissural cyst
MELANOMA MC site is the cheek, scalp, ear and neck
THYROGLOSSAL DUCT CYST

MC found at the level of the hyoid bone

sistrunk procedure part of the hyoid bone is removed to

prevent recurrence

CARCINOMA OF THE LARYNX

HPV 6, 11

clinical picture:
o glottic - hoarseness - MC early symptom
o floor of ventricle including TVC
o supraglottic dysphagia
o tip of epiglottis including false VC
o subglottic dyspnea late
o 1cm below TVC to cricoid
o transglottic advance and large tumors

lesions that cross the ventricle or involves

larynx above and below TVC

CORNICULATE CARTILAGE cartilage of santorini
CUNEIFORM CARTILAGE cartilage of wrisberg
BILATERAL ABDUCTOR PARALYSIS MC form of bilateral motor
paralysis
LARYNGOMALACIA MC congenital anomaly of larynx
INSPIRATORY STRIDOR major symptom of laryngomalacia
PTYALISM SIALORRHEA excessive saliva production
XEROSTOMIA dry mouth
SJOGREN - absence of saliva production
TB cols abscess
SCARLET FEVER / KAWASAKI strawberry tongue
DIPHTHERIA bulls neck
2:1 incidence of oral CA
FREY SYNDROME gustatory sweating after parotidectomy
S.AUREUS: MC cause of acute sialodenitis

EXTERNAL AUDITORY CANAL

outer 1/3 cartilaginous

inner 2/3 bony

fissures of santorini deficiency in cartilaginous portion

infection spread to parotid

foramen of huschke deficiency in bony meatus

infection spread to periauricular and parotid

TYMPANIC MEMBRANE

pars flaccid
o shrapnells membrane

triangular

above malleolar fold

common site of retraction pockets

pars tensa below

ACUTE CIRCUMSCRIBED OTITIS EXTENA / FURUNCULOSIS

s.aureus

s and s/x: earache, tender pinna/tragus, hearing

decreased, purulent ear discharge, circumscribed
swelling/abscess
MALIGNANT OTITIS EXTERNA / SKULL BASE OSTOMYELITIS
NECROTIZING OTITIS EXTERNA- p.aeruginosa
ACUTE NECROTIZING OTITIS MEDIA beta haemolytic streptococcus
MENIERES DSE / IDIOPATHIC ENDOLYMPHATIC HYDROPS

intermittent SNH, tinnitus, vertigo, ear fullness

cochlea hydrops fluctuating sensorineural hearing loss

and tinnitus

vestibular hydrops episosdic vertigo and aural fullness

lermoyez hydrops increasing tinnitus, hearing loss, and

aural fullness

crisis of tumarkin / drop attack loss of extensor power

BENIGN PAROXYSMAL POSITIONAL VERTIGO

canaliths

cupulolithiasis

confirmed by hallpike test positional nysgatmus w/

latency


cause: canaliths free-floating abnormally dense particles
RAMSAY HUNT SYNDROME

herpes zoster oticus of CN VII

vascular eruption and facial paralysis

CN X

Arnolds/aldermans nerve

cough reflex when external canal is stimulated

laryngeal pain in cancer

CN IX

jacobsons nerve

oropharyngeal pain in cancer

EUSTACHIAN TUBE

upper 1/3 bony

anteromedial 2/3 cartilaginous

SWIMMERS EAR

diffuse otitis externa

pseudomonas
CAULIFLOWER EAR

hematoma auris

severe perichondritis

abscess
APICAL PETROSITIS / GRADENIGO SYNDROME

discharging ear

retroorbital pain

diplopia
MELKERSSONS SYNDROME

peripheral palsy

jewish

postulated hypersensitivity
JERVELL and LANGE-NIELSEN SYNDROME

autosomal recessive

SNHL with prolonged QT interval

GJB2 / CONNEXIN 26 - MC cause of SNHL
st
ETHMOID BULLA - 1 ethmoid cell
RHINOLOGIST ARTERY - largest vessel supplying the nose
LUPUS VULGARIS

