Throat and Head & Neck Surgeries

SUB MANDIBULAR SALIVARY GLAND SWELLING

 

There is a visible lump below the jaw. This swelling is due to enlargement of submandibular salivary gland. There are six salivary glands in the body. Parotid glands are situated behind the ear. Submandibular salivary glands are situated under the mandible. Sub lingual salivary glands are situated under the tongue. Sub mandibular gland has a tortuous long duct which opens at the floor of the mouth. When saliva flows slowly along this duct there can be sediment formation. These stones can block the saliva flow during meals.

 

Patient gets a painful swelling of gland during meals. Gland returns to normal size some time after meal. when the stone is removed surgically pain and swelling disappears. Other reason for swelling of the gland is tumour. There will be painless enlargement of the gland .Best treatment is excision of the gland. Gland will be sent to the lab for further evaluation . If the report shows malignancy, further treatment is given by cancer specialists.

STONE OF SUBMANDIBULAR DUCT

Few stones are seen in an x ray of the floor of the mouth. These stones are lodged in the ducts(drainage tube) of a salivary gland situated at the floor of the mouth. Patient has severe pain during meals associated with swelling under the lower jaw. Pain is due to saliva accumulation in the gland as the stones are not allowing the flow.

IMPACTED WISDOM TEETH - PANORAMIC VIEW

When a person gets ear ache without a ear problem doctor has to suspect problems in teeth. Commonest dental problem causing earache is impacted wisdom teeth. This X Ray shows impaction of all four wisdom teeth. This is a special X ray of all 32 teeth in one film. It is called orthopantomogram. X rays are sent panoramically to take picture of all the teeth. So it is very convenient for the doctor to diagnose and treat dental problems.

DYSPHAGIA DUE TO ANAEMIA

Iron Defeciency anaemia,difficulty in swallowing due oesophageal web , smooth tongue (glossitis) and spoon shaped nails are associated together as a syndrome called Plummer Vinson Syndrome. Patients are post menapausal women.They present with dysphagia and burning sensation of mouth. Barium swallow shows the web. Treated by correction of anaemia with iron supplements and dilatation of the web by passing a rigid tube oesophagoscope.THis condition is pre malignant. Patients need life long follow up for oesophageal cancer.

HEIMLIC'S MANOUVRE

PERITONSILLAR ABSCESS

A peritonsillar abscess forms in the tissues of the throat next to the tonsils.

An abscess is a collection of pus that forms near an area of infected skin or other soft tissue.The clinical picture is that of a rapidly increasing difficulty in swallowing that occurs after a streptococcal tonsillitis (strep throat). The tonsillitis may seem to be improving for a day or two, but then, one side of the throat becomes increasingly painful. The pain is severe and radiates to the ear. Opening the mouth is difficult and so painful that the patient refuses to eat or swallow. There is drooling of saliva and bad breath. The voice is indistinct and muffled It is referred to as "hot potato speech".

On examination, there is a tense swelling of the soft palate and anterior pillar above the tonsil. The uvula may be displaced to the opposite side. It is often difficult to know at first whether the swelling is an abscess or a peritonsillar cellulitis.

The doctor has several options for treating you:

  • Needle aspiration involves slowly putting a needle into the abscess and withdrawing the pus into a syringe.

  • Incision and drainage involves using a scalpel to make a small cut in the abscess so pus can drain.

  • Acute tonsillectomy (having a surgeon remove your tonsils) may be needed if, for some reason, you cannot tolerate a drainage procedure, or if you have a history of frequent tonsillitis. 
     

You will receive an antibiotic. The first dose may be given through an IV. Penicillin is the best drug for this type of infection, but if you are allergic, tell the doctor so another antibiotic can be used (other choices may be erythromycin or clindamycin). If you are healthy and the abscess drains well, you can go home.
 
If you are very ill, cannot swallow, or have complicating medical problems (such as diabetes), you may be admitted to the hospital. 

Occasionally, the abscess ruptures spontaneously and foul-smelling thick pus drains through a crater in the anterior pillar.Antibiotics will help to expedite the recovery.

INTUBATION GRANULOMA

TONGUE CANCER

The tongue is divided into 2 separate anatomical areas, the oral tongue is the part that can be moved. The base of tongue is the part which cannot be seen during examination of the mouth.The cancer of tongue is usually located on the side border, of the oral tongue. It is usually ulcerated and is grayish-pink to red in color. It will often bleed easily if bitten or touched. Small cancers of the oral tongue can be quickly and successfully treated by surgical removal leaving behind little cosmetic or functional change. Larger cancers may indeed have some effect on speech and on swallowing, but one must remember that not treating this problem would cause far more significant problems, up to, and including death. As the size of the primary tumor increases the possibility of some cancer cells spreading through lymphatic vessels to the lymph nodes of the neck increases. The site and pattern of the involved lymph nodes is pretty much constant.

