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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
What is the biggest risk for oral cancer?
tobacco and etoh
26
what is more premalignant, erythroplakia or leukoplakia?
erythroplakia
27
What does the oral cavity include?
``` mouth floor anterior 1/3 of tongue gingiva hard palate anterior tonsillar pillars lips ```
28
what is the most common site for oral cavity ca?
lips
29
what oral cavity site has the lowest survival rate?
hard palate- hard to resect
30
What is plummer-vinson syndrome?
``` glossitis spoon fingers cervical dysphagia from esophageal web iron deficiency anemia increased oral CA risk ```
31
Treatment for oral CA?
wide resection of 2cm | -postop XRT for advanced lesions. Post op XRT.
32
Why are lower lip lesions more common?
sun exposure. May need flaps of more then 1/2 lip removed. Commissure lesions most aggressive.
33
Tongue Ca- can you still operate with jaw invasion?
Yes
34
What is a verrucous ulcer?
well differentiated tumor of the cheek not aggressive tx with full cheek resection, +/- flap, no RMND
35
What do you do with cancer of maxillary sinus?
maxillectomy
36
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
37
Oropharyngeal scca
- neck mass, sore throat - does to deep nodes - xrt or surgery, MRND for >2cm
38
Tonsillar CA
ETOH, tobacco - asymptomatic until large - tonsillectomy for biopsy, XRT
39
Hypopharyngeal scca
hoarseness, early mets - goes to anterior cervical nodes - tx- surgery- laryngectomy, MRND, postop xrt
40
Nasopharyngeal angiofibroma
benign tumor - presents in males <20 years old - vascular - angiography and embolization (usually internal maxillary artery)
41
Laryngeal cancer
Hoarseness, aspiration, dyspnea, dysphagia - take ipsilateral thyroid with MRND - papilloma most benign lesion
42
Subglottic scca
-early nodal spread to submental/submandibular small-xrt/conservative surgery large- laryngectomy, mrnd, xrt
43
Glottic scca
nodal spread to Anterior cervical chain -small xrt or laser -large laryngectomy, mrnd, xrt fixed cords requires laryngectomy
44
subglottic scca
early nodal to anterior cervical chain and metastatic spread small- xrt or conservative surgery large laryngectomy, mrnd, postop xrt
45
what can submandibular or sublingual tumors present as?
neck mass or swelling in floor of the mouth
46
mass in large salivary gland likely what?
benign
47
mass in small salivary gland likely what?
malignant
48
where is the most common site of a malignant salivary tumor?
parotid
49
Mucoepidermoid CA
``` #1 malignant tumor of salivary gland -wide range of aggressiveness ```
50
adenoid cystic CA
``` #2 malignant tumor of salivary glands. -long, indolent course, propensity to invade ```
51
What is the nodal drainage of salivary glands?
intraparotid nodes and anterior cervical chain
52
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
53
most common benign tumor of salivary glands?
pleomorphic adenoma
54
what is the second most common benign tumor of salivary glands?
warthin's tumor
55
What is the most common nerve injury in parotid surgery?
greater auricular nerve (numbness over lower portion of auricle)
56
For a submandibular gland resection, what nerves do you need to identify?
- mandibular branch of facial nerve - lingual nerve - hypoglossal nerve
57
What is the most common salivary gland tumor in children?
hemangiomas
58
What causes cauliflower hear?
undrained hematomas that organize and calcify- drain to avoid this
59
what is a chemodectoma?
vascular tumor of middle ear. | surgery, +- xrt
60
What is an acoustic neuroma?
CN VIII tinnitus, hearing loss, unsteadiness craniotomy, resection xrt
61
cholesteatoma?
epidermal inclusion cyst of ear | conductive hearing loss and clear drainage from ear
62
Ear CCA
20% metastasize to parotdi
63
most common childhood aural malignancy?
rhabdomyosarcoma
64
When do you set nose fx?
after swelling goes down
65
what do you do with a septal hematoma?
drain to avoid infection and necrosis
66
CSF rhinorrhea caused by what?
cribriform plate fx | CSF has TAU protein
67
epistaxis- what is most common site?
anterior= 90% | internal maxillary artery or ethmoid a ligation for posterior
68
What do you do with a radicular cyst?
local excision or currettage | -these are lucent on xray
69
What is an ameloblastoma?
slow growing malignancy soap bubble on x-ray can have mets wide local excision
70
What causes lip numbness?
inferior alveolar nerve damage
71
What is suppurative parotitis?
usually in elderly, dehydration staph most common org. fluids, abx, salivation, drainage
72
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
73
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
74
Peritonsilar abscess
older kids >10 trismus, odynophagia, NO airway obstruction -needle aspiration first, then through tonsillar bed
75
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
76
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
77
What is Ludwig's angina?
acute infection of floor of the mouth involves mylohyoid muscle -dental infection -can rapidly spread and cause airway obstruction
78
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
79
What is the most common distant metastases for head and neck tumors?
lung
80
Posterior neck masses are what until proven otherwise?
hodgkin's lymphoma
81
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
82
Epidermoid found in cervical node without known primary, what do you do?
1 panendoscopy 2 CT 2 ipsilateral MRND, ipsilateral tonsillectomy, bilateral XRT
83
Esophageal foreign body?
dysphagia, likely just below cricopharyngeus - dx with rigid EGD under anasthesia - perforation increases with length of time in esophagus
84
What do you do with fever and pain after EGD for foreign body?
CXR and gastrografin followed by barium swallow
85
What do you do with laryngeal foreign body?
emergeny cricothyroidectomy as a last resort
86
What is sleep apnea associated with?
MI, arrhythmmias, death | -more common in obese and those with micrognathia, retrognathia
87
What can be caused by prolonged intubation? What do you do about it?
subglotic steniosis. laser, dilation, possible excision
88
when do you do a tracheostomy?
when intubation will be greater than 7-14 days. Decreases secretions, provides easier ventilation, decreases pneumonia risk
89
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
90
Cleft palate- when do you fix?
12 months
91
What is the most common benign head and neck tumor in adults?
hemangioma
92
mastoiditis- what do you do?
Abx, may need emergent mastoidectomy | -ear is pushed forward, can be complication of untreated acute suppurtive otitis media
93
epiglottitis occurs when?
3-5 years, now rare because of HIB vaccine | early control of airway, abx
94
Kaposi's sarcoma
``` oral and pharyngeal mucosa most common can get odynophagia and dysphagia palliation XRT, intratumor vinblastine -most common neoplasm in AIDS ```

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