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
2
Q
which structure is contained in the anterior neck triangle?
A
carotid sheath
3
Q
what are the borders of the posterior neck triangle?
A
posterior border of SCM, trapezius, clavicle
4
Q
name two important contents of the posterior neck triangle
A
accessory nerve and brachial plexus
5
Q
what do parotid glands secrete?
A
mostly serous fluid
6
Q
what do sublingual glands secrete?
A
secrete mostly mucin
7
Q
what do submandibular glands secrete?
A
50/50 serous and mucous
8
Q
where are the false vocal cords in relation to the true vocal cords?
A
false cords are superior to the true cords
9
Q
describe the shape of the tracheal cartilage
A
u-shaped cartilage and posterior portion is membranous
10
Q
where does the vagus nerve run in the carotid sheath?
A
runs between the IJV and carotid artery
11
Q
where does the phrenic nerve run in the neck?
A
lies on top of the anterior scalene muscle
12
Q
where does the long thoracic nerve run in the neck?
A
runs posterior to the middle scalene muscle
13
Q
name the three branches of the trigeminal nerve and what it innervates
A
ophthalmic, maxillary, mandibular, provides sensation to the face
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
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
16
Q
what does the glossopharyngeal nerve innervate (2)
A
taste to the posterior 1/3 of tongue and motor
17
Q
what is affected by injury to the glossopharyngeal nerve?
A
injury affects swallowing
18
Q
what does the hypoglossal nerve innervate?
A
innervates for motor to all of the tongue except palatoglossus
19
Q
which way does the tongue deviate with a hypoglossal injury?
A
tongue deviates to the same side as a hypoglossal injury
20
Q
what does the recurrent laryngeal nerve innervate?
A
innervates all of the larynx except cricothyroid muscle
21
Q
what does the superior laryngeal nerve innervate?
A
innvervates the cricothyroid muscle
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
23
Q
what are the four branches of the thyrocervical trunk?
A
STAT: suprascapular artery, transverse cervical artery, ascending cervical artery, inferior thyroid artery
24
Q
what is the first branch of the external carotid artery?
A
superior thyroid artery
25
what is the arterial supply for a trapezius flap?
superior thyroid artery
26
what is the arterial supply to a pectoralis major flap (2)?
thoracoacromial artery or internal mammary artery
27
what is torus palatinus and what is its treatment?
congenital bony mass on the upper palate of the mouth, requires no treatment
28
what is torus mandibularis and what is its treatment?
congenital bony mass on the lingual surface of the mandible, requires no treatment
29
what is removed with a modified radical neck dissection?
takes omohyoid, submandibular gland, sensory nerves C2-C5, cervical branch of facial nerve and ipsilateral thyroid
30
what is the mortality difference between modified radical neck dissection and radical neck dissection?
no mortality difference between MRND and RND
31
what is the difference between modified radical neck dissection and radical neck dissection?
same as MRND plus accessory nerve, SCM, and internal jugular resection
32
what is the MCC of morbidity with radical neck dissection?
MCC of morbidity is 2/2 accessory nerve resection
33
what is the MC cancer of the oral cavity, pharyngeal, or laryngeal
squamous cell CA
34
what are the two biggest risk factors for SCC of the oral cavity, pharynx, and larynx?
tobacco & EtOH
35
which is considered more premalignant? leukoplakia or erythroplakia?
erythroplakia (red on tongue) is more premalignant than leukoplakia (white on tongue)
36
name the contents of the oral cavity
mouth floor, anterior 1/3 of tongue, gingiva, hard palate, anterior tonsillar pillars, lips
37
what is the MC location of oral cavity CA and why?
lower lip (more common than upper lip 2/2 sun exposure)
38
which location of oral cavity CA has the lowest rate of survival and why?
lowest for hard palate tumors b/c hard to resect
39
what is Plummer-Vinson syndrome?
glossitis and cervical dysphagia from esophageal web, spoon fingers, iron-deficiency anemia
40
how does Plummer Vinson syndrome affect rates of oral cavity CA?
