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Z.Fiser > Fiser.19.Head.Neck > Flashcards

Fiser.19.Head.Neck Flashcards

1
Q

what are the boundaries of the anterior neck triangle?

A

anterior border of SCM, sternal notch, inferior border of digastric muscle

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2
Q

which structure is contained in the anterior neck triangle?

A

carotid sheath

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3
Q

what are the borders of the posterior neck triangle?

A

posterior border of SCM, trapezius, clavicle

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4
Q

name two important contents of the posterior neck triangle

A

accessory nerve and brachial plexus

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5
Q

what do parotid glands secrete?

A

mostly serous fluid

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6
Q

what do sublingual glands secrete?

A

secrete mostly mucin

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7
Q

what do submandibular glands secrete?

A

50/50 serous and mucous

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8
Q

where are the false vocal cords in relation to the true vocal cords?

A

false cords are superior to the true cords

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9
Q

describe the shape of the tracheal cartilage

A

u-shaped cartilage and posterior portion is membranous

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10
Q

where does the vagus nerve run in the carotid sheath?

A

runs between the IJV and carotid artery

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11
Q

where does the phrenic nerve run in the neck?

A

lies on top of the anterior scalene muscle

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12
Q

where does the long thoracic nerve run in the neck?

A

runs posterior to the middle scalene muscle

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13
Q

name the three branches of the trigeminal nerve and what it innervates

A

ophthalmic, maxillary, mandibular, provides sensation to the face

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14
Q

what does the mandibular branch of the trigeminal nerve innervate?

A

taste to anterior 2/3 of tongue, floor of mouth, and gingiva

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15
Q

name the five branches of the facial nerve and its overall function

A

motor function to the face: temporal, zygomatic, buccal, marginal mandibular, cervical

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16
Q

what does the glossopharyngeal nerve innervate (2)

A

taste to the posterior 1/3 of tongue and motor

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17
Q

what is affected by injury to the glossopharyngeal nerve?

A

injury affects swallowing

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18
Q

what does the hypoglossal nerve innervate?

A

innervates for motor to all of the tongue except palatoglossus

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19
Q

which way does the tongue deviate with a hypoglossal injury?

A

tongue deviates to the same side as a hypoglossal injury

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20
Q

what does the recurrent laryngeal nerve innervate?

A

innervates all of the larynx except cricothyroid muscle

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21
Q

what does the superior laryngeal nerve innervate?

A

innvervates the cricothyroid muscle

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22
Q

What is Frey’s syndrome and how does it occur?

A

occurs after parotidectomy, injury of the auriculotemporal nerve that cross-innervates with sympathetic fibers to sweat glands of skin, leads to gustatory sweating

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23
Q

what are the four branches of the thyrocervical trunk?

A

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

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24
Q

what is the first branch of the external carotid artery?

A

superior thyroid artery

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25
Q

what is the arterial supply for a trapezius flap?

A

superior thyroid artery

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26
Q

what is the arterial supply to a pectoralis major flap (2)?

A

thoracoacromial artery or internal mammary artery

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27
Q

what is torus palatinus and what is its treatment?

A

congenital bony mass on the upper palate of the mouth, requires no treatment

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28
Q

what is torus mandibularis and what is its treatment?

A

congenital bony mass on the lingual surface of the mandible, requires no treatment

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29
Q

what is removed with a modified radical neck dissection?

A

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

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30
Q

what is the mortality difference between modified radical neck dissection and radical neck dissection?

A

no mortality difference between MRND and RND

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31
Q

what is the difference between modified radical neck dissection and radical neck dissection?

A

same as MRND plus accessory nerve, SCM, and internal jugular resection

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32
Q

what is the MCC of morbidity with radical neck dissection?

A

MCC of morbidity is 2/2 accessory nerve resection

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33
Q

what is the MC cancer of the oral cavity, pharyngeal, or laryngeal

A

squamous cell CA

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34
Q

what are the two biggest risk factors for SCC of the oral cavity, pharynx, and larynx?

