oy ee 4 fxamination of ip, buccal cavity, teeth, sum & floor of the mouth Greetings, consent & seff introduction 4. Inspection Tongue (is FSET CHR TA, BIA G THO, TF FAUT, STS eI), to see the motor function/ movement of ee IGS eT), to see the motor function) tof sce for any swellings, ulcer, scar mark, deformity etc : 2, With the help of tongue depressor (metallic curve tongue depressor) ‘see the vestibule of mouth, teeth, tongue, under surface of tongue Depress the anterior 2/3" of tangue and see for peritonsilar abscess, acute and chronic 3._ Indirect laryngoscopy by laryngeal mirror. i 4. Palpation of jugulo-digestric lymph node. consis. (Noise- 22] 22. Examination of oropharynx Why digastnie 2 lies neon to pont. billy of, digesrie Why dugule 2 — ker nme to internal gogaler See above Pr i s instruments. a. laryngeal mirror _ b, Gauze Headlight 4, Ughter aa Procedure- ae | hold the laryigeal mirror by right hand, heat the mirror surface , Rand tank gt fe braath. via mouth — AW ietion of votal ord) ia 71. After focusing of fight, jor wall of pharynx) 2. Hold the tongue with gauze by the left 3. Place themetalic siface over the base of wut 4 Nibe eee. (Adduehon gf Votal end) (don’t touch the poster ed 3, Median Glosso-epiglottic fold 4, Lingual surface of epiglottis 5, Ary-epiglottic fold 6. Arytenoid cartilage 7. Pyriform Fossa 8. Vestibular fold (False vocal cord) 9, Vocal cord 10. Few rings of tracheasoe cardinal features oftonslitis: 1. Both tonsils are eneged ot ose rerorplfarsare congested ‘anterior plats are cones Cee ——— 2 2 Fa none ade BSN ar one inspssated pus may come out on pressing NST TS = 4. tasplsated pus may come! sr2* Tonsilarcryptei2212, neal Biggest crypt erypta megna/intratonsilar cleft 30. Ste oflugul dgasteloh node lly of igostrcs muscle and cust nch blo bathe angen erable paren nepapeNeaneNY S87 STE | internal jugular vein 41, Larvngeal mirror, tongue depressor ie Diagnostic use of metallic curve tongue depressor (by righthend) 1, To see foreign body In oropharynx 2. Tose the acute and chronic tonsilitis 3, To see peritonsllar and retro pharyngeal abscess és Therapeutic use-(by left hand) 3 41. To remove foreign body 2, Toincision and drainage the peri Tonsil and retropharyngeal abscess Diagnostic use of laryngeal mirror- ‘Any lesion in the base of the tongue to pyriform fossa Acute & cheonklarynctis Vocal cord polyps). vaeye grit nl indirget.cause farynx can be seen by mirror eB fatne, ape. fro elt), Coricutate (fro elastic), cunelform (Nbr. Unpaied- Tyrol hyaline), eid (hyaline), Enigotic (bro elect) peace) 14, Division ofl 1. Supraglottic (inlet of larynx to upper border of vocal cord) + 2 Glottic (vocal cord) 3. Subglotic (vocal cord, lower border to upper border of cricoid cartilage)qi5 lems sunny of Interior of lary rorsuonly- futhe mvscles ofryix except ericothyr pyesternal laryngeal nerve "Old are supplied by recurrent lary er ay Beal nerve. Cricothyroid is supplied fvovethe vocal cord: internal la ryngeal nerve feow the vocal cord- recurrent lenven laryngeal nerve 15, Diferent parts and boundary of pharyny socminadult Part 4. Naso pharynx- below base of the skull 2, Oropharynx lower end of soft palette 3 (behind) 3, laryngo pharynx/ hypo pharynx- upper border IISGFCS to lower borderah Cote ere foto ler bree fccald anagem) (916. Length of esophagus Length-25 em (10 inch) Extension-C6 to T11 ‘Cross the diaphragm at the level T10 a7. ts hagus 1° Cervical (4 cm) 2. Thoracic (20 cm) 3, Abdominal (1 ern) 18. Mention thie si 1encement and end of esophagus From upper incisor es 1. Bepharyngo esophageal junction(cs)-15 cm 2. Gssing the arch of gorta (T4)-22.5 cm 3. att inciple bronchus (T5)- 27.5 em 4. Pie (710-40 cm: Fn rnin nar me penQ1. Triangles of neck Anterior & posterior part [s separated bY digastric & omohyold muscle cernocledomastotd ‘Those parts are sub divided by the ac told muscle. Those parts are sub dh 7 stent 5 1. Anterior a. Digastric Triangle b. Carotid Triangle . muscular Triangle d. sub mental Triangle 2. Posterior . Occipital Triangle b. Supra clavicular Triangle ee 2, Mid line & lateral neck swellin i Lateral neck swelling Mid line neck swelling i 1 Sub mental lymph node enlargement I. Branchial cyst 2, Sublingual dermoid 2, Carotid body tumor 3. Sub hyoid barsitis 3. Cervical lymph adenopathy. 