IMAGE BANK QUICK REFERENCE - Springer Publishing...IMAGE BANK SScott_Image Bank_03-11-14.indd...

QUICKREFERENCE OTOLARYNGOLOGY

Guide for APRNs, PAs, and Other Health Care Practitioners

Kim ScottConsultants

Richard F. Debo

Alan S. Keyes

David W. Leonard

for

IMAGE BANK

Scott_Image Bank_03-11-14.indd 1Scott_Image Bank_03-11-14.indd 1 3/17/2014 3:58:02 PM3/17/2014 3:58:02 PM

FIGURE 1.1 Normal tympanic membrane.

© Springer Publishing Company

Physical ExaminationDocumentation of Normal and Abnormal Findings From the Ear, Nose, and Throat Examination


HelixScaphoid

fossaCrura ofantihelix

Triangularfossa

Crus of helix

Tragus

Externalauditory meatus

Intertragicnotch

Antitragus

Lobule

Auriculartubercle

Cymba ofconcha

Concha ofauricle

Cavum ofconcha

Antihelix

Helix

FIGURE 1.2 Pinna.



Auricle(pinna)

External ear Middle ear Inner ear

(not to scale)

Malleus Incus

Auditory ossicles

Stapes

Temporalbone

Externalauditorymeatus

Tympanicmembrane

Semicircularcanals

Oval window

Facial nerve

Acousticnerve (VIII)

Vestibularnerve

Cochlearnerve

Vestibule

Round window

Eustachian tube

FIGURE 1.3 External, middle, and inner ear.



FIGURE 1.4 Tympanic membrane.


Pars flaccida

Incus

Pars tensa

Umbo

Cone of light

Handle of malleus

Short process

of malleus


FIGURE 1.5 Central tympanic membrane perforation.



FIGURE 1.6 Tympanosclerosis.



Frontal bone

Nasal bones

Upper lateralnasal cartilages

Septal cartilage anddorsum of the nose

Tip

Lower lateralnasal cartilages

Greater alar cartilage

Medial crus

Septal cartilage

Columalla

Alla

Alargroove

Lateral crus

FIGURE 1.7 External nose.



FIGURE 1.8 Paranasal sinuses.


Cribriform plateof ethmoid

Frontalsinus

Ethmoid air cells

Orbit

Uncinate process

Maxillary sinus

Inferior turbinateand meatus

Vomer

Middle turbinateand meatus

Superior turbinateand meatus

Lamina papyracea(ethmoid)

Orbital plate(frontal bone)


Parotidsalivary gland

Stensen’sduct

Masseter muscle

Sublingual ducts

Sublingualsalivary gland

Submandibular salivary gland

Wharton’s duct

FIGURE 1.9 Salivary glands.



FIGURE 1.10 Oral cavity and oropharynx.


Superior lip

Superior labialfrenulum

Palatoglossal arch

Palatopharyngeal arch

Posterior wallof oropharynx

Tongue

Lingual frenulum

Gingivae (gums)

Inferior labial frenulum

Vestibule

Duct ofsubmandibular gland

Palatine tonsil

Uvula

Soft palate

Hard palate

Gingivae (gums)

Inferior lip


0Surgically removed tonsils

3Tonsils are beyond

the pillars

4Tonsils extend to midline

1Tonsils hidden within

tonsil pillars

2Tonsils extending to

the pillars

FIGURE 1.11 Tonsil size scoring.



FIGURE 1.12 Oropharynx, hypopharynx, trachea, and larynx.


Frontal sinus

Sella turcica

Adenoid

Pharyngeal opening ofauditory (eustachian) tube

Thyroid cartilage

Vocal fold (cord)

Transverse arytenoid muscle

Cricoid cartilage

Trachea

Esophagus

Sphenoid sinus

Soft palate

Hard palate

Incisive canal

Uvula

Oral cavity

Body of tongue

Palatine tonsil

Lingual tonsil

Base of tongue

Epiglottis

Hyoid bone

Thyrohyoid membrane

Nasopharynx

Oropharynx

Hypopharynx


FIGURE 1.13 Larynx landmarks.


Epiglottis

Base of tongue(lingual tonsil)

Ventricular folds(false cords)

Vestibule

Aryepiglottic fold

Ventricle

ArytenoidEsophagus

Interarytenoidnotch

Piriform recess

Trachea

Glottic aperature

Vocal folds(true cords)

Vallecula

Median glosso-epiglottic fold


FIGURE 1.14 Omega-shaped epiglottis and vallecula.


OMEGA-SHAPED EPIGLOTTIS

VALLECULA


FIGURE 1.15 Cartilages of larynx.


