Examination of the neck and throat lymph nodes

We all know the swelling of the lymph nodes when we are having a cold. Sometimes, it is just as a GP inspects the lymph nodes, also useful to do this as a specialized physiotherapist in the oro-cranialfacial region during the physical examination. That way, the hypothesis can be answered or refuted.

Let me first emphasize to be aware of the so-called red flags before we do our physical examination.

These are defined as risk factors for assessment and treatment.

The Red flags stand for all traumatic, neoplastic and inflammatory processes that require immediate medical attention. Our screening questions give us the answers to whether or not our patient is in need of medical attention. (1)

The Red flags/ alarm signals indicating Neck and throat malignancy by The European Head and Neck society (2017) are as follows:

• Painful/ sensitive tongue – non-healing lesion
• Red & white mucous membranes in the mouth
• Throat pain (> 3 weeks)
• Persistent hoarseness (> 3 weeks)
• Pain and/or difficulty in swallowing
• Swelling in the neck
• Unilateral clogged nose and/or bloody nasal discharge

Therapists that work on prescription (patients who have been referred and examined by a medical specialist) will rarely need to asses for red flags since they have usually already been excluded by the medical specialist. Sometimes patients are falsely labelled with a simple diagnosis such as tension headache or myalgia of the masticatory muscles; if dur-ing the our physical examination the features do not fit the therapist should be alerted and refer patients back to the specialist or GP without delay. (1)

Read in this blog the importance of lymph node examination within physiotherapy and ask yourself the question how much attention you should pay to this matter.

Background
In the craniofacial and mandibular area, the therapist often treats asymmetry. The affected lymph tissue can cause facial asymmetries. The changes in the craniofacial area can be regarded as a problem other than that of the lymphatic tissue and thus mask the actual problem. (1)

Enlarged lymph nodes may have three causes:
• Specific and a-specific inflammations.
• Metastases of tumor cells from the surrounding tissue.
• Tumors of the lymphatic system (2).

When there are no clear indications of a craniomandibular and facial dysfunctions in a subjective examination, but a clear dominant asymmetry in the soft tissue is observed and this discomfort is not observed by an E. N.T. doctor or another specialist, the therapist can perform an global palpation examination on the lymph nodes (1).

Knowledge of the lymphatic system has to be an important clinical standard practice (3).
Palpation, for example, is a good tool to reveal lymph node pathology of the head and neck area and can be classified in several ways:

Picture 1. Assessment of the cervical and neck Lymph nodes by palpation from dorsal. (1)

Layout
It is customary to follow the classification of lymph nodes stations in the neck as practiced by the American Society of Head and Neck Surgery (4). A uniform description of the lymph node locations is important for diagnostics; there is often a relationship between the localization of enlarged lymph nodes and the cause of swelling. The drainage area of the lymph glands is at the base of this (5, 6).

The neck is divided into six levels:

Level I, Submental and submandibular lymph node group.
Level II, Upper jugular lymph node group.
Level III, Middle jugular lymph node group.
Level IV, Low-jugular lymph node group.
Level V, Posterior lymph node group.
Level VI, Lymph node group of the anterior neck triangle.

Other than this classification, Classification according to the American Society of Head and Neck Surgery, as mentioned below, according to Berghaus et al. (7) is usually sufficient to detect abnormalities and to consider referring the patient to a specialist.

Performing of the examination:
The therapist stands behind the patient, who is sitting in an upright position with the cervical spine in 20-30 degrees flexion. The palpation is performed with both hands for a comparison of both sides. It is therefore time-saving to first investigate sub mentally, then towards the angulus mandibularis, through anterocranial to the Sternocleidomastoid muscle (Jugular), the supraclavicular space and then along the edge of the Trapezius muscle (pars descendens) in the direction of the occiput (Nuchal) (1). Hold the hands and fingers flat and begin parallel to the skin. The fingers are stretched and make a rubbing or a somewhat twisting movement. Palpation might be painful, therefore pay close attention to the patient’s reactions (8).

Assessment
A normal lymph node is small, approximately 3-7 mm, usually spool-shaped, smooth, sharply edged, elastic in consistency, not fused with the skin or underlying tissues and is not painful during palpation. A normal lymph node in the neck is barely perceptible. During palpation they feel like elastic marbles (8).
Lymph nodes can be mistaken for a muscle (or artery). You must be able to roll a lymph node in two directions; up and down and from left to right. With a muscle or artery this will not be possible in these two directions (8).

Clinical interpretation of the findings
Lymph nodes in the head and neck region are not visible under normal circumstances and can hardly be palpated. After inflammation in the head and neck area, lymph nodes are often somewhat enlarged reactively. In that case, the node is also slightly firmer in consistency (8).

Size: The lymph nodes size says little about the severity of the condition, only with very large nodes is the chance of a severe illness enhanced.

Pain: Pain during palpation indicates active inflammation. Sometimes the skin above the lymph node will appear red and warm to the touch.

Consistency: A soft lymph node is usually harmless. Very firm lymph nodes are often based on metastasis, but firmness also occurs in certain forms of Hodgkin’s disease and granulomatous inflammations. A rubbery consistency fits more with malignant lymphoma and chronic leukemia.

Localization:The presence of supraclavicular lymph nodes is suspected for malignancy. On the left side in the supraclavicular space is a special lymph node (the gland of Virchov) which is of special importance, because it is located in the drainage area of the thoracic duct. When this lymph node is enlarged pathologically, you must consider a metastasis of a tumor in an area involving lymphogenic drainage via the thoracic duct (for example stomach, gall bladder, ovary, pancreas, lung and testis) (5). Lung and breast cancer often metastasize to the same side as the source. In addition, pathological infraclavicular lymph nodes occur both on the left and right.

Fusing: Enlarged lymph nodes that have grown fused to one another or with the skin, are suspected for an active infection or malignancy.

