Head and Neck 1 Flashcards
1
Q
What percent of patients require dilatation after gastric pull-up?
A
0.5
2
Q
During endoscopic evaluation of a tumor of the hypopharynx, what four questions must be answered?
A
- Can the larynx be saved?
- Is a partial or total pharyngectomy necessary?
- 3•Is a partial or total esophagectomy necessary?
- 4•Does the tumor extend into the prevertebral fascia?
3
Q
What are the indications for a supracricoid partial laryngectomy with CHP or CHEP?
A
- T2 transglottic (TG) or supraglottic (SG) lesions not amenable to SG laryngectomy secondary to ventricular invasion, glottic extension, or impaired 1VC motion.
- T3 TG/SG lesions with 1VC fixation or preepiglottic space involvement.
- 3• T4 TG/SG lesions with limited invasion of thyroid ala without extension through the outer thyroid perichondrium.
- 4• Selected glottic tumors at the anterior commissure with preepiglottic space or SG involvement.
4
Q
What are the indications for esophageal bypass?
A
- Complete esophageal stenosis and failure to establish a lumen with dilatation. Irregularity and diverticuli of the esophagus.
- Mediastinitis secondary to dilatation. Fistula formation.
- Inability to maintain a lumen of 40 Fr or greater with dilatation. Patient intolerance of frequent procedures.
5
Q
What percent of patients with long-term tracheostomies are colonized with Pseudomonas?
A
>60%.
6
Q
What are the normal dimensions of the osteotomy in GA?
A
10 X 20 H1R1.
7
Q
What is the incidence of stroke and mortality from carotid blowout?
A
10% stroke and 1% mortality rate if intravascular volume is repleted prior to going to the OR. so% stroke and 25% mortality rate if intravascular volume is not repleted prior to going to the OR.
8
Q
What is the fistula rate following free jejunal transfer (nonirradiated patients)?
A
10-20%.
9
Q
What is the incidence of permanent recurrent laryngeal nerve injury after total thyroidectomy?
A
1-4%.
10
Q
What length of jejunum is normally harvested for reconstruction?
A
15-20 cm.
11
Q
What is the fistula rate in patients who have had prior irradiation requiring total laryngectomy and partial pharyngectomy?
A
15-20%.
12
Q
Which tumors of the pyriform sinus do not necessarily require total laryngectomy?
A
2 cm or smaller, located at least 1.5 cm superior to the pyriform fossa apex, with normal vocal cord movement, and no invasion into adjacent sites; patients must also have good pulmonary function.
13
Q
What is the recommended excisional margin for a 3-cm melanoma?
A
2 cm.
14
Q
Where on the lid is the implant placed?
A
2 mm above the lash line.
15
Q
What is the minimal mandibular height necessary for performing Genioglossus advancement?
A
25 mm.
16
Q
What percent of patients with tracheoinnominate fistulae survive?
A
25%.
17
Q
What are the treatment options for Frey’s syndrome?
A
3% scopolamine cream, section Jacobson’s nerve, sternocleidomastoid muscle flap, interpose fascia lata between skin and gland, and botulinum toxin.
18
Q
What is the minimal time for functional return of the facial nerve after anastomosis or grafting?
A
4-6 months.
19
Q
What percent of all instances of tracheal bleeding developing 48 hours or longer after surgery are caused by tracheoinnominate fistulae?
A
50%.
20
Q
What is the rate of major complications after gastric pull-up?
A
50%.
21
Q
After microneurovascular muscle transfer, what is the maximum muscle power attainable compared with normal?
A
55%.
22
Q
What are the recommended margins for excision of basal cell skin cancers (BCCs)?
A
5mm.
23
Q
How far from the inferior border of the mandible should the osteotomy for Genioglossus advancement be placed?
A
8-10 mm.
24
Q
What problem arises when regional or transplanted skin flaps are used for reconstruction of the hypopharynx when the larynx is preserved?
A
A large amount of immobile pharyngeal wall interferes with the pharyngeal component of swallowing, making aspiration inevitable.
25
What is an imbrication laryngectomy?
A through-and-through excision of a horizontal segment of the larynx with anastomosis of the caudal and cephalic laryngeal margins.
26
When should PEG be performed when done as part of an oncologic resection?
After the primary resection to avoid inadvertent spread of tumor cells to the gastrostomy site.
27
During placement of a tubed flap, where should the longitudinal suture line uniting the sides of the flap into a tube be placed?
Against the prevertebral fascia.
28
What factors are associated with the highest likelihood of successful esophageal dilatation for treatment of strictures secondary to caustic ingestion?
Age
29
What preoperative factor on the patient's polysomnogram is associated with a positive long-term response to UPPP?
AHI
30
What are the advantages of this approach?
Allows wide exposure of the nasopharynx with low morbidity.
31
What should be done preoperatively for retrostyloid malignancies or tumors suspected to be involving the carotid artery?
Angiography with balloon occlusion.
32
What are the major complications of these procedures?
Aspiration pneumonia, rupture of the pexis, laryngocele, and laryngeal stenosis.
33
What is the most common and serious complication following supraglottic laryngectomy?
Aspiration pneumonia.
34
How far apart should the inferior and superior limbs be with the MacFee incision?
At least four fingerbreadths apart.
35
Where do strictures most often occur after free jejunal transfer?
At the inferior anastomosis between the jejunum and esophagus.
36
Where do fistulas most often occur after free jejunal transfer?
At the superior anastomosis between the jejunum and pharynx.
37
What is the absolute contraindication to endoscopic laser resection of supraglottic cancer?
Base of tongue involvement.
38
What are some adjunctive procedures for patients who do not improve after UPPP?
Base of tongue reduction, mandibular advancement with LeFort I osteotomy and maxillary advancement, genioglossus advancement (GA), and tracheostomy.
39
What is the plane of dissection for raising flaps during parotidectomy and how can one identify this more easily?
Between the SMAS and the superficial layer of the deep fascia-identify the platysma first and work superiorly.
40
What happens if the implant is placed too deep?
Can damage the levator muscle, causing ptosis.
41
What is the most significant early complication of this procedure?
Cervical anastomotic leak (50%).
42
What is the most significant late complication of this procedure?
Cervical anastomotic stricture (44%).
43
Which patients are at a higher risk of pneumothorax after tracheostomy?
Children.
44
What factors are most strongly related to overall speech function 3 months after surgery for oral or oropharyngeal cancer?
Closure type, percentage of oral tongue resected, and percentage of soft palate resected.
45
What is the most common esophageal bypass procedure?
Colon interposition.
46
What approach is used for resection of posterolateral tumors?
Combined suprahyoid and lateral pharyngotomy.
47
What is a functional neck dissection?
Complete cervical lymphadenectomy sparing the sternocleidomastoid muscle, spinal accessory nerve, and internal jugular vein.
