Head and Neck Clinical

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Cricothyrotomy - through what ligament?

Median Cricothyroid Ligment

Thyroid Gland Enlargement is called

Goiter

Horner's Syndrome

Loss of SNS to one side of head 1. partial ptosis (tarsalis muscle) 2. miosis (papillary constriction) 3. anhydrosis (no sweating 4. vasodilation (flushing)

CN III Palsy, can't do what?

Can't adduct, elevate, depress during abduction. + pupilary dilation and ptosis

Stair Step Diplopia - what nerve?

CN IV - Trochlear Nerve, down and in.

Bell's Palsy, what nerve? What features?

CN VII. Muscles of facial expression are weak/paralyzed on one side of face. Decreased naso-labial fold, mouth 'down'.

"Stick out your tongue"

Action of the Genioglossus is to move the tongue toward the midline, tongue deviates toward the paralyzed side.

Herpes Zoster

Affected over the cutaneous distribution, unilaterally

"Danger area of the scalp"

Loose Connective Tissue

TMJ

Synovial, with meniscus strong lateral lig., has anterior tubercle to prevent dislocation, condyles over the articular eminence w pain

Tripod Fracture

Fracture of Zygomatic Arch

Corneal Reflex

Aff: V1 Eff: VII, orbicularis oculi

Accomodation Reflex

Aff: CN II Eff: CN III, parasympathetic

Blink Reflex

Aff: CN II Eff: CN VII

Facial Paralysis, not Bell's

Skull fracture, facial nerve laceration, post-surgical, parotid tumor, otitis media.

Deafness, ABC's

Asphyxia, Bacterial meningitis, Congenital perinatal infections, Defects of H&N, Elevated bilirubin, Family Hx, Gm birth wt

Otalgia

Earache. Referred pain from Tooth abscess, Cancer of tongue, Tonsilitis, Cancer of larynx, Otitis media, TMJ, Cervical spondylosis, Herpes Z

Middle Ear Infection

Tympanic membrane perforation, Taste alteration, Facial paralysis, Mastoiditis, Balance alteration, Meningitis, Temporal lobe abscess, Hearing alteration. (v3, 7, 9, 10)

Coloboma

Keyhole pupil. Failure of closure of retinal fissure. Defect in iris.

Retinal Detachment

Between neural and pigment layers. Congenital or due to trauma to eye.

Hyaloid vessels

Distal hyaloid vessels degenerates after 6th month, but sometimes remain. Floaters

Congenital Aniridia

Absence of Iris. Bad optic cup development.

Congenital Aphakia

No Lens. Poor formation of lens placode.

Congenital Cataract

White/opaque lens at birth. Rubella.

Micropthalmia

Small eye, arrested development. Rubella.

Anophthalmia

No eye, + eyelids. Other defects associated

Cryptophthalmos

Hidden eye - palpebral fissure development poor. Small/defective eye behind the skin.

External Meatal Plug

recanalization failure. External auditory meatus, 9th yr. full-size

Auditory Ossicles

Ear bones MIS, adult size at birth

Which part of the ear develops first?

Inner ear, from the otic pit/vesicle.

Congenital Deafness

Deaf Mutism. Can be genetic. Can be part of first arch syndrome or nerve

Rubella Infection

During 7-8 weeks may cause maldevelopment of spiral organ of corti of inner ear, deafness.

Crocodile Tears/Gustolacrimal Reflex

Unilateral & spontaneous tearing along with normal eating/salivation. With facial paralysis or misdirected regenerating nerve

Vasomotor Rhinitis

Idiopathic (no idea why). use nasal spray

Honeymoon Rhinitis

Nasal stufiness during sex. Side effect of sildenafil (viagra) bc erectile tissue is similar. may be hormonal

Gag Reflex

Aff: CN IX Eff: CN X

Cough Reflex

Aff: CN X Eff: CN X

Danger Zone of Face

Triangle formed by upper lip and nose, drains to cavernous sinus. thrombosis danger to CN III, IV, V1, V2, VI and ICA.

Hay Fever Ganglion

Ptergopalatine Ganglion (PT)

Lingual Thyroid

Can be at foramen cecum which is embryonic site of attachment to thyroglossal duct.