Conclusion:
Clinicians working in the domain of the oro-facial region such as specialized physical therapists, speech language pathologists and dentists need clinical knowledge about lymph node pathology and must try to distinguish between benign- and malignant lymph nodes.
The CRAFTA® therapist is trained when it comes to this examination and it is therefore ad-visable, and actually necessary, to include this part of the examination on a regular basis to ensure good clinical reasoning. A possible pitfall for a physiotherapist is assuming that patients who come with a prescription from a doctor, have already been examined by pal-pation of the lymph nodes. It is therefore advised to integrate this physical assessment into the general examination.

Integrate and react! …….And if you are already doing this, well done!
Good luck.

Author:
Daan Bredewout, CRAFTA® Teacher in Education

References:

1. Von Pieckartz H. 2015. Kiefer, Gesichts- und Zervikalregion. Neuromuskuloskeletales Assessment und behandelungsstrategien. Stuttgart: Georg Thieme Verlag.

2. Schwenzer M, Ehrenfield M. Grimm G. 2002. Spezielle Chirurgie. Band 2: Zahn-Mund Kiefer-Heilkunde. Stuttgart: Georg Thieme Verlag

3. Bickley LS. 2009. Bates ‘Guide to Physical examination and history taking. Philadelphia: Lippincott Williams & Wilkins

4. Robbins KT, Medina JE, Wolfe GT, Levine PA, Sessions RB, et al. 1991. Standardizing neck dissection terminology. Arch Otolaryngol. Head Neck Surg. 117:601-05

5. Kramer WLM. 2006 .Handleiding chirurgisch onderzoek. Houten: Bohn Stafleu van Loghum

6. Huizing EH, Snow GB, de Vries N. 2007. Keel-, neus- en oorheelkunde en hoofd halschirurgie. Houten: Bohn Stafleu van Loghum

7. Berghaus A, Rettinger G, Bohme G. 1996. Hals-Nasen-Ohren-Heilkunde, Stuttgart: Hippokrates

8. Buis J, de Jongh TOH. 2010. Onderzoek van de lymfeklieren. Ned. Tijdschr. Geneeskd. 154:A2652

9. Tokuda Y, Kishaba Y, Kato J, Nakazato N. 2003. Assessing the validity of a model to identify patients for lymph node biopsy. Medicine. 82:414-8

Do Swollen Glands Signal Lymph Node Cancer? – Cleveland Clinic

‘Tis the season for runny noses and swollen glands (groan). More often than not, you can blame symptoms on a virus that’s spreading like wildfire.

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But occasionally, a lump on the side of the neck can signal something more dangerous. In this Q&A, internist Daniel Sullivan, MD, explains when swollen glands may be a sign of cancer — and how to know if you’re at risk.

Q: What are lymph nodes, or glands?

A:
In the neck, there are two areas that we call glands:

• The salivary glands
  provide saliva to the mouth to keep it moist. They’re under the jaw and on the
  side of our face.
• The lymph glands,
  also known as lymph nodes, are mostly on the side of the neck. 

The lymph glands are the body’s sophisticated sewer
system. They get rid of things that our body doesn’t want, such as bacteria,
viruses and other things that enter our system.

There are about 600
pea- to bean-sized lymph nodes throughout your body, from your legs to your
jaw.

Q: Why do lymph nodes sometimes swell up?

A: When a lymph node notices something harmful in the body, it uses its resources to try to destroy it. Inside the lymph nodes are blood cells that fight infection and disease. When the lymph nodes start using them, the gland gets bigger.

Colds, sore throats and ear infections all lead to swollen lymph nodes. We treat the infection, it goes away, and the lymph node shrinks.

Location matters: The glands under your jawline are rarely
a problem. They may swell because one of the ducts of saliva entering the mouth
gets narrowed or blocked. The chance of cancer developing on those glands is
small. We’re more concerned about the lymph nodes on the side of the neck.

Q: When would swollen lymph nodes be a sign of cancer?

A:
Often, lymph glands are painful when they’re swollen from an infection. We get
concerned when someone has a lymph node in their neck that:

• Is enlarged (measuring 1 centimeter
  or more in diameter).
• Isn’t tender or painful.
• Isn’t getting better and has been
  there for longer than two weeks.

Two weeks is a rough guide for us to start considering
cancer as a possibility. If it’s been there for more than two weeks and
continues to get larger, that’s an even bigger red flag.

There are some other factors
that may point to cancer:

• The patient’s background. Cancers are a little more common as we get into our middle years. The likelihood of cancer is higher in someone over 40 with swollen glands than in a 20-year-old.
• A history of skin cancer. If you had skin cancer that was treated, we’d consider the possibility that the cancer traveled beyond the skin.
• Lifestyle choices. We also pay attention to any lifestyle choices that raise the risk for cancer, including smoking and excessive alcohol use.
• Having HPV. The human papillomavirus, or HPV, is another factor that pushes the dial toward cancer. HPV is known for its risk for genital warts, but people can also develop HPV in their mouth or throat. That can lead to squamous cell cancer in the mouth or throat that can cause enlarged lymph nodes.

Q: What cancers are more often associated with swollen glands?

A: Squamous cell cancer is a big one. Skin cancers that started on the face or scalp can be a concern, too. And there are sometimes oral cancers that a dentist would recognize. If someone said to me, ‘A dentist once removed an early cancer from my mouth or cheek area,’ that may be a sign that something’s going on. We’d also consider lymphoma, cancer of the lymph nodes.

Patients’ health history is an important part of the conversation so we can plan the best next steps in their care.

Picture, Definition, Location, and Problems

Image Source

© 2015 WebMD, LLC. All rights reserved.

The tonsils (palatine tonsils) are a pair of soft tissue masses located at the rear of the throat (pharynx). Each tonsil is composed of tissue similar to lymph nodes, covered by pink mucosa (like on the adjacent mouth lining). Running through the mucosa of each tonsil are pits, called crypts.

