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Fiser absite > 19 Head and Neck > Flashcards

19 Head and Neck Flashcards

1
Q

Anterior neck triangle

A

Sternocleidomastoid muscle
Sternal notch
Inferior border of the diagstric muscle

Contains carotid sheath

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2
Q

Posterior neck triangle

A

Posterior border of the SCM
Trapezius muscle
Clavical

Contains:

  • Accessory nerve (innervates SCM, trapezius, platysma)
  • Brachial plexus
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3
Q

Parotid gland secretes:

A

Serous fluid

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4
Q

Sublingual gland secretes:

A

Mucin

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5
Q

Submandibular gland secretes:

A

50/50 serous and mucin

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6
Q

Course of the vagus nerve in neck?

A

Runs between IJV and carotid artery

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7
Q

Course of the phrenic nerve in neck?

A

On top of the anterior scalene muscle

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8
Q

Course of the long thoracic nerve in neck?

A

Posterior to the middle scalene muscle

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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

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10
Q

Facial nerve

A

Temporal, zygomatic, buccal, marginal mandibular, cervical branches
Motor to face

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11
Q

Glossopharyngeal nerve

A

Taste to posterior 1/3 tongue
Motor to stylopharyngeus
Injury effects swallowing

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12
Q

Hypoglossal nerve

A

Motor to all of tongue except palatoglossus

Tongue deviates to same side of injury

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13
Q

Recurrent laryngeal nerve

A

Innervates all of larynx except cricothyroid muscle

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14
Q

Superior larygneal nerve

A

Innervates cricothyroid mucles

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15
Q

Gustatory sweating

A

Frey’s syndrome
Occurs after parotidectomy
Injury of auriculotemporal nerve that then cross-innervates sympathetic fibers to sweat glands

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16
Q

Thyrocervical trunk

A 
STAT
Suprascapular artery
Transverse cervical artery
Ascending cervical artery
Inferior Thyroid artery
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17
Q

First branch of external carotid artery

A

Superior thyroid artery

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18
Q

Blood supply to trapezius flap

A

Transverse cervical arteryu

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19
Q

Blood supply to pectoralis major flap

A

Thoracoacrominal artery

Internal mammary artery

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20
Q

Torus palatini

A

Congenital bony mass on upper palate of mouth

No need for treatment

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21
Q

Torus mandibular

A

Congenital bony mass on lingual surface of mandible

No need for treatment

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22
Q

Modified radical neck dissection

A

Takes omohyoid, submandibular gland, sensory nerves C2-C5, cervical branch of facial nerve and ipsilateral thryoid

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23
Q

Radical neck dissection

A

MRND + accessory nerve (CN XII), SCM, internal jugular resection

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24
Q

Most common cancer of the oral cavity, pharynx and larynx? Risk factors?

A

Squamous cell CA

Tobacco and ETOH

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25
Q

Erythroplakia

A

Premalignant mouth lesion

Vs leukoplakia - non-malignant

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26
Q

Boundaries of the oral cavity

A 
Mouth floor
Anterior 1/3 toung
GIngiva
Har palate
Anterior tonisllar pillars
Lips
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27
Q

Most common site for oral cavity CA

A

Lower lip (sun exposure)

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28
Q

Plummer-vinson syndrome

A

GLossitis
Cervical dysphagia from esophageal web
Spoon fingers
Iron-deficiency anemia

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29
Q

Oral cavity CA - treatment

A

Wide resection (1cm margin)
MRND
Post op XRT

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30
Q

Indication for MRND for oral cavity CA?

A

> 4cm
Clinical positive nodes
Bone invasion

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31
Q

Indications for Post-op XRT for oral cavity CA?

A

<4cm
Positive margins
Nodal/bone involvement

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32
Q

Verrucous ulcer

A

Well-differentiated SCCA
Cheek
Oral tobacco
Tx: Full check resection +/- flap, NO MRND

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33
Q

Tonsilar cancer

A

Risk: ETOH, tobacco, male
Tx: Tonsillectomy for biopsy; wide resection with margins

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34
Q

Nasopharyngeal SCCA

A

Risks: EBV, Chinese
Goes to posterior cervical neck nodes
Tx: XRT, add chemo for advanced, NO surgery

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35
Q

Number one tumor of nasopharynx in children? Treatment?

