Head and Neck Flashcards
the ATA defined the boundaries of level VI and VII nodes
superiorly : hyoid bone
laterally : the carotid arteries
anteriorly : superficial layer of the deep cervical fascia
posteriorly : deep layer of the deep cervical fascia
and the innominate artery on the right and its corresponding axial plane on the left inferiorly.
the second most common congenital neck mass after thyroglossal duct cyst
Branchial cleft anomalies
Branchial cleft anomalies arise from ?
aberrant development or incomplete obliteration of the external clefts and internal pouches that develop from the 6 mesodermal arches
Describe each branchial arch with its structures
The first arch : the middle ear, eustachian tube, and external auditory canal
The second arch : lining of the palatine tonsils.
The third arch : inferior parathyroid glands and the thymus.
The fourth arch : superior parathyroid glands and C-cells of the thyroid.
Fifth Arch Nothing
What is the MC Branchial cleft anomaly
BCAs arising from the second arch are the most common, accounting for 70 to 90%.
describe the course tract of BCA from second arch
anywhere along a tract arising from the tonsillar fossa,
running by the glossopharyngeal and hypoglossal nerves, coursing between the internal and external carotids
and ending at the anterior border of the sternocleidomastoid
How do they Present and Diagnosis and TX
manifest in the third to fifth decade as cysts
presenting as a nontender, soft mass lying deep to the sternocleidomastoid
Ultrasound > round mass of uniform low echogenicity
CT and MRI > may be used
FNA > to rule out malignancy
complete surgical excision of the cyst or tract is the therapy of choice
Post Sentinel LNB Right Upper Back
Shoulder syndrome secondary to spinal accessory nerve (SAN; 11th cranial nerve) injury
SAN injury impairs motor function to the trapezius muscle leading to
weakness of shoulder abduction
drooping of the shoulder
Other symptoms and signs include shoulder pain and stiffness and winging of the scapula.
Coarse of SAN
exits the skull through the jugular foramen
pierces the sternocleidomastoid muscle
innervates it
runs lateral to it
is close to the greater auricular nerve
(which is a sensory nerve and can serve as a landmark for surgeons to find the SAN)
Then through the posterior triangle (level V) ends by innervating the trapezius
Most Common Parotid Tumor
-Pleomorphic adenomas
usually benign
diagnosed on FNA
low chance (3-10%) of occult malignancy
Malignant transformation more likely if the pleomorphic adenoma recurs
What is the Tx
Superficial parotidectomy without node dissection
low risk of facial nerve injury
the second most common parotid tumors ?
Warthin tumors (monomorphic adenomas)
often seen in older patients, men, and smokers, and they are often bilateral
The most common midline mass in a child ?
Thyroglossal duct cyst
a remnant from the migration of the thyroid.
when postintubation tracheal stenosis develops ?
PITS will usually develop within 3 to 6 weeks
Bronchoscopy with dilation is the initial recommended treatment for acute symptoms of PITS
Otherwise if Stable one Stage Resection anastamosis
suprahyoid laryngeal release provide additional 1.0 to 1.5 cm for Repair if needed
Level IA nodes
submental region
drain the floor of the mouth, anterior tongue, anterior mandibular alveolar ridge, and lower lip.
Level IB nodes
submandibular region
drain the oral cavity, anterior nasal cavity, midface, and submandibular gland.
Level II nodes
IIA (anterior to spinal accessory nerve)
IIB (posterior to spinal accessory nerve)
drainage to oral and nasal cavities, nasopharynx, oropharynx, hypopharynx, larynx, and parotid gland.
Level III nodes
mid jugular nodes
drain the oral cavity, nasopharynx, oropharynx, hypopharynx, and larynx.
Level IV nodes
lower jugular nodes
drains the hypopharynx, thyroid, cervical esophagus, and larynx.
Level V nodes
in the posterior triangle
VA (superior to level of cricoid)
VB (inferior to level of cricoid)
drains the nasopharynx, oropharynx, and skin and soft tissue of the posterior scalp and neck
Level VI
pretracheal and paratracheal nodes
drainage to the thyroid gland, glottis and subglottic larynx, apex of the piriform sinus, and cervical esophagus.
For neck Mass, If FNA demonstrates carcinoma but a primary site is not identified on physical exam
-laryngoscopy
-esophagoscopy
-bronchoscopy
-CT scan of the neck with intravenous contrast will identify the primary source of malignancy in a patient with a neck mass believed to be associated with a head and neck malignancy.
in Zenker Diverticulum Barium will show
barium-filled diverticulum at the level of the
cricothyroid cartilage