increased rates of oral cavity CA
41
what is the surgical treatment of oral cavity CA
wide resection with 1cm margins, MRND for tumors \> 4cm, clinically positive nodes, or bone invasion
42
what are the indications for postop XRT for oral cavity CA?
advanced lesions (\>4cm, positive margins, or nodal/bone involvement)
43
when are flaps required when resecting cancer from the lip?
when more than 1/2 of the lip is removed
44
what location of lip cancers are the most aggressive?
along the commissure
45
what is a verrucous ulcer, where is it found, and how aggressive is it?
a well-differentiated SCCA taht is often found on the cheek, not aggressive, rare metastasis, usu 2/2 oral tobacco
46
what is the treatment of verrucous ulcer
full cheek resection +/- flap, no MRND
47
what is the treatment for cancer of the maxillary sinus?
maxillectomy
48
what are three risk factors for tonsillar CA?
males, tobacco, EtOH
49
what is the MC type of tonsillar CA?
SCCA
50
how does tonsillar CA present? what is the frequency of LN mets at presentation?
asymptomatic until large; 80% have lymph node metastases at time of diagnosis
51
how do you biopsy and treat suspected tonsillar CA?
tonsillectomy is the best way to biopsy, treat with wide resection with margins
52
name two risk factors for nasopharyngeal SCCA
EBV, Chinese heritage
53
how does nasopharyngeal SCCA present?
nose bleeding or obstruction
54
which lymph nodes do nasopharyngeal SCCA metastasize to?
posterior cervical neck nodes
55
what is the treatment nasopharyngeal SCCA
XRT primary therapy, very sensitive
56
what is the treatment for advanced nasopharyngeal SCCA?
chemo-XRT, no surgery
57
what is the #1 tumor of the nasopharynx in children?
lymphoma
58
what is the treatment of nasopharyngeal lymphoma in children?
chemotherapy
59
what is the MC benign neoplasm of the nose/paranasal sinuses?
papilloma
60
how does oropharyngeal SCCA present?
neck mass and sore throat
61
which lymph nodes do oropharyngeal SCCA drain to?
posterior cervical neck nodes
62
what is the treatment of oropharyngeal SCCA \< 4cm with no nodal/bone invasion?
XRT
63
what is the treatment of oropharyngeal SCCA \>4cm or with nodal/bone invasion?
surgery, MRND, and XRT for advanced tumors
64
how does hypopharyngeal SCCA present?
hoarseness, early mets
65
where does hypopharyngeal SCCA drain to / metastasize to?
anterior cervical nodes
66
is a nasopharyngeal angiofibroma malignant or benign?
benign
67
what age/sex group is nasopharyngeal angiofibroma usually present in and with what symptoms?
males \< 20 years with obstruction or epistaxis
68
what is the vascularity of the nasopharyngeal angiofibroma?
extremely vascular
69
what is the treatment of nasopharyngeal angiofibroma
angiography and embolization (usually internal maxillary artery) followed by resection
70
how does laryngeal cancer present?
hoarseness, aspiration, dyspnea, and dysphagia
71
what is the goal of surgery with laryngeal cancer?
try to preserve larynx, so surgery is not the primary treatment
72
how do you treat laryngeal cancer limited to the vocal cord?
XRT
73
how do you treat laryngeal cancer beyond the vocal cord?
chemo-XRT
74
when is MRND indicated with laryngeal CA and what additional stuff do you need to resect?
if nodes are clinically positive, including taking the ipsilateral thyroid lobe
75
what is the MC benign lesion of the larynx
papilloma
76
name the four salivary glands
parotid, submandibular, sublingual, and minor salivary glands
77
how do submandibular or sublingual tumors usually present?
can present as a neck mass or swelling in the floor of the mouth
78
what is the most frequent site of salivary gland malignant tumors?
parotid gland
79
is a mass in a large salivary gland more likely to be benign or malignant?
benign
80
is a mass in a small salivary gland more likely to be benign or malignant?
malignant
81
name three symptoms that malignant salivary gland cancers present with?
