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ABSITE 2019-RM > Chapter 19: Head and Neck > Flashcards

Chapter 19: Head and Neck Flashcards

1
Q

Anterior neck triangle

A

Sternocleidomastoid, sternol notch, inferior border of the digastric muscle; contains the carotid sheath

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2
Q

What does the anterior triangle contain?

A

Carotid sheath

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3
Q

Posterior neck triangle

A

Posterior border of the SCM, trapezius muscle, and the clavicle; contains the accessory nerve (innervates SCM, trapezius, and platysma) and the brachial plexus

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4
Q

What does the posterior neck triangle contain?

A

Accessory nerve (innervates SCM, trapezius, and platysma) and the brachial plexus

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5
Q

Secrete mostly serous fluid

A

Parotid glands

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6
Q

Secrete mostly mucin

A

Sublingual glands

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7
Q

50/50 serous / mucin

A

Submandibular glands

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8
Q

Where are the false vocal cords?

A

In the larynx, the false vocal cords are superior to the true vocal cords

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9
Q

Has U-shaped cartilage and a posterior portion that is membranous

A

Trachea

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10
Q

Where does the vagus nerve run?

A

Between internal jugular vein and carotid artery

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11
Q

Runs on top of the anterior scalene muscle

A

Phrenic nerve

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12
Q

Runs posterior to the middle scalene muscle

A

Long thoracic nerve

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13
Q

Branches of the trigeminal nerve

A

Ophthalmic, maxillary, and mandibular branches

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14
Q

Gives sensation to most of the face

A

Trigeminal nerve

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15
Q

Taste to anterior 2/3 of tongue, floor of mouth, and gingiva

A

Mandibular branch of trigeminal nerve

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16
Q

Branches of facial nerve

A

Temporal, zygomatic, buccal, marginal mandibular, and cervical branches

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17
Q

Motor function to face

A

Facial nerve

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18
Q

Taste to posterior 1/3 tongue

A

Glossopharyngeal nerve

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19
Q
  • Motor to stylopharyngeus

- Injury affects swallowing

A

Glossopharyngeal nerve

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20
Q

Motor to all of tongue except palatoglossus

A

Hypoglossal nerve

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21
Q

Where does tongue go in hypoglossal nerve injury?

A

Same side

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22
Q

Innervates all of larynx except cricothyroid muscle

A

Recurrent laryngeal nerve

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23
Q

Innervates the cricothyroid muscle

A

Superior laryngeal nerve

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24
Q

Occurs after parotidectomy; injury of auriculotemporal nerve that then cross-innervates with sympathetic fibers to sweat glands of skin
- Symptom: gustatory sweating

A

Frey’s syndrome

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25
Q

What composes the thyrocervical trunk?

A

STAT

  • Suprascapular artery
  • Transverse cervical artery
  • Ascending cervical artery
  • Inferior thyroid artery
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26
Q

What bases the trapezius flap?

A

Transverse cervical artery

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27
Q

1st branch of external carotid artery?

A

Superior thyroid artery

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28
Q

What bases the pectoralis major flap?

A

Based on either thoracoacromial artery or the internal mammary artery

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29
Q

Congenital bony mass on upper palate of mouth

- Tx: nothing

A

Torus palatini

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30
Q

Congenital bony mass on lingual surface of mandible

- Tx: nothing

A

Torus mandibular

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31
Q

What does modified radical neck dissection (MRND) involve?

A
  • Omohyoid
  • Submandibular gland
  • Sensory nerves C2-C5
  • Cervical branch of facial nerve
  • Ipsilateral thyroid
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32
Q

Mortality: modified radical neck dissection (vs) radical neck dissection

A

No mortality difference compared with RND

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33
Q

What does radical neck dissection (RND) involve?