Epiglottis

Hyoid bone

Thyrohyoid membrane

Larynx location

Superior horn ofthyroid cartilage

Arytenoid cartilage(behind thyroid cartilage)

Thyroid cartilage

Cricothyroid ligament

Inferior horn ofthyroid cartilage

Cricoid cartilage

Trachea

Anterior View


FIG

UR

E 1.

16

Nec

k: L

ymp

hat

ic s

yste

m a

nd

no

de

gro

up

s.

© S

prin

ger

Pub

lishi

ng C

ompa

ny

Sup

erfic

ial p

arot

id n

odes

(dee

p pa

rotid

nod

es d

eep

to p

arot

id g

land

)

Occ

ipita

l nod

es

Mas

toid

nod

es

Sub

paro

tid n

ode

(Lev

el II

)

Man

dibu

lar

and

subm

andi

bula

rno

des

(Lev

el I)

Sub

men

tal n

odes

(Le

vel I

)

Sup

rahy

oid

node

(Le

vel I

)

Inte

rnal

jugu

lar

chai

n of

nod

es(d

eep

late

ral c

ervi

cal n

odes

) (L

evel

s II

and

III)

Ant

erio

r de

ep c

ervi

cal (

pret

rach

eal a

ndth

yroi

d) n

odes

(de

ep to

str

ap m

uscl

es)

(Lev

el V

I)

Ant

erio

r su

perf

icia

l cer

vica

l nod

es(a

nter

ior

jugu

lar

node

s) (

Leve

l VI)

Sup

racl

avic

ular

nod

es (

Leve

l IV

)

Faci

al n

odes

(buc

cal n

odes

)

Jugu

lodi

gast

ric n

ode

(Lev

el II

)

Dee

p la

tera

l nod

es(s

pina

l acc

esso

ry n

odes

) (L

evel

V)

Infe

rior

deep

cer

vica

l(s

cale

ne)

node

(Le

vel I

V)

Tran

sver

se c

ervi

cal

chai

n of

nod

es (

Leve

l V)

Leve

l I n

odes

Leve

l II n

odes

Leve

l III

node

s

Leve

l IV

nod

esLe

vel V

nod

esLe

vel V

I nod

es


Ear, Nose, and Throat Anatomy and PhysiologyNormal Findings

Frontal bone

Nasal bone

Zygomatic

arch

Maxilla

Mandible

Temporal bone

Occipital bone

Sphenoid bone

Parietal bone

Styloid

process

Mastoid

process

FIGURE 2.1 Skull bone landmarks.



FIGURE 2.2 Trigeminal nerve and facial nerve branches.


Temporalbranch

Ophthalmicbranch (V1)

Zygomaticbranch

Maxillarybranch (V2)

Mandibularbranch (V3)

Trigeminalnerve

Facialnerve

Buccalbranch

Mandibularbranch

Cervicalbranch


Superior andinferior ganglia

To pharynx

Glossopharyngealnerve

To stylopharyngeusmuscle

To carotid bodyand carotid sinus

To tongue for tasteand general sensation

To palatine tonsil

To parotid gland

FIGURE 2.3 Glossopharyngeal nerve.



FIGURE 2.4 Middle and inner ear.


Dura mater

Ampullae

Endolymphatic sac

Endolymphatic ductin vestibular aqueduct

Utricle

Saccule

Cochlear aqueduct

Vestibule

Auditory(eustachian) tube

Round (cochlear) window(closed by secondarytympanic membrane)

Tympanic membrane

External acoustic meatus

Tympanic cavity

MalleusIncus

Stapes in oval(vestibular) window

Lateral semicircularcanal and duct

Common crus and duct

Posterior semicircularcanal and duct

Anterior (superior) semicircular canal and duct


FIGURE 2.5 Maxillary sinuses.


MMAXILLARY SINUS CAVITIES

NASAL SEPTUM

SINUS CT SCAN: CORONAL VIEW

MAXILLARY SINUS CAVITIES

NASAL SEPTUM

SINUS CT SCAN: CORONAL VIEW


Nasal septumturned superiorly

Septal branch of facial artery

Branches of posteriorethmoidal artery

Septal branch ofnasopalatine artery

Nasopalatine artery

Sphenopalatineforamen

Lateral nasal branchof nasopalatine artery

Maxillary artery

External carotid artery

Lesser palatine arteryLateral wall of nasal cavity

Greater palatine artery

Anastomosis betweenseptal branch of

nasopalatine artery andgreater palatine artery

in incisive canal

Lateral nasalbranches offacial artery

Kiesselbach’sPlexus

Branches of anteriorethmoidal artery

FIGURE 2.6 Arteries of nasal cavity.