 

When the presence of enlarged lymph nodes in the neck is detected , then an operation called a neck dissection is performed to remove these "secondary" deposits of cancer. Following removal of the tumor,there may sometimes be the need to perform plastic surgery and reconstruction.Radiation treatments may have to be given after the surgery to try to minimize the possibility of recurrence.

CLEFT PALATE

IMPACTED WISDOM TOOTH

EPIGLOTTIS

This picture depicts a swollen red epiglottis, an endotracheal tube under the epiglottis.(which was inserted to secure the airway)Causative organism is a bacterium called Haemophilus influenzae. Before the widespread use of the Haemophilus influenzae type b vaccine, epiglottitis occurred mainly in young children. Recently, the incidence has decreased among children and increased among adults. Adult epiglottitis is different. Organism identification is less common and the mortality is higher. 15% to 21% of patients require either endotracheal intubation or emergency tracheostomy to secure the airway. The remaining cases can be safely treated with antibiotics. In certain cases intravenous corticosteroid therapy may be of benefit. The most common symptoms are sore throat, odynophagia and muffled voice. Soft-tissue lateral neck radiography shows swollen epiglottis as a thumb. Laryngoscopy under anaesthesia is the most accurate investigation to establish a diagnosis. Prompt recognition of the condition and early airway intervention by intubation or tracheostomy in cases of airway compromise are crucial to avoid a possible fatal outcome.

VOCAL CORD POLYP

This picture depicts a polyp of one vocal cord with normal opposite cord. Injury or chronic irritation causes changes in the vocal cords that can lead to polyps or nodules. The main cause is chronic voice abuse (yelling, shouting, singing loudly, or using an unnaturally low frequency). Polyps may have several other causes, including gastric reflux, untreated hypothyroid states, chronic laryngeal allergic reactions, or chronic inhalation of irritants, such as industrial fumes or cigarette smoke. Polyps may occur at the mid third of the membranous cords and are more often unilateral. Symptoms are hoarseness and a breathy voice.If these symptom persists for more than three weeks, visualization of the vocal cords with a mirror or camera is a must. Diagnosis is based on biopsy to rule out cancer. Surgical removal with the help of an operating microscope restores the voice,but removal of the irritating source is essential to prevent recurrence. Correction of the underlying voice abuse cures most nodules and prevents recurrence. Removal of the offending irritants allows healing, and voice therapy with a speech therapist reduces the trauma to the vocal cords from improper singing or protracted loud speaking.

 

In microlaryngoscopy, an operating microscope is used to examine, biopsy, and operate on the larynx. Images can be recorded on video as well. The patient is anesthetized, and the airway is secured.The microscope allows observation with magnification.Tissue can be removed precisely and accurately, minimizing damage to the vocal mechanism. Laser surgery can be done through the optical system of the microscope to allow for precise cuts.

MUCOCELE OF LIP

An oral mucocele, is a swelling consisting of collected mucin from a ruptured salivary gland duct, which is usually caused by local trauma. It has a bluish translucent color, and is more commonly found in children and young adults.The size of oral mucoceles vary from 1 mm to several centimeters. Their duration lasts from days to years, and may have recurrent swelling with occasional rupturing of its contents. Some mucoceles spontaneously resolve on their own after a short time. Others are chronic and require surgical removal. Recurrence may occur, and thus the adjacent salivary gland is excised as a preventive measure.

RANULA

A ranula is a swelling found on the floor of the mouth. They present as a swelling of collected mucin from a ruptured salivary gland duct, which is usually caused by local trauma. The latin rana means frog, and a ranula is so named because its appearance is sometimes compared to a frog's underbelly. The gland that most likely causes a ranula is the sublingual gland. Rarely submandibular gland may be involved. Treatment of ranula is excision of both the gland and the lesion through the mouth. Ranulas are likely to reccur if the sublingual gland or other gland causing them is not also removed with the lesion.

TORUS PALATINUS

Torus palatinus is a bony growth on the palate, usually present on the midline of the hard palate. Palatal tori are more common in Asian and Inuit populations, and twice more common in females. Palatal tori are usually a clinical finding with no treatment necessary.[2] It is possible for ulcers to form on the area of the tori due to repeated trauma. Also, the tori may complicate the fabrication of dentures. If removal of the tori is needed, surgery can be done to reduce the amount of bone present.

ULCER OF TONGUE

GEOGRAPHIC TONGUE

STROBOSCOPY

USE OF CPAP MACHINE IN OBSTRUCTIVE SLEEP APNOEA

The first picture shows normal open air way during sleep.Air enters through nose and goes to trachea. The tongue and the palate is in normal position. The second picture shows obstructed air way with palate and tongue falling backwards. Patient has noisy breathing with low oxygen saturation in blood. Patient struggles for breath and frequently wakes up in the night. In the morning, he/she feels tired.There is daytime sleepiness with reduced performance at work. One might fall asleep during driving with increased incidence of road traffic accidents. Low oxygen saturation in the blood can affect heart and brain with increased incidence of heart attacks and strokes. 30% of snorers get sleep apnoea. Most of the snorers are men.

