Head and Neck Flashcards
Papillary thyroid carcinoma
> Young females
Papillary and colloid follicules
Histology - papillary projections / empty nuclei
Excellent prognosis
Multinodular
Lymphnode spread
Follicular adenoma
> Single nodule
Non malignant from histology
Follicular carcinoma
> Histology - encapsulated (differentiated from adenoma)
Vascular invasion
Lymphatic spread
Common bone metastasis
Medullary carcinoma
> From parafollicular C-cells, not thyroid tissue
Secrete calcitonin
Associated with MEN Type 2a
Lymphatic and haematogenous spread
Blood supply to thyroid
superior and inferior thyroid arteries.
> Left Subclavian artery > thyrocervical trunk > inferior thyroid arteries
> External carotid artery > superior thyroid arteries
> Thyroidea ima (in 10% of population -from brachiocephalic artery or aorta)
Venous supply from thyroid
> Superior and middle thyroid veins - into the IJV
> Inferior thyroid vein - into the brachiocephalic veins
Origins of parathyroid glands
Superior parathyroids > 4th pharyngeal pouch
Inferior parathyroids > 3rd pharyngeal pouch
Contents of carotid sheath
Vagus, common carotid, IJV
Outside - Ansa cervicalis
Ansa cericalis
Sternohyoid, omohyoid, sternothyroid
1st Pharyngeal Arch
Trigeminal Nerve V
Maxillary Artery
Malleus / Incus
Mastication muscles
1st Pharyngeal Pouch
Middle ear
Thyroid
2nd Pharyngeal Arch
Facial Nerve VII
Hyoid / Stapedius Artery
Stylo-Hyoid cartilage / Stapes
Facial Expression muscles
2nd Pharyngeal Pouch
Tonsillar fossa
Thyroid
3rd Pharyngeal Arch
Glossopharyngeal Nerve IX
Internal Carotid Artery
Hyoid cartilage
Posterior portion of tongue
3rd Pharyngeal Pouch
Thymus
Inferior parathyroids
4th Pharyngeal Arch
Vagus Nerve X
Right subclavian artery / Arch of Aorta
Pharyngeal and Laryngeal muscles
4th Pharyngeal Pouch
Thymus
Superior parathyroids
Cavernous Sinus Content
Internal Carotid Artery
Nerves
> Occulomotor CN 2
> Trochlear CN 4
> Abducens CN 6
> Trigeminal - Opthalmic CN 5A
> Trigeminal - Maxillary CN 5B
Bones - Sphenoid bone from Superior orbital fissure topetrous part of temporal bone
CN1 exits skull
Cribiform plate
CN2 exits skull
Optic canal
CN3 exits skull
SOF
CN4 exists skull
SOF
CN5 exists skull
Ophthalmic = SOF
Maxilla - Foramen rotundum
Mandibular - Foramen vale
CN6 exits skull
SOF
CN7 exits skull
IAM
CN8 exits skull
IAM
CN9 exits skull
Jugular foramen
CN10 exits skull
Jugular forâmen
CN11 exist skull
Jugular forâmen
CN12
Hypoglossal canal
Lymphatics of auricle
> The lateral surface of the upper half drains to the superficial parotid lymph nodes
The cranial surface of the superior half drains to the mastoid nodes and deep cervical lymph nodes
The lower half and lobule drain into the superficial cervical lymph nodes.
Lymphatics of tongue
> Tip of the tongue > Ipsilateral sub mental nodes and from there to the deep cervical nodes.
Mid portion of the tongue > submandibular nodes and then to the deep cervical nodes. Mid tongue tumours that are laterally located will usually drain to the ipsilateral deep cervical nodes, those from more central regions may have bilateral deep cervical nodal involvement.
Posterior third of the tongue > bilateral nodal metastases are more common in this area.
Branches of external carotid
Anterior
> Superior Thyroid
> Lingual
> Facial
Posterior
> Posterior auricular
> Occipital
Deep
> Ascending Pharyngeal
Terminal
> Maxillary
> Superficial Temporal
Level of hyoid bone
C3
Level of bifurcation of carotids
C4
Level of cricoid cartilage
C6
