head and neck

Question 1

Freys syndrome

Answer 1

gustatory sweating; after parotidectomy (injury to auriculotemporl N that cross innervates sympathetics)
causes aberrant regeneration of parasympathetics

Question 2

ant to post thoracic outlet

Answer 2

SCV > phrenic > ant scalene > SCA > brachial plexus > middle scalene

Question 3

thyrocervical trunk STAT

Answer 3

suprascapular aa, tranvserse cervical aa, ascending cervical aa, inferior thyroid aa

Question 4

congenital bony mass on ppper and lingual mouth

Answer 4

upper palate: torus palatini (mgmt: nothing)
lingual mandible: torus mandibular (mgmt nothing)

Question 5

modified radical neck dissection vs radical neck dissection

Answer 5

modified: omohyoid, submandibular gland, sensory nerves C2-C5, cervical branch of CN VII facial, and ipsilateral throid lobe

radical that plus CN XI accessory, SCM, and iJ

Question 6

SCC chemotherapeutic

Answer 6

5FU and cisplatin

Question 7

HNSCC mgmt

Answer 7

wide resection 1 cm (.5-1 for all other)
modified radical nek if >4 cm, clinical nodes, bone invasion
adjuvant radiation for >4cm, positive mrgins, node positive

Question 8

syndrome ass’d HNSCC ORAL

Answer 8

plummer vinson syndrome; glossitis, cervical dysphagia, esophageal web, spoon fingers, Fe def anemia

Question 9

lip flaps required if?

Answer 9

> 1/3 lip resected

Question 10

nasopharyngeal SCC

Answer 10

EBV, Chinese,
goes to POSTERIOR cervical neck nodes
mgmt: chemoRADIATION**

Question 11

oropharyngeal SCC

Answer 11

mgmt: <4cm: radiate
>4cm: reect, RMND and radiation
goes to POSTERIOR NODES

Question 12

hypopharyngeal SCC

Answer 12

to ANERIOR cervical ndoes; same mgmt as oropharyngeal

Question 13

nasopharyngeal angiofibroma

Answer 13

BENIGN.
M<20 YO, very vasculr
mgmt: embolize (internal maxillary aa) then resect

Question 14

laryngeal ca

Answer 14

sx: hoarse, dysphagia, aspiration
PRESERVE LARYNX
mgmt: XRT if vocal cord only, add chemo if beyond vocal cordsali

Question 15

salivary gland tumor

Answer 15

smaller = more malignant

Question 16

MC salivary gland tumor location

Answer 16

PAROTID GLAND

Question 17

preauricular tumor

Answer 17

must rule out parotid tumor but don’t want to enucleate…

so diagnostic SUPERFICIAL PAROTIDECTOMY

Question 18

MC malignant tumor of salivary glands

Answer 18

mucoepidermoid

Question 19

MC tumor overall of salivaries

Answer 19

pleomorphic adenoma
mgmt; superficial partoidectomy

Question 20

MC injury during parotid surgery

Answer 20

greater auricular nerve

Question 21

MC injury during submandibular gland surgery

Answer 21

marignal mandivular nerve (drooop in corner)

Question 22

cholesteatoma

Answer 22

epidermal inclusion cyst of ear… erode and present with conductive hearing loss and clear drainage from ear

Question 23

mgmt cholesteatoma

Answer 23

resect possibly also mastoidectomy

Question 24

chemodectomya

Answer 24

vascular tumor of mdidel ear
resect

Question 25

bleeding from posterior nose

Answer 25

internal maxillary aa or ehtmoid artery

Question 26

peritonsillar abscess mgmt

Answer 26

no airway issues…
needle aspirate and if still bad, drain into mouth (tonsillar bed)

Question 27

retropharyngeal abscess patient

Answer 27

<10 yearsor Pott’s disease older

Question 28

retropharyngeal abscess mgmt

Answer 28

AIRWAY (may need intubation) , drain through posterior pharyngeal wall

Question 29

parapharyneal abscess

Answer 29

mediastinal spread via prevertebral and retropharyngeal spaces

drain through lateral neck to avoid carotid and IJ

Question 30

ludwig angina

Answer 30

floor of mouth infection involving mylohyoid

Question 31

neck mass

Answer 31

FNA > panednoscopy > CT scan> excisioanl bx +/- ipsi MRND and tonsillectomy followed by radiation

Question 32

warthin tumor

Answer 32

benign partoid tumor (smokers, old people) b/l usually
FNA: cyst fluid
mgmt: watchful waiting vs superifial parotidectomy/WLE (not full thing

Question 33

intraop facial nerve monitoring

Answer 33

helps with decreased transient nerve paralysis; but no change in permanent paralysis