oral cavity surgsoc
TRANSCRIPT
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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
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Introduction
Much of acute ENT
…………….is very simple
…………… is very common
…………… is very treatable.
But it is taught badly or not at all.
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Aims
Discuss basic anatomy of oral cavity and salivary glands
Related structures that are clinically relevant
Basic presentations of common conditions
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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!
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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!
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Oral cavity
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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
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What do you already know?
Anatomical terms
Skull anatomy
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The challenge
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Floor of mouth
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Important structures
Facial artery and vein
Lingual nerve
Hypoglossal nerve
Mylohyoid muscles
Digastric muscles
Facial nerve
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The bits at the back!
Palatal arches
- Palatoglossal
- Palatopharyngeal
Tonsils
Uvula
Tongue base
Oropharyngeal wall
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Time to get personal!
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Tonsillitis
Very common
Difficulty swallowing
Pyrexia
Dehydrated
Malaise
NO TRISMUS
Bilateral tonsillar swelling
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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
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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.
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Glandular fever
Infectious mononucleosis
From EBV
Highly contagious
Usually longer Hx than bacterial tonsillitis
Classical appearance
Must examine abdomen
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Oral cancer
Increasingly common
Smokers/HPV
Longstanding ulcers
Ongoing glossitis
Mainly SCC
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Salivary glands
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Salivary gland anatomy
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Salivary Gland function
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Parotid gland
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Parotid gland
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Submandibular gland
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Submandibular gland
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Sublingual gland
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Sialadentitis
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Sialadentitis
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Sialadentitis
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Sialadentitis
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Sialadentitis
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Mumps
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Salivary tumours
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Classification
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Investigation
Clinical examination including CNVII
Ultrasound
FNA cytology
MRI
PET
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Management
Benign
- Conservative
- Surgical
Malignant
-Surgical
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Iseli’s law
“if in doubt, cut the f***** out”
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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
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Thank you