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Head and neck Flashcards

1
Q

What nerve is commonly injured during parotid gland dissection?

A

The greater auricular nerve, leading to numbness over the lower ear.

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2
Q

What nerve is commonly injured during submandibular gland resection?

A

The marginal mandibular nerve (a branch of the facial nerve), causing droop at the corner of the mouth.

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3
Q

What syndrome occurs after parotidectomy?

A

Frey’s syndrome, which is caused by injury to the auriculotemporal nerve and results in gustatory sweating.

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4
Q

What is the treatment for Frey’s syndrome?

A

Allograft skin graft.

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5
Q

What is the first step in the workup of a neck mass?

A

Fine needle aspiration (FNA).

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6
Q

What should be done if the first FNA does not provide a diagnosis?

A

Repeat FNA, and if still no diagnosis, proceed to excisional biopsy.

EGD and bronch, neck and chest CT.

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7
Q

What is the significance of a new neck mass in a patient over 40 years old?

A

It is considered cancer until proven otherwise.

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8
Q

What is the most common type of branchial cleft cyst?

A

The second branchial cleft cyst, which typically presents as a draining sinus.

On anterior border of middle SCM, goes through carotid bifurcation and exits tonsillar pillar

1st branchial cleft cyst - angle of mandible connect with external auditory canal; facial nerve affected
3rd - lower neck, medial to or deep to SCM to piriform sinus

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9
Q

What is the treatment for branchial cleft cysts?

A

Resection of the cyst.

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10
Q

What does a modified radical neck dissection include?

A

Cervical nodes, omohyoid, sensory C2-C5, cervical branch of facial nerve, and submandibular gland.

-No mortality difference compared with RND

-Radical neck dissection: above, plus CN XI (most morbidity), SCM, internal jugular

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11
Q

What is the most common location for salivary gland tumors?

A

The parotid gland, which is mostly benign (80%).

-MC benign salivary gland tumor: pleomorphic adenoma; superficial parotidectomy (Do not enucleate this lesion)

-Small salivary gland tumors more likely to be malignant than large salivary gland tumors; sublingual > submandibular > parotid

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12
Q

What is the most common salivary gland tumor in children?

A

Hemangioma.

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13
Q

What indicates a possible cancer diagnosis in parotid gland tumors?

A

Pain or facial gland paralysis.

  • Work up is CT head neck and chest
  • Dx: FNA!!!!
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14
Q

What is the treatment for mucoepidermoid carcinoma and adenoid cystic carcinoma of the parotid?

A

Mucoepidermoid (MC CA) and adenoid cystic (sensitive to XRT) are malignant tumors of parotid

Total parotidectomy, prophylactic modified radical neck dissection (MRND), and postoperative radiation therapy (XRT).

  • Try to preserve facial nerve
    -Don’t aggressively resect adenoid cystic cancer if it would result in high morbidity since very sensitive to XRT
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15
Q

What is the treatment for Warthin’s tumor?

A

Warthin’s tumor (2nd MC parotid tumor) – Olden men, smokers, often BL. Benign. FNA= thick turbid fluid (Cystic)

Superficial parotidectomy.

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16
Q

What is the treatment for pleomorphic adenoma?

A

Pleomorphic adenoma (MC parotid gland tumor), usually benign

Superficial parotidectomy if in the superficial lobe; total parotidectomy if in the deep lobe.

  • Has chance for malignant transformation
  • Recurs frequently
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17
Q

What is parotitis?

A

Inflammation of the parotid gland due to duct obstruction by a stone.

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18
Q

What is the treatment for sialoadenitis?

A

inflammation of salivary gland by stone in duct

Incise and remove the stone.

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19
Q

What is the preferred treatment for a peritonsillar abscess?

A

Needle aspiration; otherwise, incision and drainage (I&D).

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20
Q

What is Ludwig’s angina?

A

A condition involving the mylohyoid muscle, commonly caused by dental infection.

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21
Q

What is a cholesteatoma?

A

An epidermal inclusion cyst of the ear that erodes as it grows, presenting with hearing loss and clear drainage.

Lesion containing squamous epithelium and keratin.

22
Q

What is the treatment for cholesteatoma?

A

Surgical excision; may require mastoidectomy if it involves mastoid air cells.

23
Q

What is nasopharyngeal cancer associated with?

A

EBV (Epstein-Barr Virus).

24
Q

What is the treatment for nasopharyngeal cancer?

A

Nasopharyngeal CA – EBV associated
Radiation therapy (XRT) only, no resection.

25
Q

What does a verrucous ulcer indicate?

A

Squamous cell carcinoma (SCC), often presenting as leukoplakia.

26
Q

What is the treatment for erythroplakia?

A

It is worse than leukoplakia for cancer; full cheek resection is required.

27
Q

What is the treatment for lip cancer?

A

Mohs surgery, ensuring to involve the mucosa.

28
Q

What is nasopharyngeal angiofibroma?

A

A very vascular tumor; treatment involves angioembolization followed by resection.

29
Q

What is the most common type of laryngeal cancer?

A

Squamous cell carcinoma (SCCA).

30
Q

What is the treatment for laryngeal cancer if it involves only the vocal cords?

A

Radiation therapy (XRT).

