QTORHINOLARYNGOLOGY mastow (Mast — mi fownes) ‘Towne’s View ayers View ‘Sahar View: Projection | AP projection ofthe ski wi | AP pijecton ofthe skull wih the head | Lateral projecton of the sku wih the. beam source. 30° above | tuned 45° toward the slze one vishos | beam source 0" above the the carthomeatal ine te oxamino & tho beam source 45° | canthomestal ine above the carthomestl ne View | Caw ow of te rama [Provides del vew of tng exaral | Shows oon of pioonalzaion oe ‘comparison of the petious | auciory meatus, masiol’, & palrous | marc yramid & mastlde bone’ {Prasat - wal-doeeped masa (2) Dipioic— wit twinge ar cote (8) Scieroic — with opacly dus to i | Satta PARANASAL SINUS Es z Wales Vow caw View Sa aia Sosa View Deiptonortal Vow & | Coastal ew Sierra vow = those aw ‘oroead oes view Pre Patants hood Wed [PA lwo sl wi Pee eae witntrose he in | tno bear 1 20" tem ine ts pret the oe, | fe heat ft, aye Stones te ie 7° uendar 10" the from tot, rays ao Pectin | ‘raed nonsaahy | trough te sla ures Beater wala aur Fase Seas Pye Open mouth Waters feces | Mion ~spheot nse Tsao Front niet | Riot somos | Paansr —— amo] Sparse. pore atid sirueos | sphareld snes, | forte” & namiay | chmod macys Nasaltoneseqvstd | lminapapyraces | suse &colatursea” | terial shusee 1 fepecing nasal ache tee ton Newest. Punoroe View Probe ho Bos ow ot te mandible + Requested when suspecting mandibular racture (mat sor sto beng the angle, hang te thinnest bone), deronveler abscess (DAA), amelobiasioma, & osetecmyslisis of the mandible ~ i Nock som tissue itera (Neck STL) ‘+ Requested when suspecting fereign body lodged in the neck, epglits (seen es Thumb sig), aryngotrachecoronchis e000 28 eepe sign") CXR APA. to inciede the neck and abdomen, + Requested when suspecting foreign body in tho aorocigestve tract ‘+ Possible for chigren ctherniae request for CXR AP-L fo Include the neck (ra separate STL whon not possble), pain abdomen ‘Nose soft tieaue lateral (Novo STL) + Requested together wih Water's Vow when suspecting nasal bone fractures ~ usualy felt eter geting water ito the ear, because the cerumen ewals, impinging on the pain ‘receptors in the extemal ear. May occur wih secondary otis exigma becauce of the cumsy efiors to remove he Conductive hearing loss — usualy not circa Sritcat. Cn Weber, teri atrizaton to tho ated ox Se epprented wren inpcton lent spor) a Page i of 1 inolaryngolegy ‘Jepeapal uPcKosTreatment Softening of cerumen wh baby oi or commercaly avalable ceruminavics, such 2s Docusate Na (Otoecl) 05% X 1OmL (Us on ‘he side, tuning the head sideways, slighty towards tho suriace on which you are ing. Fil te eer eanal &etay inthe pation or minatos then inserts coton woo! plug. Repeat tothe other ear I necessary. Max o 2 caneecuive rig). Have the st come beck ater 1 wook for aural rigation with clan lcewarrn water. Aural rigation i done wih the stream directed behind the cerumen and ‘et rect at, which may push I turer down the canal. [Semple charg >= "T pesiy aby pe spt 0 7 ny on acted oar 7 ya gs p10 x7 co | Rebate Feats o7ms EXTERNA ‘May resut fr ear maniptition (0.9. sharp metal abject) or the presence of foreign otjectaforsign body (FB) ‘Most common atciole agent is Stafycoceus aureus, a normal tera of ho exam ear Cuassieaton 1. Difuse ~ simmer’s oar. Swoling othe entire extemal ary mestue (EAC) + = ._Greumscrived = furuncvicsle. There is ony a creumeorbed ewoling afecng the hairy portion of he EAC. {endemess on manipulation of pine o ragus B.Serous ear discharge 4. hearing loss if swollng oooludes tne external oar _sweling on otescopy aie Beara is Media Pan Severs Notas savers "Tendarnaas on inna Tague Present ‘Absent Fever Abort Present al History of RTT sual none Usually rosa Histoy of ear manipulation Absort Hearing Not mpaied Tinpaied Masioid sar Rommal With evidonee of masts Treatment ‘Systema ofl antbictc ~ treat the infection. For children: Cloxacilin 60 mgkgléay in 4 divided doses X 7 days (126mpl peparaton) '. _Toplel steroid — reduce the sweling; usualy prepared with antbatic 1. Corticosporn: Hycrocarisone + Polymyain 8 + Neomyoin 2 Aptos Puoohione» Pohmmpen 8s heomyehy 5 Syraltr uscoiono Popa 8 > Near ©. Oral anaigene~forpan Trea ld or ae vith PUD: COX ahbos I Etlods (Arcos) 120mg OD = prefered by ENT 1. Colcol (Clbret 200mg 09. Wi. Reco (Vis 28 mg OD 3 Sratddomr: Nal ht omg 1 8. _For hen: Peracearal To mgftay pn (12a. and2S0ne/SmL propane) Fete tats le one ei te aepleation of Ootooescr. i nero no response art wah, then suspect Pasiderenasinfecton and ive a quinolone wh an: Peouomanss atv Such a8 Ciprofloxacin 500 mg tab . |_Samole Chart Enty lacln 60gfcap 1 cap PO CID X 7 days (acs) Cortcospon Ge Drops gts TID 7 days | | Erte 120 mga 1 tas OD pm or pa adits) ' || Aural tote win 1.0, 3 gs TID %7 aye prot spoieaton of Coricoeporn [ GS a'r ossosrert. ‘ACUTE OTMS MEDIA * Infection ofthe middle oar <+ wack * Usual resuls from obstrucion of the Eustachian Tube (ET), which serves as drainage ofthe mile ear. Siig too hard ‘causes @ negative pressure in the middle war, closing the ET tube; bowing the nose hard crestos a peeve prossure inthe idle ear, opering the ET tube * Obstruction ean be other ‘2 Mechanical ~ 2.9. berign or malgnant rumors ©. Functional e.g ale palate Page 2 of 2 Ctorhinoleryngology /epeapul vPcHasPreetsposing taetors ‘young age ~ ET le wider, shorter & more horizontal compared to acts 1. nmunocompromised sate = causes recurrent UAT! ©. alitude changes ‘6. ote feeding - grata isk than bresstloecing . _sngertal detect (aah plat) {Benign or malignant magees in the nasopharynx Sages eRe ‘= _Hyporomla— onset of isease; presents with otalga, ear fulness, hearing loss, over, (+) peripheral congestion ofthe oar ‘um on otoscopy . Enudative— pouring offi in te mids ear; prosonts with increased otlpla, oa ulness, hearing les and fover © Suppuraive— rupture of TM wh cscrage;eosers win musiputietdacharge, deceased pain, docoesod fever, but Increased hearing lose 14. Resolution / Campleations —a sujcal ears these with compilcatons Geaeeence~ touring of moepeosiaum “v ranage BOS > vrai sas - oa nanan? — Scion ~ pe rochual over emp masiocecony Treat elton recon { 1°" Far elton Amel 40 may MSE 8 done X 14 Gye (Tg end sci 2. itn TM prorat uch a ng he toe of puto, xo arbi such a Comer TN pte uch = dung he stage of supra, sane sch ae may ko giver bacaune of perrton alow fib ery he ag st ot 2. ite iro respons ater 'weok empedPeousonenae ncn ard gve 8 qlee wih ant Panscoronas ey ihe Gsotoxeen 5. Aalto someon Ire mace srg. Ri done roo sppcton of oicoepe, &Etopenigenerces we coe toopen the ET an ts prove age of itl a secroins rr Vaneba manner” Ato Dow none agua coeed math are pene ET 2 Tome marevar~Aak ta slow ntauth & nue Cased pens ET 5. Ghmng gun [Sana cranny | “avanS00mpp 1 cap TD 14 dye | Goticomorn ees ge 10X14 sae (on usp) | zlota win Hr ge 10 Xe Saye (ny fasperae) Ai reesse GP RED Frege ET pening ences 5 ar ape rasan ‘2 Extracranial complications (FLAPS) Facial nerve paralysis Labyryahitie Abscess ‘Subperiestal absooss Bezold's abscass abscess in the SCM Gitol's abscess - digastric Petros — Graderigo's syndrome (ORE) Diplopia a to atral ects etorotl pan do ictamentof th pt nerve Serscrinoirel ann ee ©. Internal compcatons MATH Moringle~mos eoman seer pa ear ora et cet) ‘Hydrocephalus aa CHRONIC SUPPURATIVE OTITIS HEDIA (CSOM) + Infection ofthe middle oar >4 weeks; persistent sar discharge on a perforated ear >Ewooks +, Fever nota constitutional sign Classicaion 2. Active ~ (x) decharge . Inactive ~ () discharge > 3 monthe ©. Quiescent ~(-) diecharge <3 months + Mastotd sories ie roquestad to assess preumatization ofthe mastold and aseess for cholesteatoma + Pure tone audomeiry and speech esto assess severity of hearing oes ‘+ Tympanomeby is requested TM i retracted, dil or suspecting ron Infection ofthe mile ear Page 3 of 3 Otorhinolaryagelosy Fepeaper vPcnos‘Benign ‘Dangerous Porforalion is cartalrogardoes of eis oF ahaa Perforation Te Toad or Tsated atthe margin, ale (pare Taccida) or postro-superior “Miacosalrng nthe mide ware edematous Mucosa round the peVoraion Te replaced by talfed ‘squamous epthelun. Gholestealomatous