EN4.{30,35-36,46} | Head Neck and Systemic ENT — Glossary

Malignant salivary tumour characterised by perineural invasion (skip lesions along nerve sheaths, causing pain/paraesthesia) and late haematogenous spread to lungs; has a prolonged but eventually fatal course.

A B-cell lymphoma occurring in HIV-positive patients with advanced immunosuppression (CD4 <100); the commonest lymphoma in HIV; presents as a rapidly enlarging neck mass or Waldeyer's ring involvement; treated with R-CHOP chemotherapy and ART.

A thin layer of fascia situated between the buccopharyngeal fascia anteriorly and the prevertebral fascia posteriorly; forms the anterior boundary of the danger space; fuses laterally with the carotid sheaths at C7.

Combination drug therapy targeting HIV at multiple stages of its replication cycle; the cornerstone of HIV management; suppresses plasma viral load to undetectable levels and allows CD4 count recovery, reducing susceptibility to opportunistic infections and AIDS-related malignancies.

A technique for securing a difficult airway in the conscious sedated patient by passing a flexible fibreoptic scope through the nose or mouth into the trachea under direct vision, then railroading the endotracheal tube over it; the method of choice for anticipated difficult airway in deep neck infection.

Injury resulting from a sudden change in ambient pressure that causes a pressure differential across the tympanic membrane or round window; occurs during aircraft descent, scuba diving, or blast; causes TM perforation, haemotympanum, and potentially inner ear membrane rupture.

Ecchymosis (bruising) over the mastoid process (postauricular region) appearing 24–48 hours after a basilar skull fracture involving the temporal bone; caused by blood tracking along the mastoid emissary vein.

A desialylated form of transferrin found exclusively in CSF (and perilymph); its detection in nasal or ear fluid confirms CSF leak; gold standard diagnostic test for CSF rhinorrhoea or otorrhoea after head injury.

Malignant transformation arising within a pre-existing pleomorphic adenoma; suggested clinically by rapid growth or pain in a previously stable slow-growing parotid swelling; requires wide excision and post-operative radiotherapy.

Permanent irregular thickening and deformity of the pinna resulting from organised haematoma auris; new disorganised cartilage is deposited in place of the evacuated clot, producing a gnarled appearance; entirely preventable with timely haematoma drainage.

The number of CD4+ T helper lymphocytes per microlitre of blood; the primary laboratory marker of HIV disease progression; <200 cells/μL defines AIDS-level immunosuppression and predicts risk of opportunistic infections and AIDS-defining malignancies.

Complete disruption of the junction between the cricoid cartilage and the trachea, a Schaefer Group V laryngeal injury; presents with complete airway loss; requires emergency surgical airway (tracheostomy through the injury site or below) and definitive tracheal reconstruction.

Leakage of cerebrospinal fluid through a dural tear and cribriform plate/frontal sinus bony defect, presenting as clear watery unilateral nasal discharge; complication of anterior skull base fracture; confirmed by beta-2-transferrin; risks ascending meningitis if untreated.

A fascial space between the alar fascia and the prevertebral fascia extending from the skull base to the diaphragm; its lack of lateral boundaries above C7 allows unrestricted craniocaudal spread of infection from the neck to the mediastinum.

A life-threatening complication of deep neck infection in which bacteria descend via the danger space into the mediastinum, causing necrotising infection of the mediastinal contents; mortality remains 20–40% despite aggressive surgical management.

Cytological sampling of a mass using a 22–25-gauge needle and syringe; the first-line tissue diagnostic tool for salivary gland tumours; incisional biopsy is specifically contraindicated in parotid masses.

A collection of blood between the perichondrium and the auricular cartilage of the pinna, typically caused by shear force from a direct blow; requires prompt aspiration/drainage and pressure dressing to prevent organisation and cauliflower ear deformity.

Accumulation of blood in the middle ear cavity behind an intact tympanic membrane, presenting as a blue or red discolouration of the TM; a classic sign of temporal bone fracture causing conductive hearing loss.

Clinical features indicating an immediate vascular or aerodigestive injury requiring surgery without further imaging: active arterial haemorrhage, expanding or pulsatile haematoma, absent distal pulse, stridor, tracheal deviation, air bubbling from wound, subcutaneous emphysema with respiratory crepitus.

A form of sarcoidosis involving parotid gland enlargement, uveitis, fever, and facial nerve palsy; also called uveoparotid fever; differentiated from Sjögren's by the presence of uveitis and negative anti-Ro/La.

Kaposi's Sarcoma-associated Herpesvirus; required co-factor for the development of Kaposi's sarcoma; infects endothelial cells and drives spindle-cell transformation; reactivates in the setting of HIV-induced immune suppression.

