Oral cavity & Pharynx Trachea

1. Oral cavity & Pharynx Trachea For any suggestions please call 0122358933

2. Palpation of the submental lymph node area with firm pressure and rotating the finger behind the chin.

3. Positive submental lymphadenopathy below the chin. It is enlarged from draining the severe acne skin lesions.

4. Bimanual palpation of the submandibular gland areas for the gland and for lymph node swellings in the gland. • How to differentiate between a lymph node and submandibular salivary gland swelling ?

5. Bilateral submandibular gland swellings due to reactive lymph nodes in a 24-year-old female with primary herpetic gingivostomatitis

6. Palpation of the temporomandibular joints at the tragus of the ear as the patient opens and closes the mandible.

7. Bilateral palpation and gentle squeezing of the sternocleidomastoid muscle to locate the cervical chain of nodes just medial and deeper to the muscle.

8. Palpation of the supra-clavicular area behind the clavicular bone.

9. Retraction of the upper lip with the teeth closed, revealing vestibule, gingivae with mucogingival line, and teeth.

10. Retraction of the cheek to view the buccal mucosa which includes the papilla of Stensen duct opposite the upper second molar

11. Soft palate and oropharynx viewed with the tongue depressed

12. Rigid endoscope What is the advantages of rigid endoscopic examination 1- can be done in outpatient clinic under local anasthesia 2- provides brilliant illumination 3-examination of difficult to examine areas 4-examination of inaccessible areas e.g nasal meatus nasal cavity larynx, nasopharynx etc 5-many therapeutic procedures can be done in the nasal cavity and sinuses .

13. Advantages: 1- un out-patient procedure 2-brilliant illumination 3-useful in uncooperative patient eg in patients with uncontrolable gag reflex Rigid endoscopic examinationof Larynx and Hypopharynx

14. Allows Examination of : Nasal Cavity Nasopharynx Hypopharynx Larynx Flexible Endoscopic Examination

15. Hare lipالشفة الارنبية

16. Bifid uvula

17. Symptoms in this patient: 1- 2- Cleft palate • Symptoms in this patient: • 1- nasal rugurge • 2- hypernasality of speech

18. Early congenital Syphilis-persistent rhinitis-vestibulitis-fissuring of the upper lip Late congenital SyphilisNotchoing of the upper teeh ( Hatchinson’s teeth)

19. chancre

20. Oral hairy leukoplakia • Kaposi sarcoma ? AIDS

21. Tongue tie

22. Herpes Simplex.   

23. Shingles (Herpes Zoster):  They occur many years after an individual has had chicken pox. • Once an individual has had chicken pox, he/she will carry, for life, the virus in a dormant state in the cell bodies of nerve tissue.  • Over the years, a patient's antibody levels fall and the dormant virus emerges.  • The virus causes lesions to erupt on the skin in which the nerve innervates.  This patient was treated with a seven day course of Valacyclovir given one gram three times a day. Eruptions are seen on the patient's right jaw and right half of his tongue. This corresponds to the lower division of the trigeminal nerve (V cranial nerve) and the lingual nerve (XII cranial nerve).

24. Aphthous (dyspeptic)

25. Hairy Tongue: This is a relatively rare condition which is caused by the elongation of the taste buds.  This condition can be caused by poor oral hygiene, chronic oral irritation or smoking.  The photographs show patient who has been treated with  radiation therapy for head and neck cancer and has chronic oral inflammation.  Treatment involves good oral hygiene, brushing of the tongue, mouth rinses and sometimes the trimming of the elongated papilla.  

26. Other cases with ABlack Hairy Tongue.   This patient had significant gastroesophageal reflux. 

27. Candida

28. Geographic Tongue.     This is a benign non-painful condition caused by the absence of taste bud papilla.  The glassy patches move around the tongue and change shape.  The cause of this condition is unknown and treatments are not reliable

29. Scrotal tongue

30. A 24 year old woman was found to have a 3 cm mass at the base of the tongue (arrow) . • She had been unaware of the mass and was asymptomatic Lingual Thyroid

31. These patients have a basal cell carcinoma lip cancer.  • It is a less aggressive tumor than squamous cell carcinoma, • Basal Cell Carcinoma spread and destroy tissue locally, but do not metastasize. 

32. Foreign Boby After Prof Dr Hassan Wahba Prof of ENT H&N Surg Ein Shans University After Prof Dr Hassan Wahba Prof of ENT H&N Surg Ein Shans University

33. Fish bone stuck in the left pyriform fossa, seen on direct laryngoscopy Foreign Boby

34. Torus palatinus is a hard bony growth in the center of the roof of the mouth (palate).  • It is not a tumor or neoplasm but a benign bony growth called an exostosis.  • This growth commonly occurs in females over the age of 30 and rarely needs treatment.  • Occasionally it is removed for the proper fitting of dentures.

35. Papilloma

36. Oedema of the uvula

37. Elongated Uvula

38. Answer This middle aged female presented with gradually progressive dysphagia 1- the patient is most probably suffering from PLUMMER VINSON SYNDROME. 2- you should proceed to the following investigations: A- Blood Picture (Hypochromic Anemia) B- gastric secretion (achlorohydria C- Barium Swallow (web) • This middle aged female presented with gradually progressive dysphagia 1- the patient is most probably suffering from…………. 2- you should proceed to the following investigations: A- B- koilonychia Angular Stomatitis Atrophic Glossitis

39. Lateral soft tissue X ray of the head and neck Soft tissue swelling indenting the nasopharyngeal airway (green arrow) Suggesting adenoid ( blue arrow)

40. This instrument is used for Adenoidectomy operation Which is indicated in hypertrophy of the nasopharyngeal tonsil sufficient to produce symptoms and /or complications This instrument is used for…..Which is indicated in………….

41. Normal tonsils

42. Marked hyperaemia and enlargement of the tonsils Acute parenchymatous tonsillitis

43. The surface of the tonsils has yellowish spots Acute foillicular tonsillitis

44. The yellowish spots coalesce to form non adherent yellowish true membrane Acute membranous tonsillitis

45. Chronic tonsillitisThe tonsils are markedly hypertrophied and meeting in the midline (kissing tonsils)

46. Quinsy (peritonsillar absces)

47. This right pulsatile oropharyngeal swelling was associated with right hypoglossal paralysis and right vocal cord paralysis.  An ill-defined right neck mass behind the angle of the jaw was not readily visible. • Carotid angiography revealed the presence of a large chemodectoma.  The tumor was first embolized and at surgery,

48. This child with diphtheria presented with a characteristic swollen neck, sometimes referred to as “bull neckرقبة العجل This patient presented with mild sore throat and mild fever, her pulse was 110 per minute Pharyngeal examination revealed a membrane on the left tonsil and pillars

49. This patient is feverish and can not open her mouth what is your diagnosis Ludwig’angina

50. This patient gives a history of fever and difficulty of swallowing of 3 days duration. The condition progressed to throbbing pain and dribbling of saliva What is your diagnosis? Rightparapharyngeal abscess