48
What is the "first bite syndrome"?
Complication after removal of a carotid body tumor where the patient experiences intense pain with the first bite of food.
49
What are the signs of a tracheoesophageal fistula after tracheostomy?
Copious secretions, food aspiration, and air leak around the cuff with abdominal distension.
50
What is CHP / CHEP?
Cricohyoidopexy and cricohyoidoepiglottopexy. Conservation laryngeal procedures performed in concordance with a supracricoid partial laryngectomy. Require preservation of at least one functional cricoarytenoid unit (superior laryngeal nerve, RLN, arytenoid, cricoid, and cricoarytenoid musculature).
51
How can dynamic rehabilitation be achieved in a patient with a to-year history of facial paralysis following radical parotidectomy?
Cross-facial nerve graft plus microneurovascular muscle transfer.
52
What should be done during maxillectomy to prevent epiphora postoperatively?
Dacryocystorhinostomy.
53
What is the most serious complication of this approach and how can it be avoided?
Damage to the hypoglossal and superior laryngeal nerves; can be avoided if the greater horn of the hyoid is left undissected.
54
Which complication is most likely to be avoided with endoscopic diverticulectomy versus open diverticulectomy?
Damage to the RLN.
55
What are the advantages of preoperative embolization of carotid body tumors?
Decreased intraoperative blood loss and operative time.
56
What factors are associated with the development of temporary facial paresis after parotidectomy?
Deep lobe tumor; previous parotid surgery; history of sialoadenitis; addition of a neck dissection to the parotid surgery; increased age; diabetes mellitus; increased operative time; history of parotid irradiation; no EMG monitoring.
57
Which methods of facial nerve reconstruction have the potential for spontaneous emotional response?
Direct anastomosis and cable grafting.
58
What sort of gastrointestinal complaints do patients have after gastric pull-up?
Early satiety, emesis, and dumping syndrome.
59
What can be done to treat or prevent dumping syndrome?
Eating small dry meals, restricting fluid intake during meals, and using octreotide (somatostatin analogue).
60
What is the differential diagnosis for the etiology of stridor in a patient who has undergone total glossectomy and postoperative radiation therapy?
Edema secondary to altered lymphatics; recurrent tumor; gastroesophageal reflux disease; and superinfection.
61
What are the treatment options for Tis, microinvasive, and Tt glottic carcinoma?
Endoscopic surgical excision, laser excision, thyrotomy and cordectomy, or radiation.
62
What technique is most effective in preventing postoperative stenosis afterVPL?
Epiglottopexy.
63
Which anastomotic technique is preferred by most surgeons?
Epineural anastomosis using three to eight sutures of 8-o or 10-0 synthetic monofilament suture.
64
What is meant by putting a patient on "carotid blowout precautions"?
Establish IV access with two large bore IVs, type and cross 2 units PRBCs, have an intubation tray at the bedside, and educate nursing staff.
65
What preoperative symptom best correlates with improvement in AHI after UPPP?
Excess daytime sleepiness.
66
What is the most serious complication of lateral pharyngotomy?
Excessive retraction on the great vessels leading to thrombosis or embolism.
67
What is the purpose of vestibulectomy during excision of early glottic cancer?
Excision of the false vocal cord enhances intraoperative and postoperative visualization of the entire vocal cord.
68
During exploration for primary hyperparathyroidism, three normal parathyroid glands are found but the fourth cannot be identified. "What is the next step in management?
Extend the exploration through the existing incision, to include the central neck compartment between the carotids, posteriorly to the vertebral body, superiorly to the level of the pharynx and carotid bulb, and inferiorly into the mediastinum.
69
During resection of a carotid body tumor, which vessel can be sacrificed in most cases?
External carotid artery.
70
True/False: TEP is not effective in patients reconstructed with gastric pull-up.
False, although the voice quality is poor.
71
True/False: Cricopharyngeal myotomy as an adjunctive procedure to diverticulectomy has been shown to significantly decrease the incidence of recurrence.
False.
72
What is the greatest advantage of bronchoscopic visualization during percutaneous dilational tracheostomy?
Fewer major complications occur.
73
What are the contraindications to VPL and laryngoplasty?
Fixed vocal cord, involvement of the posterior commissure, invasion of both arytenoids, bulky transglottic lesions, invasion of the thyroid cartilage, subglottic extension \>1 em anteriorly (5 mm posteriorly), and transglottic lesions extending to the supraglottis.
74
When is a total rhinotomy approach most useful?
For midline tumors where exposure of the cribriform plate and the bilateral ethmoids is necessary.
75
What are the reconstructive options after total laryngectomy and total pharyngectomy?
Free jejunal interposition graft, U-shaped pectoralis major + split-thickness skin graft (STSG), tubed thin flap (radial forearm or deepithelialized deltopectoral).
76
When the facial nerve is sacrificed during tumor resection, what must be done prior to reconstruction?
Frozen section confirmation of negative nerve margins.
77
What are the reconstructive options after total laryngopharyngectomy and cervical esophagectomy?
Gastric pull-up, free jejunal graft.
78
Which nerve is most often used for facial nerve cable grafting?
Greater auricular nerve.
79
What is Frey's syndrome?
Gustatory sweating, secondary to cross-reinnervation of the divided auriculotemporal nerve with cutaneous nerves, after parotidectomy.
80
What is the advantage of the microneurovascular muscle transfer over the temporalis muscle sling in the treatment of facial paralysis?
Has the potential to restore spontaneous muscle expressions.
81
What is the most common complication of parotidectomy?
Hematoma.
82
After primary anastomosis, what is the typical return of facial nerve function?
House grade II or III.
83
What is the best functional outcome of cable grafting?
House grade III or IV.
84
What electrolyte problem is disproportionately associated with gastric pull-up?
Hypocalcemia secondary to impaired calcium absorption and inadvertent parathyroid resection during thyroidectomy.
85
What are the six ways to identify the facial nerve trunk during parotidectomy?
Identification of the tympanomastoid suture line, tragal pointer, posterior belly of the digastric, or styloid process; tracing a distal branch retrograde or tracing the proximal portion forward by drilling out the mastoid segment.
86
If a tumor-free proximal nerve stump is unavailable for nerve grafting, what method should be used for optimal functional outcome?
If reconstruction is undertaken within 2 years of division, grafting of the proximal portion of another cranial nerve to the distal stump of the facial nerve is the next best choice.
87
When is total esophagectomy indicated?
If the inferior margin during resection of a postcricoid tumor extends below the mediastinal inlet or if a second primary is present in the distal esophagus.
88
Your patient has a unilateral vocal cord paralysis after thyroidectomy for goiter. "What are the indications for surgical intervention?
If the paralysis is well tolerated (e.g., no aspiration and voice quality acceptable to the patient), 12 months is allowed for spontaneous recovery before proceeding with surgery. If the symptoms are severe, early surgery, typically a reversible procedure, is indicated.
