Head and Neck

Question 1

Name the structures of the thoracic outlet from anterior to posterior?

Answer 1

• subclavian vein
• phrenic nerve
• anterior scalene
• subclavian artery
• brachial plexus
• middle scalene

Question 2

What are the boundaries of the anterior neck?

Answer 2

• midline anteriorly
• SCM posterior
• mandible superiorly
• sternal notch inferiorly

Question 3

What are the boundaries of the posterior neck?

Answer 3

• SCM anterior
• trapezius posteriorly
• clavicle inferiorly

Question 4

What important structures runs through the anterior and posterior neck triangles?

Answer 4

• anterior: carotid sheath
• posterior: spinal accessory nerve

Question 5

Describe the course of the right and left recurrent laryngeal nerves.

Answer 5

• right: vagus runs anterior to SCA and the RLN loops behind the SCA, traveling superiorly in the tracheoesophageal groove
• left: vagus passes anterior to the aortic arch and the RLN loops behind the arch before traveling superiorly in the TE groove

Question 6

What muscles does the RLN innervate? The external branch of the superior laryngeal?

Answer 6

• RLN: muscles of the larynx except the cricothyroid
• SLN: crichothyroid muscle

Question 7

How are head and neck cancers generally treated?

Answer 7

• stage I and II (local disease) are treated with surgery or radiation depending on location and morbidity of resection
• stage III and IV (locally aggressive or spread) are treated with WLE, MRND, and chemoradiation

Question 8

What are the indications for MRND for an oral SCC?

Answer 8

• lesion > 4cm
• bony involvement
• nodal disease

Question 9

Are large or small salivary gland tumors more likely to be malignant?

Answer 9

those of small salivary glands (sublingual > submandibular > parotid)

Question 10

What are the most common sites of unknown primary head and neck cancer?

Answer 10

• 1: tonsil
• 2: base of tongue

Question 11

How is head and neck cancer treated if no primary is found?

Answer 11

with ipsilateral MRND and bilateral chemoradiation

Question 12

What is the lymph node basin for melanomas of the head and neck?

Answer 12

• lesions anterior to an imaginary line from one tragus to the other drain to the parotid basin and get a superficial parotidectomy and selective anterior neck dissection
• posterior lesions get a selective posterior neck dissection

Question 13

What is the most common benign salivary gland tumor and how is it treated?

Answer 13

• pleomorphic adenoma
• needs superficial parotidectomy, can’t enucleate these

Question 14

What is the most common organism isolated from those with suppurative parotiditis?

Answer 14

Staph