FACIAL NERVE PALSY

Facial Nerve Injuries and Paralysis There are actually two facial nerves, one on each side of the head. The facial nerve or 7th cranial nerve is known as a "cranial nerve" since it starts in the brain. It then sends branches out to the face, neck, salivary glands (secrete saliva into the mouth), and the outer ear. A normal functioning facial nerve allows us to move our face and neck (smile, frown, wrinkle our nose and forehead), secrete saliva, lets the front of the tongue "taste" food, and makes us cough when something is placed in the ear. Problems with the facial nerve result in weakness or paralysis of the face muscles and possibly, a loss of taste on the affected side. This nerve loss is one of the most disfiguring since it involves facial movement. Without the nerve connection (innervation) intact, the eye does not close, there is loss of facial muscle tone, and movement on the affected side is reduced or lost. Causes of paralysis It is important to understand the location or pathway the facial nerve takes in the head and face. This understanding makes it easier to see how the nerve is damaged and how this damage may affect function.

 

The facial nerve starts in the brain, and then tracks through a narrow space located inside the ear (internal auditory canal). The nerve then passes through the middle ear (behind the ear drum) and leaves through another narrow passage located under the ear area (stylomastoid foramen). It then branches out to provide muscle movement and sensation to various parts of the face and neck. The branches start inside the parotid gland (in front of the ear) and travel to the forehead, cheek,nose, mouth and neck. Anything that may cause swelling or pressure on the nerve can result abnormal function. Some of the general causes of problems along the pathway of the facial nerve include; congenital (birth) abnormalities, infections of the middle ear (OTITIS MEDIA), or CHOLESTEATOMA, infections or tumors of the PAROTID GLAND, FACIAL AND NECK TRAUMA, and uncommonly, as a complication after an operation in the ear area (for example, after a MASTOIDECTOMY). One of the most common causes of facial nerve paralysis a viral infection called Bell's Palsy. How is facial paralysis evaluated? Evaluation begins with thorough history to help determine the cause.

 

A physical examination will help to determine whether the nerve damage is at the brain level (central) or closer to the ear and face area (peripheral). Usually various tests are performed as part of the evaluation. The nerve (8th cranial nerve) that allows us to hear is located close to the facial nerve, so it may also be affected (sensorineural hearing loss) when the facial nerve is paralyzed. In addition, problems with the middle ear may also be associated with a hearing loss similar to having the sensation of earplugs in the ears (conductive hearing loss). The type of hearing loss, if present, helps with diagnosis and treatment of the condition. A thorough examination is performed to determine the level of the paralysis. The extent of facial nerve paralysis can involve all of the nerve (complete) or just a part of the nerve (incomplete). An x-ray is usually performed after the history and physical examination of the patient. A computed tomography (CT) scan or magnetic resonance imaging (MRI) scan is very useful in making the diagnosis. It can help to determine exactly where swelling, infection, trauma, or tumor may be that is causing the facial nerve abnormality. More specialized tests involve the use of electrical impulses. A commonly used technique called electromyography (EMG) sends electrical impulses to muscle (as a nerve would do). This is a painless technique that helps to determine whether the problem is with the nerve or the muscle itself. Another study is known as the nerve excitability test (NET). This study uses electrical impulses to compare the normal facial nerve on one side of the face with the abnormal one on the other. Electroneurobility testing (ENoG) goes further than NET, by giving actual numbers to help with the comparison. Finally, a group of tests checking tear production, saliva production, taste sensation and small ear muscle movement can help to determine if only a small branch of the facial nerve is damaged. This is known as topographic localization.

 

When would an otolaryngologist be consulted to help manage facial paralysis? An otolaryngologist is consulted to help surgically treat many causes of facial nerve paralysis that will not resolve on their own. These conditions include a trapped nerve that needs to be released to function normally, which can be seen with FACIAL TRAUMA, tumors, or severe OTITIS MEDIA. The otolaryngologist is also skilled in surgically connecting a facial nerve that has been divided by trauma. In these instances, the facial nerve will continue to die until a surgical procedure is undertaken. This underscores the urgency in which facial nerve paralysis should be evaluated.

COIN IN THE THROAT

Small children swallow coins and it is very common all over the world. Although coins are stuck in the food passage,child may get breathing difficulty due to compression of the air way. Therefore it is necessary to take the child to hospital as soon as possible.

In the hospital, coin will be removed under anesthesia.

TONSILLECTOMY - Patient Education Leaflet

© 2019 Dr. Chandra Jayasuriya
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