Chapter 19 - Head and Neck Flashcards
Anterior neck triangle:
sternocleidomastoid muscle, sternal notch, inferior border of the digastric. Contains carotid sheath
Posterior triangle of neck:
posterior border of the sternocleidomastoid muscle, trapezius muscle, clavicle. Contains spinal accessory nerve and the brachial plexus.
Where is the phrenic nerve located in the neck?
on the anterior scalene muscle
What do the parotid glands secrete?
mostly serous fluid
What do the sublingual glands secrete?
mostly mucin
What do the submandibular glands secrete?
50/50 serous/mucin
In the larynx, what are superior, true or false vocal cords?
false
Where does the vagus nerve run in the neck?
between the IJ and Carotid
What are the branches of the trigeminal nerve?
ophthalmic, maxillary, mandibular
What are the branches of the facial nerve?
temporal zygomatic buccal marginal mandibular cervical
What does the glossopharyngeal nerve do?
sensory to posterior tongue
motor to stylopharyngeus
-injury affects swallowing
What does the hypoglossal nerve do?
motor to all of tongue except palatoglossus
Tongue deviates to the side of the injury
What does the recurrent laryngeal nerve do?
innervates all of the larynx except cricothyroid muscle
What does the superior laryngeal nerve do?
innervates cricothyroid muscle
What is Frey’s syndrome?
occurs after parotidectomy.
- injury of auriculotemporal nerve that then cross innervates with sympathetic fibers to sweat glands of skin.
- gustatory sweating
Thyrocervical trunk?
STAT: suprascapular artery transverse cervical artery ascending cervical artery inferior thyroid artery
What is the first branch of the external carotid artery?
superior thyroid
What artery is the trapezius flap based on?
transverse cervical artery
what is the pectoralis major flap based on?
thoracoacromial artery
What is torus palatini?
congenital bony mass on upper palate of mouth. Do nothing.
What is torus mandibular?
congenital bony mass on anterior lingual surface of mandible
What is a radical neck dissection?
takes accessory nerve (XII), sternocleidomastoid, internal jugular, omohyoid, submandibular gland, sensory nerves C2-C5, cervical branch of facial nerve, ipsilateral thyroid
-most morbidity from accessory nerve resection
What is a modified radical neck dissection?
takes omohyoid, submandibular, sensory c2-c5, cervical branch of facial nerve, ipsilateral thyroid
-no mortality difference bw radical and modified
What is the most common canceer of the oral cavity, pharynx, larynx?
squamous cell carcinoma
What is the biggest risk for oral cancer?
tobacco and etoh
what is more premalignant, erythroplakia or leukoplakia?
erythroplakia
What does the oral cavity include?
mouth floor anterior 1/3 of tongue gingiva hard palate anterior tonsillar pillars lips
what is the most common site for oral cavity ca?
lips
what oral cavity site has the lowest survival rate?
hard palate- hard to resect
What is plummer-vinson syndrome?
glossitis spoon fingers cervical dysphagia from esophageal web iron deficiency anemia increased oral CA risk
Treatment for oral CA?
wide resection of 2cm
-postop XRT for advanced lesions. Post op XRT.
Why are lower lip lesions more common?
sun exposure. May need flaps of more then 1/2 lip removed. Commissure lesions most aggressive.
Tongue Ca- can you still operate with jaw invasion?
Yes
What is a verrucous ulcer?
well differentiated tumor of the cheek
not aggressive
tx with full cheek resection, +/- flap, no RMND
What do you do with cancer of maxillary sinus?
maxillectomy
Nasopharyngeal Ca
EBV
Chinamen- nose bleeds or obstruction
-goes to posterior/deep cervical neck nodes
-XRT, MRND for >2cm, postop chemo for advanced
-kids- lymphoma. chemo
-papilloma- most common benign neoplasm
Oropharyngeal scca
- neck mass, sore throat
- does to deep nodes
- xrt or surgery, MRND for >2cm
Tonsillar CA
ETOH, tobacco
- asymptomatic until large
- tonsillectomy for biopsy, XRT
Hypopharyngeal scca
hoarseness, early mets
- goes to anterior cervical nodes
- tx- surgery- laryngectomy, MRND, postop xrt
Nasopharyngeal angiofibroma
benign tumor
- presents in males <20 years old
- vascular
- angiography and embolization (usually internal maxillary artery)
Laryngeal cancer
Hoarseness, aspiration, dyspnea, dysphagia
- take ipsilateral thyroid with MRND
- papilloma most benign lesion
Subglottic scca
-early nodal spread to submental/submandibular
small-xrt/conservative surgery
large- laryngectomy, mrnd, xrt
Glottic scca
nodal spread to Anterior cervical chain
-small xrt or laser
-large laryngectomy, mrnd, xrt
fixed cords requires laryngectomy
subglottic scca
early nodal to anterior cervical chain and metastatic spread
small- xrt or conservative surgery
large laryngectomy, mrnd, postop xrt
what can submandibular or sublingual tumors present as?
neck mass or swelling in floor of the mouth
mass in large salivary gland likely what?
benign
mass in small salivary gland likely what?
malignant
where is the most common site of a malignant salivary tumor?
parotid
Mucoepidermoid CA
#1 malignant tumor of salivary gland -wide range of aggressiveness
adenoid cystic CA
#2 malignant tumor of salivary glands. -long, indolent course, propensity to invade
What is the nodal drainage of salivary glands?
intraparotid nodes and anterior cervical chain
General principles of salivary gland tumor sx?
malignant of the parotid=parotidectomy
- facial nerve only sacrificed w direct invasion
- high-grade tumors should undergo rmnd
- post op xrt
most common benign tumor of salivary glands?
pleomorphic adenoma
what is the second most common benign tumor of salivary glands?
warthin’s tumor
What is the most common nerve injury in parotid surgery?
greater auricular nerve (numbness over lower portion of auricle)
For a submandibular gland resection, what nerves do you need to identify?