painful mass, facial nerve paralysis, or lymphadenopathy
82
where do malignant salivary gland tumors drain to? (2)
intraparotid LNs and anterior cervical chain nodes
83
what is the #1 malignant tumor of the salivary glands and how aggressive is it?
mucoepidermoid CA, wide range of aggressiveness
84
what is the #2 malignant tumor of the salivary glands and how aggressive is it?
adenoid cystic CA, long indolent course
85
where does adenoid cystic CA of the salivary gland tend to invade?
propensity to invade nerve roots
86
what is the radiosensitivity of adenoid cystic CA of the salivary glands?
very sensitive to XRT
87
what is the treatment for mucoepidermoid CA of the salivary glands?
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
what is the treatment of adenoid cystic CA of the salivary glands?
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
how do benign salivary gland tumors present?
present as a painless mass
90
what is the #1 benign tumor of the salivary glands
pleomorphic adenoma
91
what is the rate of malignant degeneration of a salivary pleomorphic adenoma?
5%
92
what is the treatment of salivary gland pleomorphic adenoma?
superficial parotidectomy
93
how does treatment of salivary gland pleomorphic adenoma change with malignant degeneration?
malignant degeneration requires total parotidectomy
94
what is the #2 benign tumor of the salivary glands?
Warthin's tumor
95
which sex has a higher risk of Warthin's tumor?
males
96
what percentage of patients with Warthin's tumor have bilateral involvement?
10%
97
what is the treatment of Warthin's tumor?
superficial parotidectomy
98
what is the MC injured nerve with parotid surgery and how does injury present?
injury to greater auricular nerve presents with numbness over the lower portion of the ear
99
what three nerves must you identify during submandibular gland resection?
mandibular branch of the facial nerve, lingual nerve, and hypoglossal nerve
100
what is the MC salivary gland tumor in children?
hemangiomas
101
What incision is used for superficial parotidectomy?
the standard Blair incision or facelift incision
102
Where do the branches of the facial nerve course in terms of the parotid lobes?
branches of the facial nerve course between the superficial and deep lobes of the parotid
103
where can you find the main trunk of the facial nerve?
8mm deep to thetympanomastoid suture line at the same level as the digastric muscle
104
how do you treat pinna lacerations?
suture through the involved cartilage
105
what is the pathophysiology of cauliflower ear and how can it be prevented?
secondary to undrained hematomas that organize and calcify in the ear, can be prevented by draining hematomas
106
what is a cholesteatoma?
epidermal inclusion cyst of the ear, slow growing but erodes as it grows
107
how do cholesteatomas present?
present with conductive hearing loss and clear drainage from the ear
108
how do you treat cholesteatomas?
surgical excision
109
what is a chemodectoma of the ear?
vascular tumor of the middle ear (paraganglionoma)
110
what is the treatment of a chemodectoma of the ear?
surgery +/- XRT
111
which nerve is affected by an acoustic neuroma?
CN VIII
112
how do acoustic neuromas present?
tinnitus, hearing loss, unsteadiness, can grow into cerebellar / pontine angle
113
what is the treatment for acoustic neuroma?
craniotomy and resection, XRT is an alternative
114
what % of ear SCCA metastasize to the parotid gland?
20%
115
what is the treatment of ear SCCA? When is MRND indicated?
resection and parotidectomy, MRND for positive nodes or larger tumors
116
what is the MC aural malignancy in childhood?
rhabdomyosarcoma of the middle or external ear
117
when should you set a nasal fracture?
after the swelling decreases
118
how do you treat septal hematomas and why?
need to drain them to avoid infection and necrosis of the septum
119
what protein is in CSF?
tau protein
120
what type of nasal injury is a/w CSF rhinorrhea?
cribiform plate fracture
121
how do you evaluate CSF rhinorrhea?
repair of facial fractures may help leak, may need contrast study to help find leak
122
how do you treat CSF rhinorrhea?
conservative tx for 2-3 weeks, try epidural catheter drainage of CSF, may need transethmoidal repair
123
what percentage of epistaxis is anterior?
