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Other imaging Magnetic resonance imaging (MRI) gives better soft-tissue definition and is preferred for primary tumour staging except for paranasal sinus cancers. Drawbacks of this approach include a reduction in image quality as a result of movement artefact...

PRIMARY TUMOURS OF THE NECK Neurogenic tumours Paraganglioma (carotid body tumour) This is a rare tumour that has a higher incidence in areas where people live at high altitudes because of chronic hypoxia leading to carotid body hyperplasia. The tumours most ...

Parapharyngeal abscess Parapharyngeal abscess may be confused with a peritonsillar abscess, but the maximal swelling is behind the posterior faucial pillar and there may be little or no oedema of the soft palate. The patient is usually a young child and there...

Percutaneous tracheostomy As an alternative to open tracheostomy , a percutaneous trache ostomy is commonly performed in the critical care setting in an intubated patient. A transverse skin incision is made at the level of the first and second tracheal rings; b...

Peripheral nerve tumours Schwannomas are solitary and encapsulated tumours attached to or surrounded by nerve, although paralysis of the associated nerve is unusual. The vagus nerve is the most common site. Neurofibromas also arise from the Schwann cell and ma...

Pharyngeal pouch A pharyngeal pouch is a protrusion of mucosa though Killian’s dehiscence, a weak area of the posterior pharyngeal wall between the oblique fibres of the thyropharyngeus and the transverse fibres of cricopharyngeus at the lower end of the inf...

Phonation/speech The larynx functions by closing the vocal fold against the air being exhaled from the lungs, but the rise in subglottic pres - sure forces the vocal folds apart slightly for an instant of time, resulting in an accompanying sinusoidal wave-lik...

Quinsy This is an abscess in the peritonsillar region that causes severe pain and trismus ( Figure 52.25 ). The trismus, which is caused by spasm induced in the pterygoid muscles, may make examination di ffi cult but may be overcome by instillation of local anae...

SUMMARY The anatomical and physiological performance of the pharyn - golarynx is involved in the important mechanisms of breath - ing, coughing, voice production and swallowing. A variety of congenital, traumatic, infectious and neoplastic conditions disturb...

Secondary carcinoma Metastatic spread of squamous cell carcinoma to the cervical lymph nodes is a common occurrence from head and neck primary cancers; occasionally , this may be the sole presenting feature of the disease ( Figure 52.70 ). The upper aerodige...

Sideropenic dysphagia Prolonged iron deficiency anaemia may lead to dysphagia, particularly in middle-aged women. In addition, they may have koilonychia, cheilosis and angular stomatitis together with lassitude and poor exercise tolerance. The dysphagia is caus...

Stridor in children Infants and children presenting with stridor need careful assessment with a full history and examination as appropriate. If, on presentation, a child is cyanosed and severely unwell, the airway must be secured as soon as possible, but a bri...

TRACHEOSTOMY AND OTHER EMERGENCY AIRWA Y MEASURES This procedure relieves airway obstruction or protects the airway by fashioning a direct entrance into the trachea through the skin of the neck. Tracheostomy may be carried out as an emergency for acute airway...

TRAUMA TO THE NECK The management of penetrating neck trauma depends on the structures that have been injured. The neck is classified into three zones for this purpose ( Table 52.3 ). (Note: this is di ff erent from the levels used to describe cervical lymphade...

Thoracic duct injury Wounds to the thoracic duct are usually iatrogenic and usually left sided, occurring when lymph node level IV is dissected during a neck dissection. When damage to the duct is not leak from the wound in amounts up to 2 /uni00A0 L/day with ...

Thyroglossal duct cysts Embryology The thyroid gland descends early in fetal life from the base of the tongue towards its position in the lower neck with the isthmus lying over the second and third tracheal rings. At the time of its descent, the hyoid bone h...

Tracheostomy tubes Most modern tracheostomy tubes are made of plastic ( Figure 52.46 ). Tubes of various sizes with varying curves, angles, cu ff s, inner tubes and speaking valves are available. After a newly fashioned tracheostomy is created, a cu ff ed tub...

Transtracheal ventilation This technique is simple and e ff ective and allows ventilation for periods in excess of 1 hour, providing time to allow for more elective intubation. The cricothyroid membrane is located as discussed above, and a 14- or 16-gauge plas...