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Fiser's ABSITE Ryan > Chapter 19 - Head and Neck > Flashcards

Chapter 19 - Head and Neck Flashcards

1
Q

Anterior neck triangle:

A

sternocleidomastoid muscle, sternal notch, inferior border of the digastric. Contains carotid sheath

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2
Q

Posterior triangle of neck:

A

posterior border of the sternocleidomastoid muscle, trapezius muscle, clavicle. Contains spinal accessory nerve and the brachial plexus.

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3
Q

Where is the phrenic nerve located in the neck?

A

on the anterior scalene muscle

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4
Q

What do the parotid glands secrete?

A

mostly serous fluid

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5
Q

What do the sublingual glands secrete?

A

mostly mucin

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6
Q

What do the submandibular glands secrete?

A

50/50 serous/mucin

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7
Q

In the larynx, what are superior, true or false vocal cords?

A

false

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8
Q

Where does the vagus nerve run in the neck?

A

between the IJ and Carotid

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9
Q

What are the branches of the trigeminal nerve?

A

ophthalmic, maxillary, mandibular

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10
Q

What are the branches of the facial nerve?

A 
temporal
zygomatic
buccal
marginal mandibular
cervical
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11
Q

What does the glossopharyngeal nerve do?

A

sensory to posterior tongue
motor to stylopharyngeus
-injury affects swallowing

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12
Q

What does the hypoglossal nerve do?

A

motor to all of tongue except palatoglossus

Tongue deviates to the side of the injury

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13
Q

What does the recurrent laryngeal nerve do?

A

innervates all of the larynx except cricothyroid muscle

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14
Q

What does the superior laryngeal nerve do?

A

innervates cricothyroid muscle

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15
Q

What is Frey’s syndrome?

A

occurs after parotidectomy.

  • injury of auriculotemporal nerve that then cross innervates with sympathetic fibers to sweat glands of skin.
  • gustatory sweating
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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

What is the first branch of the external carotid artery?

A

superior thyroid

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18
Q

What artery is the trapezius flap based on?

A

transverse cervical artery

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19
Q

what is the pectoralis major flap based on?

A

thoracoacromial artery

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20
Q

What is torus palatini?

A

congenital bony mass on upper palate of mouth. Do nothing.

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21
Q

What is torus mandibular?

A

congenital bony mass on anterior lingual surface of mandible

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22
Q

What is a radical neck dissection?

A

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

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23
Q

What is a modified radical neck dissection?

A

takes omohyoid, submandibular, sensory c2-c5, cervical branch of facial nerve, ipsilateral thyroid
-no mortality difference bw radical and modified

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24
Q

What is the most common canceer of the oral cavity, pharynx, larynx?

A

squamous cell carcinoma

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25
Q

What is the biggest risk for oral cancer?

A

tobacco and etoh

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26
Q

what is more premalignant, erythroplakia or leukoplakia?

A

erythroplakia

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27
Q

What does the oral cavity include?

A 
mouth floor
anterior 1/3 of tongue
gingiva
hard palate
anterior tonsillar pillars
lips
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28
Q

what is the most common site for oral cavity ca?

A

lips

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29
Q

what oral cavity site has the lowest survival rate?

A

hard palate- hard to resect

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30
Q

What is plummer-vinson syndrome?

A 
glossitis
spoon fingers
cervical dysphagia from esophageal web
iron deficiency anemia
increased oral CA risk
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31
Q

Treatment for oral CA?

A

wide resection of 2cm

-postop XRT for advanced lesions. Post op XRT.

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32
Q

Why are lower lip lesions more common?

A

sun exposure. May need flaps of more then 1/2 lip removed. Commissure lesions most aggressive.

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33
Q

Tongue Ca- can you still operate with jaw invasion?

A

Yes

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34
Q

What is a verrucous ulcer?

A

well differentiated tumor of the cheek
not aggressive
tx with full cheek resection, +/- flap, no RMND

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35
Q

What do you do with cancer of maxillary sinus?

A

maxillectomy

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36
Q

Nasopharyngeal Ca

A

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

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37
Q

Oropharyngeal scca

A
  • neck mass, sore throat
  • does to deep nodes
  • xrt or surgery, MRND for >2cm
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38
Q

Tonsillar CA

A

ETOH, tobacco

  • asymptomatic until large
  • tonsillectomy for biopsy, XRT
39
Q

Hypopharyngeal scca

A

hoarseness, early mets

  • goes to anterior cervical nodes
  • tx- surgery- laryngectomy, MRND, postop xrt
40
Q

Nasopharyngeal angiofibroma

A

benign tumor

  • presents in males <20 years old
  • vascular
  • angiography and embolization (usually internal maxillary artery)
41
Q

Laryngeal cancer

A

Hoarseness, aspiration, dyspnea, dysphagia

  • take ipsilateral thyroid with MRND
  • papilloma most benign lesion
42
Q

Subglottic scca

A

-early nodal spread to submental/submandibular
small-xrt/conservative surgery
large- laryngectomy, mrnd, xrt

43
Q

Glottic scca

A

nodal spread to Anterior cervical chain
-small xrt or laser
-large laryngectomy, mrnd, xrt
fixed cords requires laryngectomy

44
Q

subglottic scca

A

early nodal to anterior cervical chain and metastatic spread
small- xrt or conservative surgery
large laryngectomy, mrnd, postop xrt

45
Q

what can submandibular or sublingual tumors present as?

A

neck mass or swelling in floor of the mouth

46
Q

mass in large salivary gland likely what?

A

benign

47
Q

mass in small salivary gland likely what?

A

malignant

48
Q

where is the most common site of a malignant salivary tumor?

