Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior...
Transcript of Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior...
![Page 1: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/1.jpg)
1
Head & Neck Examination
Dr Irfan AhmadResident, Radiation Oncology
![Page 2: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/2.jpg)
2
The major areas comprising this region are:
Head, face & EarSalivary GlandsNose & SinusesOral CavityNasopharynxOropharynxLarynx & LaryngopharynxNeck
![Page 3: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/3.jpg)
3
Setting up the examination
Patient positioningInstruments required:
Bulls eye lampHead mirrorTongue depressorsNasal speculum(Thudicum/Vienna)Posterior nasal mirrorLaryngeal mirror
![Page 4: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/4.jpg)
4
Head, Face & Ear ExaminationHead & Face
SymptomatologyLumoUlcer
Ear SymptomatologyHearing lossTinnitusEar dischargeEarache Swelling Others(Deformity/ Dizziness/ Itching)
Examn of Mass & Ulcer
Ear Examn (+ Functional):PinnaEAM(+/- Speculum)TMMiddle ear(when TM -)MastoidEustachian Tube(when TM- & Posterior Rhinoscopy)Facial nerve
![Page 5: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/5.jpg)
5
Nose & Paranasal Sinuses Examination
Symptomatology:ObstructionDischargeEpistaxisHeadache/facial painLumpChange in voicePND
Parts of Nasal Examn :External nose Examn
Vestibule Examn
Anterior RhinoscopyPosterior RhinoscopyFunctional Examn
Parts of Sinus Examn :Maxillary/ Frontal/ EthmoidSphenoid
![Page 6: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/6.jpg)
6
Nasopharynx Examination
Symptomatology:Nasal ObstructionEpistaxisLump (in Neck)DeafnessPND
Parts of Examn :Anterior RhinoscopyPosterior RhinoscopyCN 2-12(m.c. 9-11)Neck Node Examn
OthersDigitalEndoscopyRetraction of structures(GA/LA)
![Page 7: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/7.jpg)
7
Oral cavity ExaminationSymptomatology:
PainTrismusLesion(Lump/Ulcer) Dysguesia Xerostomia/ Excess salivation
Parts of Examn :Inspection & palpation of:
LipsTeeth & gingivaRetromolar trigoneBuccal mucosaFloor of mouth Hard palateAnterior 2/3rd of tongue
![Page 8: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/8.jpg)
8
Oropharynx ExaminationSymptomatology:
OdynophagiaDysphagiaChange in voiceHalitosisEaracheSore throatHearing lossSnoring
Parts of Examn :Inspection (& palpation) of:
Tonsils & PillarsBase of Tongue(IDL)Soft PalatePosterior pharyngeal wall
![Page 9: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/9.jpg)
9
Larynx & Laryngopharynx Examination
Symptomatology:Lump (in neck)DysphagiaPain in throatRespiratory obstructionChange in voiceRepetitive clearing of throatCough(+/-Sputum)
Parts of Examn :External Examn of LarynxIndirect LaryngoscopyAssessment of Cervical lymph nodesOthers:
Flexible/Rigid fibre optic endoscopyVoice assessment
![Page 10: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/10.jpg)
10
Neck ExaminationSymptomatology:
Lump(m.c. Nodes)Pain
Parts of Examn :Inspection & palpation of:
SkinNeck NodesAny other mass besides nodes
![Page 11: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/11.jpg)
11
Examination of a MassGeneral (CC/IoF)Local:
InspectionLocation/ Number/ Color/ Surface/ Overlying skin/ ShapeSize/ Edge/ PulsatilityPressure effectMovement with
• Respiration• Swallowing• Protrusion of tongue
(Abdominal Swellings –Peristaltic movement)(Swelling connected to cavity – Ab/Pl/ Sp/ Cr) Cough Impulse)
Local:
PalpationTemperature/ TendernessSize/ Shape/ Surface/ Extent/ Edge/ ConsistencyFixation to overlying skin & underlying structuresFluctuationTranslucencyReducibility & compressibilityPulsatilityFluid thrillCough impulse
Regional Lymph NodesPercussion/ Auscultation
![Page 12: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/12.jpg)
12
Examination of an UlcerGeneralLocal:
InspectionLocation/ NumberShape/ SizeEdgeFloorDischargeSurrounding area(Peripheral ulcer –Rest of limb)
PalpationTendernessMargin/ Edge BaseDepthBleedingRelation to underlying structuresSurrounding skin
Regional Lymph Nodes(Peripheral Ulcer –vascular insufficiency + nerve lesions)
![Page 13: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/13.jpg)
13
Oral Cavity ExaminationOn Inspection:
TrismusDental Hygiene/ Edentulous/ CariesTongue protrusionUlcer/ MassDiscoloration
