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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
MC malignant tumor of salivary glands
mucoepidermoid
26
MC tumor overall of salivaries
pleomorphic adenoma mgmt; superficial partoidectomy (total parotidectomy if malignant degeneration)
27
MC injury during parotid surgery
greater auricular nerve = numbness over lower portion of the ear)
28
MC injury during submandibular gland surgery
marignal mandivular nerve branch of the CN VII (drooop in corner)
29
cholesteatoma
epidermal inclusion cyst of ear... erode and present with conductive hearing loss and clear drainage from ear
30
mgmt cholesteatoma
resect possibly also mastoidectomy
31
chemodectomya
vascular tumor of mdidel ear resect
32
bleeding from posterior nose
internal maxillary aa or ehtmoid artery - consider angioembolization if hx HTN older patient
33
peritonsillar abscess mgmt
no airway issues... needle aspirate and if still bad, drain into mouth (tonsillar bed)
34
retropharyngeal abscess patient
<10 yearsor Pott's disease older
35
retropharyngeal abscess mgmt
AIRWAY (may need intubation) , drain through posterior pharyngeal wall
36
parapharyneal abscess
mediastinal spread via prevertebral and retropharyngeal spaces drain through lateral neck to avoid carotid and IJ
37
ludwig angina
floor of mouth infection involving mylohyoid
38
neck mass
FNA > panednoscopy > CT scan> excisioanl bx +/- ipsi MRND and tonsillectomy followed by radiation
39
warthin tumor
benign partoid tumor (smokers, old people) b/l usually FNA: cyst fluid mgmt: watchful waiting vs superifial parotidectomy/WLE (not full thing
40
intraop facial nerve monitoring
helps with decreased transient nerve paralysis; but no change in permanent paralysis
41
anterior triangle boundaries
SCM, mandible, midline; has carotid sheath
42
posterior triangle boundaries
SCM, trap, 2nd third of clavicle; has CN XI
43
RLN function
motor of LARYNX except cricothyroid (SLN)
44
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
45
H&N melanoma dx
FULL THICKNESS (no shave) bx
46
mgmt melanoma H&N
resect with same margins as other sites 1 - <1mm, 2 - >2 mm
47
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
48
vocal cord disruption after emergent intubation?
thyroid cartilage fracture
49
optimal trach placement? to avoid TIF
between 2nd and 3rd cartilage
50
when to operate on facial N?
within 72 hours... if lateral to lateral canthus otherwise nonop if medial
51
vagus N
runs between IJ and carotid artery
52
how does long thoracic N run?
posterior to the middle scalene muscle
53
glossopharyngal N
taste to posterior 1/3 tongue and motor to stylopharyngeus
54
trapezius flap pedicle
transverse cervical artery
55
pec major flap
thoracoacromial artery or internal mammary artery
56
erythroplakia
more premalignant than leukoplaka
57
MC site of oral cavity ca
lower lipw
58
worst survival rate oral cavity ca
hard palate (can’t resect)
59
oral cavity components
mouth floor ant 1/3 tongue gingiva hard palate anterior tonsillar pillars lips
60
tongue ca with jaw invasion
commando procedure
61
verrucous ulcer
well differentiated SCC.... in cheek from tobacco rarely mets but tx: resect full cheek +/- flap (no need for LN dissection)
62
tonsillar ca course
mostly LN invasion at time of dx bx with tonsillectomy and then wide resection after that (1 cm wide resection usually)
63
oral cavity ca tx overall
1 cm margin MRND if >4cm, positive nodes, bone invasion XRT postop if >4cm, positive margin, nodal/bone involement
64
painless parotid mass with facial nerve paralysis ....
very suggestive of parotid malignancy
65
MC salivary gland tumor in children
hemangiomas
66
superficial parotidectomy incision
Blair incision
67
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
68
csf rhinorrhea etiology
usually cribiform plate fx (TAU) ..repair facial fractures conservative mgmt for 2-3 wks +/- epidural catheter +/- transethmoidal repair
69
radicular cyst
inflammatory cyst at the root of the teeth... can cause bone erosion LUCENT on XR local excision or curettage
70
ameloblastoma
slow growing malignancy of odontogenic epithelium (teeth) looks liek SOAP BUBBLES on XR ; wide local excision
71
lower lip numbness
inferior alveolar N damage (branch of mandibular N)
72
stensen duct lac
repair over stent (to avoid parotid PAINFUL atrophy)
73
MC location of sialoadenitis (infection from stone n salivary gland)
submandibular or sublingual gland
74
median rhomboid glossitis
failure of fusion no tx necessary
75
cleft lip repair 10s
at 10 wks 10 lb Hgb 10n
76
cleft palate tx timing
12 mos
77
ear is pushed forward
mastoiditis 2/2 AOM lkely T tubes and Abx.
78
epiglottitis bug
H flu TYPE B
79

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