Bilateral fluctuant parotid gland swellings in HIV-positive patients caused by intraglandular lymphoid hyperplasia and cystic change; benign; often regress with effective antiretroviral therapy.

The outermost layer of the deep cervical fascia, enclosing the sternocleidomastoid and trapezius muscles; splits to enclose the submandibular gland and parotid gland; contributes to the roof of the submandibular space.

A vascular neoplasm caused by Human Herpesvirus-8 (HHV-8/KSHV); the commonest AIDS-defining malignancy; presents as violaceous patches or nodules on the hard palate, skin, lymph nodes, and viscera; treatment includes intralesional therapy for local disease and systemic chemotherapy for extensive disease.

Septic thrombophlebitis of the internal jugular vein following pharyngitis, most commonly caused by Fusobacterium necrophorum; characterised by high fever, neck pain, and metastatic septic emboli to the lungs and joints; most common in healthy young adults.

A fracture line running parallel to the long axis of the petrous portion of the temporal bone; accounts for 70–80% of temporal bone fractures; typically spares the otic capsule; causes conductive hearing loss, haemotympanum, and facial nerve palsy in approximately 20% (usually delayed/neuropraxia).

Life-threatening bilateral cellulitis of the submandibular, sublingual, and submental spaces, typically from an odontogenic source; characterised by brawny induration, floor of mouth elevation, and high airway risk; managed with early airway control, IV antibiotics, and bilateral neck drainage.

Episodic swelling and pain over a salivary gland provoked by eating (salivary drive increases), subsiding after 1–2 hours when drive diminishes; pathognomonic of salivary ductal obstruction by a calculus.

The commonest malignant salivary gland tumour; occurs in the parotid and minor glands; graded low, intermediate, and high; treated by parotidectomy with neck dissection for high-grade tumours.

A life-threatening invasive fungal infection caused by fungi of the order Mucorales; affects the rhinosinuses and can invade the orbit and brain in immunocompromised patients (diabetes, HIV with CD4 <100); presents with sinusitis, black necrotic eschars in the palate or nasal mucosa; treated with amphotericin B and aggressive surgical debridement.

A thick, muffled speech quality caused by pharyngeal space occupation or pharyngeal wall displacement (e.g., in peritonsillar or parapharyngeal abscess); suggests significant peritonsillar or lateral pharyngeal oedema.

Surgical repair of a tympanic membrane perforation using a temporalis fascia or tragal perichondrium graft; indicated for traumatic perforations that fail to heal spontaneously by 3 months, or for large perforations with hearing loss.

Anatomical zones for penetrating neck injury: Zone I = thoracic inlet to cricoid cartilage (difficult surgical access, endovascular preferred); Zone II = cricoid to angle of mandible (most common injury zone, surgical exploration accessible); Zone III = angle of mandible to skull base (difficult surgical access).

Fungal infection of the oral mucosa caused by Candida albicans; presents as pseudomembranous (white removable plaques), erythematous, or angular cheilitis forms; a common early HIV manifestation responding to topical or systemic antifungals.

Corrugated white patches on the lateral borders of the tongue caused by unchecked EBV replication in squamous epithelium; cannot be wiped off; pathognomonic of significant cellular immunosuppression; strongly associated with HIV.

The dense bony shell surrounding the cochlea and semicircular canals within the petrous temporal bone; when disrupted by a transverse fracture, causes irreversible sensorineural hearing loss and vestibular loss.

An inverted cone-shaped space lateral to the pharynx, divided by the styloid process into the pre-styloid compartment (fat, parotid deep lobe, lymph nodes) and the post-styloid (carotid) compartment (carotid artery, jugular vein, CN IX–XII); a major crossroads in deep neck infection spread.

Bilateral non-tender lymphadenopathy involving two or more extra-inguinal lymph node groups, lasting more than 3 months in an HIV-positive patient without other explanation; an early HIV manifestation reflecting immune activation and reactive lymphoid hyperplasia.

The commonest benign salivary gland tumour, composed of epithelial and mesenchymal elements with a thin capsule containing pseudopod projections; treated by superficial parotidectomy — enucleation causes recurrence.

The deepest layer of the deep cervical fascia covering the prevertebral muscles and vertebral column; forms the posterior boundary of both the retropharyngeal space and the danger space.

Standard chemotherapy regimen for diffuse large B-cell lymphoma and AIDS-related NHL: Rituximab + Cyclophosphamide + Hydroxydaunorubicin (doxorubicin) + Oncovin (vincristine) + Prednisolone.

