HEAD & NECK 6

4. ORAL CAVITY

 

4.1 ORAL ULCERATION

 

Ulcers do occur in the oral cavity and the cause of these  ulcers

are infection, trauma (teeth) and dyspeptic.

 

The ulcers most commonly seen are aphtous  ulcer are  superficial

(shallow),  round or oval and they are painful to touch  and  are

soft. They usually settle in 1.2 weeks.

 

Oral  hygiene  and look for dental trauma,  local  mouthwash  can

help.

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HEAD & NECK 5 lymphoma

3.2 PRIMARY LYMPHOMA

Lymph  glands  with a typical rubbery feel,  firm  discrete  (not

matted)  at  multiple sites and are the  usual  presentation  that indicates of primary lymphoma (non hodgkin).

Hodgkins lymphoma is seen in adult of 20-30 years and 55-70 years

and  is  less common, the gland enlargment is painless.  

There  is however feeling of illness and fever. There may be loss of  appetite

and weight.

TREATMENT

Treatment is with chemotherapy and radiotherapy.

Burkitt`s  lymphoma is found in the tropics, 

suspected to be of viral origin.

In lymph gland enlargments a biopsy is required for diagnosis.

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HEAD & NECK 4

3. LYMPH GLAND ENLARGEMENTS

 

There  a few hundred lymph glands located in the head  and  neck. 

They  are  in the main distributed in  the  superficial  location

shown in Fig.Above  

They are enlarged whenever there is an inflamatory disorder in the area of drainage of these glands.  

In later  life they  are enlarged because of malignant tumours in the  area  of their  drainage.   

Therefore in lymph gland enlargements  of  the

neck the oral cavity, oesophagus  lungs and thyroid need physical examination and investigations. 

 

Lymph   glands   also  get  enlarged  in   cases   of   glandular

fever(Infections,   mononucleosis).   This   produces   bilateral

multiple  lymph  nodes fever and sore throat.  This  is  a  viral fever.

 

3.1 TUBERCULAR LYMPH GLAND enlargement  

 

These  glands present as chronic enlarged matted lymph nodes,  and are  seen in developing countries.  

One or more of  these  glands may be associated with a discharging sinus.

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HEAD NECK 3 Cysts

2.2 THYROGLOSSAL DUCT CYSTS (Fig above)

The  cyst occurs in the midline in the neck and  originates  fromthe  remnant  of the thyroglossal duct. It marks  the  path  of

descent of the thyroid from the foramen caecum of the tongue. 

The cyst  appears  when the duct or a part of it fails  to  disappearduring development.

Presents  as  a  painless  lump in the  midline  which  moves  ondeglutation and on protrusion of the tongue.

Treatment is Surgical Excision.

2.3 BRANCHIAL CYST (Pharyngeal pouch remnant)

Presents  as a lump anterior to the sternomastoid in upper  third but  may  be lower.  

It presents between 20-30  years  rarely  in

childhood it is fluctuant and transilluminant.  It sometimes gets infected  and  a sinus appears in the  neck.    

Sometimes  rarely there is an internal opening resulting in a fistula.

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HEAD & NECK 2

2.1 CLEFT PALATE.

The two maxillary shelf's may fail to unite in the midline

leaving a gap in the palate, or it may extend to the premaxillar in the

front leaving a complete gap leading into the nosal cavity

This defect causes feeding problems because of regurgitating of food.

This defect occurs in 1-3 births/1000

TREATMENT

Repair of these defects surgically is attempted between 9months to 1 year

years.

This repair and are its steps shown in Fig.above 

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HEAD & NECK 1

HEAD AND NECK

1. INTRODUCTION

The  face  and neck are prominent visible parts of the  body  and

used for human communication through facial expression, movements of  the  head  and speech. 

They deserve  special  attention  from treating surgeons in all disorders of this region so as to ensure patient's acceptance of the results of treatment and thus  insure

his satisfaction.

 

2. CONGENITAL DEFECTS

CLEFT LIP (HARE LIP)

- The incidence is one in 800 to 1300 live births.

- This defect can be unilateral or bilateral and can be  complete

  with  the defect running into the nose. the minor form of a  small

  notch in the lip or partial. 

- There is also hypoplasia of the muscle of the upper lip.  

- The cleft lip is associated with a cleft of the palate on that side.

 

TREATMENT

 

The  clefts  of the lip are closed within the first 3  months  of

life. The margins of the cleft are incised at the margin of  skin

and  mucosa.   The  flaps mobilised and mucosa  muscle  and  skin

margins sutured accurately

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Malignant Breast Carcinoma 7

8. Male Breast Cancer

It is an infrequent cancer for a 100 cancers in the female breast

one occurs in the male. 

These are infilterating duct carcinomas. 

There is early involvement of Pectoralis Major

TREATMENT

In most cases is a radical mastectomy

PRIMARY CARE PRECEPTS

1. Prevent  breast infection by nipple hygiene  simple  cleansing

   using clean water during lactation.

2. If  excess  pain or tension is felt use manual  extraction  of

   milk or breast pump.

3. If  pain in one breast and fever with local heat  and  redness

   refer for surgery.

4. If  there  is  a firm painless lump in the  breast  refer  for

   investigation and surgery to district hospital.

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