The tonsils are part of the lymphatic system, which helps to fight infections. However, removal of the tonsils does not seem to increase susceptibility to infection. Tonsils vary widely in size and swell in response to infection.

Tonsil Conditions

• Acute tonsillitis: A bacteria or virus infects the tonsils, causing swelling and a sore throat. The tonsil may develop a gray or white coating (exudate).
• Chronic tonsillitis: Persistent infection of the tonsils, sometimes as a result of repeated episodes of acute tonsillitis.
• Peritonsillar abscess: An infection creates a pocket of pus next to the tonsil, pushing it toward the opposite side. Peritonsillar abscesses must be drained urgently.
• Acute mononucleosis: Usually caused by the Epstein-Barr virus, “mono” causes severe swelling in the tonsils, fever, sore throat, rash, and fatigue.
• Strep throat: Streptococcus, a bacterium, infects the tonsils and throat. Fever and neck pain often accompany the sore throat.
• Enlarged (hypertrophic) tonsils: Large tonsils reduce the size of the airway, making snoring or sleep apnea more likely.
• Tonsilloliths (tonsil stones): Tonsil stones, or tonsilloliths, are formed when trapped debris hardens, or calcifies.

Tonsil Tests

• Throat (pharynx) swab: A doctor rubs a cotton swab on the tonsils and throat and sends the swab for tests. Usually this is done to check for bacteria such as Streptococcus.
• Monospot test: A blood test can detect certain antibodies, which can help confirm that a person’s symptoms are due to mononucleosis.
• Epstein-Barr virus antibodies: If a monospot test is negative, antibodies in the blood against EBV might help diagnose mononucleosis.

Tonsil Treatments

What is laryngeal cancer | Cancer Research UK

Laryngeal cancer is cancer that starts in the voice box (larynx). It is a rare type of head and neck cancer. 

What is the larynx?

The larynx, which includes your vocal cords, is another name for the voice box. It’s a tube about 2 inches (5cm) long in adults. It sits above the windpipe (trachea) in the neck and in front of the food pipe (oesophagus).

The larynx:

• prevents food from entering your windpipe during swallowing
• allows the air you breathe to pass in and out of the lungs
• produces sound for speaking

The larynx is the place in your body where the breathing and digestive systems separate. When you breathe in, air travels through your nose and/or mouth, larynx, windpipe (trachea), and then into your lungs.

When you swallow, your vocal cords close and a part of the larynx called the epiglottis closes tightly over your airway. This flap of cartilage stops food and saliva from going into your lungs when you swallow. Swallowing allows the food into the lower part of your food pipe (oesophagus) and into your stomach.

The vocal cords are two flexible bands of muscle tissue that are attached at the front. On speaking or breathing the vocal cords move together and apart. They protect the airway when they come together in the midline and allowing air to pass freely when they are apart.

Different sizes in the gap between the vocal cords give different sounds which can be used by your mouth, tongue and lips to make your voice.

Parts of the larynx

The larynx is made of several pieces of a smooth, shiny tissue called cartilage. The cartilage is surrounded by fibrous tissue (ligaments). The largest cartilage of the larynx is the thyroid cartilage, which forms the Adam’s apple. This is the lump in the front of your neck. This is often much easier to see in men than women. The proper name for this is thyroid cartilage.

There are 3 main parts to the larynx. These parts are the:

• supraglottis – the area above the vocal cords that contains the epiglottis cartilage
• glottis – the area of the vocal cords
• subglottis – the part below the vocal cords, containing the cricoid cartilage that continues down into the windpipe

 Cancer can develop in any or all of these parts of the larynx.

The hypopharynx

The hypopharynx is at the lower end of the throat (pharynx). It is the part of the throat that sits immediately behind the larynx. It connects the mouth and back of the nose to the windpipe and food pipe. There are 3 parts to the hypopharynx. These are the:

• right and left piriform sinuses
• posterior pharyngeal wall
• postcricoid region

Cancers can occur in any part of the hypopharynx but most commonly develop in the piriform sinuses. These are v-shaped and found on either side of the larynx. 

The symptoms may be like the symptoms of laryngeal cancer. And the treatment is also often the same which is why we have included the information here.

The lymph nodes

There are lots of lymph glands throughout the body but there are particularly more in the neck area. These are also called lymph nodes. Normal lymph nodes are small and round or bean shaped glands, which are less than 1cm long. 

They are part of the lymphatic system which runs throughout the body. The lymphatic system is filled with fluid called lymphatic fluid.

The lymph glands help to control infection by filtering anything foreign to the body, out in the lymphatic fluid. This includes bacteria and viruses.

When anything foreign enters the body, a normal immune response causes the lymph node to increase in size and become hot, red and tender.

The lymph nodes are often the first place that cancer cells reach when they break away from a tumour. So surgeons often remove them and examine them closely to see if they contain any cancer cells. They use this information to stage the cancer and make treatment decisions. 

How common is laryngeal cancer?

Laryngeal cancer is rare. Around 2,400 people are diagnosed in the UK each year.

Who gets laryngeal cancer?

Laryngeal cancer is more common in men than in women. It is diagnosed in more than 5 times as many men as women.

As with most cancers, laryngeal cancer is more common in older people than in younger people. There are very few cases in people under 40 years of age.

About mouth and oropharyngeal cancer | Mouth cancer

Mouth cancer can start in different parts of the mouth, including the lips, gums or soft sides of the mouth. Oropharyngeal cancer starts in the oropharynx. The oropharynx is the part of the throat (pharynx) just behind the mouth. It includes tonsil cancer and cancer in the back part of the tongue.

This section is about both mouth and oropharyngeal cancer. These cancers often start in the same type of cell. Doctors use similar tests and treatments for these cancers although there are some differences.

If your cancer started on your tongue, you might also find it useful to look at our information about tongue cancer.