A

tobacco & EtOH

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35
Q

which is considered more premalignant? leukoplakia or erythroplakia?

A

erythroplakia (red on tongue) is more premalignant than leukoplakia (white on tongue)

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36
Q

name the contents of the oral cavity

A

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

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37
Q

what is the MC location of oral cavity CA and why?

A

lower lip (more common than upper lip 2/2 sun exposure)

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38
Q

which location of oral cavity CA has the lowest rate of survival and why?

A

lowest for hard palate tumors b/c hard to resect

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39
Q

what is Plummer-Vinson syndrome?

A

glossitis and cervical dysphagia from esophageal web, spoon fingers, iron-deficiency anemia

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40
Q

how does Plummer Vinson syndrome affect rates of oral cavity CA?

A

increased rates of oral cavity CA

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41
Q

what is the surgical treatment of oral cavity CA

A

wide resection with 1cm margins, MRND for tumors > 4cm, clinically positive nodes, or bone invasion

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42
Q

what are the indications for postop XRT for oral cavity CA?

A

advanced lesions (>4cm, positive margins, or nodal/bone involvement)

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43
Q

when are flaps required when resecting cancer from the lip?

A

when more than 1/2 of the lip is removed

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44
Q

what location of lip cancers are the most aggressive?

A

along the commissure

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45
Q

what is a verrucous ulcer, where is it found, and how aggressive is it?

A

a well-differentiated SCCA taht is often found on the cheek, not aggressive, rare metastasis, usu 2/2 oral tobacco

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46
Q

what is the treatment of verrucous ulcer

A

full cheek resection +/- flap, no MRND

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47
Q

what is the treatment for cancer of the maxillary sinus?

A

maxillectomy

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48
Q

what are three risk factors for tonsillar CA?

A

males, tobacco, EtOH

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49
Q

what is the MC type of tonsillar CA?

A

SCCA

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50
Q

how does tonsillar CA present? what is the frequency of LN mets at presentation?

A

asymptomatic until large; 80% have lymph node metastases at time of diagnosis

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51
Q

how do you biopsy and treat suspected tonsillar CA?

A

tonsillectomy is the best way to biopsy, treat with wide resection with margins

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52
Q

name two risk factors for nasopharyngeal SCCA

A

EBV, Chinese heritage

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53
Q

how does nasopharyngeal SCCA present?

A

nose bleeding or obstruction

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54
Q

which lymph nodes do nasopharyngeal SCCA metastasize to?

A

posterior cervical neck nodes

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55
Q

what is the treatment nasopharyngeal SCCA

A

XRT primary therapy, very sensitive

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56
Q

what is the treatment for advanced nasopharyngeal SCCA?

A

chemo-XRT, no surgery

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57
Q

what is the #1 tumor of the nasopharynx in children?

A

lymphoma

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58
Q

what is the treatment of nasopharyngeal lymphoma in children?

A

chemotherapy

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59
Q

what is the MC benign neoplasm of the nose/paranasal sinuses?

A

papilloma

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60
Q

how does oropharyngeal SCCA present?

A

neck mass and sore throat

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61
Q

which lymph nodes do oropharyngeal SCCA drain to?

A

posterior cervical neck nodes

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62
Q

what is the treatment of oropharyngeal SCCA < 4cm with no nodal/bone invasion?

A

XRT

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63
Q

what is the treatment of oropharyngeal SCCA >4cm or with nodal/bone invasion?

A

surgery, MRND, and XRT for advanced tumors

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64
Q

how does hypopharyngeal SCCA present?

A

hoarseness, early mets

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65
Q

where does hypopharyngeal SCCA drain to / metastasize to?

A

anterior cervical nodes

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66
Q

is a nasopharyngeal angiofibroma malignant or benign?

A

benign

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67
Q

what age/sex group is nasopharyngeal angiofibroma usually present in and with what symptoms?

