TMJ- red flags
Weight loss,
Jaw locking
Limited opening jaw
Systemic illness
Fever
Dental problems
Trauma
Hx malignancy
Neck lump or cervical Lyphadenopathy
Pain worse on cough/sneeze (?raise ICP)
?osteonecrosis if bisphosphonates
Concurrent infection
Evidence of cranial nerve involvement
Facial mass swelling, severe trismus
Jaw clauducation/ headache/ general malaise: GCA (>50)
Hoarseness, dysphagia, mouth ulcer >3weeks
Recurrent epitaxis, purulent nasal discharge, loss of smell, hearing loss
TMJ history
Duration
Effect on QoL
Aggregating factors- stress, chewing, grinding teeth, wide yawning
Concerns
Dental hx
Smoker/alcohol
Explain TMJ disorder
Your temperament joint is the joint between your jawbone and your skull. You use it all the time when you’re chewing talking opening closing your mouth. If this joint becomes irritated or strained, it can cause pain or clicking or difficulty moving in the jaw. We call this temperament joint dysfunction. it is a condition that can often be treated with simple treatments and self-care and will often improve with this management. 
Group of conditions related to joint between Jaw and skull
- symptoms headache, limited jaw movement, sounds,
- most common cause of chronic orofacial pain
-Acute or Chronic
Diagnosis:
-pain in or around the TMJ or muscles of mastication which may radiate two head neck
-Pain is provoked by palpation of TMJ massector or temporarlis muscle
-Pain exacerbated by jaw movements or function.
-Reproduce TMJ joint noise
-ear pain with normal exam
- headache limited to temporal region exacerbated by jaw function
TMJ indication to refer
Trauma
Marked limitation of jaw opening
Known rheumatic disease
Persistent despite 6-8 week tx
Worsening
Unable to manage normal diet
??? Diagnosis
TMJ tx
Education
—- non progressive should improve
—-soft diet, rest jaw, ice/warm flannels, massage muscles, avoid trigger
—— re-enforce positive lifestyle
— paracetamol or non-steroid anti-inflammatories
—dentist to review teeth
— if persistent and already struggling consideration of amitriptyline, gabapentin or short course of diazepam
— consider a referral to dental professional physiotherapy acupuncture if appropriate 
Laryngeal cancer- red flags
Persistent sore throat
Hoarseness
sob
Weight loss
Dysphasia
Painful swallowing
Ear pain
Neck lump
Smoking
Alcohol
Sore throat and smoker
Exclude cancer
- examine weight loss, lymph node, neck lump, tonsils asymmetry
- ?baseline bloods
-hx hoarseness/SOB— CXR
Refer ENT 2ww
Head and neck cancer 2 Ww
Lump in the neck unexplained and persisting more than three weeks
Unexplained ulceration in oral cavity more than three weeks
Persistent unexplained horseless in individual individuals over 45 years old
Red or white patches in oral cavity, especially if painful, swollen or bleeding
Thyroid mass with associated features of rapid enlargement Horseness or cervical lymphadenopathy
Consider 2 referral for patients with persistent unexplained dysphasia age 45 or older.
Clinical concern
cholesteatoma
Squamous cells where they should not be
- persistent discharge
-pearly white debris/ retraction pocket
History;
Pmh ear infections/ ET dysfunction
Hearing loss- conductive
Discharge- not responding to tx
Complications
Facial nerve palsy
Brain abscess/ meningitis
labyrinthitis
Dx
-CT head
Tx
-surgery
Explain cholesteatoma
Squamous cell- just like skin cells growing on the ear drum. It is not cancer but can grow and cause complications by invading into nearby structures.
