QUICK REFERENCE for OTOLARYNGOLOGY Guide for Aprns, Pas, and Other Health Care Practitioners

IMAGE BANK QUICK REFERENCE for OTOLARYNGOLOGY Guide for APRNs, PAs, and Other Health Care Practitioners

Kim Scott Consultants Richard F. Debo Alan S. Keyes David W. Leonard

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1 33/17/2014/17/2014 3:58:023:58:02 PMPM Physical Examination Documentation of Normal and Abnormal Findings From the Ear, Nose, and Throat Examination

FIGURE 1.1 Normal tympanic membrane.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2 33/17/2014/17/2014 3:58:033:58:03 PMPM Crura of Scaphoid antihelix Helix fossa

Auricular Triangular tubercle fossa

Cymba of Crus of helix concha

Concha of auricle Tragus Cavum of concha External auditory meatus Antihelix Intertragic notch

Helix

Lobule

Antitragus

FIGURE 1.2 Pinna.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3 33/17/2014/17/2014 3:58:053:58:05 PMPM External ear Middle ear Inner ear

Auricle (not to scale) Temporal Tympanic Semicircular Facial nerve (pinna) bone membrane canals

External Vestibular nerve auditory Acoustic meatus Cochlear nerve (VIII) nerve

Vestibule Oval window Round window

Malleus Incus Stapes Eustachian tube Auditory ossicles

FIGURE 1.3 External, middle, and inner ear.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4 33/17/2014/17/2014 3:58:053:58:05 PMPM Pars flaccida Short process of malleus Incus

Handle of malleus Pars tensa

Cone of light

Umbo

FIGURE 1.4 Tympanic membrane.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5 33/17/2014/17/2014 3:58:053:58:05 PMPM FIGURE 1.5 Central tympanic membrane perforation.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6 33/17/2014/17/2014 3:58:053:58:05 PMPM FIGURE 1.6 Tympanosclerosis.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 7 33/17/2014/17/2014 3:58:073:58:07 PMPM Frontal bone

Nasal bones

Upper lateral nasal cartilages

Septal cartilage and dorsum of the nose

Tip Alar groove

Greater alar cartilage Lower lateral Lateral crus Alla nasal cartilages Medial crus

Columalla

Septal cartilage

FIGURE 1.7 External nose.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 8 33/17/2014/17/2014 3:58:083:58:08 PMPM Cribriform plate Frontal of ethmoid sinus

Orbital plate (frontal bone)

Lamina papyracea Ethmoid air cells (ethmoid) Orbit

Superior turbinate and meatus Uncinate process

Maxillary sinus Middle turbinate and meatus

Vomer

Inferior turbinate and meatus

FIGURE 1.8 Paranasal sinuses.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 9 33/17/2014/17/2014 3:58:093:58:09 PMPM Stensen’s Parotid duct salivary gland

Masseter muscle Sublingual ducts Wharton’s duct Sublingual salivary gland

Submandibular salivary gland

FIGURE 1.9 Salivary glands.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1100 33/17/2014/17/2014 3:58:093:58:09 PMPM Superior lip Gingivae (gums)

Superior labial Hard palate frenulum

Soft palate Palatoglossal arch

Uvula Palatopharyngeal arch

Palatine tonsil Posterior wall of oropharynx

Duct of submandibular gland Tongue

Lingual frenulum Vestibule Gingivae (gums) Inferior lip

Inferior labial frenulum

FIGURE 1.10 Oral cavity and oropharynx.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1111 33/17/2014/17/2014 3:58:093:58:09 PMPM 0 1 2 Surgically removed tonsils Tonsils hidden within Tonsils extending to tonsil pillars the pillars

3 4 Tonsils are beyond Tonsils extend to midline the pillars

FIGURE 1.11 Tonsil size scoring.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1122 33/17/2014/17/2014 3:58:093:58:09 PMPM Sella turcica Frontal sinus Adenoid Pharyngeal opening of Sphenoid sinus auditory (eustachian) tube

