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ABSITE > Fiser Chapter 19 HEAD AND NECK > Flashcards

Fiser Chapter 19 HEAD AND NECK Flashcards

1
Q

Anterior neck triangle

A

SCM, sternal notch, inferior border of digastric muscle

Contains carotid sheath

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2
Q

Posterior neck triangle

A

SCM posterior border, trapezium, clavicle

Contains accessory nerve (to SCM, trap, platysma) and brachial plexus

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3
Q

Parotid vs sublingual vs. submandibular gland secretions

A

Parotid -> serous

Sublingual -> mucin

Submandibular -> 50/50

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4
Q

False versus true vocal cords

A

False are superior to true in larynx

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5
Q

Location of vagus nerve in neck

A

Between carotid and IJ

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6
Q

Location of phrenic nerve in neck

A

On top of anterior scalene muscle

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7
Q

Location of long thoracic nerve in neck

A

Posterior to middle scalene muscle

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8
Q

Sensory nerve to face

A

Trigeminal with ophthalmic, maxillary, mandibular branches

Mandibular branch also gives taste to anterior 2/3 of tongue, floor of mouth, gingiva

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9
Q

Motor nerve to face

A

Facial nerve with temporal, zygomatic, buccal, marginal mandibular, cervical branches

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10
Q

Taste nerves

A

Trigeminal anterior 2/3 of tongue

Glossopharyngeal posterior 1/3 of tongue

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11
Q

Swallowing nerve

A

Glossopharyngeal (motor to stylopharyngeus, also taste posterior 1/3 tongue)

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12
Q

Motor nerve to tongue

A

Hypoglossal (motor to all of tongue except palatoglossus): tongue deviates toward same side of injury

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13
Q

Laryngeal muscle innervation

A

Superior laryngeal nerve innervates cricothyroid muscle

Recurrent laryngeal nerve innervates all the rest

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14
Q

Gustatory sweating after parotidectomy

A

Frey’s syndrome: injury to auriculotemporal nerve, that then cross-innervates with sympathetic fibers to sweat glands of skin

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15
Q

Thyrocervical trunk branches

A

STAT:

Suprascapular artery
Transverse cervical artery
Ascending cervical artery
inferior Thyroid artery

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16
Q

External carotid artery branches

A

STAPLF (like staple) OPAMST

  1. Superior thyroid artery
  2. Ascending pharyngeal
  3. Lingual
  4. Facial
  5. Occipital
  6. Posterior auricular
  7. Maxillary
  8. Superficial temporal
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17
Q

Trapezius flap blood supply

A

transverse cervical artery

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18
Q

Pectoralis major flap blood supply

A

Either thoracoacromial artery or internal mammary artery

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19
Q

Torus palatine and Toru mandibular

A

Congenital bony mass on upper palate of mouth, or on lingual surgace of mandible
Tx: Nothing

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20
Q

Radical versus modified radical neck dissection

A

Radical: takes accessory nerve, SCM, IJ, omohyoid, submandibular gland, sensory nerves C2-C5, cervical branch of facial nerve, ipsilateral thyroid

Modified: leaves accessory nerve, SCM, IJ

No mortality difference between them. Most morbidity occurs from accessory nerve resection

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21
Q

Most common cancer of oral cavity, pharynx, and larynx; risk factors

A

Squamous cell carcinoma

Risk factors tobacco and EtOH

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22
Q

Erythroplakia versus leukoplakia

A

Erythroplakia more premalignant

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23
Q

Oral cavity borders

A

Mouth floor, anterior 1/3 of tongue, gingiva, hard palate, anterior tonsillar pillars, lips

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24
Q

Most common site for oral cavity CA

A

Lower lip (more common than upper lip d/t sun exposure)

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25
Q

Oral cancer location with lowest survival rate

A

Hard palate (hard to resect)

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26
Q

Risk factor for oral cavity cancer

A

-Plummer-Vinson synrome (glossitis, cervical dysphagia from esophageal web, spoon fingers, iron-deficiency anemia)

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27
Q

Oral cavity cancer treatment

A
  • Wide resection (1 cm margins)
  • MRND: tumors >4 cm, clinically positive nodes, or bone invasion
  • Postop XRT: advanced lesions (>4 cm, positive margins, or nodal/bone involvement)
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28
Q

Lip cancer, most common site, site where most aggressive, and when flaps needed

A

Lower lip

Along commissure

Flaps if > 1/2 lip removed

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29
Q

Tongue cancer with jaw invasion, can you still operate?