TB in the nose

apple jelly nodules

LUPUS ERYTHEMATOSUS - butterfly rash
CHOANAL ATRESIA

bony / membranosseous 80-90%

membranous 10-20%
RHINITIS
1) infections most prevalent; common cold
2) allergic IgE mediated, high socioeconomic class
3) non-allergic
a. vasomotor
idiopathic rhinitis
cholinergic glandular activity
heightened sensitivity
b. gustatory eating; vagally-mediated
c. non-allergic rhinitis with eosinophilia syndrome)
unknown etiology
paroxysmal exacerbations of sx

4)

occupational
a. protein and chemical allergies IgE mediated
b. chemical respiratory sensitizers uncertain
immune mechanism
c. work aggravated rhinitis
5) hormonal pregnancy / menstrual cycles
6) drug-induced rhinitis medicamentosa
7) atrophic rhinitis thinning and drying of nasal mucosa
EPISTAXIS

mucositis MC in children

HPN mc in adults

keisselbachs plexus 90% of epistaxis

HYPEROSMIA

hypersensitive sense of smell

cystic fibrosis
PAROSMIA

perverted smell

streptomycin
HYPOSMIA

impaired smell

smoking
ANOSMIA loss of smell
ACUTE PHARYNGITIS

viral

sore throat

colds and conjunctivitis

ENDOSCOPY

rod telescope clinic

rigid O.R.
o direct laryngoscopy
o bronchoscopy
o esophagoscopy

flexible office
EOPHAGEAL DISORDERS

achalasia degeneration of auerbach plexus

diffuse esophageal spasm spiral/corkscrew

scleroderma atrophy of smooth muscle

presbyoesophagus abnormal esophageal motor function

d/t aging

CLEFT DEFECT

90% unilateral, 20% bilateral

2/3 left sided, 1/3 right sided

CLEFT PALATE

70% unilateral, 30% bilateral

MC in females
NASOPHARYNX base of skull/posterior choanae to soft palate
ORAL CAVITY

vermillion border to junction of soft and hard palate

except soft palate and base of tongue

oropharynx soft palate to hyoid
hypopharynx hyoid to cricoids
esophagus cricoids to cardia of stomach
STAPHYLOCOCCI first oral microbe in neonate

PLAUTS ANGINA/TRENCH MOUTH/VINCENTS ANGINA

acute necrotizing ulcerative gingivitis

B. vincente

tx: penicillin
THORNWALDTS DSE nasopharyngeal bursitis
QUINSY

peritonsilar abscess

tx: clindamycin
PAROTID ABSCESS

MC organism is staph

MC cause is salivary stone

ANKYLOGLOSSIA tongue tie
FISSURED/SCROTAL TONGUE

trisomy 21

melkerson Rosenthal syndrome

LEUKOPLAKIA whitish patches in oral cavity
ERYTHROPLAKIA red plaques
NODULAR LEUKOPLAKIA mixed white and red plaques
LATERAL WALL/FOSSA OF ROSENMULLER MC site for
nasopharyngeal carcinoma
posterior suspensory ligament of thyroid - LIGAMENT OF BERRY
hypothyroidism - MYXEDEMA, INCREASED TSH, DECREASED TH
hyperthyroidism - THYROTOXICOSIS
MC cause of thyroiditis and goiter - HASHIMOTOS DSE
MC single thyroid dse - HASHIMOTOS DSE
MC cause of painful thyroid - SUBACUTE GRANULOMATOUS
THYROIDITIS (DE QUERVAINS THYROIDITIS)
lymphocytic thyroiditis - SILENT/PAINLESS/POSTPARTUM
THYROIDITIS

HYPERTHYROIDISM VS HYPOTHYROIDISM
HYPERTHYROIDISM
HYPOTHYROIDISM
nervousness
fatigue, lethargy
wt loss
wt gain
excessive sweating
cool, dry, coarse skin; hair
loss
warm, smooth, moist skin
swelling face, hands, legs,
non-pitting edema
heat intolerance
cold intolerance
muscular weakness, tremor
weakness, muscle cramps,
arthralgia, paresthesia
lid lag, exophthalmos, stare
periorbital puffiness
palpitations, hyperdynamic cardiac dec heart sound intensity
pulsations, accentuated S1
tachycardia
bradycardia
inc SBP, dec DBP
dec SBP, inc DBP
frequent bowel movt
constipation