A

males < 20 years with obstruction or epistaxis

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68
Q

what is the vascularity of the nasopharyngeal angiofibroma?

A

extremely vascular

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69
Q

what is the treatment of nasopharyngeal angiofibroma

A

angiography and embolization (usually internal maxillary artery) followed by resection

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70
Q

how does laryngeal cancer present?

A

hoarseness, aspiration, dyspnea, and dysphagia

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71
Q

what is the goal of surgery with laryngeal cancer?

A

try to preserve larynx, so surgery is not the primary treatment

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72
Q

how do you treat laryngeal cancer limited to the vocal cord?

A

XRT

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73
Q

how do you treat laryngeal cancer beyond the vocal cord?

A

chemo-XRT

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74
Q

when is MRND indicated with laryngeal CA and what additional stuff do you need to resect?

A

if nodes are clinically positive, including taking the ipsilateral thyroid lobe

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75
Q

what is the MC benign lesion of the larynx

A

papilloma

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76
Q

name the four salivary glands

A

parotid, submandibular, sublingual, and minor salivary glands

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77
Q

how do submandibular or sublingual tumors usually present?

A

can present as a neck mass or swelling in the floor of the mouth

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78
Q

what is the most frequent site of salivary gland malignant tumors?

A

parotid gland

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79
Q

is a mass in a large salivary gland more likely to be benign or malignant?

A

benign

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80
Q

is a mass in a small salivary gland more likely to be benign or malignant?

A

malignant

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81
Q

name three symptoms that malignant salivary gland cancers present with?

A

painful mass, facial nerve paralysis, or lymphadenopathy

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82
Q

where do malignant salivary gland tumors drain to? (2)

A

intraparotid LNs and anterior cervical chain nodes

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83
Q

what is the #1 malignant tumor of the salivary glands and how aggressive is it?

A

mucoepidermoid CA, wide range of aggressiveness

84
Q

what is the #2 malignant tumor of the salivary glands and how aggressive is it?

A

adenoid cystic CA, long indolent course

85
Q

where does adenoid cystic CA of the salivary gland tend to invade?

A

propensity to invade nerve roots

86
Q

what is the radiosensitivity of adenoid cystic CA of the salivary glands?

A

very sensitive to XRT

87
Q

what is the treatment for mucoepidermoid CA of the salivary glands?

A

resection of the salivary gland (total parotidectomy if in parotid gland, try to prserve facial nerve), MRND, and postop XRT if high grade or advance disease

88
Q

what is the treatment of adenoid cystic CA of the salivary glands?

A

resection of the salivary gland (total parotidectomy if in parotid gland, try to prserve facial nerve), MRND, and postop XRT if high grade or advance disease

89
Q

how do benign salivary gland tumors present?

A

present as a painless mass

90
Q

what is the #1 benign tumor of the salivary glands

A

pleomorphic adenoma

91
Q

what is the rate of malignant degeneration of a salivary pleomorphic adenoma?

A

5%

92
Q

what is the treatment of salivary gland pleomorphic adenoma?

A

superficial parotidectomy

93
Q

how does treatment of salivary gland pleomorphic adenoma change with malignant degeneration?

A

malignant degeneration requires total parotidectomy

94
Q

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

A

Warthin’s tumor

95
Q

which sex has a higher risk of Warthin’s tumor?

A

males

96
Q

what percentage of patients with Warthin’s tumor have bilateral involvement?

A

10%

97
Q

what is the treatment of Warthin’s tumor?

A

superficial parotidectomy

98
Q

what is the MC injured nerve with parotid surgery and how does injury present?

A

injury to greater auricular nerve presents with numbness over the lower portion of the ear

99
Q

what three nerves must you identify during submandibular gland resection?

A

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

100
Q

what is the MC salivary gland tumor in children?

A

hemangiomas

101
Q

What incision is used for superficial parotidectomy?

A

the standard Blair incision or facelift incision

102
Q

Where do the branches of the facial nerve course in terms of the parotid lobes?

