Classifications in ent


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Classifications in ent

  1. 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. 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• Used key term “classification” on Scott-Browns to search classifications mentioned• Most useful ones included
  3. 3. Classifications - Uses• Stage a disease• Make management decisions• Predict outcome - Prognosticate• Monitor progress (treatment and natural)• Compare data
  4. 4. Classification of Classifications• Head and Neck Cancer TNM• Otology• Rhinology• Head and Neck Benign conditions (e.g Vascular lesions)• Paediatrics
  5. 5. Head and Neck Cancer
  6. 6. Squamous Cell Carcinoma
  7. 7. Regional NodesLip, 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)
  8. 8. Metastasis
  9. 9. Stage Grouping
  10. 10. Histopathological Grading
  11. 11. Definition of T stages• Definitions varies with the site• Refer Latest TNM•
  12. 12. Lymph Node Levels
  13. 13. Neck Dissections
  14. 14. Melanoma ClassificationsBreslow 1 0.75mm 2 0.75 - 1.5mm 3 1.5mm - 4mm 4 >4mmClarks 1 Confined to epidermis 2 Extends to papillary dermis but not to reticulo-papillary junction 3 Extends to reticulo-papillary junction 4 Extends to reticular dermis 5 Extends to subcutaneous tissues
  15. 15. Otology
  16. 16. Chronic Otitis Media Classification
  17. 17. Tos Classification- Pars Flaccida RetractionsGrade 1 - Small attic dimpleGrade 2 - Pars flaccida retracted maximally and draped over neck of malleusGrade 3 - As grade 2 with erosion of outer attic wall (scutum)Grade 4 - Deep retraction with unreachable accumulated keratin
  18. 18. Sadé Classification of Pars Tensa RetractionGrade 1 - Slight retraction of TM over the annulusGrade 2 - Severe retraction - TM touches long process of the incusGrade 3 - Atelectasis - TM touches the promontoryGrade 4 - Adhesive otitis - TM adherent to the promontory
  19. 19. Tympanograms
  20. 20. TympanicumType A: Tumours localised to middle ear cleftType B : Tympano-mastoid tumours no destruction of bone in the infra- labyrinthine compartment of the temporal boneType C : Tumours invading the bone of bone in the infra-labyrinthine compartment of the temporal boneType D : Tumours with intracranial extension
  21. 21. Glassock-JacksonGlomus Jugulare TumoursClass I small tumour involving jugular bulb, middle ear and mastoid processClass II tumour extending under internal auditory canal; may extendintracraniallyClass III tumour extending into petrous apex; may extend intracraniallyClass IV tumour extending beyond petrous apex into clivus or infratemporalfossa;may extend intracraniallyGlomus Tympanicum TumoursClass I small mass confined to promontoryClass II tumour completely filling middle ear spaceClass III tumour filling middle ear and extending into mastoid processClass IV tumour filling middle ear, extending into mastoid process or through tympanicmembrane to fill external auditory canal; may also extend anteriorly to internal carotid artery
  22. 22. Tympanoplasty TypesType 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 ossiclelever 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 windowacoustically separated from oval using TM sup margin on promontoryType V fixed stapes footplate, lateral SCC fenestration performed
  23. 23. Presbyacusis classification SpeechType Pathology PTA Findings Discrimination Degeneration of the Organ of Corti, Precipitous Good as SpeechSensory Particularly at the drop at High frequencies are Basal Turn of Frequencies spared cochlea. Degeneration of neurones, outer hair PrecipitousNeural cells and inner hair drop at High Very Poor cells and central Frequencies connections Metabolic insult leading toStrial FLAT Good degeneration of stria vascularis GraduallyCochlear Stiffening of the sloping hearing Goodconductive basillar membrane loss