A
  • Omohyoid
  • Submandibular gland
  • Sensory nerves C2-C5
  • Cervical branch of facial nerve
  • Ipsilateral thyroid
  • Accessory nerve
  • SCM
  • Internal jugular resection (rarely done anymore)
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34
Q

Morbidity: radical neck dissection

A

Most morbidity occurs from accessory nerve resection

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35
Q

MC cancer of oral cavity, pharynx, and larynx

A

Squamous cell cancer

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36
Q

Biggest risk factors: squamous cell CA of oral cavity

A

Tobacco and alcohol

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37
Q

Considered more premalignant than leukoplakia

A

Erythroplakia

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38
Q

What does the oral cavity include?

A 
Mouth floor.
Anterior 1/3 tongue.
Gingiva.
Hard palate.
Anterior tonsillar pillars. 
Lips.
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39
Q

MC site for oral cavity CA

A

Lower lip (more common than upper lip due to sun exposure

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40
Q

Why is survival rate lowest for hard palate tumors?

A

Hard to resect

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41
Q

Glossitis.
Cervical dysphagia from esophageal web.
Spoon fingers.
Iron-deficiency anemia.

A

Plummer-Vinson syndrome (oral cavity cancer increased in patients)

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42
Q

Tx: oral cavity cancer

A
  • Wide resection (1 cm margins)
  • MRND for tumors > 4cm, clinically positive nodes, or bone invasion)
  • Postop XRT for advanced ( > 4cm, positive margins, or nodal/bone involvement)
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43
Q

When MRND in oral cavity cancer?

A

Tumors > 4cm, clinically positive nodes, or bone invasion

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44
Q

When Post op XRT for oral cavity XRT?

A

Advanced lesions

  • > 4 cm
  • Positive margins
  • Nodal / bone involvement
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45
Q

When do you need flaps in lip cancer?

A

May need flaps if more than 1/2 of the lip is removed

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46
Q

Most aggressive lesions: lip CA

A

Lesions along the commissure are the most aggressive

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47
Q

Oral cavity cancer: commando procedure

A

Tongue CA - can still operate with jaw invasion

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48
Q

Well-differentiated SCCA; often found on the cheek; oral tobacco
- Not aggressive, rare metastasis
Treatment?

A

Verrucous ulcer

- Tx: full cheek resection +/ flap; no MRND

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49
Q

Tx: cancer of maxillary sinus

A

Tx: maxillectomy

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50
Q
  • ETOH, tobacco, males
  • SCCA most common
  • Asymptomatic until large
  • 80% have lymph node metastases at time of diagnosis
A

Tonsillar cancer

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51
Q

Treatment: tonsillar cancer

A

Tonsillectomy best way to biopsy; wide resection with margins after that

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52
Q
  • EBV
  • Chinese
  • Presents with nose bleeding or obstruction.

Where does it go?

A

Nasopharyngeal SCCA

Goes to posterior cervical neck nodes

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53
Q

Tx: nasopharyngeal cancer

A

XRT primary therapy (very sensitive; give chemo XRT for advanced disease- no surgery)

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54
Q

Do you do surgery in nasopharyngeal carcinoma?

A

NO.

Super sensitive to XRT.

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55
Q 
#1 cause tumor of nasopharynx in children
- Treatment?
A

Lymphoma.

Tx: chemotherapy

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56
Q

MC benign neoplasm of nose / paranasal sinuses

A

Papilloma

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57
Q
  • Neck mass, sore throat

- Goes to posterior cervical neck nodes

A

Oropharyngeal SCCA

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58
Q

Tx: oropharyngeal SCCA

A

XRT for tumors 4 cm, bone invasion, or nodal invasion)

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59
Q
  • Hoarseness, early metastases

- Goes to anterior cervical nodes

A

Hypopharyngeal SCCA

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60
Q

Tx: hypopharyngeal SCCA

A
  • XRT for tumors 4 cm, bone invasion or nodal invasion)
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61
Q
  • Benign tumor

- Presents in males

A

Nasopharyngeal angiofibroma

62
Q

Hoarseness, aspiration, dyspnea, dysphagia

- Try to preserve larynx

A

Laryngeal cancer

63
Q

Tx: laryngeal cancer

A

XRT (if vocal cord only) or chemo-XRT (if beyond vocal cord)

  • Surgery is not the primary treatment, try to preserve larynx
  • MRND needed if nodes clinically positive
  • Take ipsilateral thyroid lobe with MRND
64
Q

Most common benign lesion of larynx

65
Q

Where can salivary gland cancers occur?

