ENT | Master Of Medicine

Category Archives: ENT

Nasal Polyps: Antrochoanal polyp vs Ethmoidal Polyp.

Antrochoanal Polyp

  1. Due to infections
  2. Solitary, more common in children
  3. Usually unilateral
  4. Trilobed, has antral and choanal parts
  5. Arises from Maxillary sinus near ostium
  6. Grows backwards to the choana and may hang down fromĀ  behind soft palate.
  7. Not precancerous
  8. Not recurrent, usually does not recur after complete removal
  9. Treatment: Polypectomy, Caldwell Luc operation, FESS for recurrent polyp.

Ethmoid polyp

  1. Due to allergies
  2. Multiple small grape like clusters
  3. Bilateral grows anteriorly, more common in adults(30-60 years)
  4. Arises from ethmoid sinus
  5. Precancerous
  6. Recurrent
  7. Treatment:Functional Endoscopic Sinus Surgery(FESS)

Membranes and Ligaments of Larynx

Ligaments and membranes of Larynx are divided into extrinsic and intrinsic

Membranes of Larynx

Extrinsic-Thyrohyoid membrane

Intrinsic-Quadrangular membrane,Cricothyroid membrane,conus elasticus

Ligaments of larynx

Extrinsic

  1. Median thyrohyoid ligament
  2. Lateral thyrohyoid ligament
  3. Hyoepiglottic ligament
  4. Cricotracheal ligament

Intrinsic

  1. Anterior/median cricothyroid ligament
  2. Thyroepiglottic ligament.

Tip: Everything with Hyoid in it is extrinsic, also add cricotracheal ligament the extrinsic list is complete.

Tympanogram

Type A- Normal tympanogram

Type As- Compliance lower, seen in fixation of ossicles eg:Otosclerosis,malleus fixation

Type Ad- High compliance,Seen in ossicular discontinuity and lax tympanic membrane

Type B- Flat dome shaped graph.No change in compliance.Seen in middle ear fluid/thick tympanic membrane.

Type C- Maximum compliance with negative pressure in excess of 100mmHg.Seen in retracted tympanic membrane and minimal fluid in middle ear.

Trotters triad

  1. Conductive deafness(Eustachian tube blockade)
  2. Ipsilateral temperoparietal neuralgia(Vth N)
  3. Palatal palsy(Xth N)

Nasal cavity and openings

Superior and middle concha/turbinate- Part of ethmoid bone

Inferior Concha is a seperate bone.

Openings in meatus

Superior meatus- Posterior ethmoid sinus

Middle meatus- Frontal sinus,Anterior and middle Ethmoid sinus,Hiatus semilunaris recieves maxillary sinus

Inferior meatus- Nasolacrimal Duct(INDia)

Spheno ethmoidal recess- Sphenoid sinus

Tip: It is usual that the middlemen benefit the most, while the producers and retailers are least benefitted.

Levels of Lymphnodes on neck

Level I- Submandibular and sublingual triangle

Level II- Laterally from skull base upto hyoid bone(bifurcation of common carotid)

Level III-Bifurcation of CC to cricoid cartilage(Omohyoid tendon)

Level IV- Omohyoid tendon to clavicle

Level V- Posterior triangle of neck

Level VI-Anterior compartment(pretracheal)

Level VII-Anterior mediastinum

TNM Staging

N1 – Single node <3cm

N2a-Single ipsilateral node 3-6cm

N2b- Multiple ipsilateral nodes<6cm

N2c-Bilateral/conralateral nodes<6cm

N3-Nodes>6cm

Thyroglossal cyst,Branchial cyst and cystic Hygroma

Thyroglossal cyst

90% Thyroglossal cysts lie in the midline

Commonest site for thyroglossal cyst-Subhyoid.

Atypical thyroglossal cysts are usually found on left side.

Thyroglossal cyst is the commonest congenital neck swelling.

Commonest cause of recurrence is the failure to remove body of hyoid.

Treatment of papillary Ca of thyroglossal cyst-Sistrunks+Post op TSH suppression+Eltroxin

Sistrunks Operation

Surgery for thyroglossal cyst

Structures removed are

  1. Thyroglossal cyst
  2. Body of hyoid bone
  3. Core of tongue tissue pointing towards foramen caecum

Branchial cyst

Upper 1/3rd of neck on anterior border of sternocleidomastoid muscle.

Remnant of 2nd pharyngeal pouch(branchial cleft)

Cystic transformation of LN

Lined by stratified squamous epithelium.

Lymphoid tissue is seen on the walls.

Cystic Hygroma

Earliest congenital neck swelling

Posterior triangle of neck

Brilliantly transilluminant

Due to sequestration of jugular lymphsac

TOC: Surgery

Injection of sclerosants like OK-432,tertracycline,bleomycin are other modalities.

Blog performance enhanced by PHP Speedy Blog performance enhanced by PHP Speedy