Download - Nottingham SCRUBS

ENT Revision Session
Siân Dobbs
FACIAL NERVE
SUPRANUCLEAR =
UMN
INFRANUCLEAR =
LMN
N.B cutaneous
branches
Motor root CNVII
Superior salivatory nucleus
FIRST GENU –
INTERNAL ACOUSTIC MEATUS
LOCATION GENICULATE
GANGLION
FACIAL CANAL
**REMEMBER bilateral
corticobulbar innervation
SECOND GENU – PYRAMIDAL
EMINENCE
STYLOMASTOID FORAMEN
To Zanzibar By Motor Car
Important functions (recap)
• Motor – muscles of facial expression
• Motor – posterior belly of digastric, stylohyoid, stapedius
• Special Sensory – taste anterior 2/3 of tongue
• Parasympathetic – submandibular, sublingual, lacrimal glands +
glands of nasal cavity, palate and pharynx
Pathology
• UMN vs LMN
• Proximal to facial nucleus E.g: CVA = UMN. Lesion to corticobulbar
tract. Weakness contralateral lower half of face. Forehead spared.
(bilateral corticobulbar innervation of forehead mm in posterior part of facial nucleus)
• Distal to nucleus = LMN. Paralysis of all ipsilateral facial muscles and
innervated structures (dry eye, loss of taste from ant 2/3, hyperacusis,
loss of sensation around ear) E.g:
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Skull Base Pathology
Bells Palsy
Ramsay Hunt Syndrome
Parotid Disease
Quick Test…
UMN vs LMN? Where is the lesion?
Neck Lumps
On examination..
• Inspection
• Palpation
• Percussion (retrosternal goitre)
• Auscultation
• Need to be able to present:
• 3 S’s : Size, shape, site
• 3 C’s: Consistency, contours, colour
• 3 T’s: temperature, tenderness, temperature
Differential Diagnoses
MIDLINE
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Thyroid gland
Thyroid nodule
Thyroglossal cyst
Ludwigs Angina
Sebaceous cyst
Lipoma
Lymph node
ANTERIOR TRIANGLE
Branchial cyst
Laryngocele
Carotid aneurysm
Carotid body tumour
Sebaceous cyst
Lipoma
Lymph node
POSTERIOR TRIANGLE
Cervical rib
Branchial cyst
Pharyngeal pouch
Pancoasts tumour
Sebaceous cyst
Lipoma
Lymph node – Superficial Cervical
(H&N cancer) Virchows node (GI
Malignancy)
Thyroid mass – midline. move on swallowing, not on tongue protrusion.
?hyper/hypothyroid symptoms. Generalised (Goitre) or nodule (thyroid carcinoma?)
Thyroglossal cyst – midline. Move on swallowing and on tongue protrusion. Most common congenital
abnormality of the central part of the neck
Lymph nodes – multiple masses. infectious ?short history, tender, warm, red, mobile associated clinical
history. Suspicious features - >2 weeks, >1.5cm, firm, rubbery (lymphoma), matted, firm (ca), fixed. Associated
history – Red flags for H&N Ca? Red flags for lymphoma?
Branchial cyst – failure to obliterate second branchial cleft. Present in young adults, following
minor trauma or infection. Ovoid, rounded swelling just below mandible, anterior to SCM.
Cystic hygroma – children. Lymphatic malformation. Classically left posterior
triangle of neck. Fluctuant. Transilluminates.
Vascular – carotid body tumour (chemodectoma/paraganglioma) glomus tumour at carotid
bifurcation. Bruit. Carotid aneurysm – TIAs, expansile, pulsatile, bruit.
Pharyngeal pouch – protrusion of posterior pharyngeal mucosa. elderly patient,
regurgitation of food, weight loss, halitosis, neck gurgles/bulges on swallowing, aspiration
pneumonia, chronic cough, may be reducible.
Quick Test…
1.
2.
3.
4.
5.
A 20 year old woman presents with an asymptomatic painless lump in the midline just beneath her chin.
The lump is smooth, spherical, approximately 2cm in diameter, non tender and fluctuant to palpation.
The lump moves on swallowing and on tongue protrusion
An 80 year old man presents with a history of sore throats, halitosis and regurgitation. Recently seen by
his GP for chronic cough and has also noticed some difficulty swallowing. On examination he has a 510cm indistinct mass behind the sternomastoid muscle below the thyroid cartilage. The lump is soft,
smooth and compressible on palpation
A 64 year old man presents with an asymptomatic slowly growing painless lump in the posterior triangle
of the neck above the clavicle. Direct questioning reveals a 3 month history of malaise, weight loss,
pruritus and episodic night sweats. The lump is 3cm in diameter, hard and non tender
A 25 year old woman presents with a painless swelling in the upper lateral part of the left side of her
neck. On examination a 7cm ovoid, smooth, non tender fluctuant swelling is palpable lying deep to, and
protruding anteriorly from, the upper third of the sternomastoid muscle
A 72 year old man presents with an asymptomatic slowly growing painless lump in the neck. On
examination he has a hard 2cm mass lying laterally in the anterior triangle of the neck, deep to the upper
third of the left sternomastoid muscle. You notice that the patient has dysphonia.
FINALS!
Questions?