89
What is the significance of the Bell's phenomenon prior to gold weight implantation?
If the patient has a good Bell's reflex, then the surgeon can be more conservative, choosing a lighter implant to avoid ptosis.
90
What is the purpose of using an STSG to cover a small defect after excision of a tonsil cancer?
If the pterygoid muscles are exposed during resection, placing an STSG will help prevent muscle fibrosis and trismus.
91
In which circumstance can a hemilaryngectomy be performed in the presence of vocal cord fixation?
If the tumor does not extend through the cricothyroid membrane or the perichondrium of the thyroid cartilage.
92
What are the contraindications to percutaneous endoscopic gastrostomy (PEG)?
Inability to perform upper endoscopy safely; inability to transilluminate the abdominal wall; and the presence of ascites, coagulopathy, or intra-abdominal infection.
93
Why should adenoidectomy be avoided when performing UPPP?
Increases the risk of nasopharyngeal stenosis.
94
What are the complications of gold weight implantation?
Induced astigmatism, ptosis, migration, extrusion, and persistent inflammation.
95
How should this flap be modified if reconstruction with a deltopectoral flap is planned?
Inferior incision should be as low as possible.
96
What type of resection would be best for a tumor confined to the floor of the maxillary antrum?
Infrastructure maxillectomy.
97
What factors make a tumor of the nose or paranasal sinuses unresectable?
Invasion into the frontal lobe, prevertebral fascia, bilateral optic nerves, or cavernous sinus
98
What are the contraindications to VPL for treatment of postradiation tumor recurrence?
Involvement of both vocal cords, involvement of body of arytenoid, subglottic extension \>5 mm, fixed vocal cord, cartilage invasion, and different tumor type from original primary.
99
What are the contraindications to laser excision of early glottic carcinoma?
Involvement of the anterior or posterior commissure and subglottic extension.
100
What are the contraindications to radical maxillectomy?
Involvement of the sphenoid, nasopharynx, middle cranial fossa, or extensive infratemporal fossa; presence of bilateral cervical metastases or distant metastases.
101
Which cranial nerve is most often grafted to the distal facial nerve?
Ipsilateral hypoglossal.
102
What is the primary drawback of hypoglossal-facial nerve grafting?
Ipsilateral tongue paralysis.
103
What is the advantage of the dorsal radial cutaneous nerve?
It branches as it approaches the wrist, making distal separation into bundles for facial nerve branch anastomosis easier.
104
When performing a thyroid resection, where should the inferior thyroid artery be ligated?
It should not be ligated. Branches of the inferior thyroid artery should be ligated individually at the capsule.
105
What are the contraindications to percutaneous dilatational tracheostomy?
Large thyroid goiter or other neck mass, marked obesity, coagulopathy, previous neck surgery, neck trauma including burns, and inadequate access to the trachea.
106
What are other surgical approaches to the nasopharynx?
Lateral rhinotomy with facial disassembly, transpalatal split, lateral cervical approach with mandibular swing, transparotid temporal bone approach, and infratemporal fossa approach.
107
What are the three basic transfacial approaches to resection of midface tumors?
Lateral rhinotomy, total rhinotomy, and midface degloving.
108
What happens if the orbital septum is violated during resection of a sinonasal tumor?
Lid shortening and ectropion.
109
What is the primary limitation of the midface degloving approach?
Limited exposure of the skull base and anterior ethmoid sinuses.
110
What is the Weber-Ferguson incision?
Lip-splitting extension of the lateral rhinotomy incision that permits exposure for a radical maxillectomy.
111
Patients with supraglottic cancer who undergo both surgery and radiation therapy (vs. surgery alone) are at a significantly higher risk for what?
Long-term gastrostomy feeding.
112
Which neck dissection incision results in the best cosmetic outcome?
MacFee incision.
113
What is the initial treatment for a chyle leak diagnosed 3 days after neck dissection?
Maintain drains and begin medium-chain triglyceride tube feedings.
114
What are the possible complications of GA?
Mandible fracture; dental injury; failure to advance; infection; anesthesia of lower lip, gums, and chin; and bleeding/hematoma.
115
Which branch of the facial nerve is most commonly paretic after parotidectomy?
Marginal mandibular.
116
What are the available treatments for cricopharyngeal dysphagia?
Mechanical dilation, pharyngeal plexus neurectomy, cricopharyngeal myotomy, or botulinum toxin.
117
What is the best surgical approach to resection of JNAs?
Medial maxillectomy via lateral rhinotomy or midface degloving approach.
118
What is the gold standard of treatment for inverting papillomas?
Medial maxillectomy via lateral rhinotomy.
119
What are the four basic surgical procedures used to resect tumors of the midface?
Medial maxillectomy, suprastructure maxillectomy, infrastructure maxillectomy, and radical maxillectomy.
120
What are other indications for free muscle transposition surgery for facial reanimation?
Mobius syndrome or destruction of muscles secondary to trauma.
121
What are the indications for Mobs surgery?
Morpheaform BCC, recurrent BCC, and BCC in cosmetically sensitive locations.
122
What can be done to prevent functional dysphagia due to neuromuscular incoordination?
Myotomy of the jejunal musculature.
123
What precaution should be taken for a patient with a tracheostomy undergoing general anesthesia?
Nitrous oxide should be avoided, as it diffuses into the cuff and can increase the pressure by up to 40 mm Hg. If it is used during induction, the cuff should be deflated temporarily.
124
What are the indications for prophylactic central neck dissection in patients with well-differentiated thyroid cancer?
No definite indications. The American Thyroid Association advises that it may be performed for advanced, large, or invasive T3 or T4 tumors.
125
If a marginal mandibulectomy is performed and the bony margin is positive, does one irradiate the remaining bone?
No, as bone is relatively hypoxic and cannot generate many free radicals with radiation therapy; the patient should be taken back to the operating room for mandibulectomy.
126
What is the primary limitation of the gastric pull-up?
Obtaining enough length to achieve a tension-free closure.
127
When a carotid body tumor is embolized preoperatively, communication between the external and internal carotid circulation may occur through which vessel?
Occipital artery.
128
What are the advantages of transorallaser resection of early supraglottic cancer?
Oncologically sound, no tracheostomy or feeding tube is usually necessary, early discharge, rapid resumption of deglutition, and more cost effective.
129
What are five adjunctive procedures to the above dissections?
Orbital exenteration, infratemporal fossa dissection, craniotomy, contralateral maxillectomy, and rhinectomy.
130
A patient with an advanced sinonasal tumor has significant diplopia secondary to tumor invasion of the periorbital muscles. What procedure should be done in addition to maxillectomy?
Orbital exenteration.
131
What structures are preserved with an infrastructure maxillectomy that would be resected with a total maxillectomy?