A

Parotid, submandibular, sublingual and minor salivary glands

66
Q

Can present as a neck mass or swelling in the floor of the mouth

A

Submandibular or sublingual tumors

67
Q

Mass in large salivary gland

A

More likely mass is benign

68
Q

Mass in small salivary gland

A

More likely mass is malignant, although th operated gland is the most frequent site from malignant tumor

69
Q

Most frequent site for malignant tumor of salivary glands

A

Parotid gland

70
Q

Often present as a painful mass but can also present with facial nerve paralysis or lymphadenopathy

A

Salivary gland malignant tumors

71
Q

Lymphatic drainage of salivary gland malignant tumors

A

Intra-parotid and anterior cervical chain nodes

72
Q

1 malignant tumor of the salivary glands

A

Mucoepidermoid CA

- Wide range of aggressiveness

73
Q

2 malignant tumor of salivary glands

A

Adenoid cystic CA

  • Long, indolent course; propensity to invade nerve roots
  • Very sensitive to XRT
74
Q

Tx: mucoepidoermoid CA, adenoid cystic CA

A

Resection of salivary gland (e.g., total parotidectomy), prophylactic MRND, and post XRT if high grade or advanced disease
- If in parotid, need to take whole lobe; try to preserve facial nerve

75
Q

Often present as painless mass

A

Benign tumors of salivary glands

76
Q 
#1 benign tumor of the salivary glands
- Malignant degneration in 5%
A

Pleomorphic adenoma

77
Q

Tx: pleomorphic adneoma

A

Superficial parotidectomy

78
Q

Tx: malignant degeneration pleomorphic adenoma

A

Total parotidectomy

79
Q 
#2 benign tumor of the salivary glands
- Males, bilateral in 10%
A

Warthin’s tumor

80
Q

Tx: Warthin’s tumor

A

Superficial parotidectomy

81
Q

MC injured nerve with parotid surgery

A

Greater auricular nerve (numbness over lower portion of the ear)

82
Q

What do you need to find in submandibular gland resection?

A

Need to find mandibular branch of facial nerve, lingual nerve, and hypoglossal nerve

83
Q

MC salivary gland tumor in children

A

Hemangiomas

84
Q

Ear: need suture through involved cartilage in laceration

A

Pinna laceration

85
Q

Undrained hematoma that organize and calcify, need to be drained to avoid this

A

Cauliflower ear

86
Q

Epidermal inclusion cyst of ear; slow growing but erode as they grow; present with conductive hearing loss and clear drainage form ear

A

Cholesteatoma

87
Q

Tx: cholesteatoma

A

Surgical excision

88
Q

Vascular tumor of middle ear (paraganglionoma)

A

Chemodectomas

- Tx: surgery +/ XRT

89
Q

CNVIII, tinnitus, hearing loss, unsteadiness; can grow into cerebellar / pontine angle

A

Acoustic neuroma

Tx: craniotomy and resection; XRT is alternative to surgery

90
Q

Tx: acoustic neuroma

A

Craniotomy and resection

- XRT is alternative to surgery

91
Q

20% metastasize to parotid gland

92
Q

Tx: Ear SCCA

A

Resection and parotidectomy

- MRND for positive nodes or large tumors

93
Q

MC childhood aural malignancy (although rare) of the middle or external ear

A

Rhabdomyosarcoma

94
Q

When do you set nasal fractures?

