Head and Neck Flashcards
Freys syndrome
gustatory sweating; after parotidectomy (injury to auriculotemporl N that cross innervates sympathetics)
causes aberrant regeneration of parasympathetics
ant to post thoracic outlet
SCV > phrenic > ant scalene > SCA > brachial plexus > middle scalene
what does parotid vs sublingual vs submandibular secrete?
parotid: serous
sublingual: mucin
submandibular: 50/50
false vs true vocal cords
false superior to true
how does phrenic N run over anterior scalene?
lateral to medial
thyrocervical trunk STAT
suprascapular aa, transverse cervical aa, ascending cervical aa, inferior thyroid aa
congenital bony mass on upper and lingual mouth
upper palate: torus palatini (mgmt: nothing)
lingual mandible: torus mandibular (mgmt nothing)
modified radical neck dissection vs radical neck dissection
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
general w/u of primary HNSCC without known organ?
- exam with fiberoptic exam
- FNA or excisional node bx
- DL + EGD + Ipsilateral tonsillectomy
- if can’t find primary, do ipsilateral MRND and bilateral XRT
SCC chemotherapeutic
5FU and cisplatin
HNSCC
5th MC; M>F; EtOH and tobacco is SYNERGISTIC
HNSCC mgmt
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
syndrome ass’d HNSCC ORAL
plummer vinson syndrome; glossitis, cervical dysphagia, esophageal web, spoon fingers, Fe def anemia
lip flaps required if?
> 1/3 lip resected, btk’24 says 1/2
nasopharyngeal SCC
EBV, Chinese,
goes to POSTERIOR cervical neck nodes
mgmt: chemoRADIATION**
oropharyngeal SCC
mgmt: <4cm: radiate
>4cm: reect, RMND and radiation
goes to POSTERIOR NODES
hypopharyngeal SCC
to ANERIOR cervical ndoes; same mgmt as oropharyngeal
nasopharyngeal angiofibroma
BENIGN.
M<20 YO, very vasculr
mgmt: embolize (internal maxillary aa) then resect
laryngeal ca
sx: hoarse, dysphagia, aspiration
PRESERVE LARYNX
mgmt: XRT if vocal cord only, add chemo if beyond vocal cordsali
salivary gland tumor
smaller = more malignant
MC salivary gland tumor location
PAROTID GLAND
tx mucoepidermoid cancer
resect with MRND +/- postop XRT
preserve CN VII if parotidectomy
tx adenoid cystic cancer
(watch out: invades NERVES)
resect + MRND +/- postop XRT…. VERY SENSITIVE TO XRT
preauricular tumor
must rule out parotid tumor but don’t want to enucleate…
so diagnostic SUPERFICIAL PAROTIDECTOMY
MC malignant tumor of salivary glands
mucoepidermoid
MC tumor overall of salivaries
pleomorphic adenoma
mgmt; superficial partoidectomy (total parotidectomy if malignant degeneration)
MC injury during parotid surgery
greater auricular nerve = numbness over lower portion of the ear)
MC injury during submandibular gland surgery
marignal mandivular nerve branch of the CN VII (drooop in corner)
cholesteatoma
epidermal inclusion cyst of ear… erode and present with conductive hearing loss and clear drainage from ear
mgmt cholesteatoma
resect possibly also mastoidectomy
chemodectomya
vascular tumor of mdidel ear
resect
bleeding from posterior nose
internal maxillary aa or ehtmoid artery - consider angioembolization if hx HTN older patient
peritonsillar abscess mgmt
no airway issues…
needle aspirate and if still bad, drain into mouth (tonsillar bed)
retropharyngeal abscess patient
<10 yearsor Pott’s disease older
retropharyngeal abscess mgmt
AIRWAY (may need intubation) , drain through posterior pharyngeal wall
parapharyneal abscess
mediastinal spread via prevertebral and retropharyngeal spaces
drain through lateral neck to avoid carotid and IJ
ludwig angina
floor of mouth infection involving mylohyoid
neck mass
FNA > panednoscopy > CT scan> excisioanl bx +/- ipsi MRND and tonsillectomy followed by radiation
warthin tumor
benign partoid tumor (smokers, old people) b/l usually
FNA: cyst fluid
mgmt: watchful waiting vs superifial parotidectomy/WLE (not full thing
intraop facial nerve monitoring
helps with decreased transient nerve paralysis; but no change in permanent paralysis
anterior triangle boundaries
SCM, mandible, midline; has carotid sheath
posterior triangle boundaries
SCM, trap, 2nd third of clavicle; has CN XI
RLN function
motor of LARYNX except cricothyroid (SLN)
RLN course
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
H&N melanoma dx
FULL THICKNESS (no shave) bx
mgmt melanoma H&N
resect with same margins as other sites 1 - <1mm, 2 - >2 mm
how do melanomas drain in face
tragus line -
anterior: superfiical partoidectomy (drains to parotid) + selective ant neck dissection
posterior: selective posterior neck dissection without parotidectomy
vocal cord disruption after emergent intubation?
thyroid cartilage fracture
optimal trach placement? to avoid TIF
between 2nd and 3rd cartilage
when to operate on facial N?
within 72 hours… if lateral to lateral canthus
otherwise nonop if medial
vagus N
runs between IJ and carotid artery
how does long thoracic N run?
posterior to the middle scalene muscle
glossopharyngal N
taste to posterior 1/3 tongue and motor to stylopharyngeus
trapezius flap pedicle
transverse cervical artery
pec major flap
thoracoacromial artery or internal mammary artery
erythroplakia
more premalignant than leukoplaka
MC site of oral cavity ca
lower lipw
worst survival rate oral cavity ca
hard palate (can’t resect)
oral cavity components
mouth floor
ant 1/3 tongue
gingiva
hard palate
anterior tonsillar pillars
lips
tongue ca with jaw invasion
commando procedure
verrucous ulcer
well differentiated SCC…. in cheek from tobacco
rarely mets but
tx: resect full cheek +/- flap (no need for LN dissection)
tonsillar ca course
mostly LN invasion at time of dx
bx with tonsillectomy and then wide resection after that (1 cm wide resection usually)
oral cavity ca tx overall
1 cm margin
MRND if >4cm, positive nodes, bone invasion
XRT postop if >4cm, positive margin, nodal/bone involement
painless parotid mass with facial nerve paralysis ….
very suggestive of parotid malignancy
MC salivary gland tumor in children
hemangiomas
superficial parotidectomy incision
Blair incision
how does the facial nerve run
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
csf rhinorrhea etiology
usually cribiform plate fx (TAU) ..repair facial fractures
conservative mgmt for 2-3 wks +/- epidural catheter +/- transethmoidal repair
radicular cyst
inflammatory cyst at the root of the teeth… can cause bone erosion
LUCENT on XR
local excision or curettage
ameloblastoma
slow growing malignancy of odontogenic epithelium (teeth)
looks liek SOAP BUBBLES on XR ; wide local excision
lower lip numbness
inferior alveolar N damage (branch of mandibular N)
stensen duct lac
repair over stent (to avoid parotid PAINFUL atrophy)
MC location of sialoadenitis (infection from stone n salivary gland)
submandibular or sublingual gland
median rhomboid glossitis
failure of fusion
no tx necessary
cleft lip repair 10s
at 10 wks
10 lb
Hgb 10n
cleft palate tx timing
12 mos
ear is pushed forward
mastoiditis
2/2 AOM lkely
T tubes and Abx.
epiglottitis bug
H flu TYPE B