You can also find out more about cancer that starts in the tonsils.

The mouth

The medical term for the mouth is the oral cavity. Mouth cancer can start anywhere in the oral cavity. This includes the:

• lips
• inside lining of the cheeks and lips (buccal mucosa)
• front 2/3 of the tongue
• gums (gingiva)
• floor of the mouth
• roof of the mouth (hard palate) 
• area behind the wisdom teeth (retromolar trigone)

The mouth and oropharynx help us breathe, talk, eat, chew and swallow. 

The oropharynx

The medical term for the throat is the pharynx. The pharynx is divided into 3 parts.

The parts are:

• oropharynx
• nasopharynx
• laryngopharynx

The oropharynx is the part of the throat just behind the mouth. Cancer starting in this area is called oropharyngeal cancer (pronounced oar-oh-fah-rin-jee-al).

The oropharynx includes the:

• back 1/3 of the tongue 
• soft area at the back of the roof of the mouth (soft palate)
• tonsils and 2 ridges of tissue in front of and behind the tonsils (tonsillar pillars)
• back wall of the throat

The Human Papilloma Virus (HPV)

Around 70 out of 100 oropharyngeal cancers (around 70%) are linked to the human papilloma virus (HPV). This is a common virus which causes no harm in most people. But in some people, the virus can cause changes in the throat making them more likely to become cancerous in the future. 

The doctors test your oropharyngeal cancer cells to see if they contain the HPV virus. This affects what stage your cancer is and your outlook (prognosis). We know that oropharyngeal cancers containing HPV tend to do better than cancers that don’t contain HPV. At the moment, this doesn’t affect your treatment. But doctors are looking at this in research to see if people with HPV positive cancers can have less intense treatments in the future. 

Lymph nodes in your neck

Lymph nodes are small bean shaped glands that are part of the lymphatic system. 

There are major groups of lymph nodes in your neck. Cancers starting in the mouth and oropharynx can spread to these because they are close by. 

Some people with mouth or oropharyngeal cancer often have an operation to remove lymph nodes from the same side of the neck as the cancer. Rarely the surgeon might remove them on both sides. These operations are called neck dissections. 

Cancer that starts in the lymph nodes is called lymphoma. This is very different to a mouth or oropharyngeal cancer that has spread to the lymph nodes.  

What throat cancer means

The term throat cancer can be confusing because people use it to mean different types of cancer. People use the term to include the:

• 3 parts of the pharynx (oropharynx, nasopharynx, laryngopharynx)
• thyroid
• voice box (larynx)
• food pipe (oesophagus)

To avoid confusion, it is important to know the exact type of cancer you have. Cancers are treated according to where they start in the body. Ask your doctor if you do not know the name of the type of throat cancer you have. 

Who gets it

Mouth and oropharyngeal cancer is more common in men than women. 1 in 75 men and 1 in 150 women will be diagnosed with mouth cancer at some point in their life. 

Most mouth and oropharyngeal cancers are diagnosed in people over 60. 

How common it is

Each year around 7,800 new cases of mouth and oropharyngeal cancer are diagnosed in the UK.

Head and Neck Cancers | CDC

Head and Neck Cancer Regions

Illustrates location of hypopharynx, nasopharynx, hard palate, anterior tongue, lips, floor of mouth, gum, salivary glands, and HPV-associated oropharyngeal sites such as soft palate, uvula, palatine tonsils, oropharynx, base of tongue, posterior pharyngeal wall, and lingual tonsils.

1. Salivary glands are located throughout the oral cavity. These are identified for illustrative purposes only.
2. Not all sites, such as cheek, are included in this figure.

Close

Head and Neck Cancer Regions

Illustrates location of hypopharynx, nasopharynx, hard palate, anterior tongue, lips, floor of mouth, gum, salivary glands, and HPV-associated oropharyngeal sites such as soft palate, uvula, palatine tonsils, oropharynx, base of tongue, posterior pharyngeal wall, and lingual tonsils.

1. Salivary glands are located throughout the oral cavity. These are identified for illustrative purposes only.
2. Not all sites, such as cheek, are included in this figure.

Cancer is a disease in which cells of the body grow out of control. Cancers of the head and neck include cancers that start in several places in the head and throat, not including brain cancers or cancers of the eye.

These cancers can start—

• In the sinuses (the spaces around the nose on the inside of the skull).
• Inside and behind the nose.
• In the mouth, including the tongue, the gums, and the roof of the mouth.
• In the back of the mouth and the throat (pharynx), which includes three sections called the nasopharynx, oropharynx, and hypopharynx.
• In the larynx (voice box).
• On the lips, although cancer on the lips is a type of skin cancer.
• In the glands that make saliva for the mouth, but those are relatively rare.

To lower your risk for head and neck cancers, don’t use tobacco products, limit the amount of alcohol you drink, and avoid indoor tanning.

What Are the Symptoms of Head and Neck Cancers?

In the mouth, cancer can cause—

• A white or red sore that does not heal on the gums, tongue, or lining of the mouth.
• Swelling in the jaw.
• Unusual bleeding or pain in the mouth.
• A lump or thickening.
• Problems with dentures.

At the back of the mouth (pharynx), cancer can cause—

• Trouble breathing or speaking.
• A lump or thickening.
• Trouble chewing or swallowing food.
• A feeling that something is caught in the throat.
• Pain in the throat that won’t go away.
• Pain or ringing in the ears or trouble hearing.

In the voice box (larynx), cancer can cause—

• Pain when swallowing.
• Ear pain.

In the sinuses and nasal cavity, cancer can cause—

• Blocked sinuses that don’t clear.
• Sinus infections that do not respond to treatment with antibiotics.
• Bleeding through the nose.
• Headaches.
• Pain and swelling around the eyes.
• Pain in the upper teeth.
• Problems with dentures.

What Causes Head and Neck Cancers?