Soft palate Uvula Hard palate Nasopharynx Incisive canal

Oral cavity

Body of tongue

Palatine tonsil Oropharynx Base of tongue

Lingual tonsil Hypopharynx Hyoid bone

Epiglottis Transverse arytenoid muscle

Thyrohyoid membrane Cricoid cartilage

Thyroid cartilage Esophagus Vocal fold (cord) Trachea

FIGURE 1.12 Oropharynx, hypopharynx, trachea, and larynx.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1133 33/17/2014/17/2014 3:58:103:58:10 PMPM Median glosso-epiglottic fold Base of tongue (lingual tonsil) Vallecula

Vocal folds Epiglottis (true cords)

Ventricular folds (false cords) Glottic aperature

Trachea Vestibule Piriform recess Aryepiglottic fold

Interarytenoid notch Ventricle

Esophagus Arytenoid

FIGURE 1.13 Larynx landmarks.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1144 33/17/2014/17/2014 3:58:103:58:10 PMPM OMEGA-SHAPED EPIGLOTTIS

VALLECULA

FIGURE 1.14 Omega-shaped epiglottis and vallecula.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1155 33/17/2014/17/2014 3:58:103:58:10 PMPM Anterior View Epiglottis

Hyoid bone

Thyrohyoid membrane

Superior horn of thyroid cartilage

Arytenoid cartilage (behind thyroid cartilage)

Larynx location Thyroid cartilage

Cricothyroid ligament

Inferior horn of thyroid cartilage

Cricoid cartilage

Trachea

FIGURE 1.15 Cartilages of larynx.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1166 33/17/2014/17/2014 3:58:143:58:14 PMPM SScott_Image Bank_03-11-14.indd 17 c o t t _ I m a g e

B a n k _ 0 3 - 1 1 - 1 4 . i n d d

7 Superficial parotid nodes (deep parotid nodes deep to parotid gland)

Facial nodes Occipital nodes (buccal nodes) Mastoid nodes

Subparotid node (Level II) Jugulodigastric node (Level II)

Mandibular and submandibular Deep lateral nodes nodes (Level I) (spinal accessory nodes) (Level V) Submental nodes (Level I) Inferior deep cervical Suprahyoid node (Level I) (scalene) node (Level IV) Internal jugular chain of nodes (deep lateral cervical nodes) (Levels II and III) Transverse cervical chain of nodes (Level V) Anterior deep cervical (pretracheal and thyroid) nodes (deep to strap muscles) (Level VI) Anterior superficial cervical nodes (anterior jugular nodes) (Level VI) Supraclavicular nodes (Level IV)

Level I nodes Level II nodes Level III nodes

Level IV nodes Level V nodes Level VI nodes 33/17/2014 3:58:14 PM / 1 FIGURE 1.16 Neck: Lymphatic system and node groups. 7 / 2 0 1 4

3 : 5 8 : 1 4

P M Ear, Nose, and Throat Anatomy and Physiology Normal Findings

Frontal bone

Parietal bone

Nasal bone

Sphenoid bone Zygomatic arch Temporal bone Maxilla

Occipital bone

Mandible Mastoid process

Styloid process

FIGURE 2.1 Skull bone landmarks.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1188 33/17/2014/17/2014 3:58:143:58:14 PMPM Temporal branch Trigeminal nerve

Ophthalmic branch (V1) Facial nerve

Maxillary branch (V2) Buccal branch

Zygomatic branch Mandibular branch

Mandibular branch (V3) Cervical branch

FIGURE 2.2 Trigeminal nerve and facial nerve branches.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 1199 33/17/2014/17/2014 3:58:143:58:14 PMPM To parotid gland

