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ENT
Mouth and Pharynx
Built from Behrbohm — Ear, Nose and Throat Diseases with Head and Neck Surgery
What’s inside
12 sections · 198 slides
Overview
- What this topic teaches you
Applied Anatomy and Physiology
How the region is built and how it works
- The oral cavity: its walls and two rooms
- Anatomy of the mouth and pharynx
- The tongue: parts and its patterned surface
- Oral cavity and tongue: regions and nerves
- Tongue muscles and the floor of the mouth
- Muscles of the tongue and pharynx
- The mandible and the temporomandibular joint (TMJ)
- Mandible fracture lines and the TMJ
- Lining, blood supply, and lymph drainage of the mouth
- Lymph drainage of the tongue and its crossover
- Nerve supply of tongue, floor, and palate
- The pharynx: a muscular tube in three storeys
- The three divisions of the pharynx
- The nasopharynx: the top storey behind the nose
- The oropharynx and hypopharynx: the lower storeys
- The pharyngeal muscles: constrictors and the weak spot
- Pharyngeal musculature and the constrictor muscles
- Blood and nerve supply of the pharynx
- Lymphoepithelial tissue: immune cells woven into lining
- The lymphoepithelial unit
- The Waldeyer ring: the tonsils that guard the entrance
- Structure of the adenoids and the palatine tonsil
- Fine structure of a tonsil: lacunae and crypts
Physiology of the Mouth and Pharynx
Swallowing, taste, and the tonsils as immune organs
- The many jobs packed into one small region
- Eating and the role of saliva
- Swallowing: a reflex conducted by many nerves
- Taste: five basic qualities, not a tongue map
- Structure of the sense of taste on the tongue
- Nerves of taste and disorders of taste
- Where taste disorders arise (site of origin)
- The tonsils as immune organs
- Why healthy tonsils enlarge, and how they turn chronic
- Enlarged tonsils and adenoids narrow the airway
- Formation of sound and speech
Methods of Investigation
Looking, feeling, scoping, and imaging the region
- Inspection and the basic examination
- Instruments for examining the mouth and pharynx
- Examining the tonsils and using palpation
- Systematic examination of the oral cavity
- Endoscopy of the pharynx
- Examining the nasopharynx by mirror and endoscopy
- Imaging studies
- Nasopharyngeal angiofibroma on contrast MRI
- Angiofibroma before and after embolization
- Testing taste (gustometry) and special tests
Hyperplasia and Dysphagia
Oversized tonsil tissue and failed swallowing
- The main symptoms that signal mouth and pharynx disease
- Hyperplasia of the lymphoepithelial organs
- Adenoid hyperplasia: a disease of childhood
- Adenoids: diagnosis, differentials, and treatment
- Adenoidectomy technique
- Adenoids blocking the eustachian tube
- Adenoidectomy: important contraindications
- Tonsillar hyperplasia and its grading
- Complications of adenotonsillectomy
- Lingual tonsil hyperplasia and dysphagia
- Dysphagia: the pattern of problems and its treatment
Inflammatory Diseases of the Mouth
Infections and dermatoses of the lips, mucosa, and tongue
- Oral mucosa as a mirror of systemic disease
- Cheilitis and angular rhagades
- Ulceromembranous stomatitis
- Ulceromembranous stomatitis of the palate and gingiva
- Herpes simplex stomatitis and gingivitis
- Herpes labialis at the lip border
- Metal, drug, and allergic stomatitis
- Candidal stomatitis (oral thrush)
- Herpes zoster of the mouth
- Herpes zoster affecting the tongue
- Oral manifestations of HIV/AIDS
- Angular cheilitis, an early sign of HIV infection
- Kaposi sarcoma of the gingiva
- Recurrent aphthae and Behcet disease
- Oral tuberculosis and syphilis
- Primary syphilitic chancre of the tongue
- Hyperkeratosis and leukoplakia
- Hyperkeratosis on the tonsil and pharynx
- Leukoplakia of the buccal mucosa
- Bowen disease: carcinoma in situ
- Pemphigus and erythema multiforme
- Pemphigus bullae on the soft palate
- Lichen planus
- Lichen planus of the oral mucosa
- Glossitis: a burning, sore tongue
- Median rhomboid and allergic glossitis
- Geographic tongue, fissured tongue, and surface lesions
- Abscess of the floor of the mouth (Ludwig angina)
- Dental infections and floor-of-mouth spaces
The Tonsils and Waldeyer Ring
Acute and chronic tonsillitis and its surgery
- Acute tonsillitis: the clinical picture
- Lacunar tonsillitis
- Grades of tonsillitis
- Acute tonsillitis: cause and pathology
- Acute tonsillitis: diagnosis and treatment
- A patient with tonsillitis does not defervesce on penicillin. What should you think?