A

branches of the facial nerve course between the superficial and deep lobes of the parotid

103
Q

where can you find the main trunk of the facial nerve?

A

8mm deep to thetympanomastoid suture line at the same level as the digastric muscle

104
Q

how do you treat pinna lacerations?

A

suture through the involved cartilage

105
Q

what is the pathophysiology of cauliflower ear and how can it be prevented?

A

secondary to undrained hematomas that organize and calcify in the ear, can be prevented by draining hematomas

106
Q

what is a cholesteatoma?

A

epidermal inclusion cyst of the ear, slow growing but erodes as it grows

107
Q

how do cholesteatomas present?

A

present with conductive hearing loss and clear drainage from the ear

108
Q

how do you treat cholesteatomas?

A

surgical excision

109
Q

what is a chemodectoma of the ear?

A

vascular tumor of the middle ear (paraganglionoma)

110
Q

what is the treatment of a chemodectoma of the ear?

A

surgery +/- XRT

111
Q

which nerve is affected by an acoustic neuroma?

A

CN VIII

112
Q

how do acoustic neuromas present?

A

tinnitus, hearing loss, unsteadiness, can grow into cerebellar / pontine angle

113
Q

what is the treatment for acoustic neuroma?

A

craniotomy and resection, XRT is an alternative

114
Q

what % of ear SCCA metastasize to the parotid gland?

A

20%

115
Q

what is the treatment of ear SCCA? When is MRND indicated?

A

resection and parotidectomy, MRND for positive nodes or larger tumors

116
Q

what is the MC aural malignancy in childhood?

A

rhabdomyosarcoma of the middle or external ear

117
Q

when should you set a nasal fracture?

A

after the swelling decreases

118
Q

how do you treat septal hematomas and why?

A

need to drain them to avoid infection and necrosis of the septum

119
Q

what protein is in CSF?

A

tau protein

120
Q

what type of nasal injury is a/w CSF rhinorrhea?

A

cribiform plate fracture

121
Q

how do you evaluate CSF rhinorrhea?

A

repair of facial fractures may help leak, may need contrast study to help find leak

122
Q

how do you treat CSF rhinorrhea?

A

conservative tx for 2-3 weeks, try epidural catheter drainage of CSF, may need transethmoidal repair

123
Q

what percentage of epistaxis is anterior?

A

90%

124
Q

how do you treat anterior epistaxis bleeding?

A

packing

125
Q

how do you treat persistent posterior epistaxis bleeding unresponsive to packing/balloon tamponade?

A

internal maxillary artery or ethmoid artery balloon embolization

126
Q

what is a radicular cyst of the jaw?

A

inflammatory cyst at the root of the teeth that can cause bone erosion

127
Q

how does radicular cyst of the jaw appear on XR?

A

radiolucent on XR

128
Q

how do you treat radicular cyst of the jaw?

A

local excision and curettage

129
Q

what is ameloblastoma?

A

slow-growing malignancy of odontogenic epithelium (outside portion of teeth)

130
Q

what is the appearance of ameloblastoma on XR?

A

soap bubble appearance on XR

131
Q

how do you treat ameloblastoma?

A

WLE

132
Q

what is the prognosis of osteogenic sarcoma?

A

poor prognosis

133
Q

how do you treat osteogenic sarcoma?

A

multimodal approach including surgery

134
Q

how do you treat maxillary jaw fractures?

A

most are treated with wire fixation

135
Q

how do you treat TMJ dislocation?

A

closed reduction

136
Q

what is the cause of lower lip numbness a/w jaw injury?

A

inferior alveolar nerve damage (branch of mandibular nerve)

137
Q

how do you treat Stensen’s duct (parotid duct) laceration?

A

repair over catheter stent

138
Q

why should you not ligate the Stensen duct (parotid duct)?

A

ligation can cause painful parotid atrophy and facial asymmetry

139
Q

what is the MC demographic p/w suppurative parotitis?

