HEAD AND NECK Flashcards
The innervation of the carotid body
branch of the glosspharyngeal nerve (cranial nerve IX)
nerve of Herring
The function of the carotid body
autonomic control of the respiratory and cardiovascular systems.
detecting changes in the composition of arterial blood.
The only other paraganglia with similar chemoreceptor function are the aortic bodies.
Hypercapnia,
hypoxia,
or
decreasing pH
stimulate type I cells to initiate an autonomic reflex which leads to increased respiratory rate and depth, sympathetic nervous system activation (increased heart rate, systemic vascular tone and blood pressure), and cerebral cortical activity.
The carotid body is also stimulated by increased blood temperature and certain chemicals (cyanide and nicotine).
I
If the vagus nerve (cranial nerve X) is injured during neck dissection,
dysphagia and dysphonia usually result secondary to injury of the recurrent laryngeal nerve.
zenkers open diverticulectomy and the diverticulopexy what is incision and key moves - name myotomies
incision in the left neck
myotomy is performed of the proximal and distal thyropharyngeus and cricopharyngeus muscles.
zenkers In cases of a small diverticulum (<2 cm)
myotomy alone is often sufficient
The endoscopic Dohlman procedure method for Zenkers
divides the distal cricopharyngeus muscle while obliterating the sac.
The esophagus and diverticulum form a common channel.
This technique requires maximal extension of the neck and can be difficult to perform in elderly patients with cervical stenosis. This technique has gained favor and is advocated in patients with diverticula between 2 and 5 cm (CAREFUL less than 3 cm open approach may have better results)
The risk for an incomplete myotomy increases with SMALLER diverticula less than 3 cm in size.
results of open vs endoscopic in diverticulum greater than 3 cm,
SAME for GREATER than 3 cm
The treatment for a Zenker’s diverticulum greater than 2 cm
diverticulectomy in those > 2 cm.
and open is probably better then endoscopic if less than 3 cm
cricopharyngeal myotomy performed independent of size
Most minor salivary gland malignancies are
adenoid cystic carcinomas.
presentation of Most minor salivary gland malignancies
Most minor salivary gland tumors are malignant and originate in the HARD PALATE
Rapid tumor growth, pain, and ulceration are indicators of malignancy.
Approximately 90% of minor salivary gland tumors are malignant. The palate is the most common site of origin, with 50% of all minor gland tumors occurring here (choice D).
In contrast, only 15% of all minor salivary gland tumors originate in the lip (choice C) , 12% in the buccal mucosa(choice A), and 5% in both the tongue and floor of the mouth (choices B and E).
treatment of minor salivary gland malignancies
Management includes
surgical resection
including any involved mucosa,
muscle,
AND BONE!
Radiation therapy is recommended postoperatively for:
high-grade histologic features,
positive surgical margins,
perineural spread,
deep invasion into muscle or bone, or lymph node metastasis.
Adenoid cystic carcinoma is the most common minor salivary gland tumor.
Course of spinal accessory nerve
It has a cranial root and a spinal root. The fibers of the cranial root arise from the medulla.
The fibers of the cranial root join the vagus nerve in the posterior cranial fossa, exit through the jugular foramen and are distributed in the motor branches of the vagus nerve to the pharynx, the larynx, and the palate.
The fibers of the spinal root reach the neck by passing through the jugular foramen and POSTERIOR triangle of the neck
Management of the patient with a squamous cell carcinoma metastasis to the neck with an unknown primary
Bottom Line: Management of a squamous cell carcinoma to the neck from an unknown primary is controversial but currently treated nonoperatively with radiation to the oropharynx and neck bilaterally.
is extremely controversial and continues to evolve.
A primary source can ultimately be found in approximately 40% of patients.
80% of these will be from the oropharynx with the
ipsilateral tonsil being the most common site
base of the tongue second most common
When a primary source has not been identified after an extensive workup, the patient should be referred for nonsurgical management of the unknown primary.
Some patients may be cured with radiation
Current recommendations include:
excision of any remaining tonsillar tissue on the affected side followed by radiation therapy directed at the oropharynx and bilateral neck
Patients with advanced nodal disease (N2 or N3) are candidates for concomitant chemotherapy
If after radiation therapy there is felt to be a greater than 5% risk of residual disease then a planned neck dissection can be undertaken
The results describe a low grade acinic cell carcinoma of the parotid gland. During the resection, the mass is contained in the superficial lobe and is adjacent to the facial nerve.
acinic cell carcinoma of the parotid
is a malignant lesion that needs en bloc surgical resection (regardless of the 'low grade crap')
If the mass is adjacent to the facial nerve without invasion, a superficial parotidectomy can be performed and adjuvant radiation therapy is added for treating any residual micrometastases (that might be around nerve or in deep tissue not seen grossly)
Total parotidectomy is indicated for any tumor that lies in the deep lobe
Radiation therapy is also utilized for high grade malignancies, invasion of surrounding structures, neural invasion, or metastatic disease
Bottom Line: Adjuvant radiation is used for maligant parotid masses with unclear surgical margins.
Warthin’s tumor
also called: papillary cystadenoma lymphomatosum
= Warthin’s tumor
BENIGN neoplasm of the salivary glands.
Treatment with complete excision with negative margins - superficial parotidectomy
found almost exclusively in the parotid gland.
It arises from the ectopic ductal epithelium.
males in the fifth to seventh decades of life and there is an associated risk with
smokers.
There is approximately 5.0–7.5% bilaterality and 14% multicentricity in Warthin tumor.
CT scanning may demonstrate a well-defined mass in the posteroinferior segment of the superficial lobe of the parotid.
The diagnosis of a Warthin’s tumor is easily made based on histologic findings, with rare confusion with other tumors.
papillary structures composed of double layers of granular eosinophilic cells or oncocytes, cystic changes, and mature lymphocytic infiltration.