Look at the following structures:Lips, Teeth, Gingiva, Ant 2/3rd of tongue, Floor of mouth(Ant + Lat), Buccal Mucosa, Hard Palate & Retromolar Trigone
Palpation of all lesions of the oral cavity + Tongue + Bimanual Examination
![Page 14: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/14.jpg)
14Oropharynx Exam
![Page 15: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/15.jpg)
15BOT, pyriform
sinus are not shown in this diagrammatic representation
![Page 16: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/16.jpg)
16
![Page 17: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/17.jpg)
17
Indirect LaryngoscopyPositioning & methodAdduction – AaAdduction & Tension – EeeAbduction – Deep InspirationStructures seen:
EpiG, AE folds, Arytenoids, Cuneiform/ corniculate, ventricular bands, ventricles, True cords, Ant commisure, Post commisure, Subglottis, Tracheal ringsPyriform fossae, post cricoid region, post wall of laryngopharynxBOT, lingual tonsils, valleculae, medial/ lateral glossoepiglottic fold
![Page 18: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/18.jpg)
18
![Page 19: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/19.jpg)
19
Examination of Neck Nodes
Inspection of neck, followed by palpation.•
C Technique
for IJV nodes•Bimanual for Submental & Submandibular nodes
Levels of Lymph node in the neck
![Page 20: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/20.jpg)
20
Thank you
![Page 21: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/21.jpg)
21
![Page 22: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/22.jpg)
22
Terms associated with an Ulcer
X
![Page 23: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/23.jpg)
23
Ulcer Edge
Undermined edge
Punched out edge
Sloping edge
Raised edge
Rolled out edge
X
![Page 24: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/24.jpg)
24
AJCC Nodal ClassificationNX Nodes cannot be assessed N0 No lymph node metastasis N1 Single ipsilateral lymph node, <3 cm N2
N2A Single ipsilateral lymph node >3 cm but not >6 cm N2B Multiple ipsilateral lymph nodes, none >6 cm N2C Bilateral or contralateral lymph nodes, none >6 cm
N3 Metastasis in a lymph node >6 cm
(NPC)
![Page 25: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/25.jpg)
25
AJCC Nodal Classification for NPCNX Nodes cannot be assessed N0 No regional lymph node metastasis N1 Unilateral node(s) <6 cm above the supraclavicular fossa N2 Bilateral node(s) <6 cm above the supraclavicular fossa N3 Metastasis in lymph node(s)
N3a >6 cm N3b Extension to the supraclavicular fossae
X
![Page 26: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/26.jpg)
26
`
![Page 27: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/27.jpg)
27
![Page 28: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/28.jpg)
28
![Page 29: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/29.jpg)
29
![Page 30: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/30.jpg)
30
X
![Page 31: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/31.jpg)
31
X
![Page 32: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/32.jpg)
32
X
![Page 33: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/33.jpg)
33
![Page 34: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/34.jpg)
34
![Page 35: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/35.jpg)
35
![Page 36: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/36.jpg)
36
![Page 37: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/37.jpg)
37
![Page 38: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/38.jpg)
38X
![Page 39: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/39.jpg)
39X
![Page 40: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/40.jpg)
40X
![Page 41: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/41.jpg)
41X
![Page 42: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/42.jpg)
42X
![Page 43: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/43.jpg)
43
X
![Page 44: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/44.jpg)
44
X
![Page 45: Head & Neck Examinationradonc.wdfiles.com/local--files/oncology-presentations/Head... · Anterior Rhinoscopy Posterior Rhinoscopy Functional Exam. n. Parts of Sinus Exam. n : Maxillary](https://reader031.fdocuments.in/reader031/viewer/2022011812/5e221b003184c678f3172ed9/html5/thumbnails/45.jpg)
45
X