Sublingual Drug Administration

Absorption through veins, close to surface

Ankyloglossia

Tongue-tie. Short Frenulum. Speech, eating probs

Nasolacrimal groove development

Between maxillary & lateral nasal processes

Oblique Facial Cleft

Failure of maxillary process to fuse with lateral nasal process & medial nasal process on same side, open nasolacrimal duct.

Cleft Lower Lip

Failure of fusion of mandibular processes

Incisive Foramen

Between primary and secondary palate

Anterior Cleft Anomalies

Cleft upper lip and gum, failure of fusion between primary & secondary palate.

Posterior Cleft Anomalies

Failure of fusion between lateral palatine processes, behind incisive fossa - soft palate

Sinuses present at birth

Maxillary & Ethmoidal, small at birth

Natal Teeth

Breast-feeding discomfort, tongue lacerations, can be aspirated

Enamel Hypoplasia

Pitted or fissured, nutritional deficiency

Enamel Discoloration

Blue/black in erythroblastosis fetalis, yellow if tetracyclines taken when formed.

Branchial Cyst

Anterior to SCM. Failure of obliteration of cervical sinus.

Branchial Sinus

Cervical sinus and 2nd cleft (ext.) or pouch (int.) not obliterated

Branchial Fistula

Persistence of 2nd pouch & cleft. Opening into tonsillar sinus internally, between ICA and ECA externally.

Auricular Cyst/Sinus

Remnants of 1st groove or detached ectodermal folds, pit in front of ear/earlobe

Treacher-Collins Syndrome

Failure of neural crest migration to 1st arch. Micrognathia, 50% cleft palate, conductive hearing loss, malformed pinna, drooping of lateral eye, small zygoma.

Robin Sequence

Micrognathia/retrognathia (sm jaw w normal tongue)- glossoptosis (tongue in pharynx) leads to cleft palate. Feeding and respiratory problems. May outgrow.

DiGeorge Anomaly

Chromosome 22 (catch 22). Faulty migration of neural crest. Exposure to retinoids, EtOH, maternal diabetes mellitus. No Thymus. 3rd and 4th pouch derivates under-developed.

Larynx pathologies

Laryngitis (inflammation). Squamous cell carcinoma. Nodules (fr singing). Papilloma.

Obstructive Hydrocephalus

Overproduction of CSF, Obstruction in CSF flow

Communicating Hydrocephalus

Movement of CSF into venous system impaired (through loss of arachnoid granulations, subarachnoid hemorrhage)

Cerebral Hemorrhage

Rupture of artery/aneurysm, mostly fatal. Hypertension related. Severe headache, stiff-neck.

Extradural/Epidural Hematoma

Arterial (fast bleed, middle meningeal artery). Trauma, concussion leads to loss of consciousness followed by lucid interval then drowsiness, coma. "lens, lentil shaped"

Subdural Hematoma

Venous (slow bleed). Superior cerebral vein related. Reason may be trivial, forgotten, contusion. No lucid interval post loss of consciousness. "crescent shaped"

Subarachnoid Hematoma

Arterial (fast bleed, aneurysm, laceration), meningeal irritation, worst headache, stiff neck, loss of consciousness. "tree shaped"

Bone in CT

White

Fat in CT

Black

Fat & Bone in MRI

various shades of Grey

Folic Acid Supplements

Avoid Neural Tube defects

Microanencephaly/Exencephaly

Failure of rostral neuropore to close, alpha-fetoprotein in maternal serum amniotic fl.

Cranium Bifidum

Defect in cranial vault, midline.

Meningocele

Protrusion of meninges + CSF

Meningoencephalocele

Protrusion of meninges + CSF + brain

Meningohydroencephalocele

Protrusion of meninges + CSF + brain + ventricle

Holoprosencephaly

1:15,000 births, facial defects. Severe, fatal. No cleavage of the forebrain. EtOH abuse during pregnancy. Cyclop (one eye).

Hyoptelorism

Distance between eyes is reduced

Arnold-Chiari Malformation

Cerebellum herniates into the foramen mag. Posterior cranial fossa is small, CN IX, X and XII may be stretched - speech, swallowing may be affected.

Microcephaly

Small brain resulting from genetics, maternal EtOH, maternal CMV or rubella, exposure to radiation.

Craniopharyngioma

Tumor of remnant of anterior pituitary

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