A

Set after swelling decreases

95
Q

Management septal hematoma?

A

Need to drain to avoid infection and necrosis of septum

96
Q

What is CSF rhinorrhea usually secondary to?

A

Cribiform plate fracture (CSF has tau protein)

97
Q

Tx: CXF rhinorrhea

A

Repair of facial fractures may help leak; may need contrast study to help find leak.
- Tx: conservative 2-3 weeks; try epidural catheter drainage of CSF; may need transethmoidal repair

98
Q

Treatment: anterior epistaxis

A

90% are anterior. Can be controlled with packing.

99
Q

Treatment: posterior epistaxis

A

Consider internal maxillary artery or ethmoid artery embolization for persistent posterior bleeding despite packing / balloon

100
Q

Inflammatory cyst at the root of the teeth; can cause bone erosion; lucent on XR

A

Radicular cyst

  • Tx: local excision or curettage
101
Q

Slow-growing malignancy of odontogenic epithelium (outside portion of teeth); soap bubble appearance on XR

A

Ameloblastoma

Tx: wide local excision

102
Q

Poor prognosis

- Tx: multimodality approach that includes surgery

A

Osteogenic sarcoma

103
Q

Tx: maxillary jaw fractures

A

Most treated with wire fixation

104
Q

Tx: TMJ dislocations

A

Treated with closed reduction

105
Q

Cause lower lip numbness

A

Inferior alveolar nerve damage (branch of mandibular nerve)

106
Q

Management: Stensen’s duct laceration

A

Repair over catheter stent

- Ligation can cause painful parotid atrophy and facial asymmetry

107
Q

Duct from which saliva gets to mouth from parotid gland

A

Stensen’s duct

108
Q

Usually in elderly patients; occurs with dehydration; staph most common organism

A

Suppurative parotitis

109
Q

Tx: suppurative parotitis

A

Fluids, salivation, antibiotics; drainage if abscess develops or patient not improving
- Can be life threatening

110
Q

Acute inflammation of a salivary gland related to a stone in the duct; most calculi near orifice

A

Sialoadenitis

111
Q

Where does sialoadenitis most frequently occur?

A

80% of the time affects the submandibular or sublingual glands

112
Q

Cause of recurrent sialoadenitis

A

Due to ascending infection from the oral cavity

113
Q

Tx: sialoadenitis

A

Incise duct and remove stone

- Gland excision may eventually be necessary for recurrent disease

114
Q
  • Older kids (> 10 years)

- Symptoms: trismus, odynophagia; usually does not obstruct airway

A

Peritonsillar abscess

115
Q

Tx: peritonsillar abscess

A

Needle aspiration 1st, then drainage thru tonsillar bed if no relief in 24 hours (may need to intubate to drain; will self-drain with swallowing once opened)

116
Q

Younger kids (

A

Retropharyngeal abscess

117
Q

Tx: retropharyngeal abscess

A

Tx: intubate the patient in a calm setting; drainage thru posterior pharyngeal wall; will self-drain with swallowing once opened

118
Q

All age groups; occurs with dental infections, tonsillitis, pharyngitis

A

Parapharyngeal abscess

119
Q

What causes morbidity in parapharyngeal abscess?

A

Morbidity comes from vascular invasion and mediastinal spread with prevertebral and retropharyngeal spaces

120
Q

Tx: parapharyngeal abscess

A

Drain through lateral neck to avoid damaging internal carotid and internal jugular veins; need to leave drain in

121
Q

Acute infection of the floor of the mouth, involves mylohyoid muscle
- May rapidly spread to deeper structures and cause airway obstruction

A

Ludwig’s angina

122
Q

MCC dental infection of the mandibular teeth

A

Ludwig’s angina

123
Q

Tx: ludwig’s angina

A

Airway control, surgical drainage, antibiotics

124
Q

All lumps near ear

A

Parotid tumors until proven otherwise

125
Q

Diagnosis preauricular tumors

A

Diagnosis is usually made after superficial lobectomy

126
Q

80s of parotid tumors

A

80% salivary gland tumors are in parotid.
80% of parotid tumors are benign.
80% of benign parotid tumors are pleomorphic adenomas.