Alcohol and tobacco are major risk factors for cancers of the head and neck. All tobacco products, including cigarettes, cigars, pipes, and smokeless tobacco (chewing tobacco, snuff, or a type of chewing tobacco called betel quid) are linked to head and neck cancer (except for salivary gland cancers). Drinking any type of alcohol, such as beer, wine, or liquor, also raises the risk of getting cancers of the mouth, throat, and voice box.

About 70% of cancers in the oropharynx (which includes the tonsils, soft palate, and base of the tongue) are linked to human papillomavirus (HPV), a common sexually transmitted virus.

Ultraviolet (UV) light exposure, such as exposure to the sun or artificial UV rays like tanning beds, is a major cause of cancer on the lips.

Occupational exposures, or being exposed to certain substances while on the job, can increase the risk of getting cancers in the nasopharynx. Working in the construction, textile, ceramic, logging, and food processing industries can cause people to be exposed to substances like wood dust, formaldehyde, asbestos, nickel, and other chemicals.

An infection with the Epstein-Barr virus, a cause of infectious mononucleosis and other illnesses, can raise the risk of cancers in the nose, behind the nose, and cancers of the salivary glands.

Radiation treatments to the head and neck can cause head and neck cancers.

About twice as many men as women get head and neck cancers. They are more likely to be diagnosed in people who are over 50 years of age.

Lewis’ Story: Throat Cancer Changed His World

After Lewis was diagnosed with throat cancer, he and his wife Amy started a support group for people with head and neck cancers. Read his story.

How Can I Reduce My Risk for Head and Neck Cancers?

You can lower your risk of getting head and neck cancer in several ways—

• Don’t smoke. If you smoke, quit. Quitting smokingexternal icon lowers the risk for cancer.
• Don’t use smokeless tobacco products.
• Limit the amount of alcohol you drink.
• Talk to your doctor about HPV vaccination. The HPV vaccine can prevent new infections with the types of HPV that most often cause oropharyngeal and other cancers. Vaccination is recommended only for people at certain ages.
• Use condoms and dental dams consistently and correctly during oral sex, which may help lower the chances of giving or getting HPV.
• Use lip balm that contains sunscreen, wear a wide-brimmed hat when outdoors, and avoid indoor tanning.
• Visit the dentist regularly. Checkups often can find head and neck cancers early, when they are easier to treat.

Statistics

The following statistics apply to cancers of the oral cavity and pharynx, which includes cancers of the lip, tongue, mouth, pharynx, and tonsils.

The Data Visualizations tool makes it easy for anyone to explore and use the latest official federal government cancer data from United States Cancer Statistics. It includes the latest cancer data covering the U.S. population.

Thyroid gland | You and Your Hormones from the Society for Endocrinology

Where is my thyroid gland?

The thyroid gland is located at the front of the neck just below the Adam’s apple (larynx). It is butterfly-shaped and consists of two lobes located either side of the windpipe (trachea). A normal thyroid gland is not usually outwardly visible or able to be felt if finger pressure is applied to the neck.

Diagram showing the location of the thyroid gland in the neck. It has two lobes and sits in front of the windpipe (trachea). The voice box (larynx) sits just above the thyroid.

What does the thyroid gland do?

The thyroid gland produces hormones that regulate the body’s metabolic rate controlling heart, muscle and digestive function, brain development and bone maintenance.  Its correct functioning depends on a good supply of iodine from the diet. Cells producing thyroid hormones are very specialised in extracting and absorbing iodine from the blood and incorporate it into the thyroid hormones.

Who tells the thyroid to produce and release hormones? 

The signal comes from a small gland located at the bottom of our brain called the pituitary gland. The pituitary gland produces and sends out a hormone called thyroid-stimulating hormone (TSH). TSH then tells the thyroid gland how much hormones to produce and secrete. TSH levels in your blood are rising and falling depending on your body’s needs to produce more or less thyroid hormones.

There is a third actor involved in this communication. The pituitary gland responds either directly to the thyroid hormones in the blood, but it also responds to signals from the hypothalamus, which sits above the pituitary gland as part of your brain. The hypothalamus releases its own hormone thyrotropin-releasing hormone (TRH). TRH in turn stimulates the release of TSH in the pituitary, which then signals to the thyroid gland.

This whole network is also referred to as the hypothalamic-pituitary-thyroid axis (HPT) and it adapts to metabolic changes and your body’s needs.

Which hormones does my thyroid gland produce?

The thyroid gland produces thyroxine (referred to as T4), which is a relatively inactive prohormone. The highly active hormone is triiodothyronine (referred to as T3). Collectively, thyroxine and triiodothyronine are referred to as the thyroid hormones. The thyroid gland produces just 20% of the high active T3, but it produces 80% of the prohormone T4. Once secreted by the thyroid, specific enzymes in other tissues like the liver or kidneys may transform T4 in to the active hormone T3.

In addition, there are other hormone-producing cells within the thyroid gland called C-cells. These cells produce calcitonin. Calcitonin plays a role in regulating calcium and phosphate levels in the blood, which is important for your bone health and maintenance.

What could go wrong with the thyroid gland?

Normally the thyroid gland produces the exact number of hormones needed to keep your body’s metabolism running and in balance. As described earlier, hormones secreted by the pituitary gland (TSH) stay constant in your blood circulation, but their levels may increase or decrease when T4 levels in the blood are changing. This hypothalamic-pituitary-thyroid feedback loop keeps the levels of T4 in your blood stable and reacts to small changes immediately.

However, there are several disorders associated with the thyroid gland with most problems concerning the production of thyroid hormones. Either the thyroid gland produces too much hormone (called hyperthyroidism) or your thyroid doesn’t produce enough hormone (called hypothyroidism), resulting in your body using energy faster or slower than it should.

What are typical symptoms of hyper- and hypothyroidism?