A

usually in elderly patients, can be life-threatening

140
Q

what is the MCC of suppurative parotitis?

A

dehydration

141
Q

what is the MC organism that causes suppurative parotitis?

A

staph

142
Q

what is the tx of suppurative parotitis?

A

fluids, salivation, abx, drainage if abscess develops or patient not improving

143
Q

what is siloadenitis?

A

acute inflammation of a salivary gland related to a stone in the duct, most calculi are near the orifice

144
Q

what two types of salivary glands are most commonly affected by siloadenitis and how often?

A

80% of the time affects submandibular or sublingual glands

145
Q

what is the cause of recurrent siloadenitis?

A

due to ascending infection from teh oral cavity

146
Q

what is the treatment of siloadenitis?

A

incise duct and remove stone; gland excision may eventually be necessary for recurrent disease

147
Q

what age group usually presents with peritonsillar abscess?

A

older kids > 10 years

148
Q

what are the symptoms of peritonsillar abscess?

A

trismus, odynophagia, usually does NOT obstruct airway

149
Q

how do you treat peritonsillar abscess?

A

needle aspiration first, then drainage through the tonsillar bed if no relief in 24 hours, may need to intubate to drain, will self-drain with swallowing once opened

150
Q

what age group presents with retropharyngeal abscess?

A

younger kids < 10 years or elderly with Pott’s disease (TB of the vertebrae)

151
Q

how do children present with retropharyngeal abscess?

A

fever, odynophagia, drool, AIRWAY EMERGENCY

152
Q

how do you treat a patient with retropharyngeal abscess?

A

intubate patient in a calm setting; drainage through posterior pharyngeal wall, will self-drain with swallowing once opened

153
Q

what age group presents with parapharyngeal abscesses and with which comorbidities?

A

all age groups, occurs with dental infections, tonsillitis, or pharyngitis

154
Q

what is the mechanism of morbidity a/w parapharyngeal abscesses?

A

morbidity comes from vascular invasion and mediastinal spread via prevertebral and retropharyngeal spaces

155
Q

how do you treat parapharyngeal abscesses?

A

drain through lateral neck to avoid damaging internal carotid and internal jugular veins; need to leave drain in

156
Q

what is Ludwig’s angina?

A

acute infection of the floor of the mouth, involves mylohyoid muscle

157
Q

what is the MCC of Ludwig’s angina?

A

dental infection of the mandibular teeth

158
Q

What is the MOA of airway obstruction a/w Ludwig’s angina?

A

may rapidly spread to deeper structures and cause airway obstruction

159
Q

how do you treat Ludwig’s angina?

A

airway control, surgical drainage, antibiotics

160
Q

all lumps near the ear are _____ until proven otherwise

A

parotid tumors

161
Q

how do you diagnose lumps near the ear?

A

diagnosis made after superficial lobectomy

162
Q

what % of salivary tumors are in the parotid gland?

A

80%

163
Q

what % of parotid tumors are benign?

A

80%

164
Q

what % of benign parotid tumors are pleomorphic adenomas?

A

80%

165
Q

what is the MC site of metastases for head/neck tumors?

A

lung

166
Q

what is a posterior neck mass considered until proven otherwise?

A

considered Hodgkin’s lymphoma until proven otherwise

167
Q

How do you evaluate a posterior neck mass?

A

FNA or open biopsy

168
Q

What is the first line of dx for neck mass workup?

A

H&P, laryngoscopy, and FNA. Can consider abx for 2 weeks with reevaluation if you think its inflammatory

169
Q

What is the second line of dx for neck mass workup?

A

if H&P, laryngoscopy, and FNA nondiagnostic –> panendoscopy with multiple random bx and neck/chest CT

170
Q

what is the third line of dx for neck mass workup?

A

if first and second line evaluation nondiagnostic –> excisional biopsy, need to be prepared for MRND

171
Q

what should you suspect if you diagnose an adenocarcinoma of the neck?

