Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior...
Transcript of Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior...
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Head & Neck Examination
Dr Irfan AhmadResident, Radiation Oncology
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The major areas comprising this region are:
Head, face & EarSalivary GlandsNose & SinusesOral CavityNasopharynxOropharynxLarynx & LaryngopharynxNeck
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Setting up the examination
Patient positioningInstruments required:
Bulls eye lampHead mirrorTongue depressorsNasal speculum(Thudicum/Vienna)Posterior nasal mirrorLaryngeal mirror
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Head, Face & Ear ExaminationHead & Face
SymptomatologyLumoUlcer
Ear SymptomatologyHearing lossTinnitusEar dischargeEarache Swelling Others(Deformity/ Dizziness/ Itching)
Examn of Mass & Ulcer
Ear Examn (+ Functional):PinnaEAM(+/- Speculum)TMMiddle ear(when TM -)MastoidEustachian Tube(when TM- & Posterior Rhinoscopy)Facial nerve
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Nose & Paranasal Sinuses Examination
Symptomatology:ObstructionDischargeEpistaxisHeadache/facial painLumpChange in voicePND
Parts of Nasal Examn :External nose Examn
Vestibule Examn
Anterior RhinoscopyPosterior RhinoscopyFunctional Examn
Parts of Sinus Examn :Maxillary/ Frontal/ EthmoidSphenoid
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Nasopharynx Examination
Symptomatology:Nasal ObstructionEpistaxisLump (in Neck)DeafnessPND
Parts of Examn :Anterior RhinoscopyPosterior RhinoscopyCN 2-12(m.c. 9-11)Neck Node Examn
OthersDigitalEndoscopyRetraction of structures(GA/LA)
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Oral cavity ExaminationSymptomatology:
PainTrismusLesion(Lump/Ulcer) Dysguesia Xerostomia/ Excess salivation
Parts of Examn :Inspection & palpation of:
LipsTeeth & gingivaRetromolar trigoneBuccal mucosaFloor of mouth Hard palateAnterior 2/3rd of tongue
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Oropharynx ExaminationSymptomatology:
OdynophagiaDysphagiaChange in voiceHalitosisEaracheSore throatHearing lossSnoring
Parts of Examn :Inspection (& palpation) of:
Tonsils & PillarsBase of Tongue(IDL)Soft PalatePosterior pharyngeal wall
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Larynx & Laryngopharynx Examination
Symptomatology:Lump (in neck)DysphagiaPain in throatRespiratory obstructionChange in voiceRepetitive clearing of throatCough(+/-Sputum)
Parts of Examn :External Examn of LarynxIndirect LaryngoscopyAssessment of Cervical lymph nodesOthers:
Flexible/Rigid fibre optic endoscopyVoice assessment
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Neck ExaminationSymptomatology:
Lump(m.c. Nodes)Pain
Parts of Examn :Inspection & palpation of:
SkinNeck NodesAny other mass besides nodes
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Examination of a MassGeneral (CC/IoF)Local:
InspectionLocation/ Number/ Color/ Surface/ Overlying skin/ ShapeSize/ Edge/ PulsatilityPressure effectMovement with
• Respiration• Swallowing• Protrusion of tongue
(Abdominal Swellings –Peristaltic movement)(Swelling connected to cavity – Ab/Pl/ Sp/ Cr) Cough Impulse)
Local:
PalpationTemperature/ TendernessSize/ Shape/ Surface/ Extent/ Edge/ ConsistencyFixation to overlying skin & underlying structuresFluctuationTranslucencyReducibility & compressibilityPulsatilityFluid thrillCough impulse
Regional Lymph NodesPercussion/ Auscultation
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Examination of an UlcerGeneralLocal:
InspectionLocation/ NumberShape/ SizeEdgeFloorDischargeSurrounding area(Peripheral ulcer –Rest of limb)
PalpationTendernessMargin/ Edge BaseDepthBleedingRelation to underlying structuresSurrounding skin
Regional Lymph Nodes(Peripheral Ulcer –vascular insufficiency + nerve lesions)
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Oral Cavity ExaminationOn Inspection:
TrismusDental Hygiene/ Edentulous/ CariesTongue protrusionUlcer/ MassDiscoloration
Look at the following structures:Lips, Teeth, Gingiva, Ant 2/3rd of tongue, Floor of mouth(Ant + Lat), Buccal Mucosa, Hard Palate & Retromolar Trigone
Palpation of all lesions of the oral cavity + Tongue + Bimanual Examination
14Oropharynx Exam
15BOT, pyriform
sinus are not shown in this diagrammatic representation
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Indirect LaryngoscopyPositioning & methodAdduction – AaAdduction & Tension – EeeAbduction – Deep InspirationStructures seen:
EpiG, AE folds, Arytenoids, Cuneiform/ corniculate, ventricular bands, ventricles, True cords, Ant commisure, Post commisure, Subglottis, Tracheal ringsPyriform fossae, post cricoid region, post wall of laryngopharynxBOT, lingual tonsils, valleculae, medial/ lateral glossoepiglottic fold
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Examination of Neck Nodes
Inspection of neck, followed by palpation.•
C Technique
for IJV nodes•Bimanual for Submental & Submandibular nodes
Levels of Lymph node in the neck
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Thank you
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Terms associated with an Ulcer
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Ulcer Edge
Undermined edge
Punched out edge
Sloping edge
Raised edge
Rolled out edge
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AJCC Nodal ClassificationNX Nodes cannot be assessed N0 No lymph node metastasis N1 Single ipsilateral lymph node, <3 cm N2
N2A Single ipsilateral lymph node >3 cm but not >6 cm N2B Multiple ipsilateral lymph nodes, none >6 cm N2C Bilateral or contralateral lymph nodes, none >6 cm
N3 Metastasis in a lymph node >6 cm
(NPC)
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AJCC Nodal Classification for NPCNX Nodes cannot be assessed N0 No regional lymph node metastasis N1 Unilateral node(s) <6 cm above the supraclavicular fossa N2 Bilateral node(s) <6 cm above the supraclavicular fossa N3 Metastasis in lymph node(s)
N3a >6 cm N3b Extension to the supraclavicular fossae
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