Typical symptoms for hyperthyroidism is weight loss, fast heart rate, high irritability/nervousness, muscle weakness and tremors, infrequent menstrual periods, sleep problems, eye irritations and heat sensitivity.

Symptoms for hypothyroidism is the contrary of hyperthyroidism such as weight gain, slower heart rate, fatigue, more frequent and stronger menstrual periods, forgetfulness, dry skin and hair, hoarse voice and intolerance to cold. In addition, hypothyroidism is often accompanied by an enlargement of the thyroid gland known as goitre.

Who is affected by thyroid disease?

On a worldwide scale, approximately 200 million people have some form of thyroid disease. People of all ages and races can get thyroid disease. However, women are 5 to 8 times more likely than men to get problems with their thyroid function.

What causes thyroid disease?

There are various different factors causing hyper- and hypothyroidism.

The following conditions cause hypothyroidism:

Thyroiditis is an inflammation of the thyroid gland. This can lower the number of hormones produced.

A special form of thyroiditis is Hashimoto’s thyroiditis. This is a genetic disorder caused by diseases of the immune system and can be passed from one generation to the other. In addition, thyroiditis can occur in women after giving birth also referred to as postpartum thyroiditis. It is usually a temporary condition and occurs only in 5-9% of woman giving birth.

Nutrition also impacts your thyroid functions. Iodine deficiency can cause hypothyroidism. This is a worldwide problem affecting approximately 100 million people. As mentioned earlier, iodine is used by the thyroid gland to produce hormones.

The following conditions cause hyperthyroidism:

Graves’ disease is a condition where the entire thyroid gland might be overactive and produce too much hormone. Your thyroid gland might be enlarged. This problem is also called diffuse toxic goitre.

Thyroiditis (inflammation) can also cause the opposite and trigger the release of hormones that were stored in the thyroid gland. This uncontrolled release of thyroid hormones causes hyperthyroidism for a few weeks or months. It may occur in women after childbirth.

In contrast to iodine deficiency, excessive iodine intake may have negative effects on your thyroid. Excessive iodine is found in a number of drugs such as Amiodarone, Lugol’s solution (iodine) and some cough syrups. This might cause the thyroid to produce either too much or too little hormone in some individuals.

The before mentioned problems affect the production of thyroid hormone (either too much or too little). However, problems concerning the thyroid gland can be very distinct. Swelling and lumps can occur within the thyroid gland. Such nodules can be harmless, but some can cause the production of hormones or even be cancerous. In some cases, such as cancer, the thyroid is removed. You can live without your thyroid, but you need to take medicine daily to substitute the hormones produced by your thyroid gland.

How can I promote the health of the thyroid gland?

Iodine is most essential to maintain a healthy thyroid. Iodine is the critical ‘ingredient’ for the production of thyroid hormones. We don’t need a lot of iodine, it is said that “one teaspoon of iodine is enough for a lifetime”. Nonetheless, the daily and constant supply of this micronutrient is important. Too much iodine at once is counter-productive and causes your thyroid to produce less hormones. The best way to get your daily dose of iodine is through eating healthy foods like seafood and dairy products. In addition, iodized salt is a good source and you can use it to season your food. Nowadays, iodine is added to salt to combat goitres (caused by hypothyroidism).

Last reviewed: Mar 2018

90,000 Salivary gland stones → causes, symptoms, diagnosis and treatment

Stones of the salivary glands are calculi that form in the ducts or parenchyma of the salivary glands and close them. Most often, this pathology is diagnosed in people with diabetes.

The doctors of the Dentistry 32 clinic successfully diagnose and treat stones of the salivary glands. We work only with high-quality certified materials, and for diagnostics we use the latest equipment from world manufacturers.Sign up for a consultation today and get the opportunity to get rid of the disease as soon as possible.

Causes of salivary gland stones

The reasons that provoke the appearance of stones of the salivary glands include:

• non-compliance with the rules of oral hygiene;
• violation of mineral metabolism;
• Vitamin A hypovitaminosis;
• Narrowing of the ducts of the salivary glands as a result of traumatic injury or in the case of a genetically determined predisposition;

90 013 90 014 smoking;

• diseases of the gastrointestinal tract and (or) the endocrine system.

Symptoms of stones of the salivary glands

Symptomatically, the presence of stones of the salivary glands manifests itself:

• swelling;
• puffiness;
• soreness and discomfort when eating;
• by the presence of seals in the salivary gland;
• development of the inflammatory process;
• salty saliva taste;
• sensation of a foreign body in the oral cavity.

Diagnostics and treatment of stones of the salivary glands in the clinic Dentistry 32

The diagnosis is established only at a dentist’s appointment and is based on data from a visual examination of the oral cavity, an assessment of patient complaints and additional instrumental diagnostic methods (contrast sialography, CT, MRI, ultrasound).

Treatment of stones of the salivary glands will be strictly individual for each patient and will depend not only on the location and severity of the disease, but also on the characteristics of the organism of each patient.It is important to remember that only a dentist can prescribe an effective treatment regimen. Therefore, if one or more symptoms of the disease are detected, you should not self-medicate, but you should consult a doctor.

Prevention of stones of the salivary glands

Preventive measures include:

Reviews of our patients:

Alexey

In the clinic Dentistry 32, a stone of the salivary gland was removed. I never thought that such a thing happens! I liked the clinic, the doctors treat patients very well.After the procedure, I felt better.

Oksana

The clinic is wonderful! The quality of service, attention to patients, professionalism of doctors – everything is up to par! I went to the clinic more than once and always received the necessary help. Thank you so much for your work and the help you provide to patients.

90,000 Specialists – Medical center ARS

Anesthetist

Anesthesiologist

Anesthesiologist provides anesthesia (anesthesia) – relieving pain in a patient during surgery and diagnostic, gynecological, therapeutic and other medical procedures.The doctor, using medication, reduces the painfulness of manipulations, reduces the patient’s stress, thus making it easier for specialists of a different profile to perform the necessary procedures.

