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ABSITE > head and neck > Flashcards

head and neck Flashcards

1
Q

Freys syndrome

A

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

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2
Q

ant to post thoracic outlet

A

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

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3
Q

what does parotid vs sublingual vs submandibular secrete?

A

parotid: serous
sublingual: mucin
submandibular: 50/50

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4
Q

false vs true vocal cords

A

false superior to true

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5
Q

how does phrenic N run over anterior scalene?

A

lateral to medial

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6
Q

thyrocervical trunk STAT

A

suprascapular aa, transverse cervical aa, ascending cervical aa, inferior thyroid aa

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7
Q

congenital bony mass on upper and lingual mouth

A

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

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8
Q

modified radical neck dissection vs radical neck dissection

A

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

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9
Q

general w/u of primary HNSCC without known organ?

A
  1. exam with fiberoptic exam
  2. FNA or excisional node bx
  3. DL + EGD + Ipsilateral tonsillectomy
  4. if can’t find primary, do ipsilateral MRND and bilateral XRT
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10
Q

SCC chemotherapeutic

A

5FU and cisplatin

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11
Q

HNSCC

A

5th MC; M>F; EtOH and tobacco is SYNERGISTIC

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12
Q

HNSCC mgmt

A

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

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13
Q

syndrome ass’d HNSCC ORAL

A

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

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14
Q

lip flaps required if?

A

> 1/3 lip resected, btk’24 says 1/2

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15
Q

nasopharyngeal SCC

A

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

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16
Q

oropharyngeal SCC

A

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

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17
Q

hypopharyngeal SCC

A

to ANERIOR cervical ndoes; same mgmt as oropharyngeal

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18
Q

nasopharyngeal angiofibroma

A

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

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19
Q

laryngeal ca

A

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

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20
Q

salivary gland tumor

A

smaller = more malignant

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21
Q

MC salivary gland tumor location

A

PAROTID GLAND

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22
Q

tx mucoepidermoid cancer

A

resect with MRND +/- postop XRT
preserve CN VII if parotidectomy

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23
Q

tx adenoid cystic cancer

A

(watch out: invades NERVES)
resect + MRND +/- postop XRT…. VERY SENSITIVE TO XRT

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24
Q

preauricular tumor

A

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

so diagnostic SUPERFICIAL PAROTIDECTOMY

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25
Q

MC malignant tumor of salivary glands

A

mucoepidermoid

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26
Q

MC tumor overall of salivaries

A

pleomorphic adenoma
mgmt; superficial partoidectomy (total parotidectomy if malignant degeneration)

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27
Q

MC injury during parotid surgery

A

greater auricular nerve = numbness over lower portion of the ear)

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28
Q

MC injury during submandibular gland surgery

A

marignal mandivular nerve branch of the CN VII (drooop in corner)

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29
Q

cholesteatoma

A

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

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30
Q

mgmt cholesteatoma

A

resect possibly also mastoidectomy

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31
Q

chemodectomya

A

vascular tumor of mdidel ear
resect

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32
Q

bleeding from posterior nose

A

internal maxillary aa or ehtmoid artery - consider angioembolization if hx HTN older patient

33
Q

peritonsillar abscess mgmt

A

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

34
Q

retropharyngeal abscess patient

A

<10 yearsor Pott’s disease older

35
Q

retropharyngeal abscess mgmt

A

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

36
Q

parapharyneal abscess

A

mediastinal spread via prevertebral and retropharyngeal spaces

drain through lateral neck to avoid carotid and IJ

37
Q

ludwig angina

A

floor of mouth infection involving mylohyoid

38
Q

neck mass

A

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

39
Q

warthin tumor

A

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

40
Q

intraop facial nerve monitoring

A

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

41
Q

anterior triangle boundaries

A

SCM, mandible, midline; has carotid sheath

42
Q

posterior triangle boundaries

A

SCM, trap, 2nd third of clavicle; has CN XI

43
Q

RLN function

A

motor of LARYNX except cricothyroid (SLN)

