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- 1. Oral cavity and salivary glands Exeter Surgical Society 26th November 2013 Mr Richard Harris Speciality Registrar in ENT Royal Devon and Exeter Hospital
- 2. Introduction Much of acute ENT …………….is very simple …………… is very common …………… is very treatable. But it is taught badly or not at all.
- 3. Aims Discuss basic anatomy of oral cavity and salivary glands Related structures that are clinically relevant Basic presentations of common conditions
- 4. House Rules Please turn phones/bleeps off. No such thing as a silly question. Non-participants will be picked on! If you don’t understand- ask!
- 5. The bottom line If you: - Do the basic things well - Respect your own ability and take responsibility for the patient - Spot the serious things and refer early - Describe your findings accurately You and the patient are on to a winner!
- 7. Why bother? Every patient has one! Dental care is not provided for all on the NHS Oral/salivary problems very common in general medical patients Mouth a common indicator of general health
- 8. What do you already know? Anatomical terms Skull anatomy
- 12. Floor of mouth
- 13. Important structures Facial artery and vein Lingual nerve Hypoglossal nerve Mylohyoid muscles Digastric muscles Facial nerve
- 14. The bits at the back! Palatal arches - Palatoglossal - Palatopharyngeal Tonsils Uvula Tongue base Oropharyngeal wall
- 17. Time to get personal!
- 18. Tonsillitis Very common Difficulty swallowing Pyrexia Dehydrated Malaise NO TRISMUS Bilateral tonsillar swelling
- 19. Tonsillitis If drinking and apyrexial: - Pen V 500mg QDS, analgesia, home. Otherwise: - FBC/U&E/CRP/Monospot - IV Benzylpenicillin & Metronidazole - IV fluids - Single dose Dexamethasone 8mg IV - Analgesia - Refer for admission
- 20. Quinzy Peritonsillar abscess Symptoms similar to tonsillitis but: - Usually more toxic - Trismus - UNILATERAL swelling. • Workup as for tonsillitis but ref to ENT for drainage and admission.
- 22. Glandular fever Infectious mononucleosis From EBV Highly contagious Usually longer Hx than bacterial tonsillitis Classical appearance Must examine abdomen
- 24. Oral cancer Increasingly common Smokers/HPV Longstanding ulcers Ongoing glossitis Mainly SCC
- 28. Parotid gland
- 29. Parotid gland
- 32. Sublingual gland
- 33. Sialadentitis
- 34. Sialadentitis
- 35. Sialadentitis
- 36. Sialadentitis
- 37. Sialadentitis
- 38. Mumps
- 39. Salivary tumours
- 40. Classification
- 42. Investigation Clinical examination including CNVII Ultrasound FNA cytology MRI PET
- 44. Iseli’s law “if in doubt, cut the f***** out”
- 47. A career in ENT Massive variety of work Nice mix of benign/malignant pathology All ages Lots of toys Range of unique skills even at FY1 level It works! On call from home as SpR or Consultant Lots of private practice available
- 48. Thank you