The anesthesiologist ensures the maintenance of the patient’s vital processes during the operation. The doctor controls the normal functioning of the patient’s body, relieves pain, takes care of the thermoregulation of the body, controls vital functions – cardiac activity, blood pressure, respiration, brain and kidney function, and also helps to reduce pain after surgery.

When is an anesthesiologist’s consultation required?

• before surgery;
• before diagnostic examinations, which are performed under local or general anesthesia.

How to prepare before visiting an anesthesiologist?

When heading for a visit to the anesthesiologist, you should take the results of recent laboratory tests and the conclusions of the examinations carried out. It is imperative to prepare information about the medications used.This will give the doctor as much information as possible to select the appropriate method of anesthesia and medication.

How is the visit going?

The doctor gets acquainted with the patient’s state of health, the results of examinations and analyzes, with the medical history, with the type of the planned operation or manipulation, and assesses whether anesthesia is possible for a particular patient and in what acceptable form. The doctor may ask to fill out a questionnaire and / or ask additional questions to assess the individual characteristics of the patient.The anesthesiologist assesses the possible risks of anesthesia, selects the appropriate and possible type of anesthesia for each patient, and develops an individual anesthesia plan. The anesthesiologist discusses all the questions that arise with the patient and the doctor performing the operation or examination.

For the operation or examination to be successful:

• the anesthesiologist will help you choose the most appropriate type of anesthesia;
• the anesthesiologist will properly prepare the patient before the operation and familiarize with the postoperative regimen;
• the anesthesiologist will provide general information on the types of anesthesia and individually advise on the chosen anesthesia to reduce psychological discomfort before surgery / examination;
• the anesthesiologist will take care of the patient before and after the operation / examination.

In the Day hospital Medicīnas center ARS for surgical operations, general anesthesia or spinal anesthesia are used for anesthesia.

For information:

General anesthesia is a set of measures when, with the introduction of a drug into the body (intravenously or through the respiratory tract), loss of consciousness and pain sensations and muscle relaxation are achieved, which creates the necessary conditions for the operation.Before anesthesia, cannulas are inserted into the vein to ensure that drugs can be administered at all times during surgery. After the introduction of anesthetic drugs, consciousness turns off and a state similar to sleep occurs for the entire duration of the operation. Through a mask or a special tube inserted into the respiratory tract, oxygen is additionally supplied and, if necessary, artificial respiration is provided. A tube inserted into the airway (trachea) protects the airway most completely from the flow (inhalation) of saliva or stomach contents. At the end of the operation, the administration of the anesthetic substance stops and their effect on the body decreases, consciousness is gradually restored, respiration and other functional indicators of the body are stabilized. At the end of the operation, the patient is woken up and he is under the supervision and care of medical personnel until the moment when he is discharged home.

With spinal (regional) anesthesia pain is eliminated in the part of the body where the operation is performed – in one or both legs, or in the buttocks.Medications (local anesthetic drugs) are injected around the nerves that carry sensations from this area, which block the transmission of the impulse in the nerve, thus achieving a lack of sensitivity in the area of ​​operation. During spinal anesthesia, the patient can remain awake. During the operation, only sedatives are administered, which reduce possible psychological discomfort. The anesthesiologist will individually select and recommend the appropriate type of anesthesia for each patient, depending on the part of the body where the operation will be performed.

For example:

• For urological and proctological surgeries, the most suitable type is spinal anesthesia, which is called sciatic block. The sciatic block causes loss of sensation in the buttocks, preserving the motor function of the legs.
• In traumatological operations (arthroscopy), the most acceptable is spinal anesthesia, when the lack of sensitivity manifests itself in only one leg, while the other leg remains mobile.The patient has no psychological discomfort because he does not feel paralyzed.

For information:

The lack of sensitivity in the corresponding part of the body disappears after a couple of hours and the patient can go home. Spinal anesthesia has less effect on the airway and blood flow than general anesthesia and is therefore more acceptable in outpatient surgery.

In the Day hospital Medical center ARS anesthesia services are provided by anesthesiologist-resuscitator Dr.Aelita MEDYANE

For lithotripsy procedures, anesthesia services are provided by anesthesiologist-resuscitator Dr. Irena Leite.

More details
90,000 stumbling block – in the salivary gland

By Roman Kartashov, Oral and Maxillofacial Surgeon

Few people know that stones are found not only in the kidneys and gallbladder, but also in the salivary glands. Meanwhile, this is one of the most frequent cases in the practice of a maxillofacial surgeon. A few years ago, the main method of treatment for salivary stone disease was the removal of the gland – a risky operation that could lead to paresis of the facial nerve and other unpleasant consequences.Fortunately, today there is a much less traumatic method of treatment – sialoscopy.

Often, patients learn about a stone in the salivary gland only in the doctor’s office, where they complain of severe pain when swallowing, radiating to the ear or temple, with swelling on the face and neck. In rare cases, calculi are found by chance during an X-ray examination.

A stone in the salivary gland duct interferes with the normal flow of saliva and can completely close the duct.In the “blocked” salivary gland microorganisms accumulate and inflammation develops, accompanied by sharp pain and sometimes manifestations of general intoxication – low-grade fever, malaise, headache. This condition is called “salivary colic”.

Sialolithiasis causes

The exact causes of sialolithiasis – the formation of deposits in the salivary glands – have not yet been established. Presumably risk factors are calcium metabolism disorders, vitamin A deficiency.Salivary stone disease often affects men. Basically, sialolithiasis occurs in people 25 – 40 years old, much less often in children. The submandibular gland is most often affected, less often the parotid, very rarely the sublingual. The sizes of stones vary from a few millimeters to several centimeters.

