耳鼻喉科Otolaryngology topic sixteen: Diseases of oropharynx/OSA/neck mass

Diseases of oropharynx/OSA/neck mass

***Some of these contents overlap with the note of "Diseases of oral cavity".***

1. Anatomy boundary:

-- lower part: hyoid bone

-- upper part: hard/soft palate junction, circumvallate papilla

-- lateral part: palatine tonsil 

2. Innervation

-- soft palate: CN5-2--> sensory, CN10--> motor

-- tongue base: CN7

-- tongue movement: CN9, 10

Otalgia

-- tympanic branch of CN9

-- auricular branch of CN10

3. LN

-- level 2, 3

-- retropharyngeal LN(behind pharynx)

4. Closer look of anatomy

-- crypt: blind tubules

-- cervical spaces

5. Swallowing process

-- oral phase

-- pharyngeal phase < 1 sec

-- tool for examination: barium swallow study, flexible endoscope

6. UADT (upper aerodigestive tract)

-- pharyngitis: mucosal, submucosal inflammation

-- bac.: group A Streptococcous (suppurative, rheumatic fever) , Hemophilus influenza

-- virus(30~60%): rhinovirus, coronarivus, RSV, parainfluenza, influenza
-- fungus: candida(thrush)

-- Waldeyer's ring of lymphoid tissue: direct contact with other tissues

7. Tonsillectomy and adenoidectomy
-- minimal effects to immune system
-- indication: airway obstruction, recurrent infection, suspect neoplasm, few are absolute

8. SOB and sleep disorders
-- sleep pattern: NREM-->REM
-- SOB: primary snoring -->upper airway resistance syndrome(UARS)/EEG change -->OSA;  associated with age & BW
-- DDx: hypopnea, central apnea, obstructive 

-- nasopharyngoscope 
-- cephalometry: facial skeleton, do not assess soft tissue
-- polysomnography: gold standard
-- AHI= apnea index+hypopnea index (frequency in one hour)
-- Friedman staging for UPPP

--treatment: life style change/BW↓, correct hormone, nCPAP, UPPP(surgery, snoring↓ but OSA 50% remain), MMA, radiofrequency tissue volume reduction, pillar implant

9. Neck mass
-- fascia: superficial layer-->muscles, middle layer-->trachea, esophagus, larnyx,thyroid, deep layer
--  etiology: inflammatory, congenital, neoplastic (keypoint: age!!!)

10. 2nd brachial anomalies
11. Thyroglossal duct cyst: midline, Sistrunk operation
12. Metastatic neck mass: firm, fixed, rapid growth