1. Classifications in ENT
Dr. MTD Lakshan
MBBS, MS(Oto), DOHNS (UK), FEB ORL-HNS, FRCSEd ORL-HNS
Consultant ENT and Head and Neck Surgeon
DGH Hambantota
2. General Points
• Cannot include all the classifications in a 1 hour
presentation
• Details of T staging of tumour sub-sites from TNM
document e.g. Larynx, nasopharynx, thyroid etc
• Refer latest ENT UK guidelines on cancer management
https://entuk.org/docs/prof/publications/head_and_neck_cancer
• Used key term “classification” on Scott-Browns to
search classifications mentioned
• Most useful ones included
3. Classifications - Uses
• Stage a disease
• Make management decisions
• Predict outcome - Prognosticate
• Monitor progress (treatment and natural)
• Compare data
4. Classification of Classifications
• Head and Neck Cancer TNM
• Otology
• Rhinology
• Head and Neck Benign conditions (e.g Vascular
lesions)
• Paediatrics
7. Regional Nodes
Lip, oral cavity, oropharynx, hypopharynx, larynx, trachea,
paranasal sinuses, major salivary glands,
Nx Regional lymph nodes cannot be assessed Nasopharynx Nx nodes cannot be assessed N0 no regional lymph node metastasis
N1 Unilateral metastasis in lymph nodes < 6 cm above the supraclavicular fossa
N0 No regional lymph node metastasis N2 Bilateral metastasis in lymph nodes < 6 cm above the supraclavicular fossa
N3 a Metastasis in a lymph node(s)> 6 cm b extension to the
N1 Single ipsilateral lymph node 3-6 cm supraclavicular fossa
N2 a Single ipsilateral lymph node 3-6 cm
b Multiple ipsilateral nodes < 6 cm
c Bilateral lymph nodes < 6 cm
N3 Any node > 6 cm
Thyroid Nx Regional lymph nodes cannot be assessed N0 No regional
U upper neck – above cricoid
lymph node metastasis N1 Regional lymph node metastasis a
Metastasis in ipsilateral cervical lymph node(s) b Metastasis in bilateral, midline, or
contralateral cervical / mediastinal node(s)
L lower neck – below cricoid
Nx Regional lymph nodes cannot be assessed N0 No regional
lymph node metastasis N1 Regional lymph node metastasis a
Metastasis in ipsilateral cervical lymph node(s) b Metastasis in bilateral, midline, or
contralateral cervical / mediastinal node(s)
Nx Regional lymph nodes cannot be assessed N0 No regional
lymph node metastasis N1 Regional lymph node metastasis a
Metastasis in ipsilateral cervical lymph node(s) b Metastasis in bilateral, midline, or
contralateral cervical / mediastinal node(s)
17. Tos Classification- Pars Flaccida
Retractions
Grade 1 - Small attic dimple
Grade 2 - Pars flaccida retracted
maximally and draped over neck
of malleus
Grade 3 - As grade 2 with erosion of
outer attic wall (scutum)
Grade 4 - Deep retraction with
unreachable accumulated keratin
18. Sadé Classification of Pars
Tensa Retraction
Grade 1 - Slight retraction of TM over
the annulus
Grade 2 - Severe retraction - TM
touches long process of the incus
Grade 3 - Atelectasis - TM touches the
promontory
Grade 4 - Adhesive otitis - TM
adherent to the promontory
20. Tympanicum
Type A: Tumours localised to middle ear cleft
Type B : Tympano-mastoid tumours no destruction of bone in the infra-
labyrinthine compartment of the temporal bone
Type C : Tumours invading the bone of bone in the infra-labyrinthine
compartment of the temporal bone
Type D : Tumours with intracranial extension
21. Glassock-Jackson
Glomus Jugulare Tumours
Class I small tumour involving jugular bulb, middle ear and mastoid process
Class II tumour extending under internal auditory canal; may extend
intracranially
Class III tumour extending into petrous apex; may extend intracranially
Class IV tumour extending beyond petrous apex into clivus or infratemporal
fossa;
may extend intracranially
Glomus Tympanicum Tumours
Class I small mass confined to promontory
Class II tumour completely filling middle ear space
Class III tumour filling middle ear and extending into mastoid process
Class IV tumour filling middle ear, extending into mastoid process or through tympanic
membrane to fill external auditory canal; may also extend anteriorly to internal carotid artery
22. Tympanoplasty Types
Type I Reconstruction of TM with intact, mobile ossicular chain (Myringoplasty)
Type II Usually absent long process of incus. TM reconstruction and ossiculoplasty with reconstruction of 'ossicle
lever' mechanism (ISJ prosthesis)
Type III Malleus head and incus absent or removed.
i TM reconstructed to lie on stapes head to create columella (Myringostapediopexy)
ii Minor colulella: strut from TM/graft to stapes head (PORP)
iii Major columella: Stapes crura missing. Strut from TM/graft to footplate (TORP).
