19 Head and Neck Flashcards
1
Q
Anterior neck triangle
A
Sternocleidomastoid muscle
Sternal notch
Inferior border of the diagstric muscle
Contains carotid sheath
2
Q
Posterior neck triangle
A
Posterior border of the SCM
Trapezius muscle
Clavical
Contains:
- Accessory nerve (innervates SCM, trapezius, platysma)
- Brachial plexus
3
Q
Parotid gland secretes:
A
Serous fluid
4
Q
Sublingual gland secretes:
A
Mucin
5
Q
Submandibular gland secretes:
A
50/50 serous and mucin
6
Q
Course of the vagus nerve in neck?
A
Runs between IJV and carotid artery
7
Q
Course of the phrenic nerve in neck?
A
On top of the anterior scalene muscle
8
Q
Course of the long thoracic nerve in neck?
A
Posterior to the middle scalene muscle
9
Q
Trigeminal nerve
A
Ophthalmic, maxillary, mandibular branches
Sensation to face
Exception: mandibular branch gives taste to anterior 2/3 tongue, floor of mouth and gingiva
10
Q
Facial nerve
A
Temporal, zygomatic, buccal, marginal mandibular, cervical branches
Motor to face
11
Q
Glossopharyngeal nerve
A
Taste to posterior 1/3 tongue
Motor to stylopharyngeus
Injury effects swallowing
12
Q
Hypoglossal nerve
A
Motor to all of tongue except palatoglossus
Tongue deviates to same side of injury
13
Q
Recurrent laryngeal nerve
A
Innervates all of larynx except cricothyroid muscle
14
Q
Superior larygneal nerve
A
Innervates cricothyroid mucles
15
Q
Gustatory sweating
A
Frey’s syndrome
Occurs after parotidectomy
Injury of auriculotemporal nerve that then cross-innervates sympathetic fibers to sweat glands
16
Q
Thyrocervical trunk
A
STAT Suprascapular artery Transverse cervical artery Ascending cervical artery Inferior Thyroid artery
17
Q
First branch of external carotid artery
A
Superior thyroid artery
18
Q
Blood supply to trapezius flap
A
Transverse cervical arteryu
19
Q
Blood supply to pectoralis major flap
A
Thoracoacrominal artery
Internal mammary artery
20
Q
Torus palatini
A
Congenital bony mass on upper palate of mouth
No need for treatment
21
Q
Torus mandibular
A
Congenital bony mass on lingual surface of mandible
No need for treatment
22
Q
Modified radical neck dissection
A
Takes omohyoid, submandibular gland, sensory nerves C2-C5, cervical branch of facial nerve and ipsilateral thryoid
23
Q
Radical neck dissection
A
MRND + accessory nerve (CN XII), SCM, internal jugular resection
24
Q
Most common cancer of the oral cavity, pharynx and larynx? Risk factors?
A
Squamous cell CA
Tobacco and ETOH
25
Erythroplakia
Premalignant mouth lesion
| Vs leukoplakia - non-malignant
26
Boundaries of the oral cavity
```
Mouth floor
Anterior 1/3 toung
GIngiva
Har palate
Anterior tonisllar pillars
Lips
```
27
Most common site for oral cavity CA
Lower lip (sun exposure)
28
Plummer-vinson syndrome
GLossitis
Cervical dysphagia from esophageal web
Spoon fingers
Iron-deficiency anemia
29
Oral cavity CA - treatment
Wide resection (1cm margin)
MRND
Post op XRT
30
Indication for MRND for oral cavity CA?
>4cm
Clinical positive nodes
Bone invasion
31
Indications for Post-op XRT for oral cavity CA?
<4cm
Positive margins
Nodal/bone involvement
32
Verrucous ulcer
Well-differentiated SCCA
Cheek
Oral tobacco
Tx: Full check resection +/- flap, NO MRND
33
Tonsilar cancer
Risk: ETOH, tobacco, male
Tx: Tonsillectomy for biopsy; wide resection with margins
34
Nasopharyngeal SCCA
Risks: EBV, Chinese
Goes to posterior cervical neck nodes
Tx: XRT, add chemo for advanced, NO surgery
35
Number one tumor of nasopharynx in children? Treatment?