debris may be seen ‘around the peteation or inthe atle ‘Granuiation or polyps are frequery seen ithe ral obsSaring tha drainage ‘Amoxicitin S00mgjcap 1 eap TID X14 days Gortcosparin otic 3 ts TIX Ta dys (ly fave) ‘Aural tote with HeOx 3 gts TID X 14 days (only i active) i ‘AEM, neroaso OFF, KED t Frequent ET opening exercises | CB after 7 days orre-essossment | CHOLESTEATOWA = Sonar ‘argos t racotocancy eurounded by arees of serosis with + Seen edogmpiay tan rgd mas annum (ton gpa a a radlecy ares of sles ne abeoulten. Bory dosuston or erosions may Be soe. Coal ers pea wht er Gochae, very feu song pert. *+ Plana contrast CT scan wih smn temporal bone cus is requested i cricalypositve fr cholesteatoma for OR planing pir topossbitympenomastadeciomy |_ Sample Ghat Erny_ |-——~ asic aie | Piast. Grrisl CT scan pli & conta wth tr temporal bone cite fen rio VO (ANS and ron a Gindamyen omg than 30mg gah Gencospcn a's gt TID (only suppurative} ‘arly Hs 2 TD actr) Frequent ET opening exercisse ‘TOB after dey or ro-assessment ‘AURAL POLYP + Squamous hyperrophy fom the mil or extemal ear PRESBYCUSIS ‘Hearing oss related to aging process + Normal otoscopy ‘Sample Chart Entry |—~ | PrasT |. Forpossitie application of hoarng alt || TCB once wth resuts / | Si alent ENSORNEURAL HEARING Loss +ilay be uo eone owes but noe, a compoon of CSOM, aa su then or une + Grldebr wee terabon sh nef a Sane chet Ey} peer | 5 oe rate Page 4 of 4 Otorhinolaryagology ‘Jepcapel UPcHOSSPEECH DELAY SECONDARY TO HEARING MPAIRIENT ie nl ot tc causes son as ete |[senpie Ghat Eory PAST Rater t Pdia or elution and comenagement $788 once wh resc EXTERNAL AUDITORY CANAL BLEEDING SECONDARY TO EAR MANIPULATION i Fue out other causoe Antibit i given due to damage to EAC mucosa predisposing to infection (aeeioine ris eee eee Satie race cegox en Semin, feat aes See Hos eamon adage sens: Samu Hue, Meal cataral, rashes = obstruct 2 Set ee : Soom cass eoaicores ae Say Sauer ar oosiai [(Sarete Ghat Erery ; "| Gormley 625 mcap TID or 1g BID X7 days | | | Increasea OF | TOs ater 1 wook fr ro-agesement B.” Givarle- > 3 months, most corimon causa ls urireafed acu crus; usualy mized Wa {Saree Ghar Entry -—— “Tene aotes Goramoncay 625 malep TID or 1g BIO X7 dye t ‘OF! | Nasal othe 10 on each mst, ereased OF! ‘OB after | week for o-asesement \, = . =a ae [Natal douche Is prepared by mixing 1 tsp rock salt 1 tsp baking sod, and 1L of bolle tap water made to oo. ALLERGIC RANTS Sipe and Symes tnoezng aay, wut inthe momig) Sug ay vay nasal prs ‘Congestod nasal mucosa onrhinoscopy alergc salute (reaso noar the tip ofthe nose due to frequent rubking) erg shiners (ckn hyperpigmentaion below the lower syelid) ‘eigers —_may be present; most common alorgens are household dust mie, cockroach, grass pollen, molés fami history of allergy erscna hciory of bronchial asthms or eczema Page 5 of $ Otorhinolaryngology, Jepeaps) UPCHOSTreatment 12. Topical etroid—rllve the inamation "1. lleasone (Fixotde) Fluticasone nasal spray 2 pus / nostrl BID X 14 days & pm — Usualy prescribed by ENT 2 Budesonide (Eudecor) nasal soray 64 mogidose [X 120 doses} Inialy 2 pute in each nostn daly. Maintenance: 1 put in each nest aly b. Oral ant-pruntus 1. Gata (Viti) 10 mga tab OD at HS X 14 days 8 orn 2. _Loratidine (Clan) 10 mgftab Tlab OD at HS X14 days & pen © Decongestant are no of proven benefit and may cause rebound rhinle(hinile medloamentosa) it used for more than 5 aye (Beno cht roy -— sono cepa [ Psa salar 2 pute not 1 x 1 ay 8pm Carita (in) pas tes OO anes sane ose | Read engceue eter Aer Rory ae Re kn xing TCE ater 2 wooks for re-gasessment nied secs - NASAL POLYPOSIS * Usualy arises trom the esteomeatal complex (MIM HUBAd: Middle meatus, Inturdibulum, Maxilary sinus ostium, Hits semiunars, Uncnate process, Bula ettmolsale, Agger naa!) Symptoms Signe: Nasal dbstucion~mey cause sus veto strut of te crainage of ental and mail iruses b Anoemia © Rhinorthea(watory to muced) 5. Smooth, gelatinous, semiansparent o pale white mase on anterior hinoscopy 0 No pole T donot pl nd the midlets © may require Terviswaizaon TT[ Polyps extend bsiow urbinae. Vi speculum. TI] Polyps touching the nasal foo. May occioda ihe erire nasal caviy. Way be teen WwoUgh the Veslbule WinGUt The ad aTa nasal speculum ‘oniparson of Nasal Pop & Tbinaes Nasal Pops “Tarbes aor “alinned grapes" Pink rd tect td 3) Mobi Nia Fred Ear ro a) Tocaion Usually at oeloomeaialcomplor Along ene Taal nasal wall ‘Gonsistoney Sot oo Treabrent '. ” Surgory: (PEA) Polypectomy, Ethmoideciomy, Anitrostomy. Done under LA it midle-aged. Done under GA in children 8 elder. 