A

Yes (commando procedure)

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30
Q

Verrucous ulcer

A

Well-differentiated SCCA often found on the check, associated with oral tobacco; not aggressive, rare metastasis

Tx: full cheek resection +/- flap; NO MRND

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31
Q

MRND indications

A

Oral cancer > 4 cm, or if node/bone invasion

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32
Q

Maxillary sinus cancer tx

A

Maxillectomy

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33
Q

Tonsillar CA risk factors, type, tx

A

EtOH, tobacco, males

SCCA most common

Asymptomatic until large, 80% have node mets at dx

Tx: Tonsillectomy to bx, wide resection with margins afterward

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34
Q

Nasopharyngeal SCCA risk factors, presentation, metastasis, tx, types

A
  • EBV
  • Chinese

Presents: nose bleeding or obstruction

Goes to: posterior cervical neck nodes

Tx: XRT primary therapy (very sensitive; give chemo-XRT for advanced disease; NO SURGERY)

Types: is lymphoma in children, give chemotherapy
Papilloma is most common benign neoplasm of nose/paranasal sinuses

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35
Q

Treatment of nasopharyngeal cancer

A

XRT

Chemo for advanced disease

No surgery!

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36
Q

Oropharyngeal cancer presentation, mets, tx

A

Presents: neck mass and sore throat

Goes to: posterior cervical neck nodes

Tx: XRT for tumors < 4 cm and no node/bone invasion
Otherwise surgery, MRND, XRT

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37
Q

Hypopharyngeal SCCA presentation, mets, tx

A

Presents: hoarseness, early mets!

Goes to: anterior cervical nodes

Tx: XRT for tumors < 4 cm, no node/bone invasion
Otherwise surgery, MRND, XRT

38
Q

15yo male with epistaxis and nasal obstruction

A

Nasopharyngeal angiofibroma - benign tumor

Extremely vascular

Tx: Angiography and embolization (usually internal maxillary artery), followed by resection

39
Q

Where do the different types of pharyngeal cancer metastasize to, and what is tx for each?

A

Nasopharyngeal SCCA: posterior cervical neck nodes
Tx: XRT, chemo-XRT for advanced, NO surgery

Oropharyngeal SCCA: posterior cervical neck nodes
Tx: XRT as long as < 4cm and no node/bone invasion
otherwise surgery, MRND, XRT

Hypopharyngeal SCCA: anterior cervical neck nodes
Tx: XRT as long as < 4 cm and no node/bone invasion
otherwise surgery, MRND, XRT

40
Q

Hoarseness, aspiration, dyspnea, dysphagia

A

Laryngeal cancer, if benign then papilloma

Tx: XRT if vocal cord only, otherwise chemo-XRT
Try to preserve larynx, surgery is not primary tx
MRND (with ipsilateral thyroid) if nodes clinically positive

41
Q

Neck mass and swelling in the floor of the mouth

A

Salivary gland cancer

Painless mass, benign

Pain and facial nerve paralysis or LAD: malignant

80% of salivary tumors are in parotid

80% of parotid tumors are benign

80% of benign parotid tumors are pleomorphic adenomas

42
Q

Most frequent SITE for malignant salivary tumor

A

Parotid

Mass in large salivary gland more likely benign
Mass in small salivary gland more likely malignant