Orbital floor and sometimes the infraorbital nerve.
132
What is the success rate of uvulopalatopharyngoplasty (UPPP) for the treatment of obstructive sleep apnea syndrome (OSAS) in adults?
Overall, 50% experience a 50% reduction in the apnea-hypopnea index (AHI) or in the amount of oxyhemoglobin desaturation.
133
What are the general indications for performing tracheostomy on patients with OSAS?
Oxygen saturation
134
What is a major contraindication to this procedure?
Paralysis of IX or X.
135
What procedure is performed for resection of these lesions?
Partial laryngopharyngectomy.
136
What effect does tracheostomy have on the incidence of pneumonia?
Patients on a ventilator are at a higher risk of pneumonia after tracheostomy and also tend to develop more serious pneumonias (Pseudomonas) secondary to antibiotic resistance.
137
What are the risk factors for innominate artery rupture after tracheostomy?
Placement of tracheostomy below the third ring; aberrant course of the innominate artery; use of a long, curved tube; over hyperextension of the neck during the procedure; prolonged pressure by inflated cuff; and tracheal infection.
138
What is the most common cause of mortality in patients \< 1year of age who undergo tracheostomy?
Plugging or accidental decannulation.
139
What can happen if the free jejunal graft is too long?
Pooling of secretions and dysphagia.
140
What are the contraindications to craniofacial resection?
Poor surgical candidate, presence of multiple distant metastases, invasion of the prevertebral fascia, cavernous sinus (by a high-grade tumor), carotid artery (in a high-risk patient), or bilateral optic nerves/optic chiasm.
141
What are the contraindications to surgical resection of juvenile nasopharyngeal angiofibromas (JNAs)?
Poor surgical risk, recurrent tumor that has proved refractory to previous excisions, and involvement of vital structures.
142
In which subsite of the hypopharynx is cancer more common in females?
Postcricoid area.
143
What area of the sinonasal tract is better visualized via endoscopy as opposed to medial maxillectomy?
Posterior ethmoid cells, particularly those lateral to the sphenoid sinus and around the optic nerve.
144
When must the facial nerve be sacrificed during parotidectomy?
Preoperative facial nerve weakness or paralysis; adenoid cystic carcinoma abutting the nerve; malignant tumor infiltrating the nerve.
145
What are the contraindications to surgical resection of esophageal tumors?
Presence of distant metastases; involvement of prevertebral fascia, trachea, or carotid arteries.
146
What is the primary advantage of the midline mandibular osteotomy for resection of oropharyngeal tumors compared with the lateral mandibulotomy?
Preservation of the inferior alveolar and lingual nerves.
147
What are the reconstructive options after partial pharyngectomy?
Primary closure (if 3 or more em of tissue is available), skin graft, sternocleidomastoid flap, radial forearm free flap, or deltopectoral flap with a deepithelialized pedicle.
148
What are the reconstructive options after total laryngectomy and partial pharyngectomy?
Primary closure if more than 40% of the pharyngeal circumference is left in situ, regional flap (pectoralis major, deltopectoral), radial forearm free flap, gastric patch, free jejunal patch, tongue base rotation flap.
149
What maneuvers help facilitate preservation of olfaction after total laryngectomy?
Rapid facial or buccal movements, clicking" of the palate, and movement of the olfactory source.
150
What are the most common complications of gastric pull-up?
Regurgitation, cervical dysphagia, stricture, and anastomotic leak.
151
What is felt to be the safest way to address severe esophageal strictures with dilatation?
Retrograde technique using Tucker dilators over a guide string.
152
What are the advantages of the uvulopalatal flap?
Reversible; less pain and less incidence of dehiscence than UPPP.
153
What is the blood supply to the gastric pull-up?
Right gastroepiploic and right gastric arteries.
154
What does continuous facial nerve monitoring during parotidectomy prevent?
Short-term paresis.
155
What factor is most important regarding the risk of surgical complications in patients undergoing Zenker's diverticulectomy?
Size of the diverticulum.
156
What are the primary limitations to endoscopic diverticulectomy?
Size of the sac; difficult to perform in very small or large sacs (10 em); and limitations in access due to anatomic factors (i.e., inability to extend the neck or limited jaw excursion).
157
What are some other options for improvement of function after facial paralysis?
Static facial slings, dynamic muscle slings, free muscle transfers, gold weight upper lid implants, lid-tightening procedures, and brow lift.
158
Which reconstructive options restore facial nerve function most quickly?
Static slings, gold weights, and tarsorrhaphies.
159
What are the incisions used for the midface degloving approach?
Sublabial; intercartilaginous; and complete transfixion.
160
Into which plane is a gold weight placed?
Suborbicularis.
161
What intraoperative modality confirms adequate removal of parathyroid tissue in patients with hyperparathyroidism? Rapid intraoperative PTH assay (expect a decrease of at least so%). What is the surgical treatment of choice for patients with secondary hyperparathyroidism?
Subtotal (3112) parathyroidectomy or total parathyroidectomy with autotransplantation.
162
What is the blood supply to the jejunum?
Superior mesenteric arterial arcade.
163
What is the most direct approach for resection of most posterior pharyngeal wall tumors?
Suprahyoid.
164
Which of these can provide the most length?
Sural nerve (35 cm).
165
What are some possible nerves used for cable grafting?
Sural, greater auricular, dorsal radial cutaneous, and supraclavicular nerves.
166
Subcutaneous emphysema may prelude what condition after tracheostomy?
Tension pneumomediastinum.
167
What is a jump graft?
The greater auricular nerve is sutured end to side to XII and end to side to the distal facial nerve.
168
What is the anterolateral surgical approach to the nasopharynx?
The maxillary antrum attached to an anterior cheek flap is developed as an osteocutaneous flap and swung laterally.
169
What is the premise behind pursuing long-term dilatation therapy?
The native esophagus is the best esophagus.
170
What can be done for a large discrepancy between the circumference of the pharyngeal stoma and the jejunal segntent?
The proximal jejunum can be opened longitudinally along its antimesenteric border or a redundant piece of jejunum can be inserted into the proximal segment to widen the lumen.
171
What is the difference in using the right versus left colon?
The right colon is interposed in an isoperistaltic fashion, whereas the left colon is interposed in an antiperistaltic fashion.
172
What is the difference between hemilaryngectomy and vertical partial laryngectomy (VPL)?
Thyroid perichondrium is preserved in VPL and excised in hemilaryngectomy.
173
Why is the superior limb placed 1cm inferior to the mandible?
To hide the scar in the shadow of the mandible.
174
Why should the inferior turbinate be removed during resection of a sinonasal tumor?
To prevent interference with a palatal prosthesis.
175
If the leak does not resolve, what is the next step in management?
TPN.
176
What should be done if the posterior tracheal wall is disrupted during tracheostomy?
