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#DAY3_SURGERY > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

most common preventable risk factor in the head and neck CA

A

tobacco and alcohol

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2
Q

It is a second tumor detected within 6 months of the diagnosis of the initial primary lesion

A

synchronous neopllasm

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3
Q

It is a second tumor detected more than 6 months of the diagnosis of the initial primary lesion

A

metachronous neoplasm

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4
Q

What is the initial evaluation of patients with primary CA of head and neck

A

panendoscopy

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5
Q

Most common location of squamous cell CA of the lip

A

lower lip BCCA - upper lip

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6
Q

What nerve is involved when there is paresthesia of the lips

A

mental nerve

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7
Q

treatment of squamous cell cancer of the lip

A

T1 - T2: resection = radiation T3 - T4: surgical excision with histologic confirmation of tumor free margin and post operative radiation

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8
Q

Selective neck dissection

A

o Supraomohyoid dissection (I, II, and III) - for oral cavity malignancies o Lateral neck dissection (II, III, and IV) - for laryngeal malignancies o Posterolateral neck dissection (II,III,IV, and V) - for thyroid malignancies NOTES FROM ANATOMY: • Primary tumors within the Oral cavity and Lip metastasize to nodes in levels I, II and III • Oropharynx, Hypopharynx and Larynx to levels II, III and IV • Nasopharynx and Thyroid – level V

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9
Q

Tongue cancer with lingual nerve involvement causes

A

ipsilateral paresthesia

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10
Q

Tongue cancer with hypoglossal nerve involvement causes

A

deviation of tongue on protrussion and fasciculations

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11
Q

Most common location of tongue cancer

A

lateral and ventral surfaces

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12
Q

Treatment of tongue cancer

A

T1 - T2 - wide local excision Base of Tongue - partial glossectomy with supraomohyoid dissection (N0) or MRND (N+)

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13
Q

Featurs of plummer vinson syndrome

A

• dysphagia atrophic oral mucosa, spoon-shaped fingers with brittle nails, and chronic anemia • occurs in middle age edentulous women • esophageal web: drug induced lesion (FeSO4) • pre malignant lesion (SCCA)

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14
Q

Treatment of tumor of alveolus and gingiva

A
  1. minimal bone invasion - mandibular resection 2. medullary cavitiy invasion - segmental mandibulectomy
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15
Q

Treatment of tumors of nasopharynx

A

chemotherapy

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16
Q

Most common nasophryngeal malignancy in the pedatric age group

A

lymphoma

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17
Q

Lymphatic spread of nasopharynx

A
  1. bilateral regional 2. posterior triangle (level 5)
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18
Q

Lymphatic spread of oropharynx

A
  1. upper and lower cervical lymphatics (level 2, 3, 4) 2. retropharyngeal spread
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19
Q

Lymphatic spread of hypopharynx

A
  1. bilateral regional 2. mid and lower cervical lymphatics (level 3, 4)
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20
Q

Tumors of the oropharynx are radiosensitive

A

Tumors of the oropharynx are radiosensitive

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21
Q

Where does larngeal granuloma usually occur?

A

posterior larynx on the arytenoid mucosa

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22
Q

Most common cause of vocal cord paralysis

A

iatrogenic

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23
Q

Treatment of early stage glottic and supraglottic cancer

A

Radiation therapy

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24
Q

Treatment of small glottic cancer

A

partial laryngectomy

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25
Q

Treatment of supraglottic cancer without arytenoid or vocal cord extension

A

supraglottic laryngectomy

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26
Q

Treatment of advanced laryngeal tumor with extension

A

total laryngectomy with post op RT

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27
Q

Treatment of subglottic cancer

A

total laryngectomy

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28
Q

Pattern of spread from primary tumor of oral cavity and lip

A

I, II, III

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29
Q

Pattern of spread from primary tumor of oropharynx, hypopharynx and larynx

A

II, III, IV

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30
Q

Pattern of spread from primary tumor of nasopharynx and thyroid

A

V

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31
Q

Pattern of spread from primary tumor of nasopharynx, soft palate, and lateral and posterior walls of the oropharynx and hypopharynx

A

Retropharyngeal lymph nodes

32
Q

Pattern of spread from primary tumor of hypopharynx, cervical esophagus and thyroid

A

VII

33
Q

Pattern of spread from advanced tumor of glottis with subglottic spread

A

delphian node

34
Q

What is a radical neck dissection or CRILE method

A
  1. removal of level I to V lymph nodes 2. SCM 3. IJV 4. Spinal accesory nerve
35
Q

What is a modified radical neck dissections also called functional neck dissection

A

o removes levels I to V cervical lymphatics but preserves the spinal accessory nerve, the IJV and the sternocleidomastoid muscle

36
Q

What is a supraomohyoid neck dissection

A
  1. removal of level I to III 2. oral cavity malignancy
37
Q

What is a lateral neck dissection

A
  1. removal of level II to IV 2. laryngeal malignancy
38
Q

What is a posterolateral neck dissection

A
  1. removal of II to V 2. thyroid cancer
39
Q

What is the procedure of choice for thyroglossal duct cyst

A

Sistrunk procedure 1. removal of cyst, tract, and central portion of hyoid bone 2. removal of portion of the tongue base up to the foramen cecum