Superior and inferior ganglia

To pharynx

Glossopharyngeal nerve

To palatine tonsil

To carotid body and carotid sinus

To tongue for taste and general sensation

To stylopharyngeus muscle

FIGURE 2.3 Glossopharyngeal nerve.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2200 33/17/2014/17/2014 3:58:153:58:15 PMPM Anterior (superior) semicircular canal and duct Ampullae Common crus and duct Dura mater Posterior semicircular canal and duct Endolymphatic sac

Lateral semicircular canal and duct Endolymphatic duct in vestibular aqueduct Stapes in oval (vestibular) window Utricle Incus Saccule Malleus Vestibule Round (cochlear) window (closed by secondary Cochlear aqueduct tympanic membrane) Tympanic cavity External acoustic meatus Tympanic membrane Auditory (eustachian) tube

FIGURE 2.4 Middle and inner ear.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2211 33/17/2014/17/2014 3:58:153:58:15 PMPM SSINUSINUS CTCT SCAN:SCAN: CORONALCORONAL VIEWVIEW

NNASALASAL SSEPTUMEPTUM

MMAXILLARYAXILLARY SINUSSINUS CCAVITIESAVITIES

FIGURE 2.5 Maxillary sinuses.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2222 33/17/2014/17/2014 7:14:157:14:15 PMPM Septal branch of facial artery

Nasal septum turned superiorly Branches of posterior ethmoidal artery

Branches of anterior ethmoidal artery Septal branch of nasopalatine artery

Nasopalatine artery Kiesselbach’s Plexus Sphenopalatine foramen

Lateral nasal Lateral nasal branch branches of of nasopalatine artery facial artery

Anastomosis between Maxillary artery septal branch of nasopalatine artery and greater palatine artery External carotid artery in incisive canal

Greater palatine artery Lateral wall of Lesser palatine artery nasal cavity

FIGURE 2.6 Arteries of nasal cavity.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2222 33/17/2014/17/2014 3:58:153:58:15 PMPM Olfactory bulb

Olfactory nerves

Olfactory tract

FIGURE 2.7 Olfactory nerve.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2233 33/17/2014/17/2014 3:58:163:58:16 PMPM SINUSSINUS CCTT SSCAN:CAN: SSAGITTALAGITTAL VVIEWIEW

FRONTALFRONTAL SSINUSESINUSES

SPHENOIDSPHENOID SSINUSESINUSES

ETHMOIDETHMOID SINUSESSINUSES

FIGURE 2.8 Frontal, ethmoid, and sphenoid sinuses.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2255 33/17/2014/17/2014 7:14:187:14:18 PMPM Epiglottis Palatine tonsil Median glossoepiglottic fold

Lateral glossoepiglottic fold

Vallecula Base of tongue Lingual tonsil (lingual follicles)

Foramen cecum

Sulcus terminalis

Vallate papillae

Foliate papillae

Body Filiform papillae

Fungiform papilla

Median sulcus

Apex

FIGURE 2.9 Oral cavity, tongue, and oropharynx.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2244 33/17/2014/17/2014 3:58:173:58:17 PMPM III

III IV

FIGURE 2.10 Mallampati Classiﬁ cation Score.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2255 33/17/2014/17/2014 3:58:173:58:17 PMPM PIRIFORM RECESS

ARYTENOID ARYEPIGLOTTIC FOLD

FALSE VOCAL FOLDS TRUE VOCAL FOLDS ANTERIOR COMMISSURE

FIGURE 2.11 Larynx.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2266 33/17/2014/17/2014 3:58:173:58:17 PMPM Anterior View

Left vagus Right vagus nerve (X) nerve (X) Left common Anomalous right inferior carotid artery laryngeal nerve (not recurrent) Left inferior laryngeal nerve

Anomalous (retroesophageal) Left recurrent right subclavian artery laryngeal nerve

Left subclavian artery

Right common carotid artery Anomalous (retroesophageal) right subclavian artery originating from left side of aortic arch Arch of aorta Left recurrent laryngeal nerve

FIGURE 2.12 Anomalous neural and vascular anatomy of the larynx.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2277 33/17/2014/17/2014 3:58:213:58:21 PMPM Food bolus