A

parotid

49
Q

Mucoepidermoid CA

A 
#1 malignant tumor of salivary gland
-wide range of aggressiveness
50
Q

adenoid cystic CA

A 
#2 malignant tumor of salivary glands.
-long, indolent course, propensity to invade
51
Q

What is the nodal drainage of salivary glands?

A

intraparotid nodes and anterior cervical chain

52
Q

General principles of salivary gland tumor sx?

A

malignant of the parotid=parotidectomy

  • facial nerve only sacrificed w direct invasion
  • high-grade tumors should undergo rmnd
  • post op xrt
53
Q

most common benign tumor of salivary glands?

A

pleomorphic adenoma

54
Q

what is the second most common benign tumor of salivary glands?

A

warthin’s tumor

55
Q

What is the most common nerve injury in parotid surgery?

A

greater auricular nerve (numbness over lower portion of auricle)

56
Q

For a submandibular gland resection, what nerves do you need to identify?

A
  • mandibular branch of facial nerve
  • lingual nerve
  • hypoglossal nerve
57
Q

What is the most common salivary gland tumor in children?

A

hemangiomas

58
Q

What causes cauliflower hear?

A

undrained hematomas that organize and calcify- drain to avoid this

59
Q

what is a chemodectoma?

A

vascular tumor of middle ear.

surgery, +- xrt

60
Q

What is an acoustic neuroma?

A

CN VIII
tinnitus, hearing loss, unsteadiness
craniotomy, resection
xrt

61
Q

cholesteatoma?

A

epidermal inclusion cyst of ear

conductive hearing loss and clear drainage from ear

62
Q

Ear CCA

A

20% metastasize to parotdi

63
Q

most common childhood aural malignancy?

A

rhabdomyosarcoma

64
Q

When do you set nose fx?

A

after swelling goes down

65
Q

what do you do with a septal hematoma?

A

drain to avoid infection and necrosis

66
Q

CSF rhinorrhea caused by what?

A

cribriform plate fx

CSF has TAU protein

67
Q

epistaxis- what is most common site?

A

anterior= 90%

internal maxillary artery or ethmoid a ligation for posterior

68
Q

What do you do with a radicular cyst?

A

local excision or currettage

-these are lucent on xray

69
Q

What is an ameloblastoma?

A

slow growing malignancy
soap bubble on x-ray
can have mets
wide local excision

70
Q

What causes lip numbness?

A

inferior alveolar nerve damage

71
Q

What is suppurative parotitis?

A

usually in elderly, dehydration
staph most common org.
fluids, abx, salivation, drainage

72
Q

What is sialoadenitis?

A

acute inflammation of salivary gland in the duct- most likely calculi near orifice
-gland excision may eventually be necessary
incise duct and remove stone

73
Q

What is Stensen’s duct, and what do you do with a laceration?

A

duct of parotid
repair over catheter stent
ligation can cause painful parotid atrophy and facial asymmetry

74
Q

Peritonsilar abscess

A

older kids >10
trismus, odynophagia, NO airway obstruction
-needle aspiration first, then through tonsillar bed

75
Q

Retropharyngeal abscess

A

younger kids <10
fever, odynophagia, drool AIRWAY emergency
can be elderlywith potts disease
intubate, drain throu posterior pharyngeal wall, will drain with swallowing

76
Q

Parapharyngeal abscess

A

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

77
Q

What is Ludwig’s angina?

A

acute infection of floor of the mouth
involves mylohyoid muscle
-dental infection
-can rapidly spread and cause airway obstruction

78
Q

Periauricular tumors

A

all are parotid tumors until proven otherwise

  • dx after superficial lobectomy
  • 80% salivary are parotid
  • 80% parotid benign
  • 80% benign are pleomorphic adenoma
79
Q

What is the most common distant metastases for head and neck tumors?

A

lung

80
Q

Posterior neck masses are what until proven otherwise?

A

hodgkin’s lymphoma

81
Q

3 stages of neck mass workup?

A

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

82
Q

Epidermoid found in cervical node without known primary, what do you do?

A

1 panendoscopy
2 CT
2 ipsilateral MRND, ipsilateral tonsillectomy, bilateral XRT

83
Q

Esophageal foreign body?

A

dysphagia, likely just below cricopharyngeus

  • dx with rigid EGD under anasthesia
  • perforation increases with length of time in esophagus
84
Q

What do you do with fever and pain after EGD for foreign body?

A

CXR and gastrografin followed by barium swallow

85
Q

What do you do with laryngeal foreign body?

A

emergeny cricothyroidectomy as a last resort

86
Q

What is sleep apnea associated with?

A

MI, arrhythmmias, death

-more common in obese and those with micrognathia, retrognathia

87
Q

What can be caused by prolonged intubation? What do you do about it?

A

subglotic steniosis. laser, dilation, possible excision

88
Q

when do you do a tracheostomy?

A

when intubation will be greater than 7-14 days. Decreases secretions, provides easier ventilation, decreases pneumonia risk

89
Q

What causes tracheoinominate fistula? what do you do?

A

can happen after tracheostomy.
Place finger in trach hole with pressure, median sternotomy.
avoid by placing trach above the 3rd trach ring

90
Q

Cleft palate- when do you fix?

A

12 months

91
Q

What is the most common benign head and neck tumor in adults?

A

hemangioma

92
Q

mastoiditis- what do you do?

A

Abx, may need emergent mastoidectomy

-ear is pushed forward, can be complication of untreated acute suppurtive otitis media

93
Q

epiglottitis occurs when?

A

3-5 years, now rare because of HIB vaccine

early control of airway, abx

94
Q

Kaposi’s sarcoma

A 
oral and pharyngeal mucosa most common
can get odynophagia and dysphagia
palliation
XRT, intratumor vinblastine
-most common neoplasm in AIDS

Fiser's ABSITE Ryan (50 decks)

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