40
Q

Most common gland involved in salivary gland tumor

A

parotid gland

41
Q

most common benign tumor of salivary gland

A

pleomorphic adenoma

42
Q

most common malignant tumor of salivary gland

A

mucoepidermoid carcinoma

43
Q

Most frequently injured nerve in parotid surgery

A

greater auricular nerve - will produce numbness of the lower portion of the auricle and periauricular skin

44
Q

The syndrome when the auriculotemporal nerve is injured

A

Frey’s syndrome - postoperative gustatory sweating

45
Q

What are the nerves at risk in submandibular gland removal

A

lingual and hypoglossal nerve

46
Q

What crosses the recurrent laryngeal nerve

A

inferior thyroid artery

47
Q

What innervates the cricothyroid muscle

A

external laryngeal nerve of the superior laryngeal nerve of the vagus nerve

48
Q

What is a sensitive marker for medullary thyroid cancer

A

Serum calcitonin N: 0 - 4 pg/ml

49
Q

Treatment of lingual thyroid

A
  1. exogenous oral thyroid hormone 2. RAI 3. hormone replacement
50
Q

Most common GI symptom of grave’s disease

A

diarrhea

51
Q

Absolute contraindication of RAI

A
  1. pregnant 2. breastfeeding
52
Q

Relative contraindication of RAI

A
  1. young people 2. thyroid nodule 3. ophthalmopathy
53
Q

TOXIC ADENOMA (SOLITARY TOXIC NODULE) treatment

A

Unilateral lobectomy + Isthmusectomy

54
Q

Treatment of TOXIC MULTINODULAR GOITER (PLUMMER DISEASE)

A

Near total/Total thyroidectomy * signs and symptoms are similar to Graves’ disease but extra thyroidal manifestations are absent

55
Q

This is a self limiting PAINFUL thyroiditis usually occurs in 30 - 40 y.o women

A

Subacute Thyroiditis De quervain’s thyroiditis • viral in origin or post viral inflammatory response • occurs in 30-40 yrs. old women • history of preceding URTI • self-limited • Tx: symptomatic short term thyroid hormone replacement thyroidectomy reserved for failure of medical management

56
Q

Treatment of de quervain’s thyroiditis

A

NSAID since it is self limiting

57
Q

• or invasive fibrous thyroiditis • associated with auto-immune diseases and other focal sclerosing syndromes • Presentation: o painless, hard anterior neck mass o progress to compressive symptoms in weeks • PE: hard, woody thyroid gland

A

REIDEL THYROIDITIS • Dx: open thyroid biopsy • Tx: wedge excision of the thyroid isthmus o L-thyroxine o steroids

58
Q

The most common presentation of this thyroid disease is minimally or moderately enlarged firm granular gland or the awareness of painless anterior neck mass

A

Hashimoto’s thyroiditis Chronic Thyroiditis

59
Q

What is seen in microscopic examination of hashimoto’s thyroiditis?

A

Hurthle cell or Askanazy cell

60
Q

This thyroid disease is characterized by replacement of all or part of the thyroid tissue parenchyma by fibrous tissue

A

Reidel’s thyroiditis

61
Q

single most important test in the evaluation of thyroid nodules

A

Fine Needle Aspiration Biopsy (FNAB)

62
Q

Solitary Thyroid nodule management

A
63
Q

Most common site of metastasis in papillary thyroid CA

A

Lungs

64
Q

What is the type of spread in papillary thyroid CA

A

lymphatics

65
Q

What is the most important prognostic factor in determining long term survival of papillary CA

A

age

66
Q

Treatment of papillary CA

A
  1. < 1.5 cm - lobectomy + isthmusectomy 2. multicentric - near total or total thyroidectomy 3. with cervical lymph node - MDRD
67
Q

Most common route of spread of follicular CA

A

Hematogenous

68
Q

More common cancer in iodine deficient countries

A

follicular cancer

69
Q

Most common site of metastasis in follicular thyroid CA

A

lung and bone

70
Q

Treatment of follicular CA

A
  1. Follicular lesion - lobectomy + isthmusectomy 2. Follicular lesion > 4 cm - total thyroidectomy 3. Thyroid cancer - total thyroidectomy 4. Positive lymph node - MDRD
71
Q

Usual site of medullary thyroid cancer

A

superolateral in the thyroid lobes

72
Q

Where does medullary thyroid cancer arise from

A

parafollicular cells C cells

73
Q

Disease associated with men 2A

A

1, pheochromocytoma 2. parathyroid hyperplasia

74
Q

Disease associated with men 2B

A
  1. pheochromocytoma 2. neuroma
75
Q

Treatment of MTC

A

Total thyroidectomy with bilateral central node dissection

76
Q

Most common site of minor salivary gland tumor

A

junction of hard and soft palate

#DAY3_SURGERY (16 decks)

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