44
Q

RLN course

A

R: ant to SCA loops behind and travels in TE groove
L: ant to aortic arch between Left common carotid and SCA and loops behind arch up in TE groove

45
Q

H&N melanoma dx

A

FULL THICKNESS (no shave) bx

46
Q

mgmt melanoma H&N

A

resect with same margins as other sites 1 - <1mm, 2 - >2 mm

47
Q

how do melanomas drain in face

A

tragus line -
anterior: superfiical partoidectomy (drains to parotid) + selective ant neck dissection

posterior: selective posterior neck dissection without parotidectomy

48
Q

vocal cord disruption after emergent intubation?

A

thyroid cartilage fracture

49
Q

optimal trach placement? to avoid TIF

A

between 2nd and 3rd cartilage

50
Q

when to operate on facial N?

A

within 72 hours… if lateral to lateral canthus
otherwise nonop if medial

51
Q

vagus N

A

runs between IJ and carotid artery

52
Q

how does long thoracic N run?

A

posterior to the middle scalene muscle

53
Q

glossopharyngal N

A

taste to posterior 1/3 tongue and motor to stylopharyngeus

54
Q

trapezius flap pedicle

A

transverse cervical artery

55
Q

pec major flap

A

thoracoacromial artery or internal mammary artery

56
Q

erythroplakia

A

more premalignant than leukoplaka

57
Q

MC site of oral cavity ca

A

lower lipw

58
Q

worst survival rate oral cavity ca

A

hard palate (can’t resect)

59
Q

oral cavity components

A

mouth floor
ant 1/3 tongue
gingiva
hard palate
anterior tonsillar pillars
lips

60
Q

tongue ca with jaw invasion

A

commando procedure

61
Q

verrucous ulcer

A

well differentiated SCC…. in cheek from tobacco
rarely mets but
tx: resect full cheek +/- flap (no need for LN dissection)

62
Q

tonsillar ca course

A

mostly LN invasion at time of dx
bx with tonsillectomy and then wide resection after that (1 cm wide resection usually)

63
Q

oral cavity ca tx overall

A

1 cm margin
MRND if >4cm, positive nodes, bone invasion
XRT postop if >4cm, positive margin, nodal/bone involement

64
Q

painless parotid mass with facial nerve paralysis ….

A

very suggestive of parotid malignancy

65
Q

MC salivary gland tumor in children

A

hemangiomas

66
Q

superficial parotidectomy incision

A

Blair incision

67
Q

how does the facial nerve run

A

main trunk is 8mm deep to tympanomastoid suture line at the level of the digastric mm

branches of facial nerve course between superifical and deep lobes of the parotid gland

68
Q

csf rhinorrhea etiology

A

usually cribiform plate fx (TAU) ..repair facial fractures
conservative mgmt for 2-3 wks +/- epidural catheter +/- transethmoidal repair

69
Q

radicular cyst

A

inflammatory cyst at the root of the teeth… can cause bone erosion
LUCENT on XR
local excision or curettage

70
Q

ameloblastoma

A

slow growing malignancy of odontogenic epithelium (teeth)
looks liek SOAP BUBBLES on XR ; wide local excision

71
Q

lower lip numbness

A

inferior alveolar N damage (branch of mandibular N)

72
Q

stensen duct lac

A

repair over stent (to avoid parotid PAINFUL atrophy)

73
Q

MC location of sialoadenitis (infection from stone n salivary gland)

A

submandibular or sublingual gland

74
Q

median rhomboid glossitis

A

failure of fusion
no tx necessary

75
Q

cleft lip repair 10s

A

at 10 wks
10 lb
Hgb 10n

76
Q

cleft palate tx timing

A

12 mos

77
Q

ear is pushed forward

A

mastoiditis
2/2 AOM lkely
T tubes and Abx.

78
Q

epiglottitis bug

A

H flu TYPE B

79
Q
A

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