Bailey Head And Neck Surgery Otolaryngology Pdf

bailey head and neck surgery otolaryngology pdf

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Otolaryngology: E-Books

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Please consult the latest official manual style if you have any questions regarding the format accuracy. All of these are part of the oral cavity except.

The oral cavity is bounded by the vermilion border of the lips and the junction of the hard and soft palate and circumvallate papillae.

It can be thought of having eight subunits: lips, buccal mucosa, floor of mouth, anterior two-thirds of the tongue i. The retromolar trigone is a triangular spaced area from the distal surface of the last molar tooth to the maxillary tuberosity. This area is important in cancer spread as the mucosa of the mandible is tightly adherent to the underlying periosteum and therefore a weak barrier to tumor extension.

The vestibule is the area lateral to the alveolar ridges and the oral cavity proper the area medial to the teeth. The salivary ducts traverse the mucosa to drain into the oral cavity. The vascular supply of the oral cavity is derived from several branches of the external carotid artery.

These include the lingual artery which supplies the floor of mouth; the internal maxillary artery which transmits the descending palatine artery, ultimately dividing into the greater and lesser palatine arteries to supply the hard and soft palate, respectively, and the posterior, middle, and anterior superior alveolar arteries and nasopalatine artery which supply the upper alveolar ridge.

The lesser palatine artery anastomoses posteriorly with a branch of the facial artery, the ascending palatine artery. The mandibular teeth and gingiva are vascularized by the inferior alveolar artery. Venous drainage of the palate is via the pterygoid plexus hard palate and pharyngeal plexus soft palate and tongue and floor of mouth via the lingual vein.

Lymphatic drainage occurs via submandibular hard palate, lateral tongue , deep jugular most subunits , lateral pharyngeal, parotid and submental nodes tip of tongue. The oral tongue does not have bilateral drainage whereas the base of tongue posteriorone-third, part of the oropharynx does have bilateral drainage. The embryology of the oral cavity and specifically the tongue is important in describing the innervation. The anterior two-thirds of the tongue are derived from ectoderm of the first and second branchial arches and the posterior one-third from endoderm between the second and third branchial arches.

The anterior or oral tongue receives general sensation from V 3 , a nerve of the first arch and special sensation taste from the chorda tympani, a branch of VII which is the second arch nerve.

The base of tongue receives innervation from the glossopharyngeal nerve. The principle of referred otalgia from lesions or processes in the oral cavity is explained by lingual nerve V 3 innervation, the lingual also supplying the external ear, external auditory canal, and tympanic membrane. Which of the following is the most common nerve deficit after resection of a poststyloid compartment parapharyngeal neurilemmoma?

The parapharyngeal space PPS can be thought of as an inverted pyramid. The boundaries of this space are the base of skull superiorly and the hyoid bone inferiorly. The space itself is deep to the pharyngeal mucosa and superficial to the carotid sheath and it communicates with the submandibular space. It can be divided into a prestyloid and poststyloid or retrostyloid space by the syloid muscles and a band of fascia from the tensor veli palatini.

These spaces are important when discussing tumor pathology and surgical approaches. The prestyloid space contains fat, the mandibular branch of the facial nerve, the pterygoid venous plexus, whereas the poststyloid space contains cranial nerves IX—XII, the cervical sympathetic chain and the internal carotid artery and internal jugular vein IJV. The differential of masses in the PPS is large but can be broken into four categories: salivary gland tumors, neurogenic tumors, lymph node enlargement, or miscellaneous tumors.

Patients can present with symptoms of airway obstruction from poststyloid masses, pain or cranial nerve palsies of nerves in the PPS. Patients can also present with a unilateral serous otitis media from Eustachian tube dysfunction. Findings for a prestyloid PPS mass would include displacement of PPS fat medially and posteriorly, displacement of the posterior belly of the digastric and styloid muscles more posteriorly and medially, and location medial to the medial pterygoid muscle.

Findings for a poststyloid mass would include location or extension posteriorly to the styloid process, lateral and anterior displacement of the posterior belly of the digastric and styloid muscles and usually displacement of the carotid sheath contents anteriorly. Neurogenic tumors and paragangliomas are the second and third most common masses, respectively. The PPS is the second most common site in the head and neck for the location of a nerve sheath tumor, and the incidence of these is higher in females.

Neurogenic tumors are slow growing and as described above, may present with obstructive symptoms because of medial displacement of the pharynx, tonsil, and soft palate. Neurilemmomas schwannomas are the most common PPS neurogenic tumor and the cervical sympathetic chain is the nerve most frequently involved. For all PPS tumors, however, including prestyloid , a temporary paresis of the mandibular division of the facial nerve is the most common complication reported. Of paragangliomas, the carotid body tumor is the most common.

Resection of these tumors includes transcervical approaches with or without mandibulotomy, infratemporal approaches, transparotid and various combinations. The transcervical approach typically provides the best exposure for poststyloid PPS neurogenic tumors.

A 2-year-old child swallows a short straight pin and is brought to the emergency room ER by his parents. On examination, he is alert and able to control his secretions i. He has not experienced any respiratory distress and is afebrile. What is the appropriate course of action?

Children in this age group tend to explore with their mouths. Another factor is the lack of development of molars for grinding and lack of maturity of swallowing and airway protection processes. Boys outweigh girls by in frequency. Others may include disc batteries, screws, tacks, nails, and other hardware items. Increasing in frequency are toy plastic parts. The esophagus has four layers: the mucosa, submucosa, inner circular layer of muscle, and outer longitudinal layer of smooth muscle.