127
Q

MC distant metastases for head and neck tumors

128
Q

If no obvious malignant epithelial tumor, considered to have Hodgkin’s lymphoma until proven otherwise.
Need FNA or open biopsy.

A

Posterior neck masses

129
Q

Neck mass workup

A
  1. H&P, laryngoscopy, FNA (best test for dx); can consider antibiotics for 2 wks with re-eval if though to be inflammatory.
  2. Nondx? panendoscopy with multiple random biopsies, neck and chest CT
  3. Still no? Excisional biopsy (prepare for MRND)
130
Q

What does adenocarcinoma neck mass suggest?

A

Breast, GI, or lung primary

131
Q

Work up: epidermoid CA (SCCA variant) found in cervical node without known primary

A
  1. panendoscopy to look for primary; get random biopsies
  2. CT scan
  3. Still cannot find primary -> ipsilateral MRND, ipsilateral tonsillectomy (MC location for occult head / neck tumor), bilateral XRT
132
Q

MC location for occult head / neck tumor

133
Q

Dysphagia; most just below the cricopharynxgeus (95%)

- Dx and Tx: rigid EGD under anesthesia

A

Esophageal foreign body

134
Q

What dictates risk of perforation in esophageal foreign body?

A

Length of time in the esophagus

135
Q

Fever and pain after EGD for foreign body?

A

Gastrografin followed by barium swallow to rule out perforation

136
Q

Laryngeal foreign body - coughing

- Treatment?

A

Emergent cricothyroidotomy as a last resort may be need to secure airway

137
Q

Associated with MIs, arrhythmias and death

A

Sleep apnea

138
Q

More common in obese and those with micrognathia / retrognathia -> have snoring and excessive daytime somnolence

A

Sleep apnea

139
Q

Tx: sleep apnea

A

CPAP, uvulopalatopharyngoplasty (best surgical solution) or permanent trach

140
Q

Can lead to subglottic stenosis.

A

Prolonged intubation

141
Q

Treatment: subglottic stenosis after prolonged intubation

A

Tracheal resection and reconstruction

142
Q

Consider in patients who will require intubation for > 7-14 days

A

Tracheostomy

143
Q

Why tracheostomy for patients with prolonged intubation?

A

Decreases secretions, provides easier ventilation, decreased pneumonia risk

144
Q

Failure of tongue fusion.

- Tx: none necessary

A

Median rhomboid glossitis

145
Q

When can cleft lip (primary palate involve)?

A

Involves lip, alveolus or both

146
Q
  • Repair at 10 weeks, 10 lb, 10 Hgb.
  • Repair nasal deformities at same time
  • May be associated with poor feeding
A

Cleft lip (primary palate)

147
Q

Involves hard and soft palate; may affect speech and swallowing if not closed soon enough; may affect maxillofacial growth if closed too early -> repair at 12 months

A

Cleft palate (secondary palate)

148
Q

MC benign head and neck tumor in adults

A

Hemangioma

149
Q

Infection of the mastoid cells; can destroy bone

  • Rare; results as a complication of untreated acute supportive otitis media
  • Ear is pushed forward
A

Mastoiditis

150
Q

Tx: mastoiditis

A

Antibiotics, may need emergency mastoidectomy

151
Q
  • Rare since immunization against H. influenza type B
  • Mainly in children aged 3-5
  • Symptoms: stridor, drooling, leaning forward position, high fever, throat pain, thumbprint sign on lateral neck film
  • Can cause airway obstruction
A

Epiglottitis

152
Q

Tx: epiglottitis

A

Early control of the airway, antibiotics

ABSITE 2019-RM (33 decks)

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