FIGURE 2.7 Olfactory nerve.


Olfactory bulb

Olfactory nerves

Olfactory tract


FIGURE 2.8 Frontal, ethmoid, and sphenoid sinuses.


SINUS CT SCAN: SAGITTAL VIEW SINUS CT SCAN: SAGITTAL VIEW

ETHMOID ETHMOID SINUSES SINUSES

FRONTAL SINUSES FRONTAL SINUSES

SPHENOID SINUSES SPHENOID SINUSES

SINUS CT SCAN: SAGITTAL VIEW

ETHMOID SINUSES

FRONTAL SINUSES

SPHENOID SINUSES


Epiglottis

Palatine tonsil

Apex

Base oftongue

Body

Medianglossoepiglottic fold

Lateralglossoepiglottic fold

Vallecula

Lingual tonsil(lingual follicles)

Foramen cecum

Sulcus terminalis

Vallate papillae

Foliate papillae

Filiform papillae

Fungiform papilla

Median sulcus

FIGURE 2.9 Oral cavity, tongue, and oropharynx.



FIGURE 2.10 Mallampati Classifi cation Score.


I II

IVIII


PIRIFORM RECESS

TRUE VOCAL FOLDSFALSE VOCAL FOLDS

ANTERIOR COMMISSURE

ARYTENOIDARYEPIGLOTTIC FOLD

FIGURE 2.11 Larynx.



FIGURE 2.12 Anomalous neural and vascular anatomy of the larynx.


Left vagusnerve (X)

Left commoncarotid artery

Left inferiorlaryngeal nerve

Left recurrentlaryngeal nerve

Left subclavian artery

Anomalous (retroesophageal)right subclavian artery originatingfrom left side of aortic arch

Left recurrentlaryngeal nerve

Anterior View

Arch of aorta

Right commoncarotid artery

Anomalous (retroesophageal)right subclavian artery

Anomalous right inferiorlaryngeal nerve (not recurrent)

Right vagusnerve (X)


A B C

D E F

Foodbolus

FIGURE 2.13 Normal swallowing.



FIGURE 3.1 Cranial nerves.


Physical Examination of theCranial Nerves for the Head and Neck

Olfactory

Oculomotor

Trochlear

Abducens

Vestibulocochlear

Optic

Trigeminal

Facial

Glossopharyngeal

VagusHypoglossal

Accessory


Superior palpebral conjunctiva:tarsal (Meibomian) glands

shining through

Superior lacrimalpapilla and puncta

Plica semilunaris

Lacrimal carunclein lacrimal lake

Inferior lacrimalpapilla and puncta

Pupil

Cornea

Limbus of cornea

Bulbar conjunctivaover sclera

Inferior fornixof conjunctiva

Inferior palpebral conjunctiva:tarsal glands shining through

FIGURE 3.2 Eye anatomy.



FIGURE 3.3 Trigeminal nerve branches: Sensory distribution.


1st Branch:Ophthalmic (eye)

2nd Branch:Maxillary (top jaw)

3rd Branch:Mandibular (lower jaw)


Internalacoustic meatus

Brachial motor

Visceral motor

Special sensory

General sensory

Motor nucleusof facial nerve

Posteriorauricular branch

Stylomastoid foramen

FIGURE 3.4 Facial nerve motor and sensory components.



FIGURE 3.5 Vagus nerve distribution.


Vagus nerve

Superior and inferiorvagal ganglions

Cardiac branch

Pulmonary plexus

Esophageal plexus

Stomach

Liver

Colon

Small intestine

Celiac plexus

Kidney

Spleen

Heart

Lung

Laryngealbranches

Pharyngeal branch


Evaluation and Management of Hearing and Tinnitus

Quiet

Frequency in Hertz (Hz)

Hea

rin

g L

evel

in D

ecib

els

(dB

)

Loud

Low pitch

Normalhearing

High pitch

–100

102030405060708090

100110120130140

125 250 500 1000 2000 4000 8000

FIGURE 5.1 Audiogram.



FIGURE 5.2 Tympanogram.


–400

1400

1200

1000

800

600

400

200

–300 –200 –100

Type C

+100 +2000–400

1400

1200

1000

800

600

400

200

–300 –200 –100

Type B

+100 +2000–400

1400

1200

1000

800

600

400

200

–300 –200 –100

Type A

+100 +2000

–400

1400

1200

1000

800

600

400

200

–300 –200 –100

Type AS

+100 +2000 –400

1400

1200

1000

800

600

400

200

–300 –200 –100

Type AD

+100 +2000



Hea

rin

g L

evel

in d

ecib

els

(dB

)

–10

0

10

20

30

40

50

60

70

80

90

100

110125 250 500 1000 2000 4000 8000

FIGURE 5.3 Conductive hearing loss (left ear).



