Oral cavity and salivary glands

Exeter Surgical Society 26th November 2013

Mr Richard HarrisSpeciality Registrar in ENT

Royal Devon and Exeter Hospital

Introduction

Much of acute ENT

…………….is very simple

…………… is very common

…………… is very treatable.

But it is taught badly or not at all.

Aims

Discuss basic anatomy of oral cavity and salivary glands

Related structures that are clinically relevant

Basic presentations of common conditions

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!

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!

Oral cavity

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

What do you already know?

Anatomical terms

Skull anatomy

The challenge

Floor of mouth

Important structures

Facial artery and vein

Lingual nerve

Hypoglossal nerve

Mylohyoid muscles

Digastric muscles

Facial nerve

The bits at the back!

Palatal arches

- Palatoglossal

- Palatopharyngeal

Tonsils

Uvula

Tongue base

Oropharyngeal wall

Time to get personal!

Tonsillitis

Very common

Difficulty swallowing

Pyrexia

Dehydrated

Malaise

NO TRISMUS

Bilateral tonsillar swelling

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

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.

Glandular fever

Infectious mononucleosis

From EBV

Highly contagious

Usually longer Hx than bacterial tonsillitis

Classical appearance

Must examine abdomen

Oral cancer

Increasingly common

Smokers/HPV

Longstanding ulcers

Ongoing glossitis

Mainly SCC

Salivary glands

Salivary gland anatomy

Salivary Gland function

Parotid gland

Parotid gland

Submandibular gland

Submandibular gland

Sublingual gland

Sialadentitis

Sialadentitis

Sialadentitis

Sialadentitis

Sialadentitis

Mumps

Salivary tumours

Classification

Investigation

Clinical examination including CNVII

Ultrasound

FNA cytology

MRI

PET

Management

Benign

- Conservative

- Surgical

Malignant

-Surgical

Iseli’s law

“if in doubt, cut the f***** out”

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

Thank you