Head and Neck Flashcards
Name the structures of the thoracic outlet from anterior to posterior.
- subclavian vein
- phrenic nerve
- anterior scalene
- subclavian artery
- middle scalne
What are the boundaries of the anterior neck triangle?
- anterior is midline of the neck
- posterior is the SCM
- inferior apex is the sternal notch
- superior base is the body of the mandible
- contains the carotid sheath
What are the contents of the anterior neck triangle?
the carotid sheath
What are the boundaries of the posterior neck triangle?
- anterior is the SCM
- posterior is the trapezius
- base is the middle 3rd of the clavicle
- apex is the SCM/trapezius intersection
- contains the spinal accessory nerve
What is contained within the posterior neck triangle?
the spinal accessory nerve
Describe the course of the right and left recurrent larygneal nerves.
- right: vagus passes anterior to the subclavian artery and the recurrent laryngeal nerve loops behind the subclavian and travels superiorly in the tracheoesophageal groove
- left: the vagus passes anterior to the aortic arch between the left common carotid and subclavian artery and the recurrent laryngeal nerve loops behind the arch and travels superiorly in the TE groove
Describe the innervation of the laryngeal muscles.
- superior laryngeal: cricothyroid muscle
- recurrent laryngeal: all other laryngeal muscles
The superior laryngeal nerve innervates what structure?
the cricothyroid muscle, the only laryngeal muscle not innervated by the recurrent laryngeal
What is the most common head and neck cancer?
squamous cell cancer
What are the risk factors for head and neck cancer?
- male gender
- alcohol and tobacco use (synergistic)
- HPV
What is the general staging system for head and neck cancers?
- stage I and II are local disease
- stage III and IV are either locally aggressive or have distant meets
How are head and neck cancers generally treated?
- stage I and II are candidates for surgical resection (unless a critical structure like vocal cords which get radiation)
- stage III and IV are usually treated with excision, MRND, and radiation +/- chemotherapy
What is the treatment for a 4cm oral squamous cell carcinoma?
lesions > 4cm or with nodal/bone involvement need resection with MRND and post-op radiation
Are tumors of large or small salivary glands more likely to be malignant?
small (i.e. sublingual > submandibular > parotid)
What is the most common salivary gland malignancy?
mucoepidermoid cancer
What is the treatment for mucoepidermoid cancer of the salivary glands?
resection with MRND +/- post-op radiation
What is the treatment for adenoid cystic cancer of the salivary glands?
- typically resection with MRND +/- post-op radiation
- however, very sensitive to radiation so if resection would be highly morbid, it can be avoided
What is the most common site for a head and neck cancer with unknown primary?
the tonsil followed by the base of the tongue
What is the workup for a head and neck cancer with unknown primary?
- thorough exam including fiberoptic exam of nasopharynx and larynx
- FNA of regional node or excisional biopsy
- CT scan of head/neck/chest with PET
- OR for direct laryngoscopy, esophagoscopy, ipsilateral tonsillectomy (most common site)
- if still unidentified, treat with ipsilateral MRND and bilateral radiation
What is the treatment for head and neck cancer with unknown primary?
ipsilateral MRND and bilateral radiation
How is melanoma of the head and neck treated?
- resect based on typical guidelines for melanoma; can adjust if abutting critical structures; should preserve facial nerve unless involved
- if regional nodes are clinically/pathologically positive: lymphadenectomy (superficial parotidectomy and selective anterior neck dissection for anterior lesions versus selective posterior neck dissection for posterior)
- if regional nodes are clinically negative: SLN biopsy for >1mm depth
- adjuvant therapy quickly evolving and controversial
How is the lymph node basin for melanoma of the head and neck determined?
- primary lesions anterior to an imaginary line from one tragus to the other will drain anteriorly through the parotid basin
- anterior lesions require superficial parotidectomy and selective anterior neck dissection
- posterior lesions require selective posterior neck dissection
What is the most likely diagnosis for a painless mass on the roof of the mouth? How is it treated?
- torus palatinus (overgrowth of the cortical bone)
- doesn’t require treatment unless interfering with denture fit
What is the most common site for oral cavity cancer?
the lower lip (secondary to sun exposure)
What portion of the lower lip can be resected without requiring flap reconstruction?
less than 50%
Which head and neck cancer has an association with EBV? How is it treated?
- associated with nasopharyngeal squamous cell carcinoma
- treat with radiation
What are the most common benign and malignant salivary gland tumors?
- malignant: mucoepidermoid carcinoma
- benign: pleomorphic adenoma
What is the most common benign salivary gland tumor? What is the treatment?
- pleomorphic adenoma
- treat with superficial parotidectomy (cannot enucleate the lesion)
What is Frey’s syndrome?
- gustatory sweating following parotidectomy
- due to injury of the auriculotemporal nerve that cross innervates with sympathetic fibers
Describe the presentation, microbiology, and treatment of suppurative parotiditis.
- presents with fever, pain, and swelling at the angle of the jaw; typically in an elderly, post-op patient
- usually due to Staphylococcus infection
- treat with antibiotics and I&D of any abscess
How should bleeding at a tracheostomy be evaluated and managed?
- for a small amount of blood, perform bronchoscopy to rule out tracheoinnominate fistula
- for a large amount of blood, place finger into the tracheostomy, hold manual pressure against the sternum and go to the OR emergently for sternotomy, resection of innominate artery, primary closure of tracheal side, and coverage with strap muscle