FIGURE 5.4 Sensorineural hearing loss (right ear).



Sensorineural Hearing Loss AudiogramH

eari

ng

Lev

el in

dec

ibel

s (d

B)

–10

0

10

20

30

40

50

60

70

80

90

100

110125 250 500

Air conduction Bone conduction

1000 2000 4000 8000



Hea

rin

g L

evel

in d

ecib

els

(dB

)

–10

0

10

20

30

40

50

60

70

80

90

100

110125 250 500

Air conduction:

Left ear

Right ear

Left ear

Right ear

Bone conduction:

1000 2000 4000 8000

FIGURE 5.5 Mixed hearing loss (bilateral ears).



FIGURE 5.6 Otosclerosis Carhart’s notch (right ear).



Hea

rin

g L

evel

in d

ecib

els

(dB

)–10

0

10

20

30

40

50

60

70

80

90

100

110125 250 500 1000 2000 4000 8000


Evaluation and Management of Middle Ear Conditions

FIGURE 7.1 Bulging tympanic membrane as seen with otitis media.



FIGURE 7.2 Bullous myringitis.



FIGURE 7.3 Tympanic membrane perforation (large) with tympanic membrane scarring (left ear).



FIGURE 7.4 Normal tympanostomy tube (Armstrong).



FIGURE 7.5 Large tympanic membrane perforation.



FIGURE 8.1 Components of balance.


Evaluation and Management of Inner Ear Conditions

+ =

SensorimotorControl Input

• Vestibular: Inner ear

• Visual: Eyes

• Proprioception:Muscles andjoint receptors

Integration ofInput in CNS

Brainstem(sorts info)

MotorOutput

Bal

ance

• Cerebral cortex:Functions inthinking andmemory andcontains previouslylearned information

• Cerebellum:Functions as thecoordinationcenter andcontains automaticmovementspreviously learned

• Vestibulo-ocular reflex: Eye position

compensatesfor movementsof the head

• Vestibulo-spinal reflex: Controls body posture

• Vestibulo-collic reflex: Keeps head

on a level planewith movement

Components of Balance


Vestibular System

Angular Acceleration(Head Rotation)

• Anterior/superior canal and posterior canal:

detects rotations of thehead in a sagittal plane(as when nodding) and inthe frontal plane (as whencartwheeling)

• Horizontal or lateral canal:corresponds to rotation of the headaround a verticle axis (i.e., the neck)as when doing a complete spin

Linear Acceleration(One Directional Movement)

• Saccule:senses motion in the sagittalplane (up-down movement)and gravity

Each semicircular canal is a continuous endolymph-filled hoop. Hair cells sit in the small swelling at the base called an ampula. The function of these canals is to stabilize eye movement with head movement.

Both the utricle and saccule use small stones (otoliths) and a viscous fluid to stimulate their hair cells to detect motion and orientation. The major role of the utricle and saccule is to keep the person vertically oriented with respect to gravity.

• Utricle:the three semicircular canalsopen into the utricle. It sensesmotion in the horizontal plane(i.e., forward-backwardmovement, left-rightmovement, or both)

FIGURE 8.2 Vestibular system.



Posteriorcanal

Superiorcanal

Utriculus

Posterior-canalampulla

Particles

Particles

Gravity

Gravity

Vantagepoint

45°

Superiorcanal

Utriculus

Posterior-canalampulla

Posteriorcanal

Gravity

Gravity

A

B

Vantagepoint

Sagittal body

plane

FIGURE 8.3 Dix–Hallpike maneuver.



3

21

4

5

FIGURE 8.4 Epley maneuver (for right-sided posterior semicircular canal benign paroxysmal positional vertigo).



Eval

uat

ion

an

d M

anag

emen

t o

f O

lfac

tory

Dis

ord

ers

Olfa

ctor

y bu

lb

Olfa

ctor

ybu

lb

Den

drite

Olfa

ctor

y ci

lia

Muc

us

Rou

te o

f inh

aled

air

cont

aini

ng o

dor

mol

ecul

es

Crib

iform

pla

teof

eth

moi

d bo

ne

Fila

men

ts o

fol

fact

ory

nerv

e

Lam

ina

prop

riaco

nnec

tive

tissu

eA

xon

Bas

al c

ell

Olfa

ctor

yse

nsor

y ne

uron

Sup

port

ing

epith

elia

l cel

l

Olfa

ctor

yep

ithel

ium

AB

Nas

alco

ncha

e

Rou

t of

inha

led

air

Olfa

ctor

y tr

act

Olfa

ctor

ytr

act

Olfa

ctor

y gl

and

Olfa

ctor

yep

ithel

ium

FIG

UR

E 9.

