Common Head and Neck Surgeries Flashcards
procedure in which both palatine tonsils are fully removed from the back of the throat
Tonsillectomy
surgical removal of the adenoids. It’s one of the most common surgical procedures done on kids.
Adenoidectomy
- a patch of lymphoid tissue that sits at the very back of the nasal passage
- keeps the body healthy by trapping harmful bacteria and viruses that we breathe in or swallow.
Adenoids
tonsil grading system
Indications for T (+/- A) in pediatric patient
- OSA
- recurrent throat infections
- peritonsillar abscess
condition that Leads to cardiovascular and cognitive comorbidities
OSA
number of throat infections that indicate for T (+/- A) for pediatric pts
- > 7 episodes in 1y
- > 5 episodes in each of 2y
- > 3 episodes in each of 3y
Indications for Adenoidectomy in pediatric patient
- Nasal obstruction 2/2 adenoid hypertrophy - OSA
- Chronic sinusitis
- Recurrent OM with h/o tubes
contraindications for Tonsillectomy/Adenoidectomy
- Cleft palate
- Coagulopathies/anemia
- Active infection
diagnostics in which indicates for a T&A
- Clinical assessment demonstrating recurrent infections
- Sleep study (+) OSA
1.
MCC of peritonsillar abscess?
Polymicrobial, Strep pyogenes (GAS)
Staph aureus
indications for tracheostomy
- unable to wean from invasive ventilation within 1-3w of intubation - Critically ill patients; Medically induced coma
- Less time to perform
- Less expensive
- Performed by surgeon, interventional Pulmonologist, trained critical care clinician
- Can be done sooner (no OR required)
- Greater risk for tracheal injury
which type of trach
percutaneous
Contraindications (relative) to percutaneous trach
- < 15yo
- Uncorrectable bleeding diathesis
- Gross distortion of the neck - Hematoma, tumor, thyromegaly, scarring
- Infection
pros of percutaneous trach
- comfort
- weaning from vent
early complications of percutaneous/operative trach
- Obstruction - MC perc trach d/t posterior wall membranes of the trachea
- Sub-Q emphysema/Pneumothorax
late complications from percutaneous/operative trach
- Tracheal stenosis and malacia - Formation of granulation tissue
- Tracheoarterial fistula - Most devastating; Massive hemorrhage; d/t erosion of tracheal tube through anterior wall and forms fistulous communication with innominate artery
- Reduced phonation
Clinically accepted practices for changing a tacheostomy tube
- Initial change at 7-14d s/p insertion then every 30-90d
- Change if:
- Patient has discomfort
- Malposition
- Patient-ventilator asynchrony
- Cuff leak
- Fracture of tube
- Need for bronchoscopy
Appropriate candidates for decannulation AFTER weaning from mechanical ventilation must meet following criteria:
- No upper airway obstruction
- Must clear their own secretions that are neither copious or to thick
- Have an effective cough
Failed decannulation associated with what factors?
- age
- greater severity of illness
- renal failure
- shorter duration of spontaneous breathing prior to decannulation
Decannulation/Tube removal Process
- Tube Downsizing and Capping Trial
- Removal of Tube
- closing the stoma
components of Tube Downsizing and Capping Trial
- capping trial can be done in hospital or in ENT office in Airway Clinic.
- Assessing tolerance to breathing through nose and mouth with tracheostomy tube covered
- Capping during sleep should only be done during ICU observation or in a medically ordered polysomnogram (sleep study)
The opening without a tracheostomy tube is called a ?, which means an open tract between the skin and trachea.
tracheocutaneous (TC) fistula
indications for Thyroidectomy
Thyroid nodule or mass (benign or malignant), Goiter
caues of thyroid nodules
- adeoma
- cyst
- hashimotos
- multnodular goiter
- iodine def
- CA
Overgrowth of thyroid tissue (benign)
adenoma
- Typically result from degenerating adenomas
- Usually benign but can contain solid cancerous tissue
thyroid
cyst
causes of multinodular goiter
Iodine deficiency or thyroid disorder
Risk of thyroid malignancy increases with:
1) Children, adults < 30 or > 60
2) h/o head and neck irradiation
3) Family h/o thyroid CA
w/u for thyroid diagnosis
- TSH - Subnormal-hyperfunctioning thyroid; Elevated-hypofunctioning
- U/S - to determine extent of nodule/mass and if there are multiple nodules
-
FNA - cytology results determine if benign or malignant and
determine need for surgery
what is a Thyroid scintigraphy ?
findings?
- Determines “function” of nodule
- Inject radioactive contrast dye (Tc 99 or Iodide)
- Hyperfunctioning nodules = “hot” - rarely malignant
- “Cold” nodule - represents a hypofunctioning area - more likely to be malignant
classifications of thyroid cancers
primary - Papillary (MC); Follicular; Anaplastic (most aggressive; less common)
other: thyroid lymphoma, medullary CA, mets
Treatment for Thyroid Cancer
- total thyroidectomy
- lobectomy
indications for total thyroidectomy
- Multifocal nodules
- Nodule >1cm
- Nodule that extends across isthmus
- Metastatic or Anaplastic
indication for lobectomy
single nodule < 1cm
the thyroid derives its blood supply principally from what arteries?
venous drainage?
- superior and inferior thyroid arteries
- superior, middle, and inferior thyroid veins
complications of thyroidectomy
- Recurrent laryngeal nerve injury - Vocal Cord Paralysis
- Resection of parathyroids - Hypocalcemia; Muscle spasms, tetany, dementia, seizures; Chvostek’s & Trousseau’s signs
- Hypothyroidism
postop mgmt for thyroidectomy
- Monitor voice
- Check serum calcium levels
- Start on Levothyroxine (Synthroid)
indications for parotidectomy
- Blockage of parotid duct - d/t stone or mass
- Parotid mass or tumor
diagnostics for parotidectomy
- Enlargement of parotid gland
- Can start with US
- CT w/ contrast 1st-line
- MRI indicated if concerned for malignancy or vascular tumor
complications of parotidectomy
- Facial Nerve Paralysis
- Seroma
- Hematoma
- Wound Infection
a surgical procedure to remove a build-up of fatty deposits (plaque), which cause narrowing of a carotid artery.
Carotid Endarterectomy
indications of carotid endarterectomy
Carotid Stenosis (Carotid Atherosclerosis)
Symptomatic or asx
- > 5 year life expectancy
- medically qualify
diagnostics for carotid endarterectomy
- auscultation of carotids
- U/S - initial screening exam
- Angiography - “gold standard”
- CTA/MRA
where is blockage MC in cartoid stenosis
bifurcation
contraindications for Carotid Endarterectomy
- Absolute – asx complete occlusion of the carotid artery
- Relative - h/o neck irradiation, tracheostomy, h/o radical neck dissection, unacceptably high medical risk
preop prep for carotid endarterectomy
- admit - BP control, cardiac monitoring
- ASA 81mg, Statins
- preop abx
complications of carotid endarterectomy
- CVA - Ischemia, Plaque emboli, Platelet aggregates
1.MI - M/C post-op complication - Cerebral hyperperfusion
- Nerve Injury (Hypoglossal, Vagus, Facial branches, Ansa cervicalis, Recurrent Laryngeal)
- Hematoma
postop care of carotid endarterectomy
- Admitted to telemetry or ICU
- Neuro checks every hour
- BP checks every 2 hours - SBP 100-150
- Continue ASA, statins, +/- other antiplatelets
- inpatient for 3-5 days
- Follow up in 3-6 weeks for U/S