  • If vocal cord and beyond  XRT and chemo
  • Avoid surgery and preserve larynx
31
Q

What is the treatment for mastoiditis?

A

Tympanostomy tube placement and antibiotics.

32
Q

What are the structures of the thoracic outlet from anterior to posterior?

A

Subclavian vein, phrenic nerve, anterior scalene, subclavian artery, middle scalene.

-Phrenic nerve travels from lateral to medial on top of the anterior scalene as it courses into chest.

33
Q

What are the boundaries of the anterior neck triangle?

A

Anterior boundary: midline of neck; posterior boundary: sternocleidomastoid (SCM); inferior (apex): sternal notch; superior (base): lower border of body of mandible.

34
Q

What are the contents of the anterior neck triangle?

A

Carotid sheath.

35
Q

What are the boundaries of the posterior neck triangle?

A

Anterior boundary: posterior border of SCM; posterior boundary: trapezius muscle; base: middle third of clavicle; apex: intersection of SCM and trapezius.

36
Q

What are the contents of the posterior neck triangle?

A

Spinal accessory nerve.

37
Q

What is the recurrent laryngeal nerve?

A

A branch off the vagus nerve that innervates muscles of the larynx, except for the cricothyroid muscle.

-Right: Vagus passes anterior to subclavian artery; RLN loops behind SCA and travels superiorly in Tracheoesophageal (TE) groove
-Left side: Vagus passes anterior to aortic arch between Left Common Carotid Artery and SCA and RLN then loops behind aortic arch and travels superiorly in TE groove

38
Q

What is the most common head and neck cancer?

A

Squamous cell cancer (SCC), with a male to female ratio of 5:1.

39
Q

What are the risk factors for head and neck cancer?

A

Alcohol and tobacco (synergistic effect), HPV.

40
Q

What is the general treatment approach for head and neck cancer stages I and II?

A

-Stage I and II: Local disease (No regional or distant Mets)
Surgery or radiation.

41
Q

What is the general treatment approach for head and neck cancer stages III and IV?

A

-Stage III and IV – Either locally aggressive or distant mets
-Multimodality required for Stage III-IV. Usually surgery (WLE + MRND) followed by radiation +/- chemotherapy

42
Q

What is the treatment for oral SCC greater than 4 cm or with positive nodes/bone invasion?

A

Resection with MRND followed by postoperative radiation.

43
Q

What is the most common benign salivary gland tumor?

A

Pleomorphic adenoma; treated with superficial parotidectomy.

44
Q

What is the management for unknown primary head and neck cancer?

(i.e. regional metastasis to node without known primary)

A

-Head & neck exam with fiberoptic exam of nasopharynx and larynx
-FNA of regional node or excisional biopsy
-CT scan Head/Neck/Chest +/- PET
-OR for direct laryngoscopy, esophagoscopy, ipsilateral tonsillectomy, + biopsies directed by previous work-up

If no primary identified, still need ipsilateral MRND and bilateral XRT
.

45
Q

What is the most common site for unknown primary head and neck cancer?

A

1) Tonsil, 2) Base of tongue.

46
Q

What is the treatment for melanoma of the head and neck?

A

Melanoma of head & neck:
-Dx: full-thickness bx- excisional, incisional, punch; NO SHAVE bx; staged like other melanoma sites
-Tx:
-Resection with the same margins as other sites if possible (1cm for lesions <1mm in depth and 2cm for those >2mm in depth)
-Branches of facial nerve should be preserved unless clinically involved
-Moh’s surgery if resection would result in morbidity
-Lymphadenectomy if regional nodes clinically positive
-If clinically node negative: SLN for >1mm depth
-How to determine lymph node basin for melanoma of head/ neck
-Anterior lesion: superficial parotidectomy & selective anterior neck dissection
-Posterior lesion: selective posterior neck dissection
-Adjuvant interferon alpha survival benefit in advanced disease, but many SE & poorly tolerated
-Adjuvant radiation may help regional control, but no survival benefit

47
Q

What is the treatment for a painless mass on the roof of the mouth?

A

Torus palatinus (overgrowth of cortical bone); treatment is none.

48
Q

What is the most common site for oral cavity cancer?

A

Lower lip, often due to sun exposure.
flap reconstruction if > 1⁄2 lip resected

49
Q

What is the treatment for EBV-related head and neck cancer?

A

Nasopharyngeal SCC

Radiation therapy (XRT).

50
Q

What is the cause and treatment for suppurative parotiditis?

A

Caused by staphylococcus; treatment includes hydration and antibiotics, with I&D if an abscess is present.

Elderly patient with postop fever, pain, and swelling at angle of jaw?

51
Q

What should be done for bleeding at a tracheostomy site?

A

For small amounts, perform bronchoscopy to rule out Tracheoinnominate fistula ; for large amounts, apply manual pressure and prepare for median sternotomy and resection of innominate artery. Close prior tracheal stoma primarily and cover with strap muscle (do NOT put synthetic interposition graft. It will get infected and blow out).

52
Q

What are Le Fort fractures?

A

Fractures involving the maxillary buttresses: Le Fort I (inferior), Le Fort II (inferior lateral and superior medial), Le Fort III (complete craniofacial separation).

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