Common Head and Neck Sx - Exam 1 Flashcards by Johannah Crumpton

_____ is one of the MC surgical procedures done on kids. What is their purpose?

adenoidectomy

Adenoids are a patch of lymphoid tissue that sits at the very back of the nasal passage. Like tonsils, adenoids help keep the body healthy by trapping harmful bacteria and viruses that we breathe in or swallow

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What is the tonsil grading system?

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What are the 3 indications for an tonsillectomy in pediatric patients?

OSA

recurrent throat infections

peritonsillar abscess

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What are the throat infection criteria in order to have a tonsillectomy?

> 7 episodes in 1y
5 episodes in each of 2y
3 episodes in each of 3y

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What are the indications for adenoidectomy in a pediatric patient?

Nasal obstruction 2/2 adenoid hypertrophy (OSA)

Chronic sinusitis

Recurrent otitis media with h/o tubes

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What are the CI to tonsillectomy/ adenoidectomy?

Cleft palate

Coagulopathies/anemia

Active infection

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peritonsillar abscess is called by what bacteria?

group A strep

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What are the indications for a tracheostomy? what are the 2 different types?

For patients who are unable to wean from invasive ventilation within 1-3w of intubation

think critically ill patients, medically induced coma

open vs percuntaneous

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Which type of trach is preferred? Why?

percutaneous

less time to perform, does NOT require an OR and can be done sooner

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What are the CI to percutaneous trach?

less than 15yrs

Uncorrectable bleeding diathesis

Gross distortion of the neck

infection

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What are early complications of a trach?

obstruction

Sub-Q emphysema/Pneumothorax

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What type of trach are obstructions more common in?

More common in perc trach d/t posterior wall membranes of the tracheaW

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What are late complications of trach? Which one is the most devastating?

Tracheal stenosis and malacia

Tracheoarterial fistula ** most devastating

Reduced phonation

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Why is tracheoarterial fistula the most devastating complication?

Massive hemorrhage

Occurs d/t erosion of the tracheal tube through the anterior wall and forming a fistulous communication with the innominate artery

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When should a trach tube be changed?

Initial change at 7-14d s/p insertion then every 30-90d

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What is decannulation? When can you do it? What is the criteria?

Decannulation is the process of removing a tracheostomy tube, or trach tube, from the neck

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

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What is failed decannulation associated with?

age

greater severity of illness

renal failure

shorter duration of spontaneous breathing prior to decannulation

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What is the decannulation process?

Tube Downsizing and Capping Trial
Removal of tube
Closing the stoma

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What are causes of a thyroid nodule?

Thyroid adenoma

Thyroid cyst

Hashimoto’s Disease

Multinodular goiter

Iodine Deficiency

Cancer

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What increases the risk of a thyroid nodule being cancerous? What percent are malignant?

1)Children, adults < 30 or > 60

2) h/o head and neck irradiation

3) Family h/o thyroid CA

5% are malignant

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What test/imaging should you order in a thyroid nodule?

TSH

fine needle aspiration (FNA)

thyroid scintigraphy

What result of a thyroid scintigraphy is more likely to be benign?

Hyperfunctioning nodules = “hot” - rarely malignant

“Cold” nodule - represents a hypofunctioning area - more likely to be malignant

What are the 3 kinds of primary thyroid cancers? Which one is the MC?

Papillary - most common

Follicular

Anaplastic - most aggressive (not common)

What are three additional types of thyroid cancers?

Thyroid lymphoma

Medullary cancers (a part of MEN type 2)

Metastatic

What are the indications for a total thyroidectomy as part of the tx for thyroid cancer?

Multifocal nodules Nodule >1cm Nodule that extends across isthmus Metastatic or Anaplastic

When is a thyroid lobectomy indicated?

Single nodule < 1cm

What structure is super important to NOT hit when performing thyroid sx? What arteries supply the thyroid? What veins?

recurrent laryngeal nerve superior and inferior thyroid arteries Venous drainage is via the superior, middle, and inferior thyroid veins

What would damage to the recurrent laryngeal nerves present like? What do they do to help prevent damage?

hoarseness and trouble speaking use NIM monitoring to test the tissue before cutting

What are 3 complications of a thyroidectomy?

Recurrent laryngeal nerve injury Resection of parathyroids Hypothyroidism

What does resection of the parathyroids lead to?

hypocalcemia -> which leads to muscle spasms, tetany, dementia, seizures

Name this sign. What does it indicate?

Chvostek's sign low calcium

Name this sign. What does it indicate?

Trousseau's sign low calcium

What is the post-op management of a thyroidectomy?

monitor voice check calcium levels levothyroxine

What are the indications for a parotidectomy?

Blockage of parotid duct - d/t stone or mass Parotid mass or tumor

How do you dx an enlarged parotid gland? What additional imaging?

US or CT with contrast MRI indicated if concerned for malignancy or vascular tumor

What nerve would you be concerned about hitting during an parotidectomy? What would be utilized post op?

facial nerve -> use NIM monitoring would use drains

What are the complications of a parotidectomy?

Facial Nerve Paralysis Seroma Hematoma Wound Infection

What is a carotid endarterectomy?

a surgical procedure to remove a build-up of fatty deposits (plaque), which cause narrowing of a carotid artery.

What are the indications for a CEA?

Carotid Stenosis: BOTH symptomatic and asymptomatic

What is the initial imaging modality used to dx CEA? What is the gold standard to dx?

US- initial Angiography (CTA/MRA)

What are the indications for CEA? Where is the MC blockage location?

70-99% stenosis of carotid artery in pts with greater than 5 years to live at bifurcation

What is the absolute CI for CEA?

Absolute –asymptomatic complete occlusion of the carotid artery

What is the relative CI for CEA?

Relative- h/o neck irradiation, tracheostomy, h/o radical neck dissection, unacceptably high medical risk

What nerve are you concerned about hitting during CEA?

vagus nerve

**What medications should the pt START taking before a CEA?

ASA 81mg and statins **CEA the pt can stay on the ASA or start taking it**

_____ is often used during the CEA sx to maintain adequate bloodflow

use shunt around the plaque they are removing

What are the complications of CEA?

CVA MI cerebral hyperperfusion nerve injury hematoma

What nerves are at risk for damage with CEA?

Hypoglossal Vagus Facial branches Ansa cervicalis Recurrent Laryngeal

What is the post-op care for CEA? What floor?

going to ICU