- Infectious mononucleosis findings
- Infection of the lateral bands, and herpangina
- Lateral pharyngitis (infection of the lateral bands)
- Herpangina
- Scarlet fever
- Scarlet fever pharyngitis
- Diphtheria
- Diphtheria of the tonsils and palate
- Syphilitic tonsillitis, TB, and agranulocytosis
- Primary syphilitic complex on the tonsil
- Vincent angina (trench mouth)
- Vincent angina (ulceromembranous pharyngitis)
- Fungal pharyngitis and hyperkeratosis of the tonsil
- Candida (fungal) pharyngitis
- Chronic tonsillitis: a subtle but important diagnosis
- Chronic tonsillitis with pus expressed from the crypts
- Chronic tonsillitis: diagnosis and treatment
- Tonsillectomy: indications and contraindications
- Tonsillectomy: technique and the bleeding audit
- Bleeding risk by tonsillectomy technique (Audit, 2005)
- Tonsillectomy: incision and dissection
- Tonsillectomy questions, and tonsillotomy
- Principle of laser tonsillotomy
- Complications of acute tonsillitis
- Peritonsillar abscess (quinsy): clinical picture
- Peritonsillar abscess (quinsy)
- Quinsy: treatment and drainage
- Spread of tonsillogenic infection
- Incision and drainage of a peritonsillar abscess
- Tonsillogenic sepsis
- Genesis of tonsillogenic sepsis
Other Pharyngeal Disorders
Abscesses, pharyngitis, and neuralgias
- Retropharyngeal abscess in children and adults
- Retropharyngeal abscess
- Acute pharyngitis
- Acute pharyngitis
- Chronic pharyngitis
- Chronic granular (lateral) pharyngitis
- Atrophic pharyngitis (pharyngitis sicca)
- Thornwaldt cyst and Plummer-Vinson syndrome
- Neuralgias of the head and neck
- Globus pharyngeus (functional dysphagia)
- Basic conservative treatment of the mucosa
Trauma, Nerves, Pouch, and Anomalies
Injuries, paralyses, pouch, and clefts
- Alkali and acid burns and scalds
- Foreign bodies in the mouth and pharynx
- Mucosal injuries and tongue trauma
- Neurogenic disorders: pharyngeal paralysis and spasm
- Pharyngeal pouch (Zenker diverticulum): clinical
- Zenker diverticulum in the Killian triangle
- Zenker diverticulum: pathogenesis and diagnosis
- The Weerda diverticuloscope
- Zenker diverticulum: treatment
- Pulsion diverticulum and spur division
- Anomalies of the mouth and pharynx
- Clefts of the lip, jaw, and palate
- Typical types of lip, jaw, and palate cleft
- Cleft repair: a staged team effort
Tumours of the Mouth and Pharynx
Benign and malignant tumours, staging, and treatment
- Benign tumours of the oral cavity and oropharynx
- Malignant oral and oropharyngeal tumours: overview
- TNM T stage: lip and oral cavity (Brierley 2017)
- TNM T stage: pharynx (Brierley 2017)
- Oral cancer: clinical features and frequency
- Carcinoma of the right tonsil
- Carcinoma of the lateral tongue
- Oral cancer: diagnosis and staging
- Oral cancer: principles of treatment
- Surgical access routes for tumours
- Carcinoma of the lip
- Carcinoma of the oral cavity and body of the tongue
- Oncogenic viruses: HPV and EBV
- Carcinoma of the tonsil or base of the tongue
- Directions of spread of a malignant tonsil tumour
- Tumour surgery and temporalis-flap reconstruction
- Nasopharyngeal angiofibroma
- Angiofibroma: imaging, specimen, embolization
- Open removal via lateral rhinotomy
- Rare benign nasopharyngeal tumours (chordoma)
- Malignant tumours of the nasopharynx
- Nasopharyngeal carcinoma: presentation and treatment
Sleep Breathing Disorders
Snoring, apnoea, and reopening the airway
- Sleep-related breathing disorders: three clinical types
- OSA: why the airway collapses
- Defining OSA: the apnoea-hypopnoea index (AHI)
- Diagnosing OSA: a stepwise workup
- Surgical setting for sleep endoscopy
- Drug-induced sleep endoscopy (DISE)
- Sleep endoscopy: concentric velopharyngeal obstruction
- Sleep endoscopy: tongue-base obstruction
- Sleep endoscopy: epiglottic trapdoor phenomenon
- OSA: conservative treatment and CPAP
- Nasal CPAP therapy
- OSA: surgery by airway level
- Levels of upper-airway obstruction
Summary and Key Points
Pulling the topic together
- Three ideas to carry away
- Key takeaways
- References cited in this chapter
- Ear, Nose, and Throat Diseases: With Head and Neck Surgery