43
Q

Most frequent malignant salivary tumor

A
  1. Mucoepidermoid cancer, wide range of aggressiveness

2. Adenoid cystic cancer: long, indolent course, propensity to invade nerve roots, very sensitive to XRT

44
Q

Salivary gland cancer lymphatic drainage

A

Intra-parotid and anterior cervical chain nodes

45
Q

Tx of salivary gland cancer

A

Resection of salivary gland (total parotidectomy), prophylactic MRND, postop XRT if high grade or advanced
If in parotid, need to take whole loe, try to preserve facial nerve

46
Q

Benign salivary gland tumors

A
  1. Pleomorphic adenoma: Tx superficial parotidectomy; if malignant degeneration (occurs in 5%), need total parotidectomy
  2. Warthin’s tumor: males, bilateral in 10%, tx superficial parotidectomy
47
Q

Most common injured nerve with parotid surgery

A

Greater auricular nerve (numbness over lower portion of ear)

Facial nerve branches course between superficial and deep lobes

48
Q

Submandibular gland resection, which nerves must be identified?

A

Facial nerve mandibular branch, lingual nerve, hypoglossal nerve

49
Q

Most common salivary gland tumor in children

A

Hemangiomas

50
Q

Most common nasopharyngeal tumor in children

A

Lymphoma, tx chemo

51
Q

Ear pinna lacerations, how to suture

A

through involved cartilage

52
Q

Cauliflower ear

A

Undrained hematomas that organize and calcify, need to be drained to avoid this

53
Q

Epidermal inclusion cyst of ear; slow growing but erode as grow; present with conductive hearing loss and clear drainage from ear (dx and tx)

A

Cholesteatoma

Tx: Surgical excision

54
Q

Paraganglionoma (vascular tumor of middle ear, dx and tx)

A

Chemodectoma

Tx: Surgery and XRT

55
Q

Tinnitus, hearing loss, unsteadiness, tumor in cerebellar/pontine angle

A

Acoustic neuroma (CN VIII)

Tx: craniotomy and resection, XRT is alrternative

56
Q

Ear SCCA metastasis and tx

A

Goes to: parotid gland

Resection and parotidectomy, MRND for positive nodes or large tumor

57
Q

Most common childhood aural malignancy of middle or external ear

A

Rhabdomyosarcoma (though rare)

58
Q

Nasal fracture tx

A

Set after swelling decreases

59
Q

Septal hematoma tx

A

Drain to avoid infection and septum necrosis

60
Q

CSF rhinorrhea tx

A

Usually due to cribriform plate fracture
Dx: CSF has tau protein, may need contrast study to help find leak and any facial fractures

-Conservative 2-3 weeks; try epidural catheter drainage of CSF; may need transethmoidal repair

61
Q

Epistaxis tx

A

90% are anterior and can be controlled with packing

Consider internal maxillary artery or ethmoid artery embolization for persistent posterior bleeding

62
Q

Radicular cyst of tooth

A

Inflammatory cyst at root of teeth, can cause bone erosion, lucent on X ray, tx local excision or curettage

63
Q

Ameloblastoma of tooth

A

Slow-growing malignancy of odontogenic epithelium (outside portion of teeth); soap bubble appearance on X ray, tx wide local excision

64
Q

Osteogenic sarcoma of jaw

A

Poor prognosis

Tx: multimodality approach including surgery

65
Q

Maxillary jaw fracture tx

A

Wire fixation

66
Q

TMJ dislocation tx

A

Closed reduction

67
Q

Lower lip numbness, underlying nerve

A

Inferior alveolar nerve damage (branch of mandibular nerve)

68
Q

Stensen’s duct laceration (parotid duct) tx

A

Repair over catheter stent

Ligation can cause painful parotid atrophy and facial asymmetry

69
Q

Suppurative parotitis tx

A
  • Occurs in eldery patients with dehydration, staph most common organism, can be life-threatening
  • Tx: fluids, salivation, antibiotics, drainage if abscess develops or not improving
70
Q

Sialoadenitis

A

Acute inflammation of a salivary gland related to stone in duct; most calculi near orifice; 80% submandibular or sublingual glands

Recurrent d/t ascending infection from oral cavity

Tx: Incise duct and remove stone; gland excision may eventually be necessary for recurrent disease