  24. 24. House-Brackmann facial nerve palsy grading system Description CharacteristicsI Normal Normal facial function in all areasII 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 dysfunctionObvious but not disfiguring difference between two sides; noticeable but not severe synkinesis, contracture, or hemifacial spasmNormal symmetry and tone at restForehead: slight to moderate movementEye: complete closure with effortMouth: slightly weak with maximum effort
  25. 25. House Brackman Types• IV Moderately severe dysfunction Obvious weakness or disfiguring asymmetryNormal symmetry and tone at restForehead: noneEye: incomplete closureMouth: asymmetric with maximum effort V Severe dysfunctionOnly barely perceptible motionAsymmetry at restForehead: noneEye: incomplete closureMouth: slight movementVI Total paralysis No movement
  26. 26. Rhinology
  27. 27. Nasal PolypsGrade I - Polyp concealed in middle meatus, not reaching the inferior edge of themiddle turbinateGrade 2 - Polyp in the middle meatus, reaching the inferior border of the middleturbinateGrade 3 - Nasal polyp extending into the nasal cavity below the edge of the middleturbinate but not below the inferior edge of the inferior turbinateGrade 4 - Polyp filling the nasal cavity
  28. 28. Infective Rhinosinusitis • Acute (less than 12 weeks) • Chronic (more than 12 weeks) • With polyps • Without PolypsEuropean Position Paper 2012
  29. 29. Allergic Rhinitis Classification
  30. 30. AngiofibromaJuv. Nasopharyngeal Angiofibromas Staging (University of California Los Angeles) T1:Tumour involvement in the nasal cavity or paranasal sinuses (except sphenoid), sparing themost superior ethmoidal cells T2: Tumour involvement in the nasal cavity or paranasalsinuses (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: Tumourinvolvement in the brain
  31. 31. Fungal Sinusitis• Invasive - Acute invasive - Chronic granulomatous - Chronic non-granulomatous• Non Invasive - Fungal Ball - Allergic Fungal Sunusitis
  32. 32. Head and Neck Benign
  33. 33. Tonsil size grading system Grade % Obstruction Anatomical 0 0 Tonsil hidden behindanterior pillar 1 <25% Tonsil visible over anteriorpillar only 2 25-50% Tonsil over posteriorpillar 3 50-75% Almost to midline 4 >75% Touching contralateral tonsil
  34. 34. PhonosurgeryType 1 MedializingType 2 Lateralizing ShorteningType 3 Reducing tension LengtheningType 4 Increasing tension
  35. 35. Pharyngeal Pouch
  36. 36. Myer-Cotton staging system for subglottic stenosisGrade I less than 50% obstructionGrade II 51% to 70% obstructionGrade III 71% to 99% obstructionGrade IV no detectable lumen or complete stenosis
  37. 37. laryngotracheal stenosissubsiteStage I Lesion confined to the subglottis or trachea and less than 1cm longStage II Lesion isolated to the subglottis and greater then 1 cm longStage III Subglottic/tracheal lesion not involving the glottisStage IV Lesion involving the glottis.
  38. 38. FNAC thyroid classification
  39. 39. Haemangioma•Endothelial Tumout•Solid•Not present at birth•Rapid growth to 18/12•Invoution to 3-5 yrs•Responds to steroids
  40. 40. Naso-Ethmoid-Orbital Fractures
  41. 41. Temporal Bone Fracture classification
  42. 42. Cordectomy TypesType I: Subepithelial cordectomy, which is the resection of vocal cord epithelium passingthrough the superficial layer of lamina propria .Type II: Subligamental cordectomy, which is resection of epithelium, or Reinke’s space andvocal ligament.Type III: Transmuscular cordectomy, which proceeds through vocalis muscle.Type IV: Total cordectomy, which extends from vocal process to the anteriorcommissure.•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.
  43. 43. Grading System - Croup
  44. 44. Paediatric ENT
  45. 45. Orbital Cellulitis
  46. 46. Speech and LanguageDisorders in Children
  47. 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. 48. TOFOesophageal 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%
  49. 49. Hemifacial Microsomia
  50. 50. Estimated Fluid and Blood Losses
  51. 51. Thank You contact if