Lymphoma
| Chemotherapy
36
Most common benign neoplasm of nose/paranasal sinuses?
Papilloma
37
Oropharyngeal SCCA
```
Neck mass, sore throa
Goes to posterior cervical neck nodes
Tx:
- <4cm: XRT
- >4cm, bone/nodal invasion: surgery, MRND, XRT
```
38
Hypopharyngeal SCCA
```
Hoarseness, early metastasis
Goes to ANTERIOR cervical neck nodes
Tx:
- <4cm: XRT
- >4cm, bone/nodal invasion: Surgery, MRND, XRT
```
39
Nasopharyngeal angiofibroma
Benign tumor
Obstruction, epistaxis in <20yo males
Extremely vascular
Tx: Angiography and embolization (internal maxillary artery) followed by resection
40
Larygenal cancer
```
Hoarseness, aspiration, dypsnea, dysphagia
Goal - preserve larynx
Tx:
- Vocal cords only - XRT
- Beyond vocal cords - Chemo-XRT
- MRND if nodes are clinically psoitive
```
41
Most common benign lesion of larynx?
Papilloma
42
Benign or malignant?
- Mass in large salivary gland
- Mass in small salivary gland
Most frequent site for malignant tumor?
Large - benign
Small - benign
Parotid most frequent malignant site
43
Lymphatic drainage of salivary glands?
Intra-parotid and anterior cervical chain nodes
44
Most common malignant tumor of the salivary glands? Second?
Mucoepidermoid CA
Adenoid cystic CA (sensitive to XRT)
Tx: Resection of salivary gland, prophylactic MRND, postop XRT
45
Most common benign tumor of the salivary glands? Second?
Pleomorphic adenoma (mixed tumor)
Warthin's tumor
Tx: superficial parotidectomy
46
Most commonly injured nerve for parotid surgery?
Greater auricular nerve (numbness over lower portion of ear)
47
Nerves you need to identify in a submandibular gland resection?
Mandibular branch of facial nerve
Lingual nerve
Hypoglossal nerve
48
Most common salivary gland tumor in children?
Hemangiomas
49
Cauliflower ear
Due to undrained hematomas that organize and calcify
50
Cholesteatoma
Epidermal inclusion cyst of ear
Slow growing - erode as they grow
Presents with conductive hearing loss and clear drainage from ear
Tx: surgical excision
51
Chemodectomas
Vascular tumor of middle ear (paraganglionoma)
| Tx: Surgery and XRT
52
Acoustic neruoma
CN VIII
Tinnitus, hearing loss, unsteadiness
Can grow into cerebellar/pontine angle
Tx: Craniotomy and resection; XRT
53
Ear SCCA
20% metastasize to parotid gland
| Tx: resection and parotidectomy, MRND (positive nodes and large tumors)
54
Most common childhood aural malignancy of the middle/external ear?
Rhabdomyosarcoma (rare)
55
When do you set a nasal fracture?
After swelling decreases
56
Septal hematoma - treatment?
Drain to avoid infection and necrosis of the septum
57
CSF rhinorrhea
Cribriform plate fracture
Contrast study to find leak
Tx: Conservative 2-3 weeks - epidural catheter drainage; if needed, transethmoidal repair
58
Treatment of epistaxis
Anterior - packing
| Posterior - internal maxillary artery or ethmoid artery embolization
59
Radicular cyst
Inflammatory cyst at root of teeth
Can cause bony erosion
Lucent on XRAY
Tx: Local excision or curettage
60
Ameloblastoma
Slow-growing malignancy of odontogenic epithelium (outside portion of teeth)
Soap bubble appearance on XRAY
Tx: wide local excision
61
Osteogenic sarcoma
Poor prognosis
| Tx: surgery, plus.