ABC

DEF

FIGURE 2.13 Normal swallowing.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2288 33/17/2014/17/2014 3:58:213:58:21 PMPM Physical Examination of the Cranial Nerves for the Head and Neck

Olfactory

Optic Oculomotor

Trigeminal Trochlear

Facial Abducens

Glossopharyngeal Vestibulocochlear Vagus Hypoglossal

Accessory

FIGURE 3.1 Cranial nerves.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 2299 33/17/2014/17/2014 3:58:223:58:22 PMPM Superior palpebral conjunctiva: tarsal (Meibomian) glands shining through

Superior lacrimal Pupil papilla and puncta

Cornea Plica semilunaris

Limbus of cornea Lacrimal caruncle Bulbar conjunctiva in lacrimal lake over sclera

Inferior lacrimal Inferior fornix papilla and puncta of conjunctiva

Inferior palpebral conjunctiva: tarsal glands shining through

FIGURE 3.2 Eye anatomy.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3300 33/17/2014/17/2014 3:58:223:58:22 PMPM 1st Branch: Ophthalmic (eye)

2nd Branch: Maxillary (top jaw)

3rd Branch: Mandibular (lower jaw)

FIGURE 3.3 Trigeminal nerve branches: Sensory distribution.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3311 33/17/2014/17/2014 3:58:223:58:22 PMPM Brachial motor

Visceral motor

Special sensory

General sensory

Internal acoustic meatus

Motor nucleus of facial nerve

Posterior auricular branch

Stylomastoid foramen

FIGURE 3.4 Facial nerve motor and sensory components.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3322 33/17/2014/17/2014 3:58:223:58:22 PMPM Vagus nerve Pharyngeal branch

Superior and inferior vagal ganglions Laryngeal branches

Cardiac branch

Pulmonary plexus Heart Lung Esophageal plexus

Stomach Celiac plexus

Liver

Spleen

Small intestine Kidney

Colon

FIGURE 3.5 Vagus nerve distribution.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3333 33/17/2014/17/2014 3:58:233:58:23 PMPM Evaluation and Management of Hearing and Tinnitus

Quiet –10 0 Normal 10 hearing 20 30 40 50 60 70 80 90 100 110

Hearing Level in Decibels (dB) Hearing Level 120 130 Loud 140 125 250 500 1000 2000 4000 8000 Frequency in Hertz (Hz) Low pitch High pitch

FIGURE 5.1 Audiogram.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3344 33/17/2014/17/2014 3:58:233:58:23 PMPM Type A Type B Type C 1400 1400 1400 1200 1200 1200 1000 1000 1000 800 800 800 600 600 600 400 400 400 200 200 200 –400 –300 –200 –100 0 +100 +200 –400 –300 –200 –100 0 +100 +200 –400 –300 –200 –100 0 +100 +200

Type AS Type AD 1400 1400 1200 1200 1000 1000 800 800 600 600 400 400 200 200 –400 –300 –200 –100 0 +100 +200 –400 –300 –200 –100 0 +100 +200

FIGURE 5.2 Tympanogram.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3355 33/17/2014/17/2014 3:58:233:58:23 PMPM –10 0 10 20 30 40 50 60 70 80 90 Hearing Level in decibels (dB) Hearing Level 100 110 125 250 500 1000 2000 4000 8000 Frequency in Hertz (Hz)

FIGURE 5.3 Conductive hearing loss (left ear).

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3366 33/17/2014/17/2014 3:58:243:58:24 PMPM Sensorineural Hearing Loss Audiogram –10 0 10 20 30 40 50 60 70 80 90 Hearing Level in decibels (dB) Hearing Level 100 110 125 250 500 1000 2000 4000 8000 Frequency in Hertz (Hz)

Air conduction Bone conduction

FIGURE 5.4 Sensorineural hearing loss (right ear).