Type IV only stapes footplate remains. Footplate exteriorised in mastoid cavity, round window
acoustically separated from oval using TM sup margin on promontory
Type V fixed stapes footplate, lateral SCC fenestration performed
23. Presbyacusis classification
Speech
Type Pathology PTA Findings
Discrimination
Degeneration of the
Organ of Corti, Precipitous Good as Speech
Sensory Particularly at the drop at High frequencies are
Basal Turn of Frequencies spared
cochlea.
Degeneration of
neurones, outer hair Precipitous
Neural cells and inner hair drop at High Very Poor
cells and central Frequencies
connections
Metabolic insult
leading to
Strial FLAT Good
degeneration of
stria vascularis
Gradually
Cochlear Stiffening of the
sloping hearing Good
conductive basillar membrane
loss
24. House-Brackmann facial nerve
palsy grading system
Description Characteristics
I Normal Normal facial function in all areas
II Mild dysfunction Slight weakness noticeable on close inspection; may have very slight synkinesis
Normal symmetry and tone at rest
Forehead: moderate to good function
Eye: complete closure with minimum effort
Mouth: slight asymmetry
III Moderate dysfunction
Obvious but not disfiguring difference between two sides; noticeable but not severe synkinesis, contracture,
or hemifacial spasm
Normal symmetry and tone at rest
Forehead: slight to moderate movement
Eye: complete closure with effort
Mouth: slightly weak with maximum effort
25. House Brackman Types
• IV Moderately severe dysfunction
Obvious weakness or disfiguring asymmetry
Normal symmetry and tone at rest
Forehead: none
Eye: incomplete closure
Mouth: asymmetric with maximum effort
V Severe dysfunction
Only barely perceptible motion
Asymmetry at rest
Forehead: none
Eye: incomplete closure
Mouth: slight movement
VI Total paralysis No movement
27. Nasal Polyps
Grade I - Polyp concealed in middle meatus, not reaching the inferior edge of the
middle turbinate
Grade 2 - Polyp in the middle meatus, reaching the inferior border of the middle
turbinate
Grade 3 - Nasal polyp extending into the nasal cavity below the edge of the middle
turbinate but not below the inferior edge of the inferior turbinate
Grade 4 - Polyp filling the nasal cavity
28. Infective Rhinosinusitis
• Acute (less than 12 weeks)
• Chronic (more than 12 weeks)
• With polyps
• Without Polyps
European Position Paper 2012
30. Angiofibroma
Juv. Nasopharyngeal Angiofibromas Staging (University of California Los Angeles) T1:
Tumour involvement in the nasal cavity or paranasal sinuses (except sphenoid), sparing the
most superior ethmoidal cells T2: Tumour involvement in the nasal cavity or paranasal
sinuses (including sphenoid) with extension to or erosion of the cribiform plate T3:
Tumour extension into the orbit or extending into the anterior cranial fossa T4: Tumour
involvement in the brain
36. Myer-Cotton staging system
for subglottic stenosis
Grade I less than 50% obstruction
Grade II 51% to 70% obstruction
Grade III 71% to 99% obstruction
Grade IV no detectable lumen or complete stenosis
37. laryngotracheal stenosis
subsite
Stage I Lesion confined to the subglottis or trachea and less than 1cm long
Stage II Lesion isolated to the subglottis and greater then 1 cm long
Stage III Subglottic/tracheal lesion not involving the glottis
Stage IV Lesion involving the glottis.
42. Cordectomy Types
Type I: Subepithelial cordectomy, which is the resection of vocal cord epithelium passing
through the superficial layer of lamina propria .
Type II: Subligamental cordectomy, which is resection of epithelium, or Reinke’s space and
vocal ligament.
Type III: Transmuscular cordectomy, which proceeds through vocalis muscle.
Type IV: Total cordectomy, which extends from vocal process to the anterior
commissure.
•Type Va: Extended cordectomy encompassing the contralateral vocal fold.
•Type Vb: Extended cordectomy encompassing the arytenoids.
•Type Vc: Extended cordectomy encompassing the ventricular fold.
•Type Vd: Extended cordectomy encompassing the subglottis.
47. Benjamin Grading system for
laryngeal cleft
Lowest point in cleft
1 Supraglottic membranous interarytenoid cleft
2 Partial cricoid cleft
3 Total cricoid cleft
4 Intrathoracic (not compatible with life)
48. TOF
Oesophageal atresia with lower fistula to trachea 80%
Oesophageal atresia without fistula 10%
H type. No atresia with fistula to trachea 7%
K type atresia with upper and lower fistula 2%
Oesophageal atresia with upper fistula to trachea 1%