Tracheostomy tube should be replaced with an endotracheal tube.
177
What is the best surgical approach for removal of parapharyngeal tumors?
Transcervical.
178
What is the primary blood supply to the skin flaps raised in a neck dissection?
Transverse cervical artery and facial artery.
179
What are the most common complications of this approach?
Trismus and palatal fistula.
180
True/False: Due to shrinkage, at least 8-10 mm of in situ margin must be taken to achieveasmm pathologically clear margin for tumors of the oral cavity.
True.
181
True/False: Neck dissections removed in continuity with the tumor specimen are associated with a significantly higher incidence of survival than those removed separate from the tumor.
True.
182
True/False: No improvement in functional outcome has been demonstrated with the use of tubes or conduits in facial nerve anastomosis or grafting.
True.
183
True/False: The relationship between surgical margins and outcome is not clear in the treatment of Merkel cell carcinoma.
True.
184
True/False: Extension of a tumor in the pyriform sinus below the plane of the laryngeal ventricle is an absolute contraindication to supraglottic laryngectomy.
True.
185
What is the primary contraindication to nasopharyngectomy?
Tumor involvement of the cavernous sinus or cranial nerves.
186
What is the significance of tumor size on the incidence of complications with resection of carotid body tumors?
Tumors \> 5 em are associated with a significantly higher rate of complications with removal (67% for tumors \>5 em vs. 15% for tumors
187
What portion of patients after total laryngectomy will report loss of olfaction?
Two-thirds.
188
What is the most consistent landmark for identification of the facial nerve trunk?
Tympanomastoid suture line.
189
What is the incidence of permanent hypoparathyroidism after total thyroidectomy? 1-5%. What is the most common cause of persistent hyperparathyroidism after parathyroidectomy?
Undiscovered or supernumerary parathyroid gland.
190
What can be done to ameliorate this problem?
Use of a mid-tongue Z-plasty; use of only part of the hypoglossal nerve (jump graft); and reinnervation of the hypoglossal nerve with the ansa cervicalis.
191
Two weeks after undergoing salvage surgery on the neck, a patient loses Soo cc of blood from the operative site. If a bleeding source is not found on carotid arteriogram, what is the next step in management?
Venous angiography with endovascular occlusion.
192
Branches of the facial nerve anterior to do not require reconstruction for return of function.
Vertical line from lateral canthus.
193
When is radiation considered in lieu of surgery for treatment of carotid body tumors?
Very large tumors, recurrent tumors, or poor surgical candidates.
194
What intraoperative modality may assist in locating an intrathyroidal parathyroid gland? Ultrasound. What is the most reliable method of differentiating a parathyroid adenoma from parathyroid hyperplasia?
Visual inspection of all four parathyroid glands.
195
What are the contraindications to supraglottic laryngectomy?
Vocal cord fixation, extension to apex of pyriform sinus, bilateral arytenoid involvement, extensive involvement of base of tongue of the anterior commissure, invasion of the thyroid cartilage, and invasion into the interarytenoid space.
196
What are the recommended indications for elective neck dissection by the National Cancer Comprehensive Network?
When expected incidence of microscopic or subclinical disease surpass 20% (though many use 25% or 30% as the criteria).
197
How soon will deep mucosal ulcerations and exposure of tracheal cartilage occur when cuff-to-tracheal wall tension exceeds mucosal capillary tension?
Within 1week.
198
A 72-year-old man has a melanoma on his forehead just above the lateral portion of his eyebrow. Should a parotidectomy be performed in addition to resection of the melanoma?
Yes.
199
True/False: Postoperative radiation does not significantly affect the outcome after facial nerve grafting.
TRUE
200
A 43-year-old woman has a melanoma on her nasolabial fold. What surgery should be performed in addition to resection of the melanoma?
Submandibular gland excision.
201
What is the reported ratio of basal cell to squamous cell cancer in the United States
0.167361111111111
202
What % of parotid gland tumors are benign
0.8
203
How many years does it take for a former smoker to have the same probability of developing an oral cavity cancer as a nonsmoker
16
204
What % of carotid body tumors are multicentric
(30 - 40% in the hereditary form).
205
What is the 5-year survival of patients with malignant parotid gland tumors who present with Vllth nerve paresis
???
206
What is the incidence of false positives for FNA and frozen section of parotid tumors
???
207
What is the 5-year survival of advanced laryngeal cancer when lymph node metastasis is present at diagnosis
208
What is the incidence of nodal metastases if the depth of the tumor is \>4.0 mm
\>70%.
209
What are the most common complications of this approach
• grams; Trismus and palatal fistula.
210
What is the incidence of paraganglioma
1 :30,000.
211
What is the risk of developing esophageal cancer in patients who smoke and drink compared to those who don't
1 00 times higher.
212
What is the incidence of nasopharyngeal cancer among native-born Chinese compared to that among Caucasians
1 18 times higher.
213
What percentage of patients with dysplastic nevus syndrome develop melanoma if a relative has a history of melanoma
1 OO%.
214
What were the treatment arms
1. Surgery. 2. 2 cycles of cisplatinum and 5-fluorouracil. a. Responders received a 3rd cycle followed by XRT. b. Nonresponders had surgery +/postoperative XRT.
215
What are the indications for a supracricoid partial laryngectomy with CHP or CHEP
1. T2 transglottic (TG) or supraglottic (SG) lesions not amenable to SG laryngectomy secondary to ventricular invasion, glottic extension, or impaired TVC motion. 2. T3 TG/SG lesions with TVC fixation or preepiglottic space involvement. 3. T 4 TG/SG lesions with limited invasion of thyroid ala without extension through the outer thyroid perichondrium. 4. Selected glottic tumors at the anterior commissure with preepiglottic space or SG involvement.
216
What is conventional fractionated radiotherapy
1.8 - 2.5 Gy QD, 5 fractions Q week, for 4 - 8 weeks (total dose 60 - 65 Gy for small tumors, 65 - 70 Gy for larger tumors).
217
What is the incidence of ORN after radiation to the head and neck
10 - 15%.
218
What is the fistula rate following free jejunal transfer (non-irradiated patients)
10- 20°/o.
219
How much time must elapse before starting radiation after dental extractions
10 days.
220
What % of patients with a primary laryngeal cancer will eventually develop a 2nd primary
10-20%.
221
What % of SCCA arising in areas of scar or chronic inflammation metastasize
10-30%.
222
What is the incidence of subclinical neck disease with adenoid cystic carcinoma of the parotid gland
11 %.
223
What is the incidence of cranial nerve palsy at initial presentation in patients with NPC
12 - 18%.
224
What is the incidence of regional metastasis in synovial sarcomas of the head and neck
12.5%.
225
What is the incidence of recurrence after resection of inverting papilloma via lateral rhinotomy/medial maxillectomy
13 - 15%.
