Surgical conditions in the head and

neck

Department of Surgery
SAITM
 What are we learning today?

Some fundamentals regarding head and neck

disease and their surgical management

Oral ulcers

Head & neck lumps

 The Head and Neck
Head
Neurocranium & Viscerocranium
Bone and soft tissue
Neck
Neck is a conduit mostly (mostly?)
Bone and soft tissue
Larynx and Endocrine glands
 Function
Neurocranium
Brain and its many functions
Viscerocranium
Breathing
Eating
Sensory organs (four special senses)
Face and its emotive/social functions
Importance of cosmesis of the face
 Functions related to neck
Neck
Breathing
Swallowing
Vision
Speech
Hearing
Blood supply to brain
Endocrine function
What are the functional losses that results from
disease of the Head and Neck?
 Ulcers

What is the definition of an ulcer?

How do they occur?

How do they present?

How does one assess and plan management?

Prevention
 Ulcer

Definition anyone?

Anatomy of an ulcer?
 Pathological Types

Congenital

Acquired

Inflammatory, infectious, infestations

Neoplastic Benign or Malignant

Vascular Venous or arterial

Neurological

Other
 The mouth

Vestibule

Oral cavity proper

 Symptoms

I have an Ulcer doc !

Swelling

Pain

Bleeding
 Signs

Ulcer single or multiple, site, size and shape

Surrounding area

Lymphatic drainage

Loss of function

Signs of blood loss

other
 STC Mt Lavinia (the other school)
Site, size, shape, surface
Tender. Temperature, transillumination, transmission
Colour, consistency, compressibility,
Mobility, margins, movements, music (sounds)
LOOK
Below, above and beyond

Nandalal Gunaratne
 Examining the ulcer

Know the parts of an ulcer

the anatomical location

Size,shape, surface, edge, wall, floor, base

Fixity to structures (including bone)

Lymphatic drainage areas

 Common ulcers
Stomatitis
Apthous ulcers
Cancer
Benign mouth ulcers
Oral syphilis
Malignant ulcers
 Any investigations?
Why investigate?
What data can we get?
How is it useful?
Is is cost effective?
LUMPS
 Common Lumps

The approach

Diagnostic workup

Clinical decision making

Plan of management

Follow up
 Pathology

Congenital

Acquired
Traumatic
Inflammatory, infectious, infestations
Neoplastic
Vascular
 Head

Bone
Benign
Malignant primary or secondary (commoner)

Soft tissue
Benign
Malignant primary or secondary
 Head

Soft tissue
Scalp
Face
Salivary glands
 Jaws and teeth
Learn about the growths arising from the teeth
and jaws
Dentigerous cysts
Tumours of bone
Ranula
Dermoid cyst
 Neck

Goitre

Lymph nodes

Other
 Goitres

Solitary nodule
Diffuse enlargement

Why is this more worrying?

 What a goitre!!!
Sternum
What is this lump likely to be?

Why is this test

helpful?

Swallow?
Lymph nodes
 Lymph nodes
Single or multiple
Localized or generalized
Discrete or matted (can evolve - in Tuberculosis)
Firm/hard/soft
Branchial cyst Cystic hygroma
 Killian's
dehiscence
Between
thyropharyngeus
and
cricopharyngeus

pharyngoesophageal
Pharyngeal diverticulum (Zenker's
pouch
diverticulum)
What symptoms will this cause?
Torticollis
 Reading to do....
Branchial cyst
Carotid body tumour
Cystic hygroma
Pharyngeal pouch
Sternomastoid tumour with torticollis
Cervical rib
Salivary gland swelling
Stones
Pleomorphic adenoma
 Warthin's tumour or
adenolymphoma of parotid

Over 60
Over the angle
Oh! so soft

Carcinoma of parotid

Test Facial
Nerve
Other salivary glands
Mikulicz
Sjgrens