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Cricothyroidotomy Cricothyroidotomy has the advantages of speed and ease, requiring minimal equipment and surgical expertise, and has great value in the emergency setting when conditions are not optimal to perform a tracheostomy . Cricothyroidotomy is perform...

Cystic hygroma Cystic hygromas ( Figure 52.65 ) usually present in the neonate or in early infancy , and occasionally may present at birth and be so large as to obstruct labour. The cysts are filled with clear lymph and lined by a single layer of epithelium wit...

DISEASES OF THE LARYNX EMERGENCIES Stridor Stridor means noisy breathing. It may be inspiratory or expira tory or occur in both phases of respiration. Inspiratory stridor is usually due to an obstruction at or above the vocal folds is most commonly the result...

Direct pharyngoscopy and laryngoscopy Examination of the pharynx, larynx and neck under general anaesthesia may be required to assess the stage and resectabil - ity of the primary site, or in instances where comprehensive examination has not been possible; s...

Division of the trachea Wounds of the trachea are rare. They should all be formally explored and, to obtain adequate exposure, it is usually neces - sary to divide and ligate the thyroid isthmus. A small trache - ostomy below the wound followed by repair of ...

Elective tracheostomy The advantage of an elective surgical procedure is that there is complete airway control at all times, unhurried dissection and careful placement of an appropriate tube. Close cooperation between the surgeon, anaesthetist and scrub nurs...

Emergency tracheostomy If a skilled anaesthetist is unavailable, local anaesthesia is employed, but in desperate cases when the patient is uncon scious, none is required. In patients who have su ff ered severe head and neck trauma and who may have an unstable ...

FURTHER READING Bull P , Clarke R. Diseases of the ear, nose and throat . Oxford: Blackwell, 2007. Dhillon R, East C. Nose and throat, head and neck surgery , 4th edn. Amsterdam: Elsevier, 2013. Lau A, Jacques T , Tandon S, Lesser T . Evidence-based emergency...

Fibreoptic endotracheal intubation In most emergency situations, endotracheal intubation is the most direct and satisfactory method of securing the airway . Nasotracheal ‘awake’ intubation in expert hands is also a well-established technique and is particular...

Fine-needle aspiration cytology and core biopsy This is the investigation of choice when attempting to determine the nature of a neck or thyroid mass. Fine-needle Michael Anthony Epstein , b. 1921, formerly Professor of Pathology , University of Bristol, B...

Foreign bodies Both children and adults may inhale foreign bodies. Y oung children will attempt to swallow a wide variety of objects, but coins, beads and parts of toys are particularly common. In adults, the aspiration is usually food, particularly inadequa...

Glandular fever (infectious mononucleosis) This systemic condition is usually caused by EBV , but similar features can be caused by cytomegalovirus or toxoplasmosis. The tonsils are typically erythematous with a creamy grey exudate and appear almost confluent, ...

HYPOPHARYNX Tumours of the hypopharynx Benign Benign tumours of the hypopharynx are very rare, the most common being the fibroma and the leiomyoma. They show a smooth, submucosal mass lying in the lumen of the hypophar ynx or oesophagus. Malignant Malignant t...

Human immunodeficiency virus (HIV) Acquired immunodeficiency syndrome (AIDS) can a ff ect the ear, nose and throat (ENT) system at any point during the disease. The initial seroconversion may present with the symptoms of glandular fever; this is followed by an a...

Hypopharynx The superior border of the hypopharynx is at the level of the laryngeal inlet. Its inferior border is the lower border of the cricoid cartilage where it continues into the oesophagus. The hypopharynx is commonly divided into three areas: the rig...

INFLAMMATORY CONDITIONS OF THE NECK Ludwig’s angina Ludwig described a clinical entity characterised by a brawny swelling of the submandibular region combined with inflam matory oedema of the mouth. These clinical features, as well as accompanying putrid hali...

INFLAMMATORY CONDITIONS OF THE NECK Ludwig’s angina Ludwig described a clinical entity characterised by a brawny swelling of the submandibular region combined with inflam matory oedema of the mouth. These clinical features, as well as accompanying putrid hali...

INVESTIGATION OF THE PHARYNX, LARYNX AND NECK Plain lateral radiographs Plain lateral radiographs of the neck and cervical spine may show soft-tissue abnormalities, although their sensitivity and specificity is low; of particular importance is the depth and H...