1 O

lfac

tio

n.

© S

prin

ger

Pub

lishi

ng C

ompa

ny


Evaluation and Management of theNose—External Conditions

1 2 3 4 5

Type Anatomical Defi cits

1 Minor supratip or nasal dorsal depression, with a normal projection of lower third of the nose

2 Depressed nasal dorsum (moderate to severe) with relatively prominent lower third

3 Depressed nasal dorsum (moderate to severe) with loss of tip support and structural defi cits in the lower third of the nose

4 Catastrophic (severe) nasal dorsal loss with signifi cant loss of the nasal structures in the lower and upper thirds of the nose

FIGURE 10.1 Saddle nose deformity.



FIGURE 11.1 Nasal polyp.


Evaluation and Management ofthe Nasal Cavity and Paranasal Sinuses

Nasal Polyp Nasal Polyp

LEFT MIDDLE TURBINATELEFT MIDDLE TURBINATE

Nasal Polyp

LEFT MIDDLE TURBINATE


Antrochoanal Polyp Antrochoanal Polyp

BEFORE EXCISIONBEFORE EXCISION

AFTER EXCISIONAFTER EXCISION

MiddleMiddleTurbinate Turbinate

Antrochoanal Polyp

BEFORE EXCISION

AFTER EXCISION

MiddleTurbinate

FIGURE 11.2 Antrochoanal polyp.



FIGURE 11.3 Mucous retention cyst.


Left Maxillary MucousLeft Maxillary MucousRetention Cyst Retention Cyst Left Maxillary MucousRetention Cyst


POSTSURGICAL CHANGESPOSTSURGICAL CHANGES

Bilateral Ethmoidectomies withBilateral Ethmoidectomies withpatency of the frontoethmoid recesses. patency of the frontoethmoid recesses.

Postsurgical changes fromPostsurgical changes frombilateral antral window creation. bilateral antral window creation.

Moderate dependent mucosalModerate dependent mucosalthickening within the rightthickening within the rightmaxillary sinus. maxillary sinus.

POSTSURGICAL CHANGES

Bilateral Ethmoidectomies withpatency of the frontoethmoid recesses.

Postsurgical changes frombilateral antral window creation.

Moderate dependent mucosalthickening within the rightmaxillary sinus.

FIGURE 11.4 Postsurgical changes.



FIGURE 11.5 Inverted papilloma.


INVERTED PAPILLOMAINVERTED PAPILLOMA

LEFT MIDDLE TURBINATE LEFT MIDDLE TURBINATE

INVERTED PAPILLOMA

LEFT MIDDLE TURBINATE


Nasal bone

Perpendicularplate of ethmoid

Septal cartilage

Vomeronasalcartilage

MaxillaVomer

Palatinebone

Pharyngealtonsil

Sphenoidsinus

Cribriform plateof ethmoid boneFrontal sinus

FIGURE 11.6 Nasal septum anatomy.



FIGURE 11.7 Obstructed osteomeatal complex bilateral. Moderate left and right maxillary and ethmoid sinus mucosal thickening. Osteomeatal complex is

occluded bilaterally.



FIGURE 11.8 Obstructed osteomeatal complex unilateral. Complete opacifi cation of the right maxillary sinus. Near-complete opacifi cation of the

anterior ethmoid air cells. Right osteomeatal complex is opacifi ed. There is also occlusion of the right frontoethmoid recess.


R


FIGURE 11.9 Haller cell.


Haller Cell Haller Cell Haller Cell


Concha BullosaConcha BullosaConcha Bullosa

FIGURE 11.10 Concha bullosa.



FIGURE 11.11 Agger nasi cell.


Agger Nasi Cell Agger Nasi Cell Agger Nasi Cell


RIGHT MIDDLE TURBINATE RIGHT MIDDLE TURBINATE

RIGHT MAXILLARYRIGHT MAXILLARYOSTIA OSTIA

RIGHT ETHMOIDRIGHT ETHMOIDOSTIAOSTIA

RIGHT MIDDLE TURBINATE

RIGHT MAXILLARYOSTIA

RIGHT ETHMOIDOSTIA

FIGURE 11.12 Sinus ostia after endoscopic sinus surgery. View of the right ethmoid and maxillary ostia.



Oroantral Fistula Oroantral Fistula Oroantral Fistula

FIGURE 11.13 Oroantral fi stula.