4, Thyroglossal cyst 4, Sub mandibular gland & lymph node 5. Nodule of thyroid isthmus enlargement 6. Pre tracheal, pre laryngeal lymph node 5. Nodule of thyroid lobe enlargement enlargement. 03. Lymph node of neck =" Level 1 Sub mental sufanbulgy 5) Level 2. Upper 1/3" of jugila? chain (base OF the skull to hyoid bone) Level 3. Middle 2/3 of ugdlatehdin (hyold'bone to cricoid cartilage) Level 4, Leyes rhe pelea cartlage to cavicle) Level 5. pdstefior triangle Bik Level 6.8r¢ tracheal, Para tracheal, pre laryngeal ~ yy Mocledomastoid region atthe junction between upper 1/3°& lower 2/3" Branchial sinus- in sternocledomastoid region at the junction between upper 2/3" & lower 3te Treat re auricular si Excision & complete removal of the sinus Facial nove —» Totall 4A brandhy Jarrinal 6.» Parotid gland « devided by focal ee NLub mandibular gland is divided into sy anual examination Perfictal g submanalbular node ies superficial tthe my lo hyoid i aan + Pra. 4. apre pharyngeal fascia 2. Prevertebral fascia 3, Visceral fascia 4, Carotid sheath 0 0.9. Points of exemination of neck mass Temperature Tenderness . Size, shape Surface margin Consistency 1. Transluicency |. Fluctuation 9, Reducibility ic. 40. Fixity with overlying skin 11, Mobility: > 12, Relation to surrounding: structure R mM sub. Mandl ular tymph node lobes by myi PY mYlohyold muscle. So it ean be felt on bi deep muscle cle & cannot be felt bi manually Metial to latnal (AVN) Common aatotid antiy Internal jegular vein Vogua nowe— ent of mass: CAof nasopharynx, tonsil, base of the tongue, laryn%, pyriform Fossavel sm, hor. ‘onine}, T4 (thyroxin) from follicular cells & cal\toni oe Jormone-T3 (tri fodathyronine), el ender ne ore connected by isthmus. stuation- glands ie against the C5, C6, C7, 71 calls. 2 later from Pare follicular vertebra Ipuc ener rom mids of ironicartiege tothe aor 5” trachea! ing ch Jobe extents from mi a | Ree eam 2chel ne | ete a perior thyroidartery brench of external carotid artery | Peta 3 inferior thyroid artery branch of subclv oo | 3. Thyroid ima artery from brachio cephalic trunk Cin om individual) ‘*Venous drainage- 4. Superior & middle thyroid \ein drains into internal jugular Yetn) 2. Inferior thyroid vein drains in left brachio cephalic vein ‘Nerve supply= ‘Middle cervical ganglion *Palpable- when itis double *Visible- when itis triple y Q.1. Procedure of examination of neck swelling- Consent, positioning, head light Condition of overlying skin. Moyemiéht of gland during deglutition ‘MdGement with protrusionvof tofigue : root Get beloWAhe sweling Measurement of swelling, Auscultation- with the bell of the stethoscope to hear thyroid bruit, ©xamination of hand- Handshake to see the pulse, sweat/dry, warm/cold, tremor (fine)interpretation” yoerthy0id Hypothyroid Hee tachycardia bradeardla sweat ary Warm cold Fine tremor fromback Consistency of mass Mobility Fivity with overlaying skin © surface Margin eyesign- « Exopthalmos a. Von Graefe’s sign the uPper CY seball as te patient is asked 1° Jook downwards (lid 128) bb. Joffroy’s slgn- absence of swrinking on the orenesd wen te patient face inclined downward cc. Moebius’ sign inability '2 id retraction chernosis (62s reli lags behind the ey looks upwards with the converge the eyeballs ema of conjuncvs) alt the lymph node neck 6. Palpate \goscory artery, the carotid PUISE 7. Indirect lary" fit invade the carotid sans sign ether? Ea mf the hyrald& cannot be found hes ings tre palpation R obstruct acoccur sien 626 ahyrotd swe trochea procunt ol epitatry teres vethod of eV: enough which pressure te trachea, During examination (Fexopt=imes present oF not) eniphregger.™ ost: apysostossal 5} presume sinsc 2. mld ine & lateral neck swells ss in es —“iatersineck sve a sranchial cyst oe Teneck swelling —— —— aI tid body tumor wi ent “Sab rental fymph node enlersem a 2/_ sublingual dermoid = Se Bl sue gub mandibular gland & lymph node. 4. Thyroglssal cist ane 5, Nodule of thyroid isthmus ea 5 Noe arp larynecltvmon nove aes) enlargement roid wel 93.iffere oftongue (T2651) yrogossal eyt move upward after vse? 4, snvestigation roid 4, Measurement of 73,74 & TSH pm aeasremen en Ta Te neste oe m Hypothyroidism 73, T4 decrease; TSH eine Be a ranran aus (ene Noade armenian) dete ie j ois intent To tl ME oats) User Se mine a ease Thy scan by radioactive todine 131(ma117 eerie omic) escapes tan © SOP sn4 otny uptake or character of nodule Interpretation- Hot nodule erase tke ‘ ‘Warm nodule: nora untake (Euthyrelé) Cold nodule- decrease uptake = cold nodules% are er in malignancy i 19,201 Treatm sistrun peter cexcisiorofeyst with idle tird of hyeié bone and core ofthe tongue issue {to preventihe recurtente) Tyroglssel duet develop efor hyd bone, so Bone also be excised. 