Fiser ABSITE Ch. 19 Head and Neck Flashcards by CM L

The anterior neck triangle contains the carotid sheath. What are the borders?

SCM muscle, sternal notch and inferior border of the digastric muscle

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The posterior neck triangle contains the spinal accessory nerve and the brachial plexus. What are the borders?

posterior border of SCM muscle, trapezius muscle and the clavicle

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In the neck, on what muscle does the phrenic nerve sit?

anterior scalene muscle

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Three glands in the mouth can be identified by their secretions:
____ glands - secrete mostly serous fluid.
___ glands - secrete mostly mucin.
___ glands - 50/50

Parotid
Sublingual
Submandibular

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In the larynx, where are the false vocal cords located in relation to the true vocal cords?

superior

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What are the three branches of the trigeminal nerve?

ophthalmic, maxillary, mandibular

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What nerve provides motor function to face? and sensory?

facial, trigeminal

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What nerve provides sensory to posterior tongue. Motor to stylpharngeus. Injury affects swallowing?

Glossopharyngeal nerve

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Hypoglossal nerve provides motor to all of tongue except what muscle?

palatoglossus

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Recurrent laryngeal nerve innervates all of larynx except which muscle? What is it innervated by?

cricothyroid is innerved by superior thyroid nerve

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What syndrome occurs after parotidectomy; injury of auriculotemporal nerve that then cross-innervates with sympathetic fibers to sweat glands of skin • Symptom: gustatory sweating?

Frey’s syndrome

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What are the 5 branches of the thyrocervical trunk with mnemonic?

STAT, suprascapular artery, transverse cervical artery, ascending cervical artery, inferior thyroid artery

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What is the 1st branch of the external carotid artery?

superior thyroid artery

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What artery is the trapezius flap based on?

transerve cerivcal artery

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What aretery is pectoralis major based on?

thoracoacromial artery

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___ - congenital bony mass on upper palate of mouth. Tx: nothing ;
___ - similar to above but on the anterior lingual surface of the mandible

Torus palatini; Torus mandibular

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What procedure takes accessory nerve (CN XII), sternocleidomastoid, internal jugular, omohyoid, submandibular gland, sensory nerves C2-C5, cervical branch of facial nerve, and ipsilateral thyroid • Most morbidity occurs from accessory nerve resection.

Radical neck dissection

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What procedure takes omohyoid, submandibular gland, sensory nerves C2-C5, cervical branch of facial nerve, ipsilateral thyroid?

Modified radical neck dissection

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What is the most common cancer of the oral cavity, pharynx, and larynx?

squamous cell CA

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What are the two biggest risk factors for squamous cell CA of the oral cavity, pharynx and larynx?

tobacco and ETOH

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What is considered more pregmalignant, leukoplakia or erythroplakia?

erythroplakia

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What is the most common site for oral cavity CA?

lower lip

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What location for oral cavity cancer has the lowest survival rate because it is hard to resect?

hard palate tumors

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Glossitis, cervical dysphagia from esophageal web, spoon fingers, iron deficiency anemia and increased oral cavity CA

Plummer-Vinson Syndrome;

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In the tx for oral cavity CA. Wide resection if tumor is less than ___, need 1-2 cm margins.; If larger or if clinically positive nodes do what?

2 cm; MRND

What is the postop tx for oral cavity CA for advanced lesions (>2 cm, positive margins, nerve/vascular/lymphatic invasion)?

XRT

What location with lip CA is associated with more aggressive lesions?

commissure

Well-differentiated tumor of the cheek • Not aggressive • Tx: full cheek resection +/− flap; no MRND

Verrucous ulcer

What is the tx for cancer of the maxillary sinus?

maxillectomy

What is the primary tx for nasopharyngeal SCCA? and what for tumors > 2 cm or clinically positive nodes?

XRT, MRND with postop chemo for advanced disease

What is the #1 tumor of the nasopharynx in children and what is the tx?

lymphoma, chemo

What is the most common benign neoplasm of the nose/paranasal sinuses?

papilloma

What is the best way to bx tonsillary CA?

tonsillectomy

Benign tumor • Presents in males

Nasopharyngeal angiofibroma

What is the most common benign lesion of the larynx?

papilloma

What are the three locations for laryngeal cancer?