90%
124
how do you treat anterior epistaxis bleeding?
packing
125
how do you treat persistent posterior epistaxis bleeding unresponsive to packing/balloon tamponade?
internal maxillary artery or ethmoid artery balloon embolization
126
what is a radicular cyst of the jaw?
inflammatory cyst at the root of the teeth that can cause bone erosion
127
how does radicular cyst of the jaw appear on XR?
radiolucent on XR
128
how do you treat radicular cyst of the jaw?
local excision and curettage
129
what is ameloblastoma?
slow-growing malignancy of odontogenic epithelium (outside portion of teeth)
130
what is the appearance of ameloblastoma on XR?
soap bubble appearance on XR
131
how do you treat ameloblastoma?
WLE
132
what is the prognosis of osteogenic sarcoma?
poor prognosis
133
how do you treat osteogenic sarcoma?
multimodal approach including surgery
134
how do you treat maxillary jaw fractures?
most are treated with wire fixation
135
how do you treat TMJ dislocation?
closed reduction
136
what is the cause of lower lip numbness a/w jaw injury?
inferior alveolar nerve damage (branch of mandibular nerve)
137
how do you treat Stensen's duct (parotid duct) laceration?
repair over catheter stent
138
why should you not ligate the Stensen duct (parotid duct)?
ligation can cause painful parotid atrophy and facial asymmetry
139
what is the MC demographic p/w suppurative parotitis?
usually in elderly patients, can be life-threatening
140
what is the MCC of suppurative parotitis?
dehydration
141
what is the MC organism that causes suppurative parotitis?
staph
142
what is the tx of suppurative parotitis?
fluids, salivation, abx, drainage if abscess develops or patient not improving
143
what is siloadenitis?
acute inflammation of a salivary gland related to a stone in the duct, most calculi are near the orifice
144
what two types of salivary glands are most commonly affected by siloadenitis and how often?
80% of the time affects submandibular or sublingual glands
145
what is the cause of recurrent siloadenitis?
due to ascending infection from teh oral cavity
146
what is the treatment of siloadenitis?
incise duct and remove stone; gland excision may eventually be necessary for recurrent disease
147
what age group usually presents with peritonsillar abscess?
older kids \> 10 years
148
what are the symptoms of peritonsillar abscess?
trismus, odynophagia, usually does NOT obstruct airway
149
how do you treat peritonsillar abscess?
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
what age group presents with retropharyngeal abscess?
younger kids \< 10 years or elderly with Pott's disease (TB of the vertebrae)
151
how do children present with retropharyngeal abscess?
fever, odynophagia, drool, AIRWAY EMERGENCY
152
how do you treat a patient with retropharyngeal abscess?
intubate patient in a calm setting; drainage through posterior pharyngeal wall, will self-drain with swallowing once opened
153
what age group presents with parapharyngeal abscesses and with which comorbidities?
all age groups, occurs with dental infections, tonsillitis, or pharyngitis
154
what is the mechanism of morbidity a/w parapharyngeal abscesses?
morbidity comes from vascular invasion and mediastinal spread via prevertebral and retropharyngeal spaces
155
how do you treat parapharyngeal abscesses?
drain through lateral neck to avoid damaging internal carotid and internal jugular veins; need to leave drain in
156
what is Ludwig's angina?
acute infection of the floor of the mouth, involves mylohyoid muscle
157
what is the MCC of Ludwig's angina?
dental infection of the mandibular teeth
158
What is the MOA of airway obstruction a/w Ludwig's angina?
may rapidly spread to deeper structures and cause airway obstruction
159
how do you treat Ludwig's angina?
airway control, surgical drainage, antibiotics
160
all lumps near the ear are _____ until proven otherwise
parotid tumors
161
how do you diagnose lumps near the ear?
diagnosis made after superficial lobectomy
162
what % of salivary tumors are in the parotid gland?
80%
163
what % of parotid tumors are benign?
80%
164
what % of benign parotid tumors are pleomorphic adenomas?