A

Lymphoma

Chemotherapy

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36
Q

Most common benign neoplasm of nose/paranasal sinuses?

A

Papilloma

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37
Q

Oropharyngeal SCCA

A 
Neck mass, sore throa
Goes to posterior cervical neck nodes
Tx: 
- <4cm: XRT
- >4cm, bone/nodal invasion: surgery, MRND, XRT
38
Q

Hypopharyngeal SCCA

A 
Hoarseness, early metastasis
Goes to ANTERIOR cervical neck nodes
Tx:
- <4cm: XRT
- >4cm, bone/nodal invasion: Surgery, MRND, XRT
39
Q

Nasopharyngeal angiofibroma

A

Benign tumor
Obstruction, epistaxis in <20yo males
Extremely vascular
Tx: Angiography and embolization (internal maxillary artery) followed by resection

40
Q

Larygenal cancer

A 
Hoarseness, aspiration, dypsnea, dysphagia
Goal - preserve larynx
Tx: 
- Vocal cords only - XRT
- Beyond vocal cords - Chemo-XRT
- MRND if nodes are clinically psoitive
41
Q

Most common benign lesion of larynx?

A

Papilloma

42
Q

Benign or malignant?
- Mass in large salivary gland
- Mass in small salivary gland
Most frequent site for malignant tumor?

A

Large - benign
Small - benign
Parotid most frequent malignant site

43
Q

Lymphatic drainage of salivary glands?

A

Intra-parotid and anterior cervical chain nodes

44
Q

Most common malignant tumor of the salivary glands? Second?

A

Mucoepidermoid CA
Adenoid cystic CA (sensitive to XRT)
Tx: Resection of salivary gland, prophylactic MRND, postop XRT

45
Q

Most common benign tumor of the salivary glands? Second?

A

Pleomorphic adenoma (mixed tumor)
Warthin’s tumor
Tx: superficial parotidectomy

46
Q

Most commonly injured nerve for parotid surgery?

A

Greater auricular nerve (numbness over lower portion of ear)

47
Q

Nerves you need to identify in a submandibular gland resection?

A

Mandibular branch of facial nerve
Lingual nerve
Hypoglossal nerve

48
Q

Most common salivary gland tumor in children?

A

Hemangiomas

49
Q

Cauliflower ear

A

Due to undrained hematomas that organize and calcify

50
Q

Cholesteatoma

A

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
Q

Chemodectomas

A

Vascular tumor of middle ear (paraganglionoma)

Tx: Surgery and XRT

52
Q

Acoustic neruoma

A

CN VIII
Tinnitus, hearing loss, unsteadiness
Can grow into cerebellar/pontine angle
Tx: Craniotomy and resection; XRT

53
Q

Ear SCCA

A

20% metastasize to parotid gland

Tx: resection and parotidectomy, MRND (positive nodes and large tumors)

54
Q

Most common childhood aural malignancy of the middle/external ear?

A

Rhabdomyosarcoma (rare)

55
Q

When do you set a nasal fracture?

A

After swelling decreases

56
Q

Septal hematoma - treatment?

A

Drain to avoid infection and necrosis of the septum

57
Q

CSF rhinorrhea

A

Cribriform plate fracture
Contrast study to find leak
Tx: Conservative 2-3 weeks - epidural catheter drainage; if needed, transethmoidal repair

58
Q

Treatment of epistaxis

A

Anterior - packing

Posterior - internal maxillary artery or ethmoid artery embolization

59
Q

Radicular cyst

A

Inflammatory cyst at root of teeth
Can cause bony erosion
Lucent on XRAY
Tx: Local excision or curettage

60
Q

Ameloblastoma

A

Slow-growing malignancy of odontogenic epithelium (outside portion of teeth)
Soap bubble appearance on XRAY
Tx: wide local excision

61
Q

Osteogenic sarcoma

A

Poor prognosis

Tx: surgery, plus.