62
Maxillary jaw fractures
Wire fixation
63
TMJ dislocation
Closed reduction
64
Symptoms of inferior alveolar nerve damage
Lower lip numbness
65
Stensen's duct laceration
Repair over catheter stent
| Ligation - painful parotid atrophy and facial asymmetry
66
Suppurative parotitis
Elderly patient - dehydration
Staph infection
Tx: FLuids, salivation, Abx; drainage if abscess
67
Sialoadenitis
Acute inflammation of salivary gland related to stone in duct
Tx: incise duct and remove stone
68
Peritonsillar abscess
```
Older kids (>10yo)
Sx: trismus, odynophagia, NO airway obstruction
Tx: Needle aspiration, then drainage through tonsillar bed if no relief in 24hrs
```
69
Retropharyngeal abscess
Younger kids (<10yo)
Sx: fever, odynophagia, drool, airway emergency
Tx: Intubate, drain through posterior pharyngeal wall
70
Parapharyngeal abscess
All age groups - dental infections, tonsillitis, pharyngitis
Vascular invasion and mediastinal spread (prevertebral and retropharyngeal spaces)
Tx: Drain through lateral neck (avoid internal carotid and internal jugular vein) - leave a drain
71
Ludwig's angina
Acute infection of floor of mouth - involves mylohyoid muscle
Can spread rapidly - causes airway obstruction
Tx: airway control, surgical drainage, Abx
72
Preauricular tumors
Parotid until proven otherwise - superficial lobectomy
80% salivary tumors are parotid
80% of parotid tumors are benign
80% of those, are pleomorphic adenomas
73
Most common distant met for head and neck tumors?
Lung
74
Posterior neck mass
If not obvious malignant epithelial tumor, consider Hodgkin's lymphoma until proven otherwise
Dx: FNA or open biopsy
75
Neck mass workup
- H&P, laryngoscopy, FNA (abx for 2 weeks - re-assess)
If non-diagnostic:
- Panednoscopy with biopsy, neck/chest CT
Still non-diagnostic:
- Excisional biopsy, prep for MRND
76
Source of adenocarcinoma found in a neck mass?
Breast, GI or lung primary
77
Epidermoid carcinoma (SCCA variant) found in cervical node without known primary?
1st - pandendoscopy with biopsies
2nd - CT scan
3rd - Ipsilateral MRND, ipsilateral tonsillectomy, bilateral XRT
78
Esophageal foreign body
Dysphagia
| Dx/Tx: Rigid EGD under anesthesia
79
Most common place for a swallowed foreign body to rest?
Cricopharyngeus (95%)
80
Fever and pain after EGD for foreign body - next step?
Gastrografin followed by barium swallow to rule out perforation
81
Laryngeal foreign body
Coughing
Laryngescopy
Emergent cricothyroidectomy as last resort
82
Sleep apnea
Associated with MI, arrhythmias, death
| Tx: CPAP, uvulopalatopharyngoplasty or permenant trach
83
Subglottic stenosis
Associated with prolonged intubation
| Tx: tracheal resection and reconstruction
84
Trachesotomy
Consider in patients who will be intubated for >7-14 days
| Benefits: decreases secretions, provides easier ventilation, decreases pneumonia risk, more comfortable for patient
85
Median rhomboid glossitis
Failure of tongue fusion
| No treatment needed
86
Cleft lip
Failure of primary palate fusion - lips, alveolus or both
| Repair at 10weeks, 10lbs and hbg 10
87
Cleft palate
Failure of secondary palate fusion - hard and soft palate
Repair at 12 months
- Earlier - affects maxillofacial growth
- Later - effects speech and swallowing
88
Most common benign head and neck tumor in adults?
Hemangioma
89
Mastoiditis
Infection of mastoid cells - destroys bone
Complication of untreated acute suppuritive otitis media
Ear is pushed forward
Tx: Abx, emergent mastoidectomy
90
Epiglottis
Ages 3-5
Sx: stridor, drooling, tripod position, high fever, throat pain, thumbprint sign on lateral neck film
Tx: Control airway, ABx
