Ear, Nose and Throat and Head and Neck Surgery Senior Content Strategist: Jeremy Bowes Development Editor: Ewan Halley Project Manager: Julie Taylor Designer/Design Direction: Miles Hitchin Illustration Manager: Jennifer Rose Illustrator: Cactus Design Ear, Nose and FOURTH EDITION Throat and Head and Neck Surgery AN ILLUSTRATED COLOUR TEXT Ram S. Dhillon FRCS Honorary Professor, Middlesex University London; Consultant ENT, Head and Neck Surgeon, North West London Hospitals NHS Trust (Northwick Park Hospital), London; Honorary Senior Lecturer, Imperial College of Medicine, London Charles A. East FRCS Consultant Head and Neck Surgeon, The Royal National Throat, Nose and Ear Hospital, Institute of Laryngology and Otology, The Royal Free Hampstead NHS Trust, London EDINBURGH LONDON NEW YORK OXFORD PHILADELPHIA ST LOUIS SYDNEY TORONTO 2013 © 2013 Elsevier Ltd. All rights reserved. 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First edition 1994 Second edition 1999 Third edition 2006 Fourth Edition 2013 ISBN 978 0 7020 4419 9 British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging in Publication Data A catalog record for this book is available from the Library of Congress Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. 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Working together to grow libraries in developing countries www.elsevier.com | www.bookaid.org | www.sabre.org The publisher’s policy is to use paper manufactured from sustainable forests Printed in China v Contents Foreword vi Preface vi List of contributors vii Acknowledgements viii 1 The ear 1 Basic concepts 2 Otalgia 12 Disorders of balance – non-otological Audiometry, vestibulometry and Otorrhoea 14 causes 22 radiology 4 Complications of middle ear Tinnitus 23 Hearing loss – general introduction infections 16 The auricle (pinna) and ear wax 24 and childhood aetiology 6 Facial palsy 18 Otological trauma and foreign Hearing loss – adult aetiology 8 Disorders of balance – introduction bodies 26 Aids to hearing 10 and otological causes 20 Aural drops 28 2 Nose and paranasal sinuses 29 Anatomy and physiology 30 Nasal infections 38 Facial plastic surgery 46 Symptoms, signs and Nasal septal pathologies and choanal Epistaxis 48 investigations 32 atresia 40 Acute and chronic sinusitis 50 Allergic and vasomotor rhinitis 34 Facial trauma 42 Head and neck pain I 52 Nasal polyps and foreign bodies 36 Complications of facial trauma 44 Head and neck pain II 54 3 The throat 55 Anatomy and physiology 56 Maintenance and protection of the Dysphagia 76 airway 68 Symptoms, signs and examination 58 Salivary glands 78 Postoperative care and complications Dysphonia I 60 Snoring and sleep apnoea 80 of artificial airways 70 Dysphonia II 62 Oral cavity 82 Sore throats 72 Stridor 64 Foreign bodies 84 Tonsillectomy and adenoidal Laryngotracheal injury 66 conditions 74 ENT aspects of HIV infection 86 4 Head and neck neoplasia 87 Basic concepts 88 Laryngeal neoplasia 98 Neoplasia of the nasopharynx 108 Neck lumps – introduction 90 Laryngeal surgery and post- Neoplasia of the nose and paranasal Neck lumps – paediatric laryngectomy rehabilitation 100 sinuses 110 conditions 92 Neoplasia of the oral cavity 102 Neoplasia of the salivary glands 112 Neck lumps – adult conditions 94 Neoplasia of the oropharynx 104 Neoplasia of the ear 114 Neck lumps – management of malignant lumps 96 Neoplasia of the hypopharynx 106 Terminal care 116 Index 119 vi Foreword It is a privilege to be asked to write a diagnosis and modern treatment. The discipline and helps to inspire the foreword to this new fourth edition of popular presentation format from the next generation of specialist clinicians Ear, Nose and Throat and Head and third edition has been retained, with in this vital field. Neck Surgery: An Illustrated Colour topics covered within concise double or Text. Since the successful previous single-page spreads. It has been divided Professor Patrick J. Bradley edition published in 2006, the into four sections; ear, nose, throat and MBA FRCS(Ir. Eng. Ed.) discipline of ENT-HNS has expanded head and neck surgery, each FACS FRACS(Hon) its clinical platform and expertise, coordinated by contributing editors FRCSLT(Hon) with improvements in diagnostic recognized for their expertise within Honorary Professor of Head and imaging, many new therapeutic the specialty. The fourth edition Neck Oncologic Surgery, procedures employing the endoscope includes new and additional The University of Nottingham; and the frequent execution of information on neck lumps and Honorary Professor, School of Health surgery utilising the laser, with or cosmetic surgery, with an extensive and Social Sciences, Middlesex without the robot. This has merited a update of diagnostic and clinical University, London; Hunterian completely revised and updated new