oral cavity surgsoc
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Oral cavity and salivary glands
Exeter Surgical Society 26th November 2013
Mr Richard HarrisSpeciality Registrar in ENT
Royal Devon and Exeter Hospital
Introduction
Much of acute ENT
…………….is very simple
…………… is very common
…………… is very treatable.
But it is taught badly or not at all.
Aims
Discuss basic anatomy of oral cavity and salivary glands
Related structures that are clinically relevant
Basic presentations of common conditions
House Rules
Please turn phones/bleeps off.
No such thing as a silly question.
Non-participants will be picked on!
If you don’t understand- ask!
The bottom line
If you:
- Do the basic things well
- Respect your own ability and take responsibility for the patient
- Spot the serious things and refer early
- Describe your findings accurately
You and the patient are on to a winner!
Oral cavity
Why bother?
Every patient has one!
Dental care is not provided for all on the NHS
Oral/salivary problems very common in general medical patients
Mouth a common indicator of general health
What do you already know?
Anatomical terms
Skull anatomy
The challenge
Floor of mouth
Important structures
Facial artery and vein
Lingual nerve
Hypoglossal nerve
Mylohyoid muscles
Digastric muscles
Facial nerve
The bits at the back!
Palatal arches
- Palatoglossal
- Palatopharyngeal
Tonsils
Uvula
Tongue base
Oropharyngeal wall
Time to get personal!
Tonsillitis
Very common
Difficulty swallowing
Pyrexia
Dehydrated
Malaise
NO TRISMUS
Bilateral tonsillar swelling
Tonsillitis
If drinking and apyrexial:
- Pen V 500mg QDS, analgesia, home.
Otherwise:
- FBC/U&E/CRP/Monospot
- IV Benzylpenicillin & Metronidazole
- IV fluids
- Single dose Dexamethasone 8mg IV
- Analgesia
- Refer for admission
Quinzy
Peritonsillar abscess
Symptoms similar to tonsillitis but:
- Usually more toxic
- Trismus
- UNILATERAL swelling.
• Workup as for tonsillitis but ref to ENT for drainage and admission.
Glandular fever
Infectious mononucleosis
From EBV
Highly contagious
Usually longer Hx than bacterial tonsillitis
Classical appearance
Must examine abdomen
Oral cancer
Increasingly common
Smokers/HPV
Longstanding ulcers
Ongoing glossitis
Mainly SCC
Salivary glands
Salivary gland anatomy
Salivary Gland function
Parotid gland
Parotid gland
Submandibular gland
Submandibular gland
Sublingual gland
Sialadentitis
Sialadentitis
Sialadentitis
Sialadentitis
Sialadentitis
Mumps
Salivary tumours
Classification
Investigation
Clinical examination including CNVII
Ultrasound
FNA cytology
MRI
PET
Management
Benign
- Conservative
- Surgical
Malignant
-Surgical
Iseli’s law
“if in doubt, cut the f***** out”
A career in ENT
Massive variety of work
Nice mix of benign/malignant pathology
All ages
Lots of toys
Range of unique skills even at FY1 level
It works!
On call from home as SpR or Consultant
Lots of private practice available
Thank you
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