A

suggests breast, GI, or lung primary

172
Q

what is the diagnostic workup for epidermoid CA (SCCA variant) found in cervical node without known primary? (3 lines)

A

1st line is panendoscopy to look for primary; get random bx; 2nd line is CT scan; 3rd line is ipsilateral MRND, ipsilateral tonsillectomy, bilateral XRT

173
Q

why is ipsilateral tonsillectomy indicated as the third line for workup of epidermoid CA found in cervical node?

A

tonsils are the MC location for occult head/neck tumors

174
Q

what is the presenting sx of an esophageal foreign body?

A

dysphagia

175
Q

what is the MC location of esophageal foreign bodies and with what frequency?

A

95% just below the cricopharyngeus

176
Q

what is the dx and tx of esophageal foreign body?

A

rigid EGD under anesthesia

177
Q

what increases the risk of perforation with esophageal foreign body?

A

perforation risk increases with length of time in the esophagus

178
Q

how do you evaluate fever and pain after EGD for foreign body?

A

gastrograffin followed by barium swallow to r/o perforation

179
Q

how does laryngeal foreign body present?

A

coughing

180
Q

how do you treat laryngeal foreign body

A

emergent cricothyroidotomy as a last resort to be needed to secure airway

181
Q

what are two anatomical risk factors a/w sleep apnea

A

obesity, micrognathia / retrognathia

182
Q

what are three complications a/w sleep apnea?

A

MIs, arrhythmias, death

183
Q

how do you treat sleep apnea (3)

A

CPAP, uvulopalatopharyngoplasty (best surgical solution), or permanent trach

184
Q

what is a complication of prolonged intubation?

A

subglottic stenosis

185
Q

how do you treat subglottic stenosis?

A

tracheal resection and reconstruction

186
Q

when is tracheostomy indicated in the ventilated patient?

A

pts who require intubation for >7-14 days

187
Q

what are three benefits of tracheostomy in a patient with prolonged intubation?

A

decreases secretions, provides easier ventilation, decreases pneumonia risk

188
Q

what is the cause of median rhomboid glossitis (glossal central papillary atrophy)?

A

failure of tongue fusion

189
Q

how do you treat median rhomboid glossitis?

A

no treatment needed

190
Q

what is the involvement of primary palate cleft lip?

A

involves lip, alveolus, or both

191
Q

what is the treatment of primary palate cleft lip?

A

repair at 10 weeks, 10lb, Hb 10. Repair nasal deformities at the same time.

192
Q

what is the effect of primary palate cleft lip on feeding?

A

may be a/w poor feeding

193
Q

what is affected by secondary palate cleft palate?

A

involves hard and soft palates

194
Q

what is the complication of cleft palate that is closed too late?

A

may affect speech and swallowing if not closed soon enough

195
Q

what is the complication of cleft palate that is closed too early?

A

may affect maxillofacial growth if closed too early

196
Q

when should cleft palate be closed?

A

at 12 months

197
Q

what is the MC benign head and neck tumor in adults?

A

hemangioma

198
Q

what is mastoiditis?

A

infection of the mastoid cells and can destroy bone

199
Q

how does mastoiditis present?

A

ear is pushed forward

200
Q

what is the MCC of mastoiditis?

A

rare, results as a complication of untreated acute suppurative otitis media

201
Q

what is the treatment of mastoiditis?

A

antibiotics, may need emergency mastoidectomy

202
Q

why has the incidence of epiglottitis decreased recently?

A

rare since immunization against H. influenzae type B

203
Q

what is the age group MC affected by epiglottitis?

A

mainly in children ages 3-5

204
Q

what are the S/Sx of epiglottitis

A

stridor, drooling, leaning forward position, high fever, throat pain, can cause airway obstruction

205
Q

how does epiglottitis appear on lateral neck film?

A

thumbprint sign

206
Q

what is the treatment of epiglottitis?

A

early control of airway, antibiotics

Z.Fiser (22 decks)

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