ENT Surgery

Question 1

In terms of cochlear implant surgery, what major surgery is performed alongside it for the implant

Answer 1

Mastoidectomy

Question 2

What are the indications for a mastoidectomy?

State some complications

Answer 2

Acute mastoiditis
Chronic suppurative otitis media
Cholesteatoma
Temporal bone malignancy
Cochlear implant surgery

For acute mastoiditis: (from Acute otitis media with complications, not resolved with grommet if recurrent)

Complications:
Facial nerve dysfunction
Hearing loss
Tinnitus
Vertigo
Intracranial complications (Meningitis, abscess, haemorrhage)
Sigmoid sinus thrombosis

Question 3

Frey’s syndrome is associated with what surgery?

What is Frey’s syndrome?

Answer 3

Parotidectomy

Gustatory sweating due to regeneration of damaged auriculotemporal nerve (V3)

Basically abnormal parasympathetic regeneration causes actual sweat glands to be formed => when thinking of food, you sweat instead of salivate.

Question 4

There are superficial and total parotidectomies. When would you perform either?

Complications of both

Answer 4

Superficial if benign or low grade malignant tumours involving the superficial lobe with preservation of the facial nerve

Total if high grade malignant/deep lobe involvement/facial nerve involvement

Complications:
Bleeding/haematoma
Loss of sensation to skin over the ear lobe, parotid, and mastoid (greater auricular nerve - C2, C3)
Frey’s syndrome
Sialocele
Cutaneous salivary gland fistula
Facial nerve paresis (Hyperacusis, Tasting Ant 2/3 (corda tympani), Motor - Muscles of the face except muscles of mastication -CNV), Sensory - Ramsay Hunt Area (Cavum Concha of pinna), Lacrimal glands, submandibular, and sublingual salivary (only bisects the parotid gland (CNIX), Stapes)

Question 5

Neck dissection is the surgical management of head and neck malignancies and involves excision of the cervical lymph node. What are the 3 main types of neck dissection?

Answer 5

Selective neck dissection
Modified radical neck dissection
Radical neck dissection

Question 6

What does Selective neck dissection involve removal of?

Answer 6

Excision of nodes at risk of metastasis

Question 7

What does a Radical neck dissection involve?

Answer 7

Excision of node levels I-V
Spinal accessory nerve
Internal jugular vein
SCM

Question 8

If you chose to do a modified radical neck dissection, there are 3 types of surgeries you may perform. Excision of what is included in all 3 types?

What are the differences between all 3 types?

Answer 8

All involve excision of node levels I-V
Type 1: + Internal jugular + SCM
Type 2: + SCM
Type 3: All are spared => only node I-V

Recall that there is a flap involved

Question 9

Laceration of the spinal accessory nerve in neck dissection leads to what sequelae?

Answer 9

Frozen shoulder syndrome
=> patients undergoing modified/radial neck dissection need physio for this

Question 10

Sacrificing the internal jugular nerve in neck dissection leads to what sequelae?

Answer 10

Facial and cerebral oedema (less drainage => oedema)

Question 11

What are the specific complications of neck dissection

Answer 11

Flap necrosis
Facial/cerebral oedema (IJV)
Frozen shoulder (Spinal accessory nerve)
Vagus nerve injury
Marginal mandibular nerve injury
Carotid artery
Thoracic duct leak => Chyle leak and fistula.