Supraglottic SCCA Glottic SCCA Subglottic SCCA

What is the tx for small laryngeal cancer?

XRT or conservative surgery (glottic is laser or chordectomy with recurrence)

What are the three treatments for large laryngeal cancer?

laryngectomy, MRND, post op XRT

With glottic laryngeal cancer, what treatment is required for fixed cords?

laryngectomy

What is the most frequent salivary gland for malignant tumor?

parotid

Is a mass in a large salivary gland more likely benign or malignant? and a small salivary gland?

mass in large gland is more likely benign

What is the #1 type of malignant tumor of the salivary gland?

Mucoepidermoid CA

What is the #2 type of malignant tumor of the salivary glands and the #1 malignant salivary tumor of the minor salivary glands?

Adenoid cystic CA

Tx for malignant tumor of the salivary gland is resection of the gland and if high grade or SCCA what are 2 other additional treatments?

prophylactic MRND and postop XRT

With parotidectomy when should the facial nerve be sacrificed?

facial nerve should be sacrificed only for direct tumor invasion or for preexisting facial paralyses

What is the #1 benign tumor of the salivary glands? what

pleomorphic adenoma

What percentage of pleomorphic adenoma have malignant degeneration?

What is the difference in tx for pleomorphic adenoma and one with malignant degeneration?

superficial parotidectomy for pleomorphic adenoma and total parotidectomy with malignant degeneration with MRND if high grade

What is the #2 benign tumor of the salivary glands?

Warthin's tumor

What sex preference for Warthin's tumor? what percent are bilateral?

males, 10%

What is the tx for Warthin's tumor?

superficial parotidectomy

What is the most common injured nerve with parotid surgery and what is the sx?

greater auricular nerve, numbness over lower portion of auricle

For submandibular gland resection what three nerves need to be found?

mandibular branch of the facial nerve, lingual nerve and hypoglossal nerve

What is the most common salivary gland tumor in children?

hemangiomas

The facial nerve runs between what two lobes of the parotid gland?

superficial and deep

What is the physiology of cauliflower ear? and tx?

undrained hematomas that organize and calcify; need to be drained to avoid this

What is the name of a vascular tumor of the middle ear (paraganglionoma), tx: surgery and +/- XRT

chemodectomas

CN VIII, tinnitus, hearing loss, unsteadiness; can grow into cerebellar/pontine angle. Tx: craniotomy and resection; XRT is alternative to surgery

Acoustic neuroma

Epidermal inclusion cyst of ear; slow growing but erode as they grow; present with conductive hearing loss and clear drainage from ear. Tx: surgical excision.

Cholesteatoma

20% of Ear SCCA metastasize to where?

parotid gland

What is the most common childhood aural malignancy (although rare) of the middle or external ear?

rhabdomyosarcoma

What is the tx for septal hematoma?

need to drain to avoid infection and necrosis of septum

What is the tx for nasal fractures?

set after swelling decreases

CSF rhinorrhea usually indicates what fracture?

cribiform plate

CSF rhinorrhea tx is conservative for how long? then try epidural catheter, may need transethmoid repiar.

2-3 weeks

What percentage of epistaxis is anterior and can be controlled with packing?

90%

Persistant posterior epistaxis, consider ligation (direct or angiographically) of what two arteries?

internal maxillary artery or ethmoid artery

Slow-growing odontogenic malignancy; soap bubble appearance on xray; can have metastases. Tx: wide-local excision.

Ameloblastoma

Treatment for TMJ dislocation?

closed reduction

What nerve damage can cause lip numbness?

inferior alveolar nerve

What is the tx for Stensen's duct laceration? why not ligation?

repair over catheter stent. Ligation can cause painful parotid atrophy and facial asymmetry

What is the most common organism is suppurative parotitis?

staph

Tx for suppurative parotitis includes fluids, salivation, antibiotics; and ___ if abscess develops or pt not improving.

drainage

Acute inflammation of the salivary gland related to a stone in the duct; most calculi near orifice. Recurrent is thought to be due to ascending infection from the oral cavity. 80% of the time affects the submandibular or sublingual glands.

