52 T_h e pharynx, larynx and neck

Acute epiglottitis In children acute epiglottitis is of rapid onset. It tends to occur in childr...

Acute laryngitis This often occurs as part of an upper respiratory tract infection in associatio...

Adenoidectomy Adenoid tissue can be removed alone or in conjunction with a tonsillectomy . The in...

Anatomical relationships of the pharynx Some of these are illustrated in Figure 52.5 . Paraphary...

Angiography or digital subtraction vascular imaging These techniques may be indicated if a vascul...

Angiography or digital subtraction vascular imaging These techniques may be indicated if a vascul...

Barium swallow and videofluoroscopy Barium (or water-soluble contrast if a pharyngeal or oesoph -...

Branchial cyst A branchial cyst ( Figure 52.63 ) develops from the vestigial remnants of the sec...

Branchial fistula A branchial fistula ( Figure 52.64 ) may be unilateral or bilateral and is though...

CLINICAL ANATOMY AND PHYSIOLOGY The pharynx The pharynx is a fibromuscular tube forming the upper ...

CLINICAL EXAMINATION Pharynx and larynx Before examination of the pharynx, the oral cavity shoul...

Cervical lymphadenitis Cervical lymphadenitis is common owing to infection or inflammation in the ...

Chronic retropharyngeal abscess This condition is now rare and is most commonly the result of an...

Chronic tonsillitis Chronic tonsillitis usually results from repeated attacks of acute tonsillit...

Clinical features The cysts almost always arise in the midline but, when they are adjacent to the...

Complications of tracheostomy The intraoperative, early and late postoperative complications of ...

Computed tomography scanning Computed tomography (CT) scanning provides high- resolution imaging ...

Cricothyroidotomy Cricothyroidotomy has the advantages of speed and ease, requiring minimal equi...

Cystic hygroma Cystic hygromas ( Figure 52.65 ) usually present in the neonate or in early infanc...

DISEASES OF THE LARYNX EMERGENCIES Stridor Stridor means noisy breathing. It may be inspiratory o...

Direct pharyngoscopy and laryngoscopy Examination of the pharynx, larynx and neck under general ...

Division of the trachea Wounds of the trachea are rare. They should all be formally explored and...

Elective tracheostomy The advantage of an elective surgical procedure is that there is complete ...

Emergency tracheostomy If a skilled anaesthetist is unavailable, local anaesthesia is employed, ...

FURTHER READING Bull P , Clarke R. Diseases of the ear, nose and throat . Oxford: Blackwell, 200...

Fibreoptic endotracheal intubation In most emergency situations, endotracheal intubation is the m...

Fine-needle aspiration cytology and core biopsy This is the investigation of choice when attempt...

Foreign bodies Both children and adults may inhale foreign bodies. Y oung children will attempt t...

Glandular fever (infectious mononucleosis) This systemic condition is usually caused by EBV , but...

HYPOPHARYNX Tumours of the hypopharynx Benign Benign tumours of the hypopharynx are very rare, t...

Human immunodeficiency virus (HIV) Acquired immunodeficiency syndrome (AIDS) can a ff ect the ear, n...

Hypopharynx The superior border of the hypopharynx is at the level of the laryngeal inlet. Its ...

INFLAMMATORY CONDITIONS OF THE NECK Ludwig’s angina Ludwig described a clinical entity characteri...

INFLAMMATORY CONDITIONS OF THE NECK Ludwig’s angina Ludwig described a clinical entity characteri...

INVESTIGATION OF THE PHARYNX, LARYNX AND NECK Plain lateral radiographs Plain lateral radiographs...

INVESTIGATION OF THE PHARYNX, LARYNX AND NECK Plain lateral radiographs Plain lateral radiographs...

Introduction No content extracted automatically.

LARYNGEAL DISEASE CAUSING LARYNGEAL DISEASE CAUSING

LUMP IN THE NECK On presentation, a careful history and examination are essential. The clinical s...

Laryngeal mask airway The laryngeal mask airway (LMA) is a wide-bore airway with an inflatable cu ...

Laryngeal papillomata These are rare benign tumours occurring mainly in children but can also pre...