226
What is the risk of melanomatous transformation of giant congenital nevi
14%.
227
What length of jejunum is normally harvested for reconstruction
15 - 20 em.
228
What is the fistula rate in patients who have had prior irradiation requiring total laryngectomy and partial pharyngectomy
15 - 20°/o.
229
Which tumors of the pyriform sinus do not necessarily require total laryngectomy
2 em or smaller, located at least 1.5 em superior to the pyriform fossa apex, with normal vocal cord movement, and no invasion into adjacent sites; patients must also have good pulmonary function.
230
What is the recommended excisional margin for a 3 em melanoma
2 em.
231
What proportion of patients with supraglottic cancer present with advanced disease
2/3.
232
What % of malignant tumors of the parotid gland present with facial nerve weakness or paralysis
20%.
233
Nasopharyngeal cancer accounts for what % of all cancers diagnosed in the Kwantung province of southern China
20%.
234
What % of melanomas occur in the head and neck
20°/o.
235
What is the incidence of recurrent disease in the treated N0 neck in the absence of primary site recurrence
2-4%.
236
What % of glottic tumors display perineural and vascular invasion
25%.
237
What % of these tumors will metastasize to the cervical lymph nodes
25%.
238
What is the incidence of skull base erosion in patients with NPC
25%.
239
When does mucositis typically appear
2nd week of RT.
240
What % of SCCA arising in areas of actinic change metastasize
3 - 5%.
241
When should postoperative RT begin
3 - 6 weeks postoperatively.
242
When, after RT, is a positive biopsy a reliable indicator for persistent disease
3 months after treatment.
243
What % of patients with xeroderma pigmentosa develop melanoma
3%.
244
What is the incidence of cervical metastasis of mucoepidermoid carcinomas
30 - 40°/o.
245
What is the incidence of positive cervical nodes in patients with T3 glottic tumors
30- 40%.
246
What is the 5-year survival of patients with WHO I disease
30%.
247
What is the 5 year survival of patients with Merkel cell carcinoma
30%.
248
What is the overall 5-year survival for sino nasal SCCA
30%.
249
What is the incidence of delayed decannulation after partial laryngectomy
3-5%.
250
For SCCA of the tongue, invasion beyond ___ is associated with a significantly higher incidence of lymph node metastasis.
4 mm (30°/o versus 7°/o if 4mm or less invasion).
251
What is the incidence of malignancy in adults with asymmetric tonsils with normal-appearing mucosa and no cervical lymphadenopathy
4.8%.
252
What is the 5-year survival rate
40 - 50%.
253
What is the maximum dose of radiation to the spinal cord
45 Gy (increased risk of radiation myelitis above this level).
254
What is the incidence of immediate onset of facial nerve dysfunction after parotidectomy for benign disease
46%.
255
What is the rate of lymph node metastasis from SCCA of the parotid gland
47%.
256
What is the perioperative mortality rate of gastric pull-up
5 - 20°/o.
257
What is the incidence of clinically significant pneumocephalus after anterior craniofacial surgery
5 12%.
258
What are the recommended margins for excision of basal cell skin cancers
5 mm.
259
What % of laryngeal tumors are primarily subglottic
5%.
260
What is the incidence of contralateral neck metastasis after unilateral selective neck dissection (in the N0 neck)
5%.
261
What % of tumors are not pigmented (amelanotic)
5%.
262
What is the chance that a patient with melanoma will develop a second melanoma
5%.
263
What % of people with GERD have Barrett's esophagus and what % of these people will develop adenocarcinoma
5%; 5 - lO% respectively.
264
At what doses can radiation retinopathy or optic neuropathy occur
50 - 55 Gy.
265
What is the 5-year survival of advanced laryngeal cancer without lymph node metastasis
50%.
266
What is the 5-year survival rate for patients with T3 glottic tumors
50%.
267
What is the rate of major complications after gastric pull-up
50%.
268
What % of patients require dilatation after gastric pull-up
50%.
269
What % of T3/T4 tumors of the tonsil can be salvaged after failing primary XRT
50%.
270
After having a basal or squamous cell carcinoma of the skin, what are the chances of developing another one within 5 years
50%.
271
When do maximal skin reactions usually appear
5111 week of RT.
272
What is the incidence of a 2"d primary at the time of diagnosis in patients with hypopharyngeal cancer
5-8%.
273
What is the incidence of persistent aspiration after hemilaryngectomy
6 - 10°/o.
274
Cataracts can occur after how much RT
6 Gy.
275
What % of patients with NPC will have a normal exam by fiberoptic endoscopy at the time of initial evaluation
6%.
276
What is the incidence of local recurrence
60 - 90%, usually within 2 years.
277
What is the incidence of cervical metastases at the time of presentation of pyriform sinus tumors? What % are bilateral or fixed
60%, 25°/o, respectively.
278
What is the incidence of recurrence after excision of odontogenic keratocyst
62% in the first 5 years.
279
What % of head and neck paragangliomas are familial
7- 1 O%.
280
What is the incidence of nasopharyngeal cancer among North American-born Chinese compared to that among Caucasians
7 times higher.
281
What is the incidence of cervical metastases from base of tongue (BOT), tonsil, and soft palate SCCA
70%, 60°/o, 40%, respectively.
282
What is the 5-year survival of patients with WHO II or III disease
70%.
283
What % of SCCA arising de novo metastasize
8%.
284
What is the incidence of nodal metastases if the depth of the tumor is
8%.
285
What % of patients with WHO types II and III tumors have abnormally increased titers to EBV VCA and NA
80 - 90%.
286
What is the approximate 5-year survival for T2 glottic cancer involving the anterior commissure treated with primary radiotherapy
80% (70% for true crossing tumors).
287
What % of patients with sinonasal tumors are asymptomatic at presentation
9 - 12%.
288
What % will fail if bilateral neck dissections are performed
9%.
289
What is CD44
A cell surface adhesion molecule that plays an important role in the growth and metastasis of several kinds of tumors.
290
What is an alloantigen
A human antigen from a different individual.
291
What problem arises when regional or transplanted skin flaps are used for reconstruction of the hypopharynx when the larynx is preserved
A large amount of immobile pharyngeal wall interferes with the pharyngeal component of swallowing, making aspiration inevitable.
292
What is a proto-oncogene? oncogene
A proto-oncogene participates in normal cellular signaling, transduction, and transcription; an oncogene is a mutant allele of a proto-oncogene.
293
How should a lesion suspicious for melanoma be biopsied
A sample should be taken of the tumor and the underlying tissue so that depth can be ascertained; a shave biopsy should never be performed.
294
What is an antisense drug
A small single-stranded nucleotide complementary to a target mRNA molecule that binds to mRNA and halts transcription.
295
What is an imbrication laryngectomy
A through-and-through excision of a horizontal segment of the larynx with anastomosis of the caudal and cephalic laryngeal margins.