information, supported by new clinical Professor, Royal College of Surgeons, edition. pictures. England; Emeritus Consultant The publication aims to inform and This book offers an easily accessible Otorhinolaryngologist, Head and educate medical, dental and allied and practical introduction to diseases Neck Surgeon, Nottingham health students and professionals and disorders of the ear, nose and University Hospitals, Nottingham, UK about symptom presentation within throat. I also hope it serves to ENT, their investigation, differential stimulate further interest in our Nottingham 2013 Preface The fourth edition of Ear, Nose and has remained the same, wih topics We have endeavoured to cover the Throat and Head and Neck Surgery is dealt with in double-page spreads and new developments and extensions still primarily intended for medical the content presented in a mixture of within the speciality, including those students, general practitioners, text, line drawings, tables, colour of cochlear implantation for the deaf, including those with a special interest illustrations and key point summaries. investigations of snoring and sleep in head and neck diseases, and This ‘educational unit’ approach apnoea, airway management and the nursing and paramedical staff. enhances accessibility and is extremely value of PET (Positron Emission Feedback over the years has also useful in revision. ENT and head and Tomography). The more common highlighted that the book is valuable neck surgery has now become a disorders are covered in detail in both to other clinicians treating diseases of major speciality within the surgical diagnostic and management areas; the head and neck; in particular, it has domain. It encompasses not only the however, the operative details have acted as a primer for junior ENT time-honoured ear, nose and throat been kept to a minimum as we specialists both nationally and but also facial, aesthetic and recognize that these are particularly internationally. reconstructive surgery, head and neck relevant to dedicated ENT and head We both recognize that, with and skull base surgery. It has a and neck specialists. increasing diversification and non-surgical branch in audiology subspecialization, help was needed in – audiological medicine – that London Ram S. Dhillon achieving an up-to-date textbook that bears the same relationship to 2012 Charles A. East covers the vast range of diseases ENT surgery as neurology to related to ENT and head and neck neurosurgery and cardiology to surgery. The basic style of the book cardiac surgery. vii Contributors J-P. Jeannon FRCS Consultant ENT Surgeon Guy’s and St Thomas’ NHS Foundation Trust, London A. Narula FRCS Honorary Professor, Middlesex University, London Consultant ENT Surgeon St Mary’s NHS Trust, London H. Saleh FRCS Consultant Rhinologist/Facial Plastic Surgeon, Charing Cross and Royal Brompton Hospitals, London Honorary Senior Lecturer, Imperial College of Medicine, London G. Sandhu FRCS Consultant ENT Surgeon, The Hammersmith Hospitals NHS Trust The Royal National Throat, Nose and Ear Hospital, London viii Acknowledgements We are extremely grateful to From the First Edition in 1994. Dr Tanya Levine and Dr Wai Lup numerous friends and colleagues who Many colleagues have helped with Wong have provided us with have assisted us in completing this advice and illustations. These include: illustrations of cytology and PET book. Martin Bailey, Tony Wright, David scanning respectively. We must thank Mr Richards Howard, Robin Kantor, David Katz, Our appreciation to all those Williams who, at the inception of this Peter Phelps, Jim Fairley, Charles Croft, unnamed individuals, colleagues and text, was Director of the Ferens Saleem Goolamali, Edward Townsend, family, who have supported and Institute of Otolaryngology at Steve Watt-Smith, J.N. Blau, Glynn encouraged us. We our indebted to University College London Medical Lloyd, Ian Colquhoun and Arnold the publishing team who have greatly School and allowed us free rein of the Maran. Additionally, thanks go to leaned on us to complete the fourth excellent facilities available there. The the Institute of Laryngology and edition. Ferens is now part of the Institute of Otology Medical Photography Finally a big thanks to all who have Laryngology and Otology, University Department and David Fenton for bought copies and thus effectively College London. Figure 4.51, page 106 (Nail in ensured publication of this edition We are delighted that our colleagues Disease published by Butterworth and hopefully more in the future. Antony Narula, Guri Sandhu, Jean- Heinemann). A very specific thanks to Pierre Jeannon and Hesham Saleh Garry Glover, whose slide collection London RSD have written significant contributions was invaluable and liberally sprinkled 2012 CAE to the fourth edition. in the text. The Ear