80%
165
what is the MC site of metastases for head/neck tumors?
lung
166
what is a posterior neck mass considered until proven otherwise?
considered Hodgkin's lymphoma until proven otherwise
167
How do you evaluate a posterior neck mass?
FNA or open biopsy
168
What is the first line of dx for neck mass workup?
H&P, laryngoscopy, and FNA. Can consider abx for 2 weeks with reevaluation if you think its inflammatory
169
What is the second line of dx for neck mass workup?
if H&P, laryngoscopy, and FNA nondiagnostic --\> panendoscopy with multiple random bx and neck/chest CT
170
what is the third line of dx for neck mass workup?
if first and second line evaluation nondiagnostic --\> excisional biopsy, need to be prepared for MRND
171
what should you suspect if you diagnose an adenocarcinoma of the neck?
suggests breast, GI, or lung primary
172
what is the diagnostic workup for epidermoid CA (SCCA variant) found in cervical node without known primary? (3 lines)
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
why is ipsilateral tonsillectomy indicated as the third line for workup of epidermoid CA found in cervical node?
tonsils are the MC location for occult head/neck tumors
174
what is the presenting sx of an esophageal foreign body?
dysphagia
175
what is the MC location of esophageal foreign bodies and with what frequency?
95% just below the cricopharyngeus
176
what is the dx and tx of esophageal foreign body?
rigid EGD under anesthesia
177
what increases the risk of perforation with esophageal foreign body?
perforation risk increases with length of time in the esophagus
178
how do you evaluate fever and pain after EGD for foreign body?
gastrograffin followed by barium swallow to r/o perforation
179
how does laryngeal foreign body present?
coughing
180
how do you treat laryngeal foreign body
emergent cricothyroidotomy as a last resort to be needed to secure airway
181
what are two anatomical risk factors a/w sleep apnea
obesity, micrognathia / retrognathia
182
what are three complications a/w sleep apnea?
MIs, arrhythmias, death
183
how do you treat sleep apnea (3)
CPAP, uvulopalatopharyngoplasty (best surgical solution), or permanent trach
184
what is a complication of prolonged intubation?
subglottic stenosis
185
how do you treat subglottic stenosis?
tracheal resection and reconstruction
186
when is tracheostomy indicated in the ventilated patient?
pts who require intubation for \>7-14 days
187
what are three benefits of tracheostomy in a patient with prolonged intubation?
decreases secretions, provides easier ventilation, decreases pneumonia risk
188
what is the cause of median rhomboid glossitis (glossal central papillary atrophy)?
failure of tongue fusion
189
how do you treat median rhomboid glossitis?
no treatment needed
190
what is the involvement of primary palate cleft lip?
involves lip, alveolus, or both
191
what is the treatment of primary palate cleft lip?
repair at 10 weeks, 10lb, Hb 10. Repair nasal deformities at the same time.
192
what is the effect of primary palate cleft lip on feeding?
may be a/w poor feeding
193
what is affected by secondary palate cleft palate?
involves hard and soft palates
194
what is the complication of cleft palate that is closed too late?
may affect speech and swallowing if not closed soon enough
195
what is the complication of cleft palate that is closed too early?
may affect maxillofacial growth if closed too early
196
when should cleft palate be closed?
at 12 months
197
what is the MC benign head and neck tumor in adults?
hemangioma
198
what is mastoiditis?
infection of the mastoid cells and can destroy bone
199
how does mastoiditis present?
ear is pushed forward
200
what is the MCC of mastoiditis?
rare, results as a complication of untreated acute suppurative otitis media
201
what is the treatment of mastoiditis?
antibiotics, may need emergency mastoidectomy
202
why has the incidence of epiglottitis decreased recently?
rare since immunization against H. influenzae type B
203
what is the age group MC affected by epiglottitis?
mainly in children ages 3-5
204
what are the S/Sx of epiglottitis
stridor, drooling, leaning forward position, high fever, throat pain, can cause airway obstruction
205
how does epiglottitis appear on lateral neck film?
thumbprint sign
206
what is the treatment of epiglottitis?
early control of airway, antibiotics