A potential space between the posterior pharyngeal wall and the prevertebral fascia, extending from the skull base to T1–T2 where it communicates with the posterior mediastinum; site of retropharyngeal abscess, predominantly in children <6 years.

A depression of the nasal dorsum at the level of the cartilaginous skeleton, resulting from avascular necrosis of the nasal septal cartilage; the end result of an untreated or inadequately treated septal haematoma.

A five-group severity classification for blunt laryngeal trauma: Group I (minor mucosal/oedema, no fracture) and II (oedema, mucosal disruption) are managed conservatively; Group III (massive oedema, exposed cartilage) and IV (unstable fractures) require tracheostomy and open repair; Group V (cricotracheal separation) requires emergency surgical airway.

Hearing loss affecting the cochlea or auditory nerve in HIV-positive patients; mechanisms include direct HIV neurotoxicity, opportunistic cochlear infections (CMV cochleitis), and ototoxicity from aminoglycosides (TB treatment) or cisplatin (KS chemotherapy).

Accumulation of blood in the subperichondrial plane of the nasal septum, separating the perichondrium from the cartilage; must be drained within 24–48 hours to prevent avascular necrosis of the septal cartilage and permanent saddle-nose deformity.

Inflammation of a salivary gland, usually due to bacterial infection (acute suppurative) or immune-mediated processes; presents with pain, swelling, and erythema over the affected gland.

Non-inflammatory, non-neoplastic bilateral parotid enlargement (hypertrophy of acinar cells) associated with systemic metabolic conditions including alcoholism, malnutrition, diabetes mellitus, and liver disease; asymptomatic and requires no specific treatment.

A surgical procedure in which a salivary duct is incised longitudinally to remove an obstructing calculus and laid open to widen the ostium, preventing re-obstruction; used for distal duct calculi accessible from the oral cavity.

Minimally invasive endoscopic technique using a 0.8–1.6 mm sialendoscope introduced into the ductal orifice to visualise, irrigate, and remove ductal calculi without open surgery.

Radiological examination of the salivary ductal system by cannulating Stensen's or Wharton's duct and injecting contrast medium under fluoroscopy; demonstrates ductal anatomy, strictures, calculi, and sialectasis.

Formation of calcified stones (sialoliths) within the ductal system of a salivary gland, most commonly the submandibular duct; causes obstructive symptoms with characteristic mealtime swelling and pain.

Autoimmune exocrinopathy characterised by lymphocytic infiltration of salivary and lacrimal glands, producing xerostomia and xerophthalmia (the sicca complex); serological markers are anti-Ro(SSA) and anti-La(SSB) antibodies.

The excretory duct of the parotid gland, approximately 5 cm long, running from the anterior surface of the gland across the masseter muscle to open into the oral cavity opposite the upper second molar tooth.

Surgical removal of the superficial lobe of the parotid gland with identification, dissection, and preservation of the facial nerve; the standard operation for benign parotid tumours including pleomorphic adenoma.

A fracture line running perpendicular to the petrous axis, crossing the bony labyrinth; accounts for approximately 20% of temporal bone fractures; causes sensorineural hearing loss, severe vertigo, and facial nerve palsy in approximately 50% (usually immediate, often permanent due to nerve transection).

Inability to open the mouth fully (inter-incisal distance <30 mm in adults), resulting from spasm or infection of the muscles of mastication (masseter, pterygoids); in the context of neck swelling it strongly suggests masticator or parapharyngeal space involvement.

The annular arrangement of lymphoid tissue in the upper aerodigestive tract — palatine tonsils, pharyngeal tonsil (adenoids), lingual tonsil, and tubal tonsils; a major site of HIV replication and viral reservoir; B-cell NHL frequently arises from Waldeyer's ring lymphoid tissue.

Forceps used in closed reduction of a laterally displaced nasal fracture; one blade is passed intranasally under the displaced nasal bone and the other over the dorsum; the nasal bone is elevated and displaced back to the midline.

Benign parotid tumour (papillary cystadenolymphoma) with oncocytic epithelium and lymphoid stroma; exclusive to the parotid, bilateral in ~10%, more common in older men and smokers.

The excretory duct of the submandibular gland, approximately 5 cm long, running forward from the deep lobe of the gland to open at the sublingual papilla on the floor of the mouth; susceptible to calculus formation due to its uphill course and mucous-rich alkaline secretion.

Subjective sensation of dry mouth due to reduced or absent salivary flow; causes dental caries, dysphagia, mucositis, and oral infections; common in Sjögren's syndrome, post-radiotherapy, and anticholinergic drug use.