296
How do adnexal carcinomas arising from hair follicles classically present
A tuft of white hair emerges from the central portion of the tumor.
297
What is the histologic appearance of Warthin's tumor
Abundant lymphoid sheets with distinct germinal centers; bilayer epithelium.
298
What are the 2 categories of altered fractionation
Accelerated and hyperfractionated.
299
What is the difference between these
Accelerated: total dose is the same as conventional treatment, but overall treatment time is decreased Hyperfractionated: overall treatment time is the same as conventional treatment, but total dose is increased, dose per fraction is decreased, and the number of fractions is increased.
300
What is the most common salivary gland malignancy to occur bilaterally
Acinic cell.
301
Which type of melanoma occurs on palms, soles, nail beds, and mucous membranes
Acral lentiginous melanoma.
302
What is the most common premalignant skin lesion of the head and neck
Actinic keratosis.
303
What is the second most common malignant tumor of the minor salivary glands
Adenocarcinoma.
304
What is the 2"d most common malignant sinonasal neoplasm
Adenocarcinoma.
305
Which salivary gland tumor has a high propensity for perineural invasion
Adenoid cystic carcinoma.
306
What is the most common malignancy of the submandibular and minor salivary glands
Adenoid cystic.
307
What type of tumor comprises 50°/o of all lacrimal gland neoplasms
Adenoid cystic.
308
What are the advantages of using adenovirus
Adenovirus is highly infective of both quiescent and actively-dividing cells, has a known tropism for cells of the upper aerodigestive tract, and can carry large genes.
309
What viruses are employed in head and neck gene therapy
Adenovirus, adena-associated virus, herpes virus, retroviruses, and vaccinia virus.
310
During placement of a tubed flap, where should the longitudinal suture line uniting the sides of the flap into a tube be placed
Against the prevertebral fascia.
311
What are the advantages of this approach
Allows wide exposure of the nasopharynx with low morbidity.
312
Where does a radicular or periapical cyst occur
Along the root of a non-viable tooth, as the liquefied stage of a dental granuloma.
313
What are the three most common odontogenic tumors
Ameloblastoma, cementoma, odontoma.
314
What is allovectin-7
An alloantigen that encodes for class I MHC HLA-87. It is plasmid DNA with a liposome vector that is injected directly into the tumor. Partial response without toxicity has been demonstrated in Phase I trials.
315
What should be done preoperatively for retrostyloid malignancies or tumors suspected to be involving the carotid artery
Angiography with balloon occlusion.
316
What are the boundaries of a glottic carcinoma traversing the anterior commissure associated with normal or limited cord mobility
Anterior commissure tendons, vocal ligament, conus elasticus.
317
Which parts of the glottis are most difficult to treat with radiation
Anterior commissure, posterior I /3 of the vocal cord.
318
Which portion of the larynx has sparse lymphatic drainage
Anterior glottis (epithelium of the TVC).
319
Which portion of the larynx has sparse lymphatic drainage
Anterior glottis (epithelium of the TVC).
320
Extension into which space is associated with the worst prognosis in patients with N PC
Anterior masticator space.
321
What test provides prognostic information in patients with NPC
Antibody-dependent cellular cytotoxicity (ADCC) assay.
322
What is the risk of cervical metastases in patients with Tl, T2, T3 and T4 tumors of the supraglottis
Approximately 20%, 40%, 60%, and 80%, respectively.
323
Where do dentigerous cysts develop
Around the crown of an unerupted, impacted tooth.
324
Which structures separate the hypopharynx from the larynx
Aryepiglottic folds.
325
How do these tumors appear radiographically
As a "dumbbell'; they must traverse through the stylomandibular tunnel to access the parapharyngeal space.
326
What are the major complications of these procedures
Aspiration pneumonia, rupture of the pexis, laryngocele, laryngeal stenosis.
327
What is the usual cause of death from esophageal cancer
Aspiration pneumonia.
328
What kind of epithelium lines the nasopharynx
At birth, pseudostratified columnar epithelium; by age I 0, the majority is replaced by stratified squamous epithelium. The lateral portion does not change, and the area where these two types meet is lined by transitional epithelium.
329
How far apart should the inferior and superior limbs be with the MacFee incision
At least 4 fingerbreaths apart.
330
Where does the adeno-associated virus vector insert its DNA in the host cell
At the I 9q 13.4 location.
331
Where do strictures most often occur after free jejunal transfer
At the inferior anastomosis between the jejunum and esophagus.
332
Where do fistulas most often occur after free jejunal transfer
At the superior anastomosis between the jejunum and pharynx.
333
What are the late radiation effects caused by fibroblast injury
Atrophy, contraction, and fibrosis of soft tissue.
334
In what area of the world is the incidence of melanoma the highest
Australia.
335
What is the inheritance pattern of familial carotid body tumors
Autosomal dominant but only the genes passed from the paternal side are expressed.
336
What is basal cell-nevoid syndrome
Autosomal dominant disorder characterized by multiple basal cell carcinomas (BCC), odontogenic keratocysts, rib abnormalities, palmar and plantar pits, and calcification of the falx cerebri.
337
Which UV light is most responsible for acute actinic damage
B.
338
An olfactory neuroblastoma involving the ethmoid sinuses would be classified as what stage by the Kadish system
B.
339
Involvement of which areas of the bodv increases the risk of metastases?
BANS: back, arms, neck and scalp.
340
Metaplasia of the distal esophagus is otherwise known as what
Barrett's esophagus.
341
Multiple odontogenic keratocysts are a manifestation of what syndrome
Basal cell nevus syndrome.
342
What are the four types of monomorphic adenomas
Basal cell, trabecular, canalicular, and tubular.
343
What is the absolute contraindication to endoscopic laser resection of supraglottic SCCA
Base of tongue involvement.
344
What are the 7 different types of squamous cell aberrations occurring in the larynx
Benign hyperplasia, benign keratosis (no atypia), atypical hyperplasia, keratosis with atypia or dysplasia, intraepithelial carcinoma, microinvasive SCCA, invasive SCCA.
345
What are the 7 different types of squamous cell aberrations occurring in the larynx
Benign hyperplasia, benign keratosis (no atypia), atypical hyperplasia, keratosis with atypia or dysplasia, intraepithelial carcinoma, microinvasive SCCA, invasive SCCA.
346
What prognostic significance does the presence of microcalcifications have
Better prognosis.
347
When do patients with synovial sarcoma usually present
Between ages 25 to 36.
348
Where do posterior pharyngeal wall tumors metastasize
Bilaterally to level II cervical nodes, mediastinum, and superiorly to the nodes of Rouviere at the skull base.
349
In what age group is olfactory neuroblastoma typically seen
Bimodal distribution... people in their 20's and 50's.
350
What is the most common site of distant metastases
Bones.