62
Q

Maxillary jaw fractures

A

Wire fixation

63
Q

TMJ dislocation

A

Closed reduction

64
Q

Symptoms of inferior alveolar nerve damage

A

Lower lip numbness

65
Q

Stensen’s duct laceration

A

Repair over catheter stent

Ligation - painful parotid atrophy and facial asymmetry

66
Q

Suppurative parotitis

A

Elderly patient - dehydration
Staph infection
Tx: FLuids, salivation, Abx; drainage if abscess

67
Q

Sialoadenitis

A

Acute inflammation of salivary gland related to stone in duct
Tx: incise duct and remove stone

68
Q

Peritonsillar abscess

A 
Older kids (>10yo)
Sx: trismus, odynophagia, NO airway obstruction
Tx: Needle aspiration, then drainage through tonsillar bed if no relief in 24hrs
69
Q

Retropharyngeal abscess

A

Younger kids (<10yo)
Sx: fever, odynophagia, drool, airway emergency
Tx: Intubate, drain through posterior pharyngeal wall

70
Q

Parapharyngeal abscess

A

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
Q

Ludwig’s angina

A

Acute infection of floor of mouth - involves mylohyoid muscle
Can spread rapidly - causes airway obstruction
Tx: airway control, surgical drainage, Abx

72
Q

Preauricular tumors

A

Parotid until proven otherwise - superficial lobectomy
80% salivary tumors are parotid
80% of parotid tumors are benign
80% of those, are pleomorphic adenomas

73
Q

Most common distant met for head and neck tumors?

A

Lung

74
Q

Posterior neck mass

A

If not obvious malignant epithelial tumor, consider Hodgkin’s lymphoma until proven otherwise
Dx: FNA or open biopsy

75
Q

Neck mass workup

A
  • 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
Q

Source of adenocarcinoma found in a neck mass?

A

Breast, GI or lung primary

77
Q

Epidermoid carcinoma (SCCA variant) found in cervical node without known primary?

A

1st - pandendoscopy with biopsies
2nd - CT scan
3rd - Ipsilateral MRND, ipsilateral tonsillectomy, bilateral XRT

78
Q

Esophageal foreign body

A

Dysphagia

Dx/Tx: Rigid EGD under anesthesia

79
Q

Most common place for a swallowed foreign body to rest?

A

Cricopharyngeus (95%)

80
Q

Fever and pain after EGD for foreign body - next step?

A

Gastrografin followed by barium swallow to rule out perforation

81
Q

Laryngeal foreign body

A

Coughing
Laryngescopy
Emergent cricothyroidectomy as last resort

82
Q

Sleep apnea

A

Associated with MI, arrhythmias, death

Tx: CPAP, uvulopalatopharyngoplasty or permenant trach

83
Q

Subglottic stenosis

A

Associated with prolonged intubation

Tx: tracheal resection and reconstruction

84
Q

Trachesotomy

A

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
Q

Median rhomboid glossitis

A

Failure of tongue fusion

No treatment needed

86
Q

Cleft lip

A

Failure of primary palate fusion - lips, alveolus or both

Repair at 10weeks, 10lbs and hbg 10

87
Q

Cleft palate

A

Failure of secondary palate fusion - hard and soft palate
Repair at 12 months
- Earlier - affects maxillofacial growth
- Later - effects speech and swallowing

88
Q

Most common benign head and neck tumor in adults?

A

Hemangioma

89
Q

Mastoiditis

A

Infection of mastoid cells - destroys bone
Complication of untreated acute suppuritive otitis media
Ear is pushed forward
Tx: Abx, emergent mastoidectomy

90
Q

Epiglottis

A

Ages 3-5
Sx: stridor, drooling, tripod position, high fever, throat pain, thumbprint sign on lateral neck film
Tx: Control airway, ABx

Fiser absite (58 decks)

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