71
Q

15yo kid with trismus, odynophagia, airway fine

A

Peritonsillar abscess

Tx: Needle aspiration first, then drainage through tonsillar bed if no relief in 24hrs (may need to intubate to drain, will self-drain with swallowing once opened)

72
Q

5yo kid with fever, odynophagia, drooling

A

Retropharyngeal abscess, AIRWAY EMERGENCY

Can also occur in elderly with Pott’s disease

Tx: Intubate patient in calm setting, drainage through posterior pharyngeal wall, will self-drain with swallowing once opened

73
Q

Parapharyngeal abscess, morbidity is from what; tx

A

Occurs with dental infections, tonsillitis, pharyngitis

Morbidity from vascular invasion and mediastinal spread via prevertebral and retropharyngeal spaces

Tx: Drain through lateral neck to avoid damaging internal carotid and IJ; leave drain in

74
Q

Acute infection of floor of mouth involving mylohyoid muscle

A

Ludwig’s angina

MCC dental infection of mandibular teeth

May rapidly spread to deeper structures and cause airway obstruction

Tx: airway control, surgical drainage, abx

75
Q

Preauricular tumor

A

Parotid tumor until proved otherwise

76
Q

Most common distant mets for head and neck tumors

A

Lung

77
Q

Posterior neck mass

A

If no obvious malignant epithelial tumor, considered to have Hodgkin’s lymphoma until proved otherwise. Need FNA or open biopsy

78
Q

Neck mass workup

A
  1. H&P, laryngoscopy, FNA (best test for dx); can consider abx for 2 week with re-eval if seems inflammatory
  2. Panendoscopy with multiple random biopsies, neck and chest CT
  3. Perform excisional biopsy; need to be prepared for MRND
79
Q

Adenocarcinoma on bx of head and neck cancer

A

Suggests breast, GI, or lung primary

80
Q

Epidermoid CA (SCCA variant) found in cervical node without known primary -> what do you do?

A
  1. Panendoscopy with random biopsies
  2. CT scan
  3. If still cannot find primary, ipsilateral MRND, ipsilateral tonsillectomy (most common location for occult head/neck tumor), bilateral XRT
81
Q

Dysphagia, found to have esophageal foreign body (most just below cricopharyngeus) -> dx and tx?

A

Rigid EGD under anesthesia

Perforation risk increases with length of time in esophagus

82
Q

Fever and pain after EGD for foreign body -> next step

A

Gastrografin followed by barium swallow to rule out perforation

83
Q

Coughing, found to have laryngeal foreign body

A

May need emergent cricothyroidotomy as last resort to secure airway

84
Q

Sleep apnea associated with what

A

MIs, arrhythmias, death

Most common in obese and those with micrognathia/retrognathia

85
Q

Sleep apnea tx

A

CPAP

Uvulopalatopharyngoplasty (best surgical solution)

Or permanent trach

86
Q

Prolonged intubation complication and tx

A

Subglottic stenosis

Tx: Tracheal resection and reconstruction

87
Q

Indication for tracheostomy

A

Patients who will require intubation for > 7-14 days

Decreases secretions, provides easier ventilation, decreases PNA risk (???)

88
Q

Median rhomboid glossitis

A

Failure of tongue fusion

Tx: none necessary

89
Q

Cleft lip (primary palate) tx

A

Involves lip, alveolus, or both

May be associated with poor feeding

Tx: Repair at 10 weeks, 10 lb, Hgb 10
- Repair nasal deformities at same time

90
Q

Most common benign head and neck tumor in adults

A

Hemangioma

91
Q

Mastoiditis

A

Infection of mastoid cells, can destroy bone, rare

Results as complication of untreated ACUTE SUPPURATIVE OTITIS MEDIA

Ear is pushed forward

Tx: Abx, may need emergency mastoidectomy

92
Q

4yo with stridor, drooling, leaning forward, high fever, throat pain, thumbprint sign on lateral neck film

A

Epiglottitis

Rare since HiB vaccine

Tx: early control of airway, abx

ABSITE (34 decks)

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