'b. Starlds — glven 1 week prior to OR to decrease the sling & minimize bleeding itragp 4. Predrisone frghkg GD X 1 wosk prior to OR 2. Metryiprecnisoiona 16 mg 2 tsb OD every othor day for 1 weak © SAPOD cleerance: CBC wih PC & 06, BUN/Cree, RBSIFES, Na, K, Ci, WA, 121 ECG, CXR Same an Ere PEALAcio minor OR ‘redrigane YOmgKg OD X 1 week prior to OR ‘SAPOD clearance: GAG with PC & DC, BUNCree, RBSIFBS, Na, K, Cl, UIA, 12L ECG, CXR ‘TCB once wih results fr OF scheduln NASAL FOREIGN BODY * Usual presen as sunilteral, fou-smeling, purient nasal discharge, usualy in children & hanleapped + Removal may be done wih theuse of Hartmann forceps, aligatc forcaps, ofa blunt ight-angled hook Done in office setig with ‘the use of resraits for uncooperative tions, especialy chien. INVERTING PAPILLOMA ‘+ Most common benign neoplasm inthe nose & sinuses ‘+ Premalignant laion usually vrata 10% dovolops SCA. + Complete excision Page 6 of 6 otorhinolaeyngolosy Fepeaput uRCHOSTHE THYROID GLAND fan Fai We ‘Cool, ty, coarse sn; ess of hal ‘Sweling of ho fac9, i ‘Gal intlorares ued ‘Decreased inion of haar sounds ‘SBP, TSP. Intolerance, palptiaions, Gaphaglalayapnes, ingerremors ~ NOBULAR NON-Toxic GOITER (NTNG)_ ‘+ Prasent as an asymrmetic anterior neck mass (ANM) that moves with deglttion and usually nedular on palpation; no or minimal _symptoms of hypamyperhyreciam [Sample Chart Entry fmm as Fra, TSH ER a th rie DIFFUSE TOXIC GOITER (076) resents as symmetic ANM which moves with ceglution ana smooth on palpation: with symptoms of hyperthyroidism * £14 je requested and not total T4 because isthe active form. Free TS is only requested when both FT 8 TSH are normal and ‘he bts cincally hyperthyroid. Betwoon the two, TSH le more slagnesti of typerthyroiism. Catwin pea De | Fase 10 ara song i 2 wm ot | rare Sonat eB forced ptt, rd ans fer to ENDO re: DTG. ee a = - NODULAR Toxic GOITER + Net vor commen; pass as an asyretis AN wich moves with degliton andrea en poo, but presets wth Syma ot yperhyrodam Tame FRAB's doe becae fight of coun of CAln alr ote [Sample Ghat Eney _ f-——— Tae | Baton TU Somgtab 2 abs TD Onirm of soma Propranll rgh fl BI fr achyeara,pptatone, ac aie) Ratoro ENOD NT DierUBE NowToNEC GOITER * Not vay common presets wth sets AN which moves wih gon ard sos on plan tt has no spams of ‘hyperthyroidism Treatment FNAB isnot done due to low incidence of CA in DN. Thyreld sean is requested to determine the size and activity ofthe ANM. Page 7 of 7 Otorhinolaryagelogy /epeapel uPcHosMost common completions of hyo u = Tararte «West ata rare ros nad prot sty 5. Hypocaloamia~cceurs i al parathyroid ands are avert removed ori acheria coca . Recurrere laryngeal nave vansacion~ Pt wou prevent wn Reareanoss ‘THE UPPER AERODIGESTIVE TRACT BELL'S PALSY. : ‘.Faciat nerve paralysis (ON Vl) usualy fotowing irl nfection GGracng of Facil Nerve Involvement {2 sors involved: cant sme 354 chooks voted S orbiculais involved: car olose eyes 6 frontal involved; can't wrinkle forahoad ‘Sample Chan Enty | EMG-NCV Prednisone Smpfab 4 tabs AM, $ tab lunch, 2 tabs PMX 2 wooks Etoniconb 120 mgtab for pan Flor to Neu. Fete io Opttha re: Expogure keratitis ‘TEMPOROMANDIBULAR JOINT DYSFUNCTION ‘+ Most common: Myotaselal pain and dysfunction, usualy the result of brusm or jaw clenching, related to stess/ anxiety! ‘depression chron pain * Less commonly due to mechanical probiem or OA. Or pmary intemal derangement of joint (has clicking during opericose) pigadina te dee Genacomert, due a mary cause. ‘Traumatic (A, condyle x, TMJ subluxation, whiplash, capsule synovitis) Dental (malocciusion, reconstruction, poor fing prosthesis! dentures! erthodorics) {atrogent (ETT intubation, ewgles) Systemic (RA, gout, Pagets, psoriasis) Infectious (BC, syphits, TB, actinomycceis, AF, Lyme dz ~> eyele pain a¥-Sme lasting 7-14) Congenital (epasia, hyperplasia, typopasia,bitd condye) thers: sress, bruxism, ilopathic, myofascial pain. 3 Cartina features ‘8. oroacil pain — Ciassle: pain in front of tagus wth radiation to oat/ lower jaw choeW/ temple, Preauticuar, temporal, ear that ‘may radiates to headiaceoye. Pt alse may clo pain in the neck’ shoulder, Gnnitus, HA, insomria. Pain worse In AM ra ‘ecu in ayocal apicodes, » restcted jaw function - Jaw moverent is described as atghiness tlckng!cetcrngflockng. nose inte joint (euncty pap ging), Physical Examination &Gleking TMs 5. Check ROM 1. Open & close, <30mm between testh is abnormal. Should be able to insert your digs 234 in between p's incisor 2. Check he ltaral excursion of marco, ask to move his aw from side to side, Paoate masseter and temporas m set ry een Sea va echinacea eee Tashan conan tee 0: ten, ss rico aan ha, ods t hehb t ae ace aw more essga Wt hat Sd abe eee Nee a eae ee Sa corals a ». Biome Gow = veal pte sp an an ren eh on inant x Freon Sted ton and Bro Mauer | Seroe Gt Ean " ‘Soft dist X 1 wook i Soret nab sb OD we pan | ) tooth Wear dentures all tho tie except curing sleep TONSILS: + Most commonly caused by Streptococcus gp, + Treated with Cindamycin 180mg (children) or 300mgtab (adute) tab TID X 1 week Page 8 of 8 ctorhinolaryngology ‘Jepcapsl UPCMOSTONSILOPHARYNGITIS: + Troated wth Rexthromycin 1S0mghab BID X 1 week 7 For tonsilctomyiGA, | ‘SAPOD clearance: CBC with PC & DC, BUNICrea, RBSIFBS, Na, K, Cl, UA, 121 ECG, CXR | ‘TCB once wih resus for OR scheduling i * foe tweet oni 4 oo [Sale Cnr nf Conszoae amg ub SD x2 wooke wie 1 Increased OF! / Wa saline garge | ‘TCB after 2 weeks once with rests LARYNGOPHARYNGEAL REFLUX ‘= Charactrizod by foreign body sansation Inthe trast + Treated with Omeprazsle 20mg 1 tab OD X2 weeks GASTROESOPHAGEAL REFLUX DISEASE (GERD) ‘Characterized by rérostoral ost pain + Trosted with Omeprazole 20mgtab 1 tab OD X 2 woeks + Diet moctfoation: No spicy & sour food, eat smaltporioned meals. ‘+ Sloop at 30" angle and rest the voice FOREIGN BODY INGESTION + PL may fel pln onthe anatomic lstion where the FB was lodged (ccphanns notch on esophagus, arch of he act, L Sorts owe esophged sre) * Ogres mrougnradegrephe sues which may be epeted ova 12 hours. FB spears stko when In he eecphague an tral xray FB inthe sama, retort Surgoy. Bs inthe aay but bojend he man bon lo 1Gue ENT manages FBin the esophagus ar uppt sway (rashes & man ones) Barun ewalow is done when plan adogaph ae non lagost, Ris not equete FB is matali. ‘Samo Chart Enty NPOron IVF 0808 NaCl x8 {CXGLAPL onus nck and omen Gn chien) {©xR-APL ie the neck, la seman aa, epaate neck STL may be requested when ot poss) ‘SOFT TISSUE INFECTIONS ceuLuums {Samet Chan Ey | Gloss soomgiap 1 cap 10 x7 oaye cera ono rex ar ear er ] Page 9 of 8 (Ctorhinolaryngelogy ‘Jepcapsl UPcNOS+ Include dentosiveclar abscess (DAA), tnsilar abscess, parotid abscess, and parapharyngeal abecees Treatment ‘2 Iresion and {analgesic isnot used since itis not effective inthe presence of an abscess Draiiage. Local Anite, To cover for f) 8), Pen Gis gen. To cover for ansarbes, Cindamysn or Metrondazsa, oF acs: " |, Pan G 4 mtion units V LD) ANST thn 2 millon units gs iUndamyan 600mg 1 LD () ANST tan 30 mp cen G8 MarrigazleS00mG WV LD ()ANST thon 220 9 gh 2 Forno i, Pen 80,000 unt IV LD (JANST then 25,000 untae 6h i. Gindamyan 20 mpg V LD) ANST ten 10mg ce8 GF Mavondazae 16 oka W LD.) ANST thon 7S ogg aah Proparations | Pan Gis avaliable in 1 milion unter preparation I. Cindamyein i avaliable in 7,600 mean preparation 4. _Ater'Vloaing and 18D, the pé may be sont home with th folowing mec |. Pon G 250 mgfab 1 tab GID to complete 7days 40,000 unt = 2507). ‘Glindamyeln SOGma/ab 1 tab GID to complete 7 days ) ANST then 2 milion unite gh ‘ANST then 300 