R

FIGURE 11.14 Silent sinus syndrome. Scan shows marked reduction in left maxillary sinus volume. There is inferior bowing of the orbital fl oor with

increased left orbital volume and enophthalmos with an absence of the left maxillary ostium (compared to the right) and complete opacifi cation of the left

maxillary sinus with occlusion of the left osteomeatal complex (OMC). These fi ndings are compatible with silent sinus syndrome. Incidental note: There is a

mucus retention cyst versus a polyp in the right maxillary sinus. The right OMC is patent.



Evaluation and Management ofNasopharynx Conditions

FIGURE 12.1 Adenoid hypertrophy blocking the posterior nasopharynx on nasal endoscopic examination.



FIGURE 12.2 Postop adenoidectomy scar as seen on nasopharyngoscopy examination.



Evaluation and Management ofOropharynx Disorders

FIGURE 13.1 Aphthous ulcer.



TONSIL HYPERTROPHYTONSIL HYPERTROPHYTONSIL HYPERTROPHY

FIGURE 13.2 Tonsil hypertrophy (on fi beroptic laryngoscopy examination).



FIGURE 13.3 Tonsillitis.


Infected tonsil

Edematous uvula

Tongue

Infected tonsil


FIGURE 15.1 Warthin’s tumor. Within left parotid gland there is a peripherally enhancing mass with smooth well-defi ned margins arising within the deep parotid lobe and extending below it, measuring 2.8 x 2.77 cm. It abuts the

sternocleidomastoid. Pathology confi rmed Warthin’s tumor.


Evaluation and Management ofSalivary Gland Conditions

R


FIGURE 16.1 Branchial cleft cyst. Cyst in the right neck anterior to the parotid gland. Excision of the lesion was done and it was determined to be moderately

differentiated cystic squamous cell carcinoma.


Evaluation and Management ofBenign Neck Conditions


R

FIGURE 16.2 Thyroglossal duct cyst: Rounded lesion within midline of the tongue measures 3.3 x 6.1 x 4.5 cm with no evidence of calcifi cation. The lesion is

above the hyoid bone without extension beyond the borders of the tongue.



Overview ofMalignant Neck Conditions

Dorsum ofDorsum ofTongueTongue

SCC of the tongueSCC of the tongue

Dorsum ofTongue

SCC of the tongue

FIGURE 17.1 Tongue mass.



FIGURE 17.2 Squamous cell carcinoma at the base of the tongue: Mass has irregular margins, crossing the midline and measuring 3.7 x 3.4 x 5.9 cm.

It was determined to be a moderately to poorly differentiated squamous cell carcinoma predominantly involving the oropharynx with extension into the

posterior tongue.


R


Nasopharyngeal MassNasopharyngeal Mass


Nasopharyngeal MassNasopharyngeal MassNasopharyngeal MassNasopharyngeal Mass

Nasopharyngeal Mass

Nasopharyngeal Mass


FIGURE 17.3 Nasopharyngeal mass.



R

FIGURE 17.4 Squamous cell carcinoma of neck: CT with contrast shows a left neck mass interior to the sternocleidomastoid, with increased heterogeneity,

compatible with necrosis. The mass abuts the left carotid artery. There are multiple adjacent lymph nodes as well. Pathology results indicated that the neck

mass was a moderately differentiated squamous cell carcinoma.



R

FIGURE 17.5 Lymphoma: Solid right parotid gland mass just inferior to the right ear along the posterior aspect of the inferior-most parotid

gland, 20 x 13 mm. The borders are indistinct with mild surrounding fatty infi ltration. No calcifi cation is observed. Pathology indicated malignant

lymphoma, follicular type.



Evaluation and Management ofTrachea Disorders and Conditions

Cricothyroidotomy

Percutaneousdilational

tracheostomy site

Standardtracheostomy site

Thyroid cartilage

Cricothyroid membrane

Cricoid cartilage

Subcricoid space

First tracheal cartilage

Second tracheal cartilage

FIGURE 20.1 Tracheostomy tube insertion site.



Plug

ObturatorInner cannula

Pilot balloon

Cuff inflation line

Outer cannula

Cuff

Fenestration

FIGURE 20.2 Tracheostomy tube.



Evaluation and Management ofLarynx and Hypopharynx Disorders

FIGURE 22.1 Reinke’s edema.



FIGURE 22.2 Vocal cord polyp and nodule.


Right TVCRight TVC

Right TVCRight TVC Left TVCLeft TVC

Left TVCLeft TVC

VC PolypVC Polyp

VC NoduleVC Nodule

Right TVC

Right TVC Left TVC

Left TVC

VC Polyp

VC Nodule


FIGURE 22.3 Right true vocal cord polyp.