Diagnosis of sialolithiasis

For diagnostics, ultrasound, X-ray, CT or MRI are used. First of all, conservative therapy is prescribed in the form of treatment with antibiotics, drugs that stimulate the production of saliva and anti-inflammatory drugs.But in 40% of cases, therapy is ineffective. Re-inflammation often occurs and the process can become chronic. In such cases, surgery is the only treatment that addresses the underlying cause of the inflammation.

Sialolithiasis treatment

Until recently, to get rid of stones in the salivary gland, it had to be removed. The main risk when performing surgery on the salivary glands is associated with the fact that the facial, lingual and hypoglossal nerves pass in close proximity to them.

Trauma to the branches of the facial nerve is fraught with a gross violation of facial expressions, damage to the lingual and hypoglossal nerves can lead to loss of sensitivity and speech disorders. In addition, there is a risk of damage to the large vessels of the face and neck.

Other possible complications include Frey’s syndrome – burning pain and inflammation in the temporal and parotid region, salivary fistulas, dry mouth, numbness along the path of the large ear nerve, infections.Even if risks are minimized in the hands of an experienced surgeon, unpleasant consequences remain in the form of a scar on the neck and general complications after surgery.

In addition, radical removal of the salivary gland may subsequently be accompanied by xerostomia – insufficient salivation, impaired oral microflora, accelerated tooth decay.

The salivary glands are an important organ of the human digestive system. Saliva performs numerous functions – neutralizes bacteria in the oral cavity, maintains an optimal environment, cleans mucous membranes and teeth from plaque, softens food, preparing it for digestion in the stomach.

Sialoendoscopy is a modern effective method of treatment

Sialendoscopy is a method that allows you to penetrate the ducts of the salivary glands through the thinnest endoscopes, the diameter of which is 0.9-1.3 mm, without dissecting tissues, and visualize the salivary system at high magnification. The endoscope is inserted into the opening of the gland duct in the mouth, and then, using special microinstruments, the surgeon can inspect the ducts, remove the stone of the salivary gland, inject medicinal substances into the gland and perform other manipulations.The treatment is carried out on an outpatient basis under local anesthesia and does not cause discomfort to the patient.

Despite the information content and high efficiency of the technique, due to the high cost of the equipment, sialoscopy is still not very common in Russia. In Moscow, this procedure is carried out only in three or four large clinics. EMC maxillofacial surgeons have been successfully using sialoscopy in practice for several years.

“Previously, the presence of a stone in the intraglandular part of the duct was an indication for removal of the gland in the overwhelming majority of cases.Now we have the opportunity to preserve the organ and, most importantly, to selectively eliminate the cause of the disease, ”says maxillofacial surgeon Roman Kartashov. – Sialoscopy is performed not only for salivary stone disease, but for any pathological processes in the salivary glands. Unfortunately, not all patients are aware of modern treatment options and continue to remove inflammation with drugs, fearing surgery. Sialoscopy is an opportunity to quickly diagnose, treat in one step and forget about the problem forever. “

90,000 HORNER SCHEME is … What is a HORNER SCHEME?

HORNER DIAGRAM

– a trick for finding an incomplete quotient

and the remainder when dividing a polynomial by a binomial, where all the coefficients lie in a certain field, for example, in the field of complex numbers. Any polynomial can be represented in a unique way in the form where is the incomplete quotient, and r is the remainder, equal by to Vez’s theorem f (a) . The coefficients g (x). And r are calculated using the recurrent formulas

When calculating, use the table

the upper row is given a swarm, and the lower one is filled in by the formulas (*). This method essentially coincides with the Tien Yuan method used in medieval China. At the beginning of the 19th century. it was rediscovered almost simultaneously by W. Horner [1] and P. Ruffini [2].

Ref. : [1] Horner W. G., “Philos. Trans. Roy. Soc. London A”, (819, y. 1, p. 308-35; [2] Ruffini P., “Mem. Coronata della Societa Italiana delle Scienze”, 1802, v. 9 , p. 444 – 526. V.N. Remeslennikov.

Encyclopedia of Mathematics. – M .: Soviet encyclopedia.
I. M. Vinogradov.
1977-1985.

• THROAT ELLIPSE
• GRAVITATION

See what “GORNERA SCHEMA” is in other dictionaries:

• Horner’s scheme – (or Horner’s rule, Horner’s method) an algorithm for calculating the value of a polynomial written as a sum of monomials (monomials) for a given value of a variable.Horner’s method allows finding the roots of the polynomial [1], as well as calculating the derivatives … … Wikipedia

• Horner’s method – Horner’s scheme (or Horner’s rule, Horner’s method) an algorithm for calculating the value of a polynomial written as a sum of monomials for a given value of a variable. Horner’s method allows you to find the roots of a polynomial, as well as calculate the derivatives … … Wikipedia

• Horner, William George – William George Horner (1786, Bristol 22 September 1837) British mathematician.Born in 1786 in Bristol, England. He was educated at the Kingwood School of Bristol. At the age of 14, he became assistant director at … … Wikipedia

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• RADICULITES – (from lat.radix root), diseases of the roots of the spinal nerves, a term that was established at the beginning of the 20th century. thanks to the works of Dejerine and his school. R. is based on the inflammatory degenerative process in the roots [see. a separate table (Art. 255 … … Great Medical Encyclopedia

• Root of polynomial – This term has other meanings, see Root (meanings). The root of a polynomial (not identically equal to zero) over a field k is an element such that the following two equivalent conditions are satisfied: this polynomial is divisible by a polynomial; … … Wikipedia

• THYROID – (gl.thyreoidea, syn. corpus thyreoideum), one of the most important endocrine glands of vertebrates. In embryonic development, Shch. arises from the epithelium of the lower wall of the gill part of the intestine; in the larvae of cyclostome fish, it also looks like … … Great Medical Encyclopedia

• Radiculitis – I Radiculitis (lat.radicula root + itis) is an inflammatory and compressive lesion of the roots of the spinal nerves. Combined lesion of the anterior and posterior roots at the level of their connection to the common cord (Fig.