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3377 33/17/2014/17/2014 3:58:243:58:24 PMPM –10 0 10 20 30 40 50 60 70 80 90 Hearing Level in decibels (dB) Hearing Level 100 110 125 250 500 1000 2000 4000 8000 Frequency in Hertz (Hz)

Air conduction: Bone conduction: Left ear Left ear Right ear Right ear

FIGURE 5.5 Mixed hearing loss (bilateral ears).

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3388 33/17/2014/17/2014 3:58:243:58:24 PMPM –10 0 10 20 30 40 50 60 70 80 90 Hearing Level in decibels (dB) Hearing Level 100 110 125 250 500 1000 2000 4000 8000 Frequency in Hertz (Hz)

FIGURE 5.6 Otosclerosis Carhart’s notch (right ear).

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 3399 33/17/2014/17/2014 3:58:243:58:24 PMPM Evaluation and Management of Middle Ear Conditions

FIGURE 7.1 Bulging tympanic membrane as seen with otitis media.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4400 33/17/2014/17/2014 3:58:243:58:24 PMPM FIGURE 7.2 Bullous myringitis.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4411 33/17/2014/17/2014 3:58:263:58:26 PMPM FIGURE 7.3 Tympanic membrane perforation (large) with tympanic membrane scarring (left ear).

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4422 33/17/2014/17/2014 3:58:273:58:27 PMPM FIGURE 7.4 Normal tympanostomy tube (Armstrong).

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4433 33/17/2014/17/2014 3:58:283:58:28 PMPM FIGURE 7.5 Large tympanic membrane perforation.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4444 33/17/2014/17/2014 3:58:293:58:29 PMPM Evaluation and Management of Inner Ear Conditions

Components of Balance Brainstem (sorts info)

Sensorimotor Integration of Motor Control Input Input in CNS Output

• Vestibulo-ocular reflex: Eye position • Cerebral cortex: • Vestibular: Inner ear compensates Functions in for movements thinking and of the head memory and contains previously +=learned information • Vestibulo-spinal • Visual: Eyes reflex: Controls Balance body posture

• Cerebellum: Functions as the • Vestibulo-collic • Proprioception: coordination reflex: Keeps head Muscles and center and on a level plane joint receptors contains automatic with movement movements previously learned

FIGURE 8.1 Components of balance.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4455 33/17/2014/17/2014 3:58:313:58:31 PMPM Vestibular System

Angular Acceleration Linear Acceleration (Head Rotation) (One Directional Movement)

• Anterior/superior canal • Utricle: and posterior canal: the three semicircular canals detects rotations of the open into the utricle. It senses head in a sagittal plane motion in the horizontal plane (as when nodding) and in (i.e., forward-backward the frontal plane (as when movement, left-right cartwheeling) movement, or both)

• Horizontal or lateral canal: • Saccule: corresponds to rotation of the head senses motion in the sagittal around a verticle axis (i.e., the neck) plane (up-down movement) as when doing a complete spin and gravity

Each semicircular canal is a continuous Both the utricle and saccule use small stones endolymph-filled hoop. Hair cells sit in the (otoliths) and a viscous fluid to stimulate their small swelling at the base called an ampula. hair cells to detect motion and orientation. The The function of these canals is to stabilize eye major role of the utricle and saccule is to keep movement with head movement. the person vertically oriented with respect to gravity.

FIGURE 8.2 Vestibular system.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4466 33/17/2014/17/2014 3:58:313:58:31 PMPM Sagittal body plane Gravity 45°

Vantage point

Superior canal

Posterior canal

Utriculus Gravity

Posterior-canal ampulla A Particles

Gravity

Utriculus Posterior-canal Superior ampulla canal

Vantage Gravity point Posterior canal Particles B

FIGURE 8.3 Dix–Hallpike maneuver.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4477 33/17/2014/17/2014 3:58:313:58:31 PMPM 1 2

FIGURE 8.4 Epley maneuver (for right-sided posterior semicircular canal benign paroxysmal positional vertigo).

