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Surgery > Common Head and Neck Surgeries > Flashcards

Common Head and Neck Surgeries Flashcards

1
Q

What is a tonsillectomy?

A

Procedure in which both palatine tonsils are fully removed from the back of the throat

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2
Q

What is a adenoidectomy?

A

Surgical removal of the adenoids, one of the most common surgical procedures in kids

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3
Q

What are adenoids?

A

Patch of lymphoid tissue that sits at back of nasal passage
Trap harmful bacteria and viruses that we breathe in or swallow

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4
Q

Indications for tonsillectomy (+/- adenoidectomy) in a pediatric patient

A

OSA first-line treatment
Recurrent throat infections if >7 in 1 year, >5 in each of 2 years of >3 in each of 3 years
Peritonsillar abscess

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5
Q

What is a grade 0 tonsil grade? 4?

A

0: not visible beyond anterior tonsillar pillar/surgically removed; IV: tonsils meet at midline “kissing tonsils”

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6
Q

What does OSA lead to?

A

Cardiovascular and cognitive comorbidities

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7
Q

COmplications of peritonsillar abscess

A

Airway obstruction
Recurrent infection

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8
Q

Indications for adenoidectomy in pediatric patient

A

Nasal obstruction due to adenoid hypertrophy with OSA
Chronic sinusitis
Recurrent otitis media with h/o tubes

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9
Q

Contraindications to tonsillectomy/adenoidectomy

A

Cleft palate
Coagulopathies/anemia
Active infection

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10
Q

Diagnosis of T&A surgical need?

A

Clinical assessment demonstrating recurrent infections
Sleep study + OSA

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11
Q

What most commonly causes peritonsillar abscess?

A

Group B strep

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12
Q

Tracheostomy indications

A

For patients who are unable to wean from invasive ventilation within 1-3 weeks of intubation
Critically ill patients or medically induced coma

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13
Q

What are benefits of percutaneous tracheostomy?

A

Less time to perform
Less expensive
Can be done sooner

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14
Q

Who performs a percutaneous tracheostomy?

A

Surgeon
Interventional pulmonologist
Trained critical care clinician

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15
Q

What is the risk of percutaneous tracheostomy

A

greater risk for tracheal injury

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16
Q

Contraindications (relative) of trach?

A

<15 yo
Uncorrectable bleeding diathesis
Gross distortion of neck due to hematoma, tumor, thyromegaly, or scarring
Infection

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17
Q

Benefits of trach

A

Comfort: need for pain meds and sedation decrease
Weaning from ventilation

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18
Q

Early complications of a trach

A

Obstruction: more common in percutaneous d/t posterior wall membranes of the trachea
SubQ emphysema/pneumothorax: 1%

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19
Q

Late complications of trach

A

Tracheal stenosis and malacia: formation of granulation tissue
Tracheoarterial fistula
Reduced phonation

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20
Q

What is the most devastating complciation of trach? What happens?

A

Tracheoarterial fistula
Erosion of the tracheal tube through anterior wall forming fistula communicating with innominate artery

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21
Q

When are tracheostomy tubes changed?

A

Initially at 7-14 days s/p insertion then every 30-90 days

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22
Q

What additional factors should cause you to change trach tube?

A

Patient has discomfort
Malposition
Patient-ventilator asynchrony
Cuff leak
Fracture of tube
Need for bronchoscopy

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23
Q

What criteria must be met in order to decannulate

A

Weaned from mechanical ventilation
No upper airway obstruction
Clear their own secretions that are neither copious or too thick
Have an effective cough

24
Q

What is failed decannulation associated with?

