Chapter 3: Head and Neck

Overview

The skull is a closed cavity with numerous apertures for neurovascular transmission. Like the other body cavities, there is constant equalization of pressure between the CSF and venous systems via the arachnoid villi and the apertures. When this becomes lop-sided, it is the soft neural structures and their vascular supplies that are compromised.

The neck is a transmission zone between multiple regions. It contains a high concentration of vital structures in a small area (similar to the internal capsule of the brain), so small pathology can cause big pathology.

The head and neck are now called modules. The regions that make up the head can be grouped into cranial, facial and airway. The regions that make up the neck can be grouped into superficial and deep. The head and neck contain vital fragile structures, and great awareness is required in dealing with patients having potentially life-threatening injuries - in fact, the most important diagnostic aid is clinical awareness.

Certain conditions require urgent referral to specialists but this does not excuse ignorance of acute management before referral.

Thyroid Gland

Goiter is enlargement of the thyroid gland due to any cause and may be toxic or non-toxic. Gross appearance may be diffuse, nodular or multinodular.

The history will generally give a guide to the presence of toxemia. The examination will usually indicate the gross nature. A provisional diagnosis thus formed requires investigation for confirmation. These may include:

• i) Thyroid function tests and antibodies

  

• ii) Thyroid scan

  

• iii) Aspiration

  

• iv) Biopsy

  

• v) Ultrasound

  

• v) CT or MRI

  

Treatment depends on the diagnosis but options are:

• i) Reassurance

• ii) Iodine

• iii) Thyroxine replacement

• iv) Antithyroid drugs

  

• v) Radioactive iodine

  

• vi) Surgery

  

Surgical complications are non-specific or thyroid specific.