mg qh OR | Etotcea 120mgftab 1 fab OD pen for pain | lr t LUDWIG's ANGINA ‘Abscess clsecting the muscie planes ofthe chin which pushes the floor af the mouth upwarde ‘+ Palpatad as a board-tke mass inthe oor of he mou ‘Usual originates forma DAA ‘+ Commonly causes by Borrelia spirochote which Is responsive to Pen G / Metronidazole / Clindamycin | Sant at ry >= | sPlaD Pan's len unk LD () ANS an 2 ion ste th ‘Gindamycin 600mg IV LD () ANST then 300 mg gen OR Etteoeb 120mptD 1 tb OD pm opin Mh REACTIVE LYMPHADENOPATHY Usually has a focus of Infection * Commonly due to dental care, hair too, skin infection nthe head and neck {Should rule out TB aden. ‘Sample Chart Entry ie eee re eeton | Settmtieenee noes gt x7 eo =| Te ADeNis 5 May o ay not preter tn cre coh (2 wea), wo, reo pan wl, arr 1 Sroid rou easte LAD [[Sepe cna ery f= FAAS | Bikaes | Seam araxs TB once rots PAROTIDITS, 10 of 10 otorhinolaryagelosy /epeapsl uPCHos+ If vies) (mumps), treatment is supportive with Etoricoxdb 120 mgtab 1 tab OD prin for pain, bed rest, increased OF, and woldance of close contac wih househols membere + i bectoral teat with Co-amonclav 825 mgfab TID ort gab BID X 7 ays MAXILLO-FACIAL TRAUMA NASAL BONE FRACTURE. MP down depart + Common due ots midline lation onthe face . ‘Most commen mechanism of injury is mating, folowed by vehicular acidents ~flpating the orbit one ortat jsually associated wit «history of mpact othe midtacil area + Saldto be "neglected" fracture >14 days postiniury lower on me eter ermal en aeaton ibeievin plate op Se Coseneset? ‘asa cpocien dv innit partion? asa! speculum deviation parvine hetoring oto nove i . Inareased moby ott ‘ srosmia UF evinerrwa epics + noy dato ta. filer pope OS Pires Treaimant ‘2. Imaging ~ Rasiogrephic studies cannot distinguish betwaon recent and ot fractures. Thersfoe, these ere net uso for ‘medicoiogal cases, wit a hich rate of alga nagativos and alee postive, . 2 '. Packing ~ conte bleeding using artbictc impregnated nasal peck for 25 days. Antbioles are gWven as propryaxs ‘because nasal bone fractures are usually associated with laceratons of the nasal mucosa or ein “Antibes — Pericitn (Cioxaciln) and frst generation cephalosporin (Cefalexn ~ Cefalexin SOomg cap or 125mg!SmL ‘suspension ar usually given as prophylactc anibots. 4. Pain Wodieatons: ©. Closed reduction fs done when sweling hss subsided to allow forbear sxsessment ofthe deformity. In chen, swoting uy subsides in <3 days while in ads, it akos 3-5 days. wth away compromio, dont wa for be swaling subside. {.__ Open rection wth intemal ization (ORIF) is done only i the fracture Is comminuted. [Baro Gha i pa ‘Waters View { Nose STL. | ‘ioxasiin So0mgleap 1 cap GIO X 7 days | | | Etoricoxb 120 mptab 1 tas OD pm for pain | Seid eampres 18min TI ortho 1°26 Rours then warm compress terator | Top ater '. Septal hematoma ieveribie damage to the underying earlage can oocur within -4 days if not crained 1. Infection © CSF leak MAXILLARY FRACTURE, Classtcation Lotor 1 (Guern Wadiure Tae rasta efor (Graniotatal yuna) Torani jon. Tho palalo The mala and tho 2yyoma ae Separated form the rect of the maxi, ‘separated. from. the cranium {rough the rnte-thmod and tho tor zygomatic sutures. Tagg: Wales View, Caldwal wow, Lateral iow. CT wean yung cme ete use pe Nghor Hap - Kang on aie se Pe hep Pe Type Page 11 of 12 Otorhinoleryngology /epeapal uPcHosFor wound Waing Pale § oF Hales aed past tem practane MANDIBULAR FRACTURE Swat orerd movant sone up Masse, ral & medal legos, tempos Ata’ grup down, backward movemert.Gonobyod, Ageaa, mychye, gerigeshun hols rable — mussie forces tend to keap fragments together My arly 2 b. Unfavorable ~ muscle forces tend to pull fragments apart & ‘maging states < 2. "Panorox iw single best asgraph 8. APvebtque, moditad Towne's ZYGOMATIC FRACTURE Toes 3. simplo tracture of the arch '.trmolar or tiped tractors —iwolves all suture nes © quadtpod fracture ~maniary-2ygomatc butroce eoneldered ‘maging: Waters, axial or auamentovericl vows. CLEFT uP Milare Kein + May be urilateral or bilateral Ste bat leon Giasshcation 