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 4488 33/17/2014/17/2014 3:58:333:58:33 PMPM SScott_Image Bank_03-11-14.indd 49 c o t t _ I m a g e

B a n k _ 0

3 Evaluation and Management of Olfactory Disorders - 1 1 - 1 4 . i n d d

4 Olfactory Olfactory 9 tract bulb

Cribiform plate of ethmoid bone

Filaments of olfactory nerve

Olfactory bulb Lamina propria Olfactory tract connective tissue Axon Olfactory epithelium Olfactory gland Basal cell Olfactory sensory neuron Olfactory Supporting epithelium epithelial cell Dendrite Nasal Olfactory cilia conchae Mucus Rout of inhaled air Route of inhaled air containing odor molecules AB 33/17/2014 3:58:34 PM /

1 FIGURE 9.1 Olfaction. 7 / 2 0 1 4

3 : 5 8 : 3 4

P M Evaluation and Management of the Nose—External Conditions

12 3 45

Type Anatomical Deﬁ cits

1 Minor supratip or nasal dorsal depression, with a normal projection of lower third of the nose

2 Depressed nasal dorsum (moderate to severe) with relatively prominent lower third

3 Depressed nasal dorsum (moderate to severe) with loss of tip support and structural deﬁ cits in the lower third of the nose

4 Catastrophic (severe) nasal dorsal loss with signiﬁ cant loss of the nasal structures in the lower and upper thirds of the nose

FIGURE 10.1 Saddle nose deformity.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5500 33/17/2014/17/2014 3:58:353:58:35 PMPM Evaluation and Management of the Nasal Cavity and Paranasal Sinuses

NasalNasal PPolypolyp

LEFTLEFT MIDDLEMIDDLE TURBINATETURBINATE

FIGURE 11.1 Nasal polyp.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5511 33/17/2014/17/2014 3:58:353:58:35 PMPM BEFOREBEFORE EEXCISIONXCISION

MiddleMiddle TurbinateTurbinate AntrochoanalAntrochoanal PPolypolyp

AFTERAFTER EXCISIONEXCISION

FIGURE 11.2 Antrochoanal polyp.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5522 33/17/2014/17/2014 3:58:373:58:37 PMPM LeftLeft MMaxillaryaxillary MMucousucous RetentionRetention CCystyst

FIGURE 11.3 Mucous retention cyst.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5555 33/17/2014/17/2014 7:14:317:14:31 PMPM POSTSURGICALPOSTSURGICAL CCHANGESHANGES

BilateralBilateral EEthmoidectomiesthmoidectomies wwithith patencypatency ooff tthehe ffrontoethmoidrontoethmoid rrecesses.ecesses.

PostsurgicalPostsurgical cchangeshanges ffromrom bilateralbilateral aantralntral windowwindow ccreation.reation. ModerateModerate dependentdependent mucosalmucosal thickeningthickening withinwithin thethe rightright maxillarymaxillary ssinus.inus.

FIGURE 11.4 Postsurgical changes.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5566 33/17/2014/17/2014 7:14:327:14:32 PMPM INVERTEDINVERTED PPAPILLOMAAPILLOMA

LEFTLEFT MMIDDLEIDDLE TURBINATETURBINATE

FIGURE 11.5 Inverted papilloma.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5533 33/17/2014/17/2014 3:58:413:58:41 PMPM Cribriform plate Frontal sinus of ethmoid bone

Nasal bone

Perpendicular plate of ethmoid Sphenoid sinus Septal cartilage

Vomeronasal Pharyngeal cartilage tonsil

Maxilla Palatine Vomer bone

FIGURE 11.6 Nasal septum anatomy.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5544 33/17/2014/17/2014 3:58:453:58:45 PMPM FIGURE 11.7 Obstructed osteomeatal complex bilateral. Moderate left and right maxillary and ethmoid sinus mucosal thickening. Osteomeatal complex is occluded bilaterally.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5599 33/17/2014/17/2014 7:14:347:14:34 PMPM R

