carcinoma oropharynx and oroantral fistula PowerPoint presentation

Ug level.ppt

1. OROANTRAL FISTULA

2. DEFINITION Abnormal communication between oral cavity and nasal cavity Alveolar / buccal sulcus

3. ETIOLOGY Dental extraction Tumor- erosion Trauma Caldwell – luc surgery incision failure to close Maxilla- osteitis by trauma, granulomatous condition

4. TYPES ALVEOLAR SUBLABIAL PALATAL

5. SYMPTOMS food regurgitation Discharge- foul smelling Difficulty to build pressure in oral cavity- leakage of air Pain epistaxis

6. RISK FACTORS Periapical infection Chronic sinusitis

7. RECENT ONSET Under antibiotic coverage; suturing & periodontal packing <5mm - no intervention >5mm- surgical Following tooth extraction

8. CHRONIC Treat the infection Sinus irrigation with warm saline Diseased bone removed Flap – local/ distant Grafting

9. LOCAL FLAP BUCCAL PALATAL LIP

10. DISTANT FLAP TONGUE BUCCAL FAT TEMPORALIS MYOFASCIAL FLAP BUCCINATOR MYOMUCOSAL FLAP OBTURATOR

11. TUMORS OF OROPHARYNX SUBSITES BASE OF TONGUE TONSIL & FOSSA FAUCIAL ARCH PHARYNGEAL WALL BENIGN/ MALIGNANT

12. BENIGN PAPILLOMA- pedunculated , asymptomatic, excision only when there is irritation. HEMANGIOMA- CAPILLARY & CAVERNOUS EXCISION BY CRYOTHERAPY/ LASER/ DIATHERMY/ SCLEROSANT INJECTION

13. MALIGNANT GROSS HISTOLOGICAL SUPERFICIAL SQUAMOUS EXOPHYTIC LYMPHOEPITHELOMA ULCERATIVE ADENOCARCINOMA INFILTRATIVE LYMPHOMAS SUPERFICIAL & EXOPHYTIC- PALATINE ARCH , RARELY METASTASIS REST- BASE OF TONGUE, TONSIL- INVASIVE, POOR PROGNOSIS, METASTASIS ESP REGIONAL

14. ETIOLOGY SMOKING ALCOHOL HPV-16

15. INVESTIGATIONS INDIRECT LARYNGEAL EXAMINATION ON TABLE CT MRI BIOPSY

16. CA BASE OF TONGUE ASYMPTOMATIC FOREIGN BODY SENSATION CERVICAL LYMPHADENOPATHY DYSPHAGIA REFERRED OTALGIA HOT POTATO VOICE LOCAL – INFILTRATIVE JUGULODIGASTRIC NODES DISTANT METASTASIS

17. TREATMENT RADIOTHERAPY T1, T2, N0 N1- EXCISION +_ NECK DISSECTION T3, T4 - COMMANDO – Combined approach hemimandibulectomy & neck dissection PALLIATIVE / ADJUNCT CHEMO

18. TONSIL & FOSSA ULCER WITH NECROTIC BASE U/L TONSILLAR ENLARGEMENT DYSPHAGIA HALITOSIS TRISMUS OTALGIA LOCAL- soft palate, pillar, muscles of mastication, parapharyngeal space 50% lymphadenopathy JD node

19. TREATMENT T1, T2- RADIOSENSITIVE ------------ RT COMMANDO – Combined approach hemimandibulectomy & neck dissection

20. PALATINE ARCH SQUAMOUS-80% PAIN REFERRED OTALGIA WELL DIFFERENTIATED RADIATION EXCISION

21. POSTERIOR/ LATERAL PHARYNGEAL WALL ASYMPTOMATIC-60% SUBMUCOSAL SPREAD SEEN AS A BULGE LYMPHNODE METASTASIS RADIOTHERAPY EXCISION

22. COMPLICATIONS OF SINUSITIS LOCAL Mucocele Mucous retention cyst Osteomyelitis ORBITAL Preseptal edema of lids Subperiosteal abscess Orbital cellulitis Orbital abscess Superior orbital fissure syndrome Orbital apex syndrome INTRACRANIAL Meningitis Extradural abscess Subdural abscess Cavernous sinus thrombosis

23. MUCOCELE Chronic obstruction to sinus ostium Accumulation of secretion Expansion of sinus and destroy bony walls

24. Cystic dilatation of mucous gland Content is sterile

25. FRONTAL SINUS- proptosis , forward, downward and laterally Cystic, non tender, egg shell cracking Headache,diplopia CT- loss of scalloping frontoethmoidectomy

26. ETHMOID SINUS- proptosis Middle meatus bulge Uncapping ethmoidal bulge, intranasal operation External approach MAXILLARY SINUS-CT for diagnosis SPHENOID –slow expansion and destruction Superior orbital fissure- 3,4,6 & ophthalmic division of 5 Orbital apex syndrome- in addition 2 nd & maxillary division of 5

27. OSTEOMYELITIS MAXILLA INFANT Edema of lower lid, purulent nasal discharge, swelling of cheek Subperiosteal abscess Oroantral fistula Antibiotics and drainage FRONTAL ADULT Trauma pott’s puffy drainage & antibiotics Trephination

28. ORBITAL COMPLICATION CHANDLER CLASSIFICATION PERIORBITAL CELLULITIS ORBITAL CELLULITIS SUBPERIOSTEAL ABSCESS ORBITAL ABSCESS CST S.AUREUS/ STREPTOCOCCUS

29. ROUTE OF INFECTION & SYMPTOM ETHMOID- LAMINA PAPYRACEA OSTEITIS / THROMBOPHLEBITIS of etmoidal veins Edema ,erythema, ptosis, conjunctival chemosis , fever Visual impairment, proptosis , impaired colour vision & ocular motility

30. MANAGEMENT C/S SWAB CBC- leucocytosis Orbital USG - abscess detection CT& MRI-extent Antibiotic coverage , analgesic

31. SURGICAL INDICATIONS Unresponding to medical management Progressive loss of vision Abscess Cantholysis / canthotomy Drainage of pus

32. CAVERNOUS SINUS THROMBOSIS ETIOLOGY

33. CLINICAL FEATURES Chills, rigor, pt is toxic Swollen eyelid, chemosis , proptosis Ophthalmoplegia - extraocular muscle palsy Dilated pupil, optic disc congestion, visual impairment CECT/ MRI Antibiotics