- mandibular branch of facial nerve
- lingual nerve
- hypoglossal nerve
What is the most common salivary gland tumor in children?
hemangiomas
What causes cauliflower hear?
undrained hematomas that organize and calcify- drain to avoid this
what is a chemodectoma?
vascular tumor of middle ear.
surgery, +- xrt
What is an acoustic neuroma?
CN VIII
tinnitus, hearing loss, unsteadiness
craniotomy, resection
xrt
cholesteatoma?
epidermal inclusion cyst of ear
conductive hearing loss and clear drainage from ear
Ear CCA
20% metastasize to parotdi
most common childhood aural malignancy?
rhabdomyosarcoma
When do you set nose fx?
after swelling goes down
what do you do with a septal hematoma?
drain to avoid infection and necrosis
CSF rhinorrhea caused by what?
cribriform plate fx
CSF has TAU protein
epistaxis- what is most common site?
anterior= 90%
internal maxillary artery or ethmoid a ligation for posterior
What do you do with a radicular cyst?
local excision or currettage
-these are lucent on xray
What is an ameloblastoma?
slow growing malignancy
soap bubble on x-ray
can have mets
wide local excision
What causes lip numbness?
inferior alveolar nerve damage
What is suppurative parotitis?
usually in elderly, dehydration
staph most common org.
fluids, abx, salivation, drainage
What is sialoadenitis?
acute inflammation of salivary gland in the duct- most likely calculi near orifice
-gland excision may eventually be necessary
incise duct and remove stone
What is Stensen’s duct, and what do you do with a laceration?
duct of parotid
repair over catheter stent
ligation can cause painful parotid atrophy and facial asymmetry
Peritonsilar abscess
older kids >10
trismus, odynophagia, NO airway obstruction
-needle aspiration first, then through tonsillar bed
Retropharyngeal abscess
younger kids <10
fever, odynophagia, drool AIRWAY emergency
can be elderlywith potts disease
intubate, drain throu posterior pharyngeal wall, will drain with swallowing
Parapharyngeal abscess
all age groups
dental infections, tonsillitis, pharyngitis
morbitiy from vascular invasionand mediastinal spread via prevertebral and retropharyngeal spaces
-tx w/ draianage through lateral neck- leave drain
What is Ludwig’s angina?
acute infection of floor of the mouth
involves mylohyoid muscle
-dental infection
-can rapidly spread and cause airway obstruction
Periauricular tumors
all are parotid tumors until proven otherwise
- dx after superficial lobectomy
- 80% salivary are parotid
- 80% parotid benign
- 80% benign are pleomorphic adenoma
What is the most common distant metastases for head and neck tumors?
lung
Posterior neck masses are what until proven otherwise?
hodgkin’s lymphoma
3 stages of neck mass workup?
1 laryngoscopy, abx if inflammatory, FNA if hard
2 panendoscopy with multiple random bx, neck and chest CT
3 excisional bx, prepared for MRND
-adenoma suggest breast, GI, lung
Epidermoid found in cervical node without known primary, what do you do?
1 panendoscopy
2 CT
2 ipsilateral MRND, ipsilateral tonsillectomy, bilateral XRT
Esophageal foreign body?
dysphagia, likely just below cricopharyngeus
- dx with rigid EGD under anasthesia
- perforation increases with length of time in esophagus
What do you do with fever and pain after EGD for foreign body?
CXR and gastrografin followed by barium swallow
What do you do with laryngeal foreign body?
emergeny cricothyroidectomy as a last resort
What is sleep apnea associated with?
MI, arrhythmmias, death
-more common in obese and those with micrognathia, retrognathia
What can be caused by prolonged intubation? What do you do about it?
subglotic steniosis. laser, dilation, possible excision
when do you do a tracheostomy?
when intubation will be greater than 7-14 days. Decreases secretions, provides easier ventilation, decreases pneumonia risk
What causes tracheoinominate fistula? what do you do?
can happen after tracheostomy.
Place finger in trach hole with pressure, median sternotomy.
avoid by placing trach above the 3rd trach ring
Cleft palate- when do you fix?
12 months
What is the most common benign head and neck tumor in adults?
hemangioma
mastoiditis- what do you do?
Abx, may need emergent mastoidectomy
-ear is pushed forward, can be complication of untreated acute suppurtive otitis media
epiglottitis occurs when?
3-5 years, now rare because of HIB vaccine
early control of airway, abx
Kaposi’s sarcoma
oral and pharyngeal mucosa most common can get odynophagia and dysphagia palliation XRT, intratumor vinblastine -most common neoplasm in AIDS