26. Neooas ods él fot f thyroid gland 41. Benign- follicular adenoma 2, Malignant- Primary 41) Follicular epithelium: differentiated = Papillary carcinoma (60%) + Follicular carcinoma (20%) 2) Follicular epithelium- undifferentiated ~bnoplontic earvinoma (407,) es a ae oe Medullany tansinoma (5p) 4) Lymphoid ect, — Lymphoma Cayo) © beeonany — “eae Te diem op boo _ileny KadREE BF malar mus ~Loeal ve Maeve.» ownothete72, Near total Hivraidectorny-totel lobectomy (2 lobe) + jsthmusactomy + subtot inne tot Babe Kuring lm bar cindnaion oe 1) Anaplastic ¢ 3) Para folicuar ceig °™® 10%) = Medullary car. 4) Lymphoid celis- "2 (5%) > lLymphor @ Secondary- metastny 4, Branchial cyst 2, Branchial sinus 3, Preauricular sinus old swelling is clinically euthyroia 16 thyroid then he is said. euthyroid en 4, Follicular adenoma: lobectomy with isthmusectomy + thyroxin replacement 2 Papilan/carcinoms- total thyroidectomy with neck dsectio ao iodine ablation + rl hyena {lifelong) in suppressive dose to suppress TSH Ms Follicular carcinoma- total thyroidectomy + radio jodine ablation + thyroxin therapy (lifelong) In suppressive dose to suppress TSH 4, Medullary carcinoma- total thyroidectomy + lymphnode resection + oral thyroxin | 5, Anaplastic carcinoma- rz apy (6 Lymphoma- radiothersi a mae » A}obectomy (2 lobes) + isthmusectomy a aece tal lobectomy (another side) to sovepara thyroid gland ; eae 3. Safustalthyoidectomy/lobecony. ay onelobectomy jsthmusectomy 4. \stitlusectomy- only isthmusectomy but no lobectomy Heemorrhage Injury to recurrent laryngeal nerve Injury to superior laryngeal nerve Injurytotrachea & oesophagus Respiratory distress due to tension Laryngeal oedema ‘Thyrotoxic crisis Para thyroid insufficiency pao eee 2 dn cone ¢ unilateral POU fron aronlly- fransima thd from norumal car. y 4 mul Ge dunes on pound 19 dintontd ear to ie She ial9, Thyrold insufficiency, 410. Wound infection **complicati Haemorthage Hematoma Parotid fistula ‘Wound infection Keloid formation faa nena lure s+scompllcaton of parathyrol insulin Para thyroid tetany Treatment- 1. 10%, 410ml calcium gluconate infusion for 10 minutes 2. Calcium with vitamin D +epecurrent laryngeal nerve: right side Is short due tot eross the subelav/2" artery (injured during 07) & leit Tide is longer due to it cross arch ofthe aorta (its porn to disease) itis called recurrent due tot goes to chest then return back to neck #*injury to nt laryngeal nerve Unilateral- hoarseness of voice Bilateral- respiratory distress. f- 9, Treatment of b tance Complete excision ofthetiec up to the pherynx ‘tractet branchial cyst because it may go through the bifurcation of the Artery supply- supplied by external carotid artery Venous dralnage- retromandibular vein ‘inflammation of salivary gland- Sialadenitis ‘Stone in salivary gland- Sialithiasis4. Incision under GA 2. Incision & drainage like ty pleal paroti 3, Antiblotics- Ceftriaxon, idectomy under fliucloxacillin eee 1. Pleomorphic adenoma 2. Warthin’s tumor 3, Oncocytoma t 5 1. Muco epidermoid carcinoma 2. Adenocarcinoma 3. Acinic cell carcinoma 4, Malignant mixed tumor nation test positive in- 1. Cystic hygroma 2. Branchial cyst important IS (Fine Needle aspiration Cytology) in thyroid swellin To detect whether the swelling is benign or malignant Q15, USG of thyroid Peye 1. Fpberculin test 2. TC,DC, ESR 3. FNACof lymph node 4. Krayof chest. eee unt of pre ai sinus Excision & complete removal of the sinus‘**2Classification of thyrold swelliny a simple goiter (euthyroid) a. Diffuse hyperplastic goiter b. Multinodular goiter Toxic goiter 2. Diffuse toxic goiter- grave's disease b. Toxic multinodular goiter ©. Toxicadenoma Neoplastic goiter a. Benign’ b. Malignant Inflammatory goiter 2. Autoimmune- chronic lymphocytic thyroiditis, b. Granulomatous- De Quervan’s thyroiditis c. Infective- acute, chronic d. Other- amyloid *Thyroglossal cyst- congenital “Thyroglossal fistula- acquired Hashimoto’s thyroiditis