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Surgery > Fiser ABSITE Ch. 19 Head and Neck > Flashcards

Fiser ABSITE Ch. 19 Head and Neck Flashcards

1
Q

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

A

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

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2
Q

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

A

posterior border of SCM muscle, trapezius muscle and the clavicle

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3
Q

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

A

anterior scalene muscle

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4
Q

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

A

Parotid
Sublingual
Submandibular

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5
Q

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

A

superior

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6
Q

What are the three branches of the trigeminal nerve?

A

ophthalmic, maxillary, mandibular

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7
Q

What nerve provides motor function to face? and sensory?

A

facial, trigeminal

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8
Q

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

A

Glossopharyngeal nerve

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9
Q

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

A

palatoglossus

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10
Q

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

A

cricothyroid is innerved by superior thyroid nerve

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11
Q

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

A

Frey’s syndrome

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12
Q

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

A

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

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13
Q

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

A

superior thyroid artery

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14
Q

What artery is the trapezius flap based on?

A

transerve cerivcal artery

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15
Q

What aretery is pectoralis major based on?

A

thoracoacromial artery

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16
Q

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

A

Torus palatini; Torus mandibular

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17
Q

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.

A

Radical neck dissection

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18
Q

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

A

Modified radical neck dissection

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19
Q

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

A

squamous cell CA

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20
Q

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

A

tobacco and ETOH

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21
Q

What is considered more pregmalignant, leukoplakia or erythroplakia?

A

erythroplakia

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22
Q

What is the most common site for oral cavity CA?

A

lower lip

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23
Q

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

A

hard palate tumors

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24
Q

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

A

Plummer-Vinson Syndrome;

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25
Q

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?

A

2 cm; MRND

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26
Q

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

A

XRT

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27
Q

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

A

commissure

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28
Q

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

A

Verrucous ulcer

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29
Q

What is the tx for cancer of the maxillary sinus?

A

maxillectomy

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30
Q

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

A

XRT, MRND with postop chemo for advanced disease

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31
Q

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

A

lymphoma, chemo

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32
Q

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

A

papilloma

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33
Q

What is the best way to bx tonsillary CA?

A

tonsillectomy

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34
Q

Benign tumor • Presents in males

A

Nasopharyngeal angiofibroma

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35
Q

What is the most common benign lesion of the larynx?

A

papilloma

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36
Q

What are the three locations for laryngeal cancer?

A

Supraglottic SCCA
Glottic SCCA
Subglottic SCCA

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37
Q

What is the tx for small laryngeal cancer?

A

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

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38
Q

What are the three treatments for large laryngeal cancer?

A

laryngectomy, MRND, post op XRT

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39
Q

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

A

laryngectomy

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40
Q

What is the most frequent salivary gland for malignant tumor?

A

parotid

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41
Q

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

A

mass in large gland is more likely benign

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42
Q

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

A

Mucoepidermoid CA

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43
Q

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

A

Adenoid cystic CA

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44
Q

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?

A

prophylactic MRND and postop XRT

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45
Q

With parotidectomy when should the facial nerve be sacrificed?

A

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

46
Q

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

A

pleomorphic adenoma

47
Q

What percentage of pleomorphic adenoma have malignant degeneration?

A

5%

48
Q

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

A

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

49
Q

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

A

Warthin’s tumor

50
Q

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

A

males, 10%

51
Q

What is the tx for Warthin’s tumor?

A

superficial parotidectomy

52
Q

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

A

greater auricular nerve, numbness over lower portion of auricle

53
Q

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

A

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

54
Q

What is the most common salivary gland tumor in children?

A

hemangiomas

55
Q

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

A

superficial and deep

56
Q

What is the physiology of cauliflower ear? and tx?

A

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

57
Q

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

A

chemodectomas

58
Q

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

A

Acoustic neuroma

59
Q

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.

A

Cholesteatoma

60
Q

20% of Ear SCCA metastasize to where?

A

parotid gland

61
Q

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

A

rhabdomyosarcoma

62
Q

What is the tx for septal hematoma?

A

need to drain to avoid infection and necrosis of septum

63
Q

What is the tx for nasal fractures?

A

set after swelling decreases

64
Q

CSF rhinorrhea usually indicates what fracture?

A

cribiform plate

65
Q

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

A

2-3 weeks

66
Q

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

A

90%

67
Q

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

A

internal maxillary artery or ethmoid artery

68
Q

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

A

Ameloblastoma

69
Q

Treatment for TMJ dislocation?

A

closed reduction

70
Q

What nerve damage can cause lip numbness?

A

inferior alveolar nerve

71
Q

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

A

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

72
Q

What is the most common organism is suppurative parotitis?

A

staph

73
Q

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

A

drainage

74
Q

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.

A

Sialoadenitis

75
Q

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

A

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

76
Q

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

A

older kids (>10 years), younger kids (

77
Q

Which is an airway emergency peritonsillar abscess or retropharyngeal abscess?

A

retropharyngeal abscess

78
Q

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

A

Pott’s disease

79
Q

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

A

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

80
Q

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

A

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

81
Q

What age group does parapharyngeal abscess occur in?

A

all age groups

82
Q

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

A

vascular invasion

83
Q

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

A

internal carotid and internal jugular veins

84
Q

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

A

Ludwig’s angina

85
Q

All lumps near ear are what until proven otherwise?

A

parotid tumors

86
Q

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

A

Lung

87
Q

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

A

Hodgkin’s lymphoma, FNA or open bx

88
Q

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

A

FNA, excisional biopsy

89
Q

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

A

breast, GI or lung

90
Q

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 ___

A

panendoscopy,

XRT

91
Q

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

A

just below the cricopharyngeus

92
Q

Perforation risk with esophageal foreign body increases with what?

A

length of time in the esophagus

93
Q

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

A

CXR and gastrografin followed by barium swallow to rule out perforation

94
Q

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

A

cricothyroidotomy

95
Q

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

A

vermillion border, Layered

96
Q

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

A

subglottic stenosis

97
Q

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

A

14-Jul

98
Q

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

A

pneumonia risk

99
Q

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

A

tracheo-innominate fistula, median sternotomy

100
Q

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

A

3rd tracheal ring

101
Q

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

A

none necessary

102
Q

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.

A

10 weeks, 10 lb, Hgb 10.

103
Q

Cleft palate should be repaired at what age?

A

12 months

104
Q

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

A

hemangioma

105
Q

Thumbprint sign on lateral neck film indicates what?

A

Epiglottitis

106
Q

Why is epiglottits rare?

A

H. influenzae type B vaccine

107
Q

What is the tx for epiglottitis?

A

early control of airway and abx

108
Q

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

A

oral and pharyngeal mucosa

109
Q

What is the most common neoplasm in pts with AIDS?

A

Kaposi’s sarcoma

110
Q

What are the 2 treatments for Kaposi’s sarcoma?

A

XRT and intratumor vinblastine

Surgery (33 decks)

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