A

Age
Greater severity of illness
Renal failure
Shorter duration of spontaneous breathing prior to decannulation

25
What is the process of decannulation?
1) Tube downsizing and capping trial in hospital or ENT office 2) removal of tube: stroma covered with occlusive dressing and observation for 24-48 hours 3) closing the stroma
26
When is capping not done unless in ICU or in medically ordered polysomnogram?
during sleep
27
How is stoma closed?
tracheocutaneous fistula (open tract between skin and trachea) covered with bandage until fully closed bandage replaced daily or more frequently if it becomes saturated
28
what are causes of thyroid nodules?
Thyroid adenoma thyroid cyst hashimoto's disease multinodular goiter iodine deficiency cancer
29
what is a thyroid adenoma?
benign overgrowth of tissue
30
what is a thyroid cyst
results from degenerating adenomas usually benign but can contain solid cancerous tissue
31
what is hashimotos disease
chronic inflammation
32
what causes a multinodular goiter
iodine deficiency or thyroid disorder
33
what are characteristics of thyroid cancer?
Hard, large, painful or non-painful mass
34
What increases risk of thyroid mass malignancy?
1) Children, adults <30 or >60 2) h/o head and neck irradiation 3) family h/o thyroid CA
35
diagnosis of thyroidectomy need
physical exam revealing enlarged thyroid or thyroid mass If TSH subnormal-hyperfunctioning thyroid If TSH 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 need for surgery Thyroid scintigraphy
36
What is the purpose of thyroid scintigraphy?
Determines function of nodule by injecting radioactive contrast dye Hyperfunctioning nodules are rarely malignant "hot" "cold" hypofunctioning areas are more likely to be malignant
37
what are the primary thyroid cancers?
papillary (MC) follicular anaplastic (most agressive but not common)
38
What are secondary forms of thyroid cancers
Thyroid lymphoma Medullary cancers (a part of MEN type 2) Metastatic
39
Treatment for thyroid cancer
Total thyroidectomy Lobectomy
40
When would a total thyroidectomy be performed?
Multifocal nodules Nodule >1 cm Nodule that extends across isthmus Metastatic or anaplastic
41
When could a lobectomy be performed?
Single nodule <1 cm
42
Complications of thyroidectomy
Recurrent laryngeal nerve injury --> vocal cord paralysis Resection of parathyroids --> hypocalcemia --> muscle spasms, tetany, dementia, seizures, Chvostek and Trousseaus sign Hypothyroidism
43
Postoperative management of thyroidectomy
Monitor voice Check serum calcium levels Start on levothyroxine
44
Indications for parotidectomy
Blockage of parotid duct d/t stone or mass Parotid mass or tumor
45
Diagnosis of parotidectomy
Enlargement of the parotid gland Can start with US but is limited by sonographer experience CT with contrast first line imaging/MRI if concerned for malignancy or vascular tumor
46
Complications of parotidecomy
Facial nerve paralysis Seroma Hematoma Wound infection
47
What is a carotid endarterectomy?
Procedure to remove build-up of fatty deposits, which cause narrowing of a carotid artery
48
Indications of need for carotid endarterectomy
Carotid stenosis, symptomatic or asymptomatic
49
Diagnosis of need for carotid endarterectomy
Physical exam with auscultation of carotids US is initial screening Angiography as gold standard CTA/MRA
50
Indications for surgery via carotid endarterectomy
70-99% stenosis of carotid artery Patient >5 year life expectancy who medically qualifies
51
Where is a carotid artery blockage most common?
At bifurcation
52
Contraindications to carotid endarterectomy
Absolute: asymptomatic complete occlusion of the carotid artery Relative: h/o neck irradiation, tracheostomy, h/o radical neck dissection, unacceptably high medical risk
53
Preop preparation for carotid endarterectomy
ASA 81 mg Statins Often admitted for BP and heart monitoring prior, preop antibiotics
54
Complications of carotid endarterectomy
CVA (30 day p/o rates of .25-3%: ischemia --> plaque emoli --> platelet aggregates MI (MC) cerebral hyperperfusion nerve injury (hypoglossal, vagus, facial branches, ansa cervicalis, recurrent laryngeal) Hematoma
55
Postop care after carotid endarterectomy
Admit to telemetry or ICU Neuro checks every hour BP checks every 2 hours: systolic BP b/t 100-150 Continue aspirin and statins Typically inpatient for 3-5 days Follow up in 3-6 weeks for U/S

Surgery (7 decks)

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