FIGURE 11.8 Obstructed osteomeatal complex unilateral. Complete opacifi cation of the right maxillary sinus. Near-complete opacifi cation of the anterior ethmoid air cells. Right osteomeatal complex is opacifi ed. There is also occlusion of the right frontoethmoid recess.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6600 33/17/2014/17/2014 7:14:347:14:34 PMPM HallerHaller CellCell

FIGURE 11.9 Haller cell.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5555 33/17/2014/17/2014 3:58:453:58:45 PMPM ConchaConcha BBullosaullosa

FIGURE 11.10 Concha bullosa.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5566 33/17/2014/17/2014 3:58:483:58:48 PMPM AggerAgger NNasiasi CCellell

FIGURE 11.11 Agger nasi cell.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5577 33/17/2014/17/2014 3:58:513:58:51 PMPM RIGHTRIGHT MMIDDLEIDDLE TURBINATETURBINATE

RIGHTRIGHT ETHMOIDETHMOID OSTIAOSTIA

RIGHTRIGHT MAXILLARYMAXILLARY OSTIAOSTIA

FIGURE 11.12 Sinus ostia after endoscopic sinus surgery. View of the right ethmoid and maxillary ostia.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5588 33/17/2014/17/2014 3:58:543:58:54 PMPM OroantralOroantral FFistulaistula

FIGURE 11.13 Oroantral ﬁ stula.

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FIGURE 11.14 Silent sinus syndrome. Scan shows marked reduction in left maxillary sinus volume. There is inferior bowing of the orbital fl oor with increased left orbital volume and enophthalmos with an absence of the left maxillary ostium (compared to the right) and complete opacifi cation of the left maxillary sinus with occlusion of the left osteomeatal complex (OMC). These fi ndings are compatible with silent sinus syndrome. Incidental note: There is a mucus retention cyst versus a polyp in the right maxillary sinus. The right OMC is patent.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6666 33/17/2014/17/2014 7:14:427:14:42 PMPM Evaluation and Management of Nasopharynx Conditions

FIGURE 12.1 Adenoid hypertrophy blocking the posterior nasopharynx on nasal endoscopic examination.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 5599 33/17/2014/17/2014 3:58:573:58:57 PMPM FIGURE 12.2 Postop adenoidectomy scar as seen on nasopharyngoscopy examination.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6600 33/17/2014/17/2014 3:58:593:58:59 PMPM Evaluation and Management of Oropharynx Disorders

FIGURE 13.1 Aphthous ulcer.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6611 33/17/2014/17/2014 3:59:003:59:00 PMPM TONSILTONSIL HHYPERTROPHYYPERTROPHY

FIGURE 13.2 Tonsil hypertrophy (on ﬁ beroptic laryngoscopy examination).

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6622 33/17/2014/17/2014 3:59:013:59:01 PMPM Infected tonsil

Infected tonsil

Edematous uvula

Tongue

FIGURE 13.3 Tonsillitis.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6633 33/17/2014/17/2014 3:59:053:59:05 PMPM Evaluation and Management of Salivary Gland Conditions

FIGURE 15.1 Warthin’s tumor. Within left parotid gland there is a peripherally enhancing mass with smooth well-deﬁ ned margins arising within the deep parotid lobe and extending below it, measuring 2.8 x 2.77 cm. It abuts the sternocleidomastoid. Pathology conﬁ rmed Warthin’s tumor.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 7722 33/17/2014/17/2014 7:14:487:14:48 PMPM Evaluation and Management of Benign Neck Conditions

FIGURE 16.1 Branchial cleft cyst. Cyst in the right neck anterior to the parotid gland. Excision of the lesion was done and it was determined to be moderately differentiated cystic squamous cell carcinoma.