Sialoadenitis

What is the tx for sialoadenitis? and for recurrent disease?

incise duct and remove stone, gland excision may eventually be necessary for recurrent diesease

What age group is peritonsillar abscess more common? and retropharyngeal abscess?

older kids (>10 years), younger kids (

Which is an airway emergency peritonsillar abscess or retropharyngeal abscess?

retropharyngeal abscess

Retropharyngeal abscess is usually seen in younger kids but can be seen in the elderly with what disease?

Pott's disease

What is the 1st tx for peritonsillar abscess? and if no relief in 24 hrs?

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

Retropharyngeal abscess is an airway emergency. What is the tx?

Intubate the patient in a calm setting; drainage through posterior pharyngeal wall; will self-drain with swallowing once opened.

What age group does parapharyngeal abscess occur in?

all age groups

Morbitity in parapharyngeal abscess comes from ___ and mediastinal spread via prevertebral and retopharyngeal spaces.

vascular invasion

Tx for parapharyngeal abscess includes drainage through lateral neck to avoid damaging what 2 structures? will need to leave drain in.

internal carotid and internal jugular veins

Acute infection of the floor of the mouth, involves mylohyoid muscle • Most common cause is dental infection of the mandibular teeth • May rapidly spread to deeper structures and cause airway obstruction • Tx: airway control, surgical drainage, antibiotics

Ludwig's angina

All lumps near ear are what until proven otherwise?

parotid tumors

What is the most common distant metastases location for head and neck tumors?

Lung

With posterior neck masses, if no obvious malignant epithelial tumor, considered to have what until proven otherwise? and how to dx?

Hodgkin's lymphoma, FNA or open bx

Neck mass workup: • 1st - history and exam, laryngoscopy, antibiotics if thought to be inflammatory, ___ if hard • 2nd - panendoscopy with multiple random biopsies, neck and chest CT • 3rd - still cannot figure it out → perform ____; need to be prepared for MRND

FNA, excisional biopsy

Adenocarcinoma found in neck mass workup suggests what 3 possible primaries?

breast, GI or lung

Epidermoid CA found in cervical node without known primary • 1st - ___ with random biopsies • 2nd - CT scan • 3rd - still cannot find primary → ipsilateral MRND, ipsilateral tonsillectomy, bilateral ___

panendoscopy, | XRT

What is the most common location for esophageal foreign body (95%)?

just below the cricopharyngeus

Perforation risk with esophageal foreign body increases with what?

length of time in the esophagus

Fever and pain after rigid EGD for esophageal foreign body. What next?

CXR and gastrografin followed by barium swallow to rule out perforation

Laryngeal foreign body, what might be needed as a last resort to secure airway?

cricothyroidotomy

Lip lacerations - apposition of the ___ is key. ___ closure is preferred

vermillion border, Layered

Prolonged intubation - can lead to ___, which is treated with laser, dilatation, possible excision

subglottic stenosis

Tracheostomy should be considered in any pt who will require intubation for more than how many days?

14-Jul

Tracheostomy decreases secretions, provides easier ventilation, and decreases what other risk?

pneumonia risk

Rapid exsanguination after tracheostomy, think what? and do what?

tracheo-innominate fistula, median sternotomy

Tracheo-innominate fistula can be avoided by keeping tracheostomy above what?

3rd tracheal ring

Median rhomboid glossitis is failure of tongue fusion. What is the tx?

none necessary

Cleft lip should be repaired at how many weeks, how many pounds and with a Hgb of what? Repair nasal deformities at the same time.

10 weeks, 10 lb, Hgb 10.

Cleft palate should be repaired at what age?

12 months

What is the most common benign head and neck tumor in adults?

hemangioma

Thumbprint sign on lateral neck film indicates what?

Epiglottitis

Why is epiglottits rare?

H. influenzae type B vaccine

What is the tx for epiglottitis?

early control of airway and abx

What are the most common sites for Kaposi's sarcoma?

oral and pharyngeal mucosa

What is the most common neoplasm in pts with AIDS?

Kaposi's sarcoma

What are the 2 treatments for Kaposi's sarcoma?

XRT and intratumor vinblastine