FIGURE 22.4 Right true vocal cord polyp before and after excision.



FIGURE 22.5 Vocal cord cysts.



FIGURE 22.6 Right true vocal cord intracordal cyst.



FIGURE 22.7 Vocal cord granuloma.



FIGURE 22.8 Vocal cord papilloma.



R

FIGURE 22.9 Squamous cell carcinoma of right true vocal cord. CT shows signifi cant soft tissue density surrounded and nearly occluded

by the glottic portion of the airway. CT fi ndings were worrisome for malignancy. Biopsy results confi rmed moderately differentiated squamous cell carcinoma of

the right true vocal cord.



Quick Reference for Otolaryngology1.Physical Examination Documentation of Normal and Abnormal Findings From the Ear, Nose, and Throat ExaminationFigure 1.1 Normal tympanic membrane.Figure 1.2 Pinna.Figure 1.3 External, middle, and inner ear. Figure 1.4 Tympanic membrane.Figure 1.5 Central tympanic membrane perforation.Figure 1.6 Tympanosclerosis.Figure 1.7 External nose.Figure 1.8 Paranasal sinuses.Figure 1.9 Salivary glands.Figure 1.10 Oral cavity and oropharynx.Figure 1.11 Tonsil size scoring.Figure 1.12 Oropharynx, hypopharynx, trachea, and larynx.Figure 1.13 Larynx landmarks.Figure 1.14 Omega-shaped epiglottis and vallecula.Figure 1.15 Cartilages of larynx.Figure 1.16 Neck: Lymphatic system and node groups.

2. Ear, Nose, and Throat Anatomy and Physiology Normal FindingsFigure 2.1 Skull bone landmarks.Figure 2.2 Trigeminal nerve and facial nerve branches.Figure 2.3 Glossopharyngeal nerve.Figure 2.4 Middle and inner ear.Figure 2.5 Maxillary sinuses.Figure 2.6 Arteries of nasal cavity.Figure 2.7 Olfactory nerve.Figure 2.8 Frontal, ethmoid, and sphenoid sinuses.Figure 2.9 Oral cavity, tongue, and oropharynx.Figure 2.10 Mallampati Classification Score.Figure 2.11 Larynx.Figure 2.12 Anomalous neural and vascular anatomy of the larynx.Figure 2.13 Normal swallowing.

3. Physical Examination of the Cranial Nerves for the Head and NeckFigure 3.1 Cranial nerves.Figure 3.2 Eye anatomy.Figure 3.3 Trigeminal nerve branches: Sensory distribution. Figure 3.4 Facial nerve motor and sensory components.Figure 3.5 Vagus nerve distribution.

5. Evaluation and Management of Hearing and TinnitusFigure 5.1 Audiogram. Figure 5.2 Tympanogram.Figure 5.3 Conductive hearing loss (left ear).Figure 5.4 Sensorineural hearing loss (right ear).Figure 5.5 Mixed hearing loss (bilateral ears).Figure 5.6 Otosclerosis Carhart’s notch (right ear).

7. Evaluation and Management of Middle Ear ConditionsFigure 7.1 Bulging tympanic membrane as seen with otitis media.Figure 7.2 Bullous myringitis.Figure 7.3 Tympanic membrane perforation (large) with tympanic membrane scarring (left ear).Figure 7.4 Normal tympanostomy tube (Armstrong).Figure 7.5 Large tympanic membrane perforation.

8. Evaluation and Management of Inner Ear ConditionsFigure 8.1 Components of balance.Figure 8.2 Vestibular system.Figure 8.3 Dix–Hallpike maneuver. Figure 8.4 Epley maneuver (for right-sided posterior semicircular canal benign paroxysmal positional vertigo).

