PD Lec-Head & Neck

200 million people in the world have enlarged thyroid glands known as a...

goiter. Due to lack of iodine

What are 90% of head and neck cases associated with?

Poor dental hygeine
Tobacco
Exposure to Nickel
Alcohol

What is the most common endocrine cancer?

Thyroid
Women>Men

How many bones is the head composed of?

22

How many of these bones are in the face?

14

What is the facial skeleton composed of?

mandible, maxilla, the nasal, palatine, lacrimal, and vomer bones.

What does the cranial skeleton consiste of?

frontal, temporal, parietal, occipital bones.

What structure is important in diseases of the ear?

mastoid process which is part of the temporal bone

What is the principal muscle of the mouth?

Orbicularis Oris, open and closes the list

What muscle surrounds the eye and closes the lids?

Orbicularis Oculi

What is the thin muscle that is superficial on the neck and acts to pull the mandible down?

Platysma

What are the muscles of mastication?

masseter, ptergoid, and temporalis. They insert on the mandible and effect chewing.

What cranial nerve carries sensory fibers from the face, oral cavity, teeth, and carries the efferent fibers to the muscles of mastication?

Trigeminal, 5th Cranial Nerve

What muscle divides the neck into anterior and posterior triangles?

Sternocleidomastoid

The SCM is a strong muscle that serves to raise what structure during respiration?

Sternum

What are the two heads of the SCM?

Sternal and clavicular

Where does the sternal head of the SCM arise from?

Manubrium Sterni

Where does the clavicular head originate from?

Sternal end of the clavicle.

The 2 heads of the SCM unite and insert on the...

lateral aspect of the mastoid process.

What nerve is the SCM innervated by?

Spinal Accessory Nerve, 11th cranial nerve

What are the borders of the anterior triangle?

SCM, midline and mandible

What does the anterior triangle contain?

Thyroid Gland
Larynx
Pharynx
Lymph Nodes
Submandibular Gland
Salivary Gland
Fat

What is the largest endocrine gland in the body?

Thyroid Gland

Describe the structure of the thyroid gland.

envelops the upper trachea and consists of two lobes connected by the isthmus.

Where does the isthmus of the thyroid lie?

across the trachea just below the cricoid cartilage of the larynx.

What is the function of the thyroid gland?

produce thyroid hormone in accordance with the needs of the body.

What does the SCM muscle overlie?

Carotid sheath, which lies lateral to the phalanx

What does the carotid sheath contain?

Carotid artery,internal jugular, and the vagus nerve.

What are the posterior triangle boarders?

SCM, Trapezius, and the clavicle

How many lymph nodes does the neck contain?

75 on each side grouped into chains

What are the lymph nodes of the neck?

Posteriorly:
Occipital
Posterior Auricular
Posterior Cervical
Superficial and deep cervical
Tonsillar
Submaxillary
Submental
Pre auricular
Supraclavicular

What are the midline structures of the neck?

Hyoid bone
thyroid cartilage
cricoid cartilage
trachea
thyroid gland

Which direction does the trachea deviate with pneumothorax and atelectasis?

pneumOthorax - opposite
Atelectasis - sAme side

What is atelectasis?

collapsed area of the lung caused by infection, pulls trachea towards collapsed area.

What is another term for enlarged thyroid?

Goiter

The most common symptoms related to the neck are...

neck mass, swelling and stiffness

What is likely if there is pain accompanying the mass, swelling, or stiffness?

infection

If it is present for a few days, most commonly it is _______ whereas if present for months, most likely ________.

inflammatory, neoplastic

A lump in a patient younger than 20 may be...

an enlarged lymph node or a congenital mass such as a thyroglossal duct cyst.

The location of the mass is not important. True or False

False

Midline masses tend to be...

benign or congenital lesions

Lateral masses tend to be...

neoplastic or a benign brachial cleft cyst

Masses in the the lateral upper neck may be...

metastatic from tumors in the breast or stomach

What does hoarseness associated with a thyroid nodule suggest?

vocal cord paralysis due to impingement of the recurrent laryngeal nerve

What is stiffness of the neck usually caused by?

spasm of cervical muscles and is common cause of tension headaches.

Sudden onset of stiff neck, fever and headache should raise suspician of possible...

meningeal irritation

The most common reaction to head and neck disease is...

depression

Examination of the head and neck consists of _______, ___________, and _________ of the carotids and thyroid.

inspection, palpation, and auscultation.

What does the normal thyroid gland of the consistency of?

muscle

Unusual hardness is associated with...

scarring or malignancy

Softness or sponginess is often seen with...

toxic goiter

Tenderness of the thyroid is associated with...

acute infections or hemmrrhage into gland.

What should be done if the thyroid is enlarged?

auscultate with the bell and diaphragm of a stethescope.

What are you listening for when auscultating?

a bruit, which is a murmur heard when there is increased turbulence in a vessel.
Then palpate suprclavicular lymph nodes

What is the greatest worldwide cause of of thyroid enlargement?

iodine deficiency

Other important causes of thyroid enlargement are...

infection
autoimmune disease
cancer
isolated nodules

Enlarged thyroid may be associated with...

hyperthyroidism, hypothyroidism, or simple or multinodular goiter of normal function.

Rarely the thyroid gland can extend into the chest and can obstruct...

venous blood flow or airway

What is a useful maneuver for detecting latent obstruction in the thoracic inlet?

Pemperton's Sign

What is the most common type of hyperthyroidism?

Grave's disease-diffuse toxic goiter that can occur at any age

Symptoms for hyperthyroidism are...

warm, moist skin, tremor erythema, hyperhydrosis, anxiety, alopeccia, and palpatations.

Plummer's Disease accounts for how many hyperthyroidism cases?

10%

What is Plummer's disease caused by?

A single autonomously functioning thyroid adenoma(benign tumor)

Approximately ___ of the population has a single thyroid nodule larger than one centimeter.

5%

What is hypothyroidism?

low levels of circulating thyroid hormone

Symptoms of hypothyroidism are...

weight gain, fatigue, constipation, hair loss, dry skin, short attention span.

Many patients with thyroid cancer...

do not experience symptoms

What is Papillary Thyroid Cancer?

most common (80-85%)
slow growing
Grows in one lone of Thyroid

What is Follicular Thyroid Cancer?

occurs in older individuals with a low iodine diet

What is Medullary Thyroid Cancer (MTC)?

Sporadic and familial associated with endocrine neoplasms.

What is Anaplastic Thyroid Cancer?

least common
most aggressive
Most difficult to control.

What is acromegaly?

Condition caused by hyper secretion of growth hormone, almost always due to pituitary tumor

If GH hyper secretes in childhood before closure of epiphyses(growth plate), will lead to...

pituitary gigantism.
... if after this then acromegaly

What is nephrotic syndrome?

complex that follows severe prolonged increase in glomerular permeability to protein.

Signs and symptoms of nephrotic syndrome include...

proteinuria
hypoalbuminemia
generalized edema
hyperlipidemia
Face is pale and edematous(swollen from fluid)
Swelling appears around eyes first

What is Cushing's Syndrome?

over secretion of cortisol by adrenal gland or steroids.
Symptoms are round moon face with red cheeks, excessive hair growth around mustach, sideburns, and chin

What is Myxedema?

charateristic of thyroid hormone deficiency.
Symptoms dull, puffy face, edema around eyes, dry skin, and hair is dry, coarse and thinned.

What is Parkinson's Disease?

idiopathic, slow progressing, degenerative CNS disorder.

What is the most common thyroid cancer?

Papillary

What is the least common thyroid cancer?

anaplastic