1. Compete ~clet reaches the vastbule Spe anance 1. incomplete does not reach the vestiote pipere. ety oper ‘Rule of Ten: Pt should baat least 10 Ibs, 10 weeks, andhas 10mg Heo —r | DYE He CLEFT PALATE ‘+ Reconatructon is performed before 2 years of age to ac in novmal speech developnient Early ate to nutton i ‘because sucking is impaired, Important ‘Thalwi classication: LAH_S. HALL Divide te kay aaas ofthe face (Up, Alveoius, Herd paluts& Soft palate) ito tds, LAH ~ ight, HAL lit HEA & NECK TUMORS NASOPHARYNGEAL CARCINOMA ‘+ Prosents with epistas, nasal cbsrucston, anosmia, constiutonal $Sx ot malignancy {+ On minoscopy, (+) for fungating mass in ts nasopharynx | Bipon Sogy nA ‘SAPOD Gioarance: GBC with DC & PO, BUN, Crea, RBSIFBS, Ne, K, Cl, WA, 121. E06, CXR | TeB once wih rosuts Primary tumor stage Tr Tumor contines to % ‘Ta Tumor extends to sot tssu06 of eropharynx or nasal fossa ‘Tee Without peraphanyngealextonson 72> _ Wit peraphanyngoa extonsion 73 Tumorinvades bony structures or paranasa! sinuses Ts _,jumor wth intracranial extension or involvement of cranial nerves, natemporal fossa, hypopharyn, or obit ‘Stage groupings Page 12 of 12 otorhinclaryagclogy Jepeapal vecHos' T1NOMO Tea NOWo NB 71,2aN1 Mo; 72» No, Ni Mo MW —THENeM0; T3NO.1,2 Mo VA T4NOa.2Mo Wve any TNS MO We AnyTAryNMA Treatment Primary tumors: RT alone (lateral) Ie used for both the primary tumor and the regional nodal metastases. Surgery is rot feasible because ofthe inadequacy of the surgical margins a tho basa of tha skal and the frequent involvement of ho reropmarynged! and ‘cereal nodes bltoraly. PAROTID TUMOR + Bonign tumors are more common than malignant one + MW olateral, probably Werthi's tumor * Mos corn lg Woe re \tanctormaton. 2. Malignant adoro cystic CA —more commen in mine esivary gin 3._Mucoepidermold eye - malignant ej salivary gland; with pseudopeds so remove mass with margins: with 1% malignant | SAPOD Closrance: CBC wih DC & PC, BUN, Crea, RBSIFBS, Na, KCl, WA, 12L ECG, CXR ‘Siaging of Saivaiy Giana Caroma rary tuner stage Tx” "Primary tumor cannot be assessed TO ——_No-evigenee of primary tumor J} Tumor <2 em without exaparenchymal extansion T2 Tumor >2 om but <4 om exraparenchyal extension TS Tumor >4 om but < om or having exeparenchymal extonsion without seversh earl ners involvement Té Tumor invados base of sku or severdnnerve rls >8 Gm ‘Stage groupings or major salvar gland carcinomas t T123 NOMO 4 TSNOMO mM T2NtMo 'V_T#NOMO;T9,4 Nt Mo; any T N2.3 Mo: ary T ary N MM MAXILLARY CARCINOMA Mest carmen pets SCCA lowed by aes ate CA [Semple Ghat Enry 1 pas | 53P00 cuwarc: COC win & PE, BUN, is, SFB Na. KC, UA, 1. £60, xR | 1eBens taro | MUCOUS RETENTION cYST * Originates from the maxilary sinuses ‘+ Usualy not touched, but may de puncture via Caldwel-uc it hard enough LARYNGEAL CARCINOMA + Presents with hoarseness (other causes inclued VC mass, VC ilammation, VC paralysis) Invelvomet ofthe erica cartlage indicates a subglotic exiansion which has a poore: prognosis Pris sett the ER i wih dyspnea for emergency tracheostomy and then poslsle admission for futhar work-up + Total laryngectomy with next dissecon s done for proven laryngeal CA [Sere Gra yf - oo Ties prance wth ipa of nrg! masu.A SAFOD Crane, GBC wih Bo 8 PO BUN, Ges, RESTS, Ns K, 0, UA 12. ECG, CXR 6B owe wt rnute | Prenary Teor Page 13 of 13 Ctorhinolacyngolosy Jepeapat uPcKasGat Soa, Sopagiot Te | Carcronaanahy TH | Tumor conned to oie of origin with nomad mobity 1 “Tumor confined to vocal coro) wit normal vocal cord “Taner caniined To -aabg 2 | Tumor Tnvelves adjacent supragioile ees or ote without fxaton ‘Subraplotic oF cubgoeie oeneionot {tumor wih normal or mpeted mobilly “Tamer edansion t vetal cores win nonmal oF Impaired cord ‘obity ‘TS Tomer Tinted To Taryn wa fralon or etenaion to Involve posteroald. area, medial wall of Tamer Contd TS Taryn wah core ‘ration “Tamer contned To Taryn wir cord tation Drilom snus or ore-eniots space TH] Masshe tumor etencing Boyond tho Taye rophars skin or toh tues of neck, oF Waseive ter wih Tayo earags estructon "or "acension beyond Tiassive tumor withcarags ‘esiruction or extansion Bayond deacon of hyd catage ents of tay bo senines olny Tiga isomer await a TNe— mini roqurorera to assess nodes cannot hem 5 NO=re ely pomtve rede OTE THNOMO T2NOMO TBNOMO; 71, 72, T3N1 MO Ineations for ry erelo ooyceking te way Retropnaryngealabece ‘Severe myasthenia Laryngeal CA with Obstruction ‘THYROID CARCINOMA PAPILLARY CANCER ‘+ Most common, affect younger patios T4NO MO; Té'NO MO; Any T N2, NB MO; Any NM Tracheostomy ‘Peammeme bodies are usualy presen In histologic sections. + Distan metastases to lungs, bone, skin and other organe oocur late. + lay « Popuar = Pastimes = Saqevomwar ares ‘staging Primary taro (7) ‘TX Primary tumor cannot be assessed. ‘TO: No evidence of primary tumor is found. ‘Ti: Tumor size Is 2m o oes in greatest cimansion ands limited tothe thyroid, ‘T2: Tumor size is greater than 2 cm but las than & cm, and tumor site to the tryrie ‘TS; Tumor siza is grater than 4 om, and tumor i mite to tho tryrldor ary tumor with minimal extrathyoial extension {omension to sterotiyrid muscle of perihyold sot issue). ‘Téa: Tumor extends beyond the tryrid capsule and invades any ofthe folowing: subcutaneous sot tissues, lary, (rach, ‘2s0phagus, of recurrent laryngeal nerve. ‘Ts: Tumor invades prevertebral fascia, meciastinal vessels, or encases tho carols artey. onal mon ross "RX Rogar node ant be asessd No: Ne ogond rode meta our apable lymph nodes ~ Poste" uptake « Posve prognosis = Postop "scan to 'N1a: Motastass fo found in level VI (pretraches! and paratracheal,nclusingprolaryngetl and Delphan) lymph nodes. Nib: Metastasis i found in united, blatral,or contralateral cervical or upporeuperir meciastinal mg noses Distant motastaci (M) ‘NOC Distant metastasis cannot be assessed. ‘No letant metastasis is found. Mt: Distant metastasis is present. ‘Stages Sago ‘Youngar Than Years 7g 45 Voara and Oder Page 14 of 14 ocorhinolaryagelosy /epcapul uecnosWa Ne Ne. FOLLICULAR CANCER, * Peak incidarce at 40 yoate of age * They tend to invade blood vessals and to metastasize hematogerously to visceral sites, partovlary bone. Lymph node ‘otastabes are reatvaly rare, especialy compared with papllary carcor. + Hortie cell cancer is a varian of flleuiarcarenoma and nasa elaively aggreteivo metastatic coure. + Folloular = Fr-away metastasis = Femalo (8:1) = FNAB NOT (diagnosed by fesuesiructre) = Favorable prognosis Staging (Siane | ‘Youngor Than 45 Yours 5 Vaars nd Older 7 [ET aN We eae nw ‘ay N, MO (Canc i in the TIT [ERE RS are nO ye ny ee ry TOT OTA | Tei the thyroid only and may Be To Bath on obo) | Any Te any NWA (Cancar Tas: oproad 16 | "72, NO, Wi and TS, NO, MO (Cancor Te ho Tyo ony and argar Thar ‘stant organs) 15am) ra “Ta, NO, MO and any T, NT, MO (Cartcar has Spread outside ro Wyrod Bae not outside of the neck) iw ‘Any, any N, Mi (Cancer has apread to cr paris ofthe body] MEDULLARY THYROID CANCER * Secreto cakitorin. ACTH, histaminase, and an unigertied substance that produces diahes may also be secreted by these ‘umors. Large amourte of amylia are evidert by histologic examination. ‘+ Metastases are mostly found in the neck and mectastnal ymph nodes and may cael. Widespread visceral metastases occur tate. + Medullary = MEN I= aliyoid = Mactan ph node dlssaction « Mostiod neck desection if lateral nodes are pose ‘Staging H Cancer is loss than 1 coniator (about 1/2 neh) in size, | Cancars between 1 and 4 contrttors (about 1/29 11/2 nehee) in size. IM Canear has spread to the ympn nodes. NV Gancar has spread to othe pat ofthe boc, ANAPLAGTIC GIANT AND SPINDLE CELL CANCER ‘* Occur most often in patients older then GO years cf age. Anaplastic thyrod cancers are aggressive cancer, which reply invado urounding local issues and metastasize to dilant organ = There is ne number staging syetom used fer anaplastic cance. ‘runaround nn hod neue Hodgkin phoma valet of sf eave scones ard tata canoes or alone par att: Sa col cnc fy au e Nclogay Seis panes end spned eh ‘yminodb aan ates sh. surgery ms. 5 Page 15 of 15 Oterhinolazyngology /epeapah uPcHos