9. Evaluation and Management of Olfactory DisordersFigure 9.1 Olfaction.

10. Evaluation and Management of the Nose—External ConditionsFigure 10.1 Saddle nose deformity.

11. Evaluation and Management of the Nasal Cavity and Paranasal SinusesFigure 11.1 Nasal polyp.Figure 11.2 Antrochoanal polyp.Figure 11.3 Mucous retention cyst.Figure 11.4 Postsurgical changes.Figure 11.5 Inverted papilloma.Figure 11.6 Nasal septum anatomy. Figure 11.7 Obstructed osteomeatal complex bilateral. Moderate left and right maxillary and ethmoid sinus mucosal thickening. Osteomeatal complex is occluded bilaterally.Figure 11.8 Obstructed osteomeatal complex unilateral. Complete opacification of the right maxillary sinus. Near-complete opacification of the anterior ethmoid air cells. Right osteomeatal complex is opacified. There is also occlusion of the right frontoethmoid recess.Figure 11.9 Haller cell.Figure 11.10 Concha bullosa.Figure 11.11 Agger nasi cell.Figure 11.12 Sinus ostia after endoscopic sinus surgery. View of the right ethmoid and maxillary ostia.Figure 11.13 Oroantral fistula.Figure 11.14 Silent sinus syndrome. Scan shows marked reduction in left maxillary sinus volume. There is inferior bowing of the orbital floor with increased left orbital volume and enophthalmos with an absence of the left maxillary ostium (compared to the right) and complete opacification of the left maxillary sinus with occlusion of the left osteomeatal complex (OMC). These findings are compatible with silent sinus syndrome. Incidental note: There is a mucus retention cyst versus a polyp in the right maxillary sinus. The right OMC is patent.

12. Evaluation and Management of Nasopharynx ConditionsFigure 12.1 Adenoid hypertrophy blocking the posterior nasopharynx on nasal endoscopic examination.Figure 12.2 Postop adenoidectomy scar as seen on nasopharyngoscopy examination.

13. Evaluation and Management of Oropharynx DisordersFigure 13.1 Aphthous ulcer.Figure 13.2 Tonsil hypertrophy (on fiberoptic laryngoscopy examination).Figure 13.3 Tonsillitis.

15. Evaluation and Management of Salivary Gland ConditionsFigure 15.1 Warthin’s tumor. Within left parotid gland there is a peripherally enhancing mass with smooth well-defined margins arising within the deep parotid lobe and extending below it, measuring 2.8 x 2.77 cm. It abuts the sternocleidomastoid. Pathology confirmed Warthin’s tumor.

16. Evaluation and Management of Benign Neck ConditionsFigure 16.1 Branchial cleft cyst. Cyst in the right neck anterior to the parotid gland. Excision of the lesion was done and it was determined to be moderately differentiated cystic squamous cell carcinoma.Figure 16.2 Thyroglossal duct cyst: Rounded lesion within midline of the tongue measures 3.3 x 6.1 x 4.5 cm with no evidence of calcification. The lesion is above the hyoid bone without extension beyond the borders of the tongue.

17. Overview of Malignant Neck ConditionsFigure 17.1 Tongue mass.Figure 17.2 Squamous cell carcinoma at the base of the tongue: Mass has irregular margins, crossing the midline and measuring 3.7 x 3.4 x 5.9 cm. It was determined to be a moderately to poorly differentiated squamous cell carcinoma predominantly involving the oropharynx with extension into the posterior tongue.Figure 17.3 Nasopharyngeal mass.Figure 17.4 Squamous cell carcinoma of neck: CT with contrast shows a left neck mass interior to the sternocleidomastoid, with increased heterogeneity, compatible with necrosis. The mass abuts the left carotid artery. There are multiple adjacent lymph nodes as well. Pathology results indicated that the neck mass was a moderately differentiated squamous cell carcinoma.Figure 17.5 Lymphoma: Solid right parotid gland mass just inferior to the right ear along the posterior aspect of the inferior-most parotid gland, 20 x 13 mm. The borders are indistinct with mild surrounding fatty infiltration. No calcification is observed. Pathology indicated malignant lymphoma, follicular type.

20. Evaluation and Management of Trachea Disorders and ConditionsFigure 20.1 Tracheostomy tube insertion site.Figure 20.2 Tracheostomy tube.

22. Evaluation and Management of Larynx and Hypopharynx DisordersFigure 22.1 Reinke’s edema.Figure 22.2 Vocal cord polyp and nodule.Figure 22.3 Right true vocal cord polyp.Figure 22.4 Right true vocal cord polyp before and after excision.Figure 22.5 Vocal cord cysts.Figure 22.6 Right true vocal cord intracordal cyst.Figure 22.7 Vocal cord granuloma.Figure 22.8 Vocal cord papilloma.Figure 22.9 Squamous cell carcinoma of right true vocal cord. CT shows significant soft tissue density surrounded and nearly occluded by the glottic portion of the airway. CT findings were worrisome for malignancy. Biopsy results confirmed moderately differentiated squamous cell carcinoma of the right true vocal cord.

IMAGE BANK QUICK REFERENCE - Springer Publishing...IMAGE BANK SScott_Image Bank_03-11-14.indd...

Documents

Transcript of IMAGE BANK QUICK REFERENCE - Springer Publishing...IMAGE BANK SScott_Image Bank_03-11-14.indd...