351
Which site in the oropharynx is associated with the worst functional outcome after combined surgery and RT regardless of tumor stage
BOT.
352
Which classification system is based on depth of invasion by millimeters
Breslow's.
353
What is the most common and serious complication following supraglottic laryngectomy
Bronchopneumonia.
354
What is Marjolin's ulcer
Bum or ulcer associated with the development of malignancy.
355
What is a Pindborg tumor
Calcified epithelial odontogenic tumor that is less aggressive than ameloblastoma and is associated with an impacted tooth.
356
What are the problems with using retroviruses
Can only infect actively dividing cells, are permanently integrated into the host cell's genome, and randomly insert into the host genome.
357
What is the most common paraganglioma of the head and neck
Carotid body tumor.
358
What structures are found in the poststyloid compartment of the parapharyngeal space
Carotid sheath, IX, X, XII, cervical sympathetic chain.
359
What are the ocular complications of RT
Cataracts, radiation retinopathy, optic nerve injury, lacrimal gland damage, ectropion/entropion.
360
What are some physical methods of gene transfer
Cationic liposomes, plasmid DNA, ballistic particle, calcium-phosphate-induced uptake and electroporation.
361
Which classification system is based on histologic layers
Clark's.
362
What are the histologic features of BCC
Clefting, lack of intracellular bridges, nuclear palisading, and peritumoral lacunae.
363
What are the indications for neck dissection in the treatment of salivary gland malignancies
Clinical metastasis, submandibular tumor, SCC A, undifferentiated carcinoma, size \>4 em, and high grade mucoepidermoid carcinoma.
364
What factors are most strongly related to overall speech function 3 months after surgery for oral or oropharyngeal cancer
Closure type, % oral tongue resected, and % soft palate resected.
365
What approach is used for resection of posterolateral tumors
Combined suprahyoid and lateral pharyngotomy.
366
What is a functional neck dissection
Complete cervical lymphadenectomy sparing the sternocleidomastoid muscle, spinal accessory nerve, and internal jugular vein.
367
What is the "first bite syndrome"
Complication after removal of a carotid body tumor where the patient experiences intense pain with the first bite of food.
368
What anatomic structures inhibit malignant invasion by laryngeal cancers
Conus elasticus, quadrangular membrane, thyrohyoid membrane, cricothyroid membrane, internal perichondrium of the thyroid lamina.
369
What are the 4 types of growth patterns of adenoid cystic carcinoma and which is most common
Cribiform (most common... looks like Swiss cheese), tubular/ductular, trabecular, or solid.
370
What is CHP? CHEP
Cricohyoidopexy and cricohyoidoepiglottopexy. Conservation laryngeal procedures performed in concordance with a supracricoid partial laryngectomy. Require preservation of at least one functional cricoarytenoid unit (SLN, RLN, arytenoid, cricoid, and cricoarytenoid musculature).
371
What are the boundaries of the cervical esophagus
Cricopharyngeus muscle to sternal notch.
372
Which of these is a variant of nodular BCC and produces pigment
Cystic.
373
SNUC tumors have antibodies to what substances
Cytokeratin, epithelial membrane antigen, and neuron-specific enolase.
374
What should be done during maxillectomy to prevent epiphora postoperatively
Dacryocystorhinostomy.
375
What are the most common late effects of RT to the head and neck
Damage to the eyes, hearing loss, endocrine disorders, xerostomia, chondro- and osteoradionecrosis, soft tissue fibrosis and necrosis.
376
What is the most serious complication of this approach and how can it be avoided
Damage to the hypoglossal and superior laryngeal nerves; can be avoided if the greater hom of the hyoid is left undissected.
377
What are the advantages of preoperative embolization of paragangliomas
Decreased intraoperative blood loss and operative time.
378
What is the role of large-dose fraction radiotherapy in the management of melanoma
Decreases incidence of locoregional recurrence among NO patients.
379
What factors are associated with the development of temporary facial paresis after parotidectomy
Deep lobe tumor; previous parotid surgery; history of sialoadenitis; addition of a neck dissection to the parotid surgery; increased age; diabetes mellitus; increased operative time; history of parotid irradiation; no EMG monitoring.
380
What chromosomal abnormality do osteosarcoma and retinoblastoma have in common
Deletion of the long arm of chromosome 13.
381
What is the pathogenesis behind transient radiation myelopathy
Demyelination of the posterior columns.
382
What is the most important prognostic factor of melanomas
Depth of invasion.
383
How does treatment failure usually manifest in NPC
Disease at both the primary site and cervical lymph nodes.
384
What is Plummer-Vinson syndrome
Disease of young women characterized by iron-deficiency anemia, glossitis, splenomegaly, esophageal stenosis, achlorhydria, and severe GERD. These patients have a higher incidence of cancer of the postcricoid area.
385
How does ameloblastoma appear radiographically'
Displaced surrounding structures, with multiple Ioculations and a honeycomb appearance.
386
What are the risk factors for development of ORN
Dose of radiation (\>70 Gy), size and extent of primary, post-radiation dental extraction.
387
What is the prognostic significance of CD44
Down-regulation of CD44v6 in head and neck tumor cells is closely related to metastases and invasion.
388
What effects does RT have on the skin
Dryness secondary to damaged sebaceous and sweat glands, thinning of the epidermis, telangiectasias.
389
What are the three most common presenting symptoms of hypopharyngeal cancer
Dysphagia, neck mass, and sore throat (in descending order of incidence).
390
What is the most common form of hereditary cutaneous melanoma
Dysplastic nevus syndrome.
391
What sort of Gl complaints do patients have after gastric pull-up
Early satiety, emesis, dumping syndrome.
392
What can be done to treat or prevent dumping syndrome
Eating small dry meals, restricting tl uid intake during meals, using octreotide (somatostatin analogue).
393
What is the differential diagnosis for the etiology of stridor in a patient who has undergone total glossectomy and post-op XRT
Edema secondary to altered lymphatics; recurrent tumor; GERD; superinfection.
394
In which country does postcricoid involvement occur in 50°/o of hypopharyngeal tumors
Egypt.
395
What is the principle sign of transient radiation myelopathy
Electric shock sensations triggered by flexing the cervical spine (L'Hermitte's sign).
396
Which types of radiation beams are used for superficial tumors and why
Electron beams; their finite range spares deeper tissues.
397
What are the most common immunologic findings among patients with NPC
Elevated lgA and IgG antibodies against the viral capsid antigen of EBV.
398
Smooth, submucosal nasopharyngeal masses located in the midline are most often what
Embryologic remnants (Thomwaldt's cysts, pharyngeal bursa remnants).
399
What is the treatment of pneumocephalus
Emergent drainage with needle aspiration, airway diversion (i.e. tracheostomy), nasal repacking.
400
What are odontomas composed of
Enamel, dentin, cementin, and pulp.