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FIGURE 16.2 Thyroglossal duct cyst: Rounded lesion within midline of the tongue measures 3.3 x 6.1 x 4.5 cm with no evidence of calciﬁ cation. The lesion is above the hyoid bone without extension beyond the borders of the tongue.

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DorsumDorsum ooff TongueTongue

SCCSCC ofof thethe ttongueongue

FIGURE 17.1 Tongue mass.

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FIGURE 17.2 Squamous cell carcinoma at the base of the tongue: Mass has irregular margins, crossing the midline and measuring 3.7 x 3.4 x 5.9 cm. It was determined to be a moderately to poorly differentiated squamous cell carcinoma predominantly involving the oropharynx with extension into the posterior tongue.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 7766 33/17/2014/17/2014 7:14:527:14:52 PMPM NasopharyngealNasopharyngeal MMassass

NasopharyngealNasopharyngeal MMassass

NasopharyngealNasopharyngeal MMassass NasopharyngealNasopharyngeal MMassass

FIGURE 17.3 Nasopharyngeal mass.

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FIGURE 17.4 Squamous cell carcinoma of neck: CT with contrast shows a left neck mass interior to the sternocleidomastoid, with increased heterogeneity, compatible with necrosis. The mass abuts the left carotid artery. There are multiple adjacent lymph nodes as well. Pathology results indicated that the neck mass was a moderately differentiated squamous cell carcinoma.

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FIGURE 17.5 Lymphoma: Solid right parotid gland mass just inferior to the right ear along the posterior aspect of the inferior-most parotid gland, 20 x 13 mm. The borders are indistinct with mild surrounding fatty inﬁ ltration. No calciﬁ cation is observed. Pathology indicated malignant lymphoma, follicular type.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 7799 33/17/2014/17/2014 7:14:587:14:58 PMPM Evaluation and Management of Trachea Disorders and Conditions

Thyroid cartilage

Cricothyroid membrane

Cricothyroidotomy Cricoid cartilage

Subcricoid space

First tracheal cartilage Percutaneous dilational tracheostomy site Second tracheal cartilage

Standard tracheostomy site

FIGURE 20.1 Tracheostomy tube insertion site.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6666 33/17/2014/17/2014 3:59:243:59:24 PMPM Outer cannula

Inner cannula Obturator Cuff Cuff inflation line

Pilot balloon

Plug

Fenestration

FIGURE 20.2 Tracheostomy tube.

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FIGURE 22.1 Reinke’s edema.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6688 33/17/2014/17/2014 3:59:253:59:25 PMPM RightRight TTVCVC LeftLeft TVCTVC

VCVC PolypPolyp

RightRight TTVCVC LeftLeft TTVCVC

VCVC NoduleNodule

FIGURE 22.2 Vocal cord polyp and nodule.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 6699 33/17/2014/17/2014 3:59:263:59:26 PMPM FIGURE 22.3 Right true vocal cord polyp.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 7700 33/17/2014/17/2014 3:59:333:59:33 PMPM FIGURE 22.4 Right true vocal cord polyp before and after excision.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 7711 33/17/2014/17/2014 3:59:353:59:35 PMPM FIGURE 22.5 Vocal cord cysts.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 7722 33/17/2014/17/2014 3:59:393:59:39 PMPM FIGURE 22.6 Right true vocal cord intracordal cyst.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 7733 33/17/2014/17/2014 3:59:403:59:40 PMPM FIGURE 22.7 Vocal cord granuloma.

SScott_Imagecott_Image BBank_03-11-14.inddank_03-11-14.indd 7744 33/17/2014/17/2014 3:59:413:59:41 PMPM FIGURE 22.8 Vocal cord papilloma.

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FIGURE 22.9 Squamous cell carcinoma of right true vocal cord. CT shows signifi cant soft tissue density surrounded and nearly occluded by the glottic portion of the airway. CT fi ndings were worrisome for malignancy. Biopsy results confi rmed moderately differentiated squamous cell carcinoma of the right true vocal cord.

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