HNN Topic 19 - Mouth Flashcards
(44 cards)
List the causes of mouth ulcers
- Traumatic ulcers
- Recurrent aphthous stomatitis
- Infection
- Viral - chickenpox, herpetic stomatis, HIV
- Bacterial - syphillis, tuberculosis
- Fungal
- Parasitic
- Drug induced - alendronate (bisphosphonate for osteoporosis), cytotoxic drugs (methotrexate, chemotherapy), NSAIDs, cocaine
- Malignancy
- Allergy
- Haematological e.g. anaemia
- GI e.g. coeliac, Crohn’s disease, ulcerative collitis
- Nutritional e.g. iron, folate, B12 deficiency
Describe the location of the deep cervical nodes
Vertical chain, close to internal jugular vein within carotid sheath
Where are the intrinsic muscles of the tongue and what is their function?
Within tongue, change tongue shape/size for speaking, chewing and eating
Describe the organisation of lymph nodes and vessels in the head/neck
- Superficial and deep vessels
- Superficial drain to superficial ring of lymph nodes at junction of head and neck
- Deep vessels arise from deep cervical nodes, converge to form the left and right jugular lymphatic trunks
- Superficial and deep cervical nodes
- Superficial in ring arrangement, drain into deep
- Deep in vertical column, drain to deep lymphatic vessels
Describe the pharyngeal phase of swallowing
- Bolus moved to pharynx, pressure receptors activated in the palate and anterior pharynx, signals to swallowing centre in brainstem
- Respiration inhibited, larynx raised, glottis closed, oesophageal sphincter opened
- Soft palate elevated to close nasopharynx and allow passage of food
- Vocal cords close to prevent aspiration
- Bolus moved towards oesophagus via peristalsis of pharyngeal constrictor muscles
What is the function of styloglossus muscle?
Retracts and elevates the tongue
Describe the complications of oral cancers and how these are overcome
- Dysphagia - risk of malnutrition, aspiration, pneumonia
- Speech
Managed by a speech and language therapist - exercises to improve speech and swallowing function
Describe the attachments of palatoglossus muscle
From palatine aponeurosis to attach broadly across tongue
Describe the innervation of the intrinsic muscles of the tongue
Hypoglossal nerve
List the intrinsic muscles of the tongue
- 4 paired muscles, named for direction of travel
- Superior longitudinal
- Inferior longitudinal
- Transverse
- Verticle
Describe the location and function of the submandibular nodes
3-6 nodes below the mandible in the submandibular triangle, collect lymph from cheeks, lateral nose, upper lip, lateral lower lip and gums/anterior tongue. Submental and facial nodes also drain into submandibular nodes.
Describe the location and function of occipital nodes
1-3 nodes on back of head, drain the occipital areas of the scalp
Describe the diagnosis of oral cancer
- Forceps biopsy of lesion - local anaesthesia
- Assess histology
- PET-CT of head and neck
- Shows size, presence/absence of neck nodes, distant metastases
Describe the treatment of mouth ulcers
- Cause-related treatment
- Usually heal without intervention
- Maintain good oral hygiene, use antiseptic mouthwash to prevent secondary infection
Describe the attachments of the genioglossus muscle
Mental symphysis of the mandible to the dorsum of the tongue
Describe the vasculature of the tongue
- Mostly lingual artery (branch of external carotid artery)
- Tonsillar artery (branch of facial artery) - collateral circulation
- Drainage - lingual vein, drains into internal jugular vein
Where do the deep cervical nodes drain to?
- Deep cervical vessels arise from the deep cervical nodes, converge to form the left and right jugular lymphatic trunks
- Left lymphatic trunk joins thoracic duct at root of neck
- Right lymphatic trunk empties into R lymphatic duct at root of neck
Describe the location and function of the superior cervical nodes
- Superficial anterior cervical lymph nodes and posterior lateral superficial nodes
- Anterior close to anterior jugular vein, drains superficial anterior neck
- Posterior close to external jugular vein, drain superficial neck
What is the function of the superficial cervical nodes?
Receive lymph from scalp, face and neck
Describe the voluntary phase of swallowing
- Mastication produces bolus of food
- Back of tongue elevated and soft palate pulled anteriorly - keeps food within oral cavity, allows airway to remain open
Describe the treatment of oral cancers
- Radiotherapy
- Surgery
- Chemotherapy
List the important deep cervical nodes
Jugulo-omohyoid, jugulodigastric, supraclavicular nodes
Describe the epidemiology of oral cancers
- Oral cancer - 6th most common malignancy worldwide, 3rd most common in developing countries
- Squamous cell carcinoma most common form
- Men > women
- Age of occurrence typically >40 years
- Usually identified in late stage, overall 5 year survival rate <60%
What is the function of the deep cervical nodes?
Receive all lymph from the head and neck - directly or indirectly