The upper 5 cm are skeletal muscle, the upper midsection is an overlap of striated skeletal and smooth muscle, and the lower half is smooth muscle. The myenteric plexus of Auerbach is found within muscle layers and the submucosal plexus of Meissner is found in the submucosa.

Both plexi are parasympathetic in innervation. The mucosa of the esophagus contains stratified squamous epithelium with poor absortion and low level secretory functions. Because there is no serosa, the esophagus is relatively more prone to perforation.

There are four anatomic narrowings in the esophagus: the cricopharyngeus muscle, aortic crossing, left mainstem bronchus crossing, and the diaphragm. The signs and symptoms of esophageal foreign body aspiration are dyspnea or airway distress, drooling, and dysphagia. The party wall between the anterior esophagus and posterior trachea is very compliant and if a large foreign body is engaged here it can compress the airway from behind.

Any evidence of fever, tachycardia, tachypnea, and increasing pain should arouse suspicion for esophageal perforation and possible mediastinal emphysema or retropharyngeal abscess. The most common area for an esophageal foreign body to lodge is at the level of the cricopharyngeus or at C6. If it lodges elsewhere, investigation for another congenital anatomic disorder of the esophagus is warranted. Typically, small sharp objects pass spontaneously and thus, this type of ingestion can be treated conservatively.

Objects that require immediate removal include disc batteries or any ingestions with airway symptoms. Disc batteries can cause esophageal perforation within 8—12 h of ingestion, but if radiography reveal they have passed into the stomach, these ingestions can be treated more conservatively. Coins less than 20 mm in diameter dimes, pennies can pass spontaneously. Other objects that are high risk for causing perforation are long straight pins, chicken and fish bones, and toothpicks.

Initial workup for any foreign body ingestion are posterior to anterior PA and lateral chest x-rays. As the majority of objects are coins, these are radiopaque and easy to spot on film. If there is still no evidence radiographically, then a very small sip of barium can be given to outline a possible nonradiopaque object. Barium esophagography is generally not used, however for several reasons, including the possible delay of an endoscopic procedure because of nullifying the nothing by mouth NPO status of the patient, increased difficulty of subsequent removal with barium , and possible barium aspiration with mediastinitis.

The safest method of extraction of esophageal foreign bodies is a controlled situation with a protected airway under general anesthesia. On examination in the ER you see a 7 cm laceration in the anterior neck, subcutaneous emphysema, and a hematoma which does not appear to be expanding.

He is unable to lay flat and has a muffled voice. On flexible laryngoscopy, you see diffuse but mild edema of the supraglottis and glottis, reduced vocal cord abduction, and bloody secretions in the subglottis. Initial management of this patient would involve. External laryngeal trauma is diagnosed on the basis of history and physical findings.

A patient who presents with evidence of anterior neck trauma should be assumed to have upper airway trauma. This compounded with subcutaneous emphysema, voice changes, and orthopnea should arouse suspicion for disruption of the larynx or trachea.

There is potential for worsening of the edema and bleeding in the next 8—12 h. As a result, an awake tracheostomy is the best option. The addition of general anesthesia in this situation may cause laryngospasm and resultant complete airway obstruction.

Any situation in which this is considered precludes oral or nasal intubation as intubation may worsen the existing damage or convert a partial laryngotracheal or cricotracheal separation into a complete separation. The pathophysiology behind blunt trauma to the larynx involves crushing of the laryngeal skeleton against the cervical spine. There is a shearing effect between the laryngeal ligaments, the thyroarytenoid vocalis muscle, and the perichondrium of the thyroid and cricoid cartilages.

In addition arytenoid cartilage dislocation or subluxation and recurrent laryngeal nerve injury via traction or actual transection may occur. The result is mucosal tears, edema, and hematoma or hemorrhage.

Any damage to the cricoid can be particularly devastating as it is the only complete ring of the airway and is the cornerstone of structural support for the larynx. Some external laryngeal trauma can be treated conservatively with medical management. Conditions include: minor edema or hematomas with intact mucosa, single nondisplaced thyroid cartilage fractures, small lacerations without exposed cartilage.

Medical management would include elevation of the head of bed with bedrest to reduce edema. Corticosteroids are probably only beneficial in the early postinjury period and antibiotics are used in the event of lacerations or mucosal tears as prophylaxis. Cool humidified air is important to prevent crust formation with tracheostomies and with mucosal tears. Voice rest is sometimes recommended to reduce edema or hematoma progression.

Gastroesophageal reflux prevention is also important with either H2 blockers or proton-pump inhibitors. Any patient not meeting the criteria for conservative management proceeds to surgery. Frequently, the lacerations are used to explore the laryngeal framework and mucosa. Early intervention is advocated for less scarring and granulation tissue. Discussion about surgical techniques is beyond the scope of this question; however, the reader is recommended to review the attached bibliography.

Bailey's Head and Neck Surgery: Otolaryngology, 5th Edition

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If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style if you have any questions regarding the format accuracy. All of these are part of the oral cavity except. The oral cavity is bounded by the vermilion border of the lips and the junction of the hard and soft palate and circumvallate papillae. It can be thought of having eight subunits: lips, buccal mucosa, floor of mouth, anterior two-thirds of the tongue i.

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Bailey's Head and Neck Surgery - Otolaryngology Review

Otolaryngology—Head and Neck Surgery by Cummings et al is the fourth edition of a comprehensive compendium of information pertaining to this specialty.

Bailey's Head and Neck Surgery: Otolaryngology

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Otolaryngology–Head and Neck Surgery

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Bailey's Head and Neck Surgery: Otolaryngology. Publication Year: Edition​: 5th Ed. Authors/Editor: Johnson, Jonas. Publisher: Lippincott Williams.

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