Laryngotracheobronchitis (croup) Croup is usually of slower onset than acute epiglottitis and oc...

Larynx It is important to appreciate that the main function of the larynx is not the production ...

Learning objectives To understand: The relevant anatomy, physiology, disease processes and • inve...

Malignant The most important epithelial tumour is squamous cell carci noma, which constitutes app...

NASOPHARYNX Enlarged adenoid The most common cause of an enlarged adenoid (there is only one nas...

Neck The neck is divided into anterior and posterior triangles by ). the sternocleidomastoid mus...

Nerve supply The sensory nerve supply to the larynx above the true vocal folds is from the intern...

Neurovascular injury Penetrating wounds of the neck may involve the common - carotid or the exte...

OROPHARYNX Acute tonsillitis This common condition is characterised by a sore throat, fever, gene...

OTHER EMERGENCY AIRWAY PROCEDURES OTHER EMERGENCY AIRWAY PROCEDURES

Obstructive sleep apnoea This condition is becoming increasingly diagnosed in children and is imp...

Other causes of acute pharyngolaryngeal oedema Angioneurotic oedema, radiotherapy and laryngeal t...

Other imaging Magnetic resonance imaging (MRI) gives better soft-tissue definition and is preferre...

PRIMARY TUMOURS OF THE NECK Neurogenic tumours Paraganglioma (carotid body tumour) This is a rare...

Parapharyngeal abscess Parapharyngeal abscess may be confused with a peritonsillar abscess, but t...

Percutaneous tracheostomy As an alternative to open tracheostomy , a percutaneous trache ostomy i...

Peripheral nerve tumours Schwannomas are solitary and encapsulated tumours attached to or surroun...

Pharyngeal pouch A pharyngeal pouch is a protrusion of mucosa though Killian’s dehiscence, a wea...

Phonation/speech The larynx functions by closing the vocal fold against the air being exhaled fro...

Quinsy This is an abscess in the peritonsillar region that causes severe pain and trismus ( Figur...

SUMMARY The anatomical and physiological performance of the pharyn - golarynx is involved in the...

Secondary carcinoma Metastatic spread of squamous cell carcinoma to the cervical lymph nodes is ...

Sideropenic dysphagia Prolonged iron deficiency anaemia may lead to dysphagia, particularly in mid...

Stridor in children Infants and children presenting with stridor need careful assessment with a f...

TRACHEOSTOMY AND OTHER EMERGENCY AIRWA Y MEASURES This procedure relieves airway obstruction or p...

TRAUMA TO THE NECK The management of penetrating neck trauma depends on the structures that have...

Thoracic duct injury Wounds to the thoracic duct are usually iatrogenic and usually left sided, o...

Thyroglossal duct cysts Embryology The thyroid gland descends early in fetal life from the base o...

Tracheostomy tubes Most modern tracheostomy tubes are made of plastic ( Figure 52.46 ). Tubes o...

Transtracheal ventilation This technique is simple and e ff ective and allows ventilation for peri...

Treatment Treatment must include excision of the whole thyroglossal tract, which involves remova...

Tuberculous adenitis This condition most commonly a ff ects children or young adults but can occur...

Tumours of the larynx Benign tumours of the larynx are extremely rare. Squamous cell carcinoma i...

Tumours of the nasopharynx Benign There are two main types of benign tumours of the nasophar yn...

Tumours of the oropharynx mal Benign Benign tumours of the oropharynx are rare, papillomas being...

VOICE DISORDERS Vocal nodules These are fibrous thickenings of the vocal folds at the junction - ...

Vagal body tumours Vagal paragangliomas arise from nests of paraganglionic tissue of the vagus n...

Vocal fold palsy This may be unilateral or bilateral ( Figure 52.55 ). Unilateral cord palsy is m...

Vocal fold polyps These are usually unilateral and may be associated with an acute infective epis...

Voice rehabilitation The loss of the larynx as a generator of sound does not prevent patients s...

Wounds above the hyoid bone The cavity of the mouth or pharynx may have been entered and the epi...

Wounds of the thyroid and cricoid cartilage Blunt crushing injuries or severe laceration injuries...