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Absite Behind the Knife > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

Neck structures anterior to posterior beneath clavicle

A 
Subclavian Vein
Phrenic nerve
Anterior Scalene
Subclavian Artery
Middle Scalene
Long Thoracic
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2
Q

Anterior Triangle

A

Midline of neck
Ant SCM
Apex: Sternal notch
Base: Lower border of body of mandible

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3
Q

Posterior Triangle

A

Post SCM
Trapezius muscle
Middle third of clavicle

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4
Q

What does anterior triangle contain?

A

Carotid Sheath - common carotid, internal jugular, vagus nerve

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5
Q

What does posterior triangle contain?

A

Spinal accessory nerve

Brachial plexus

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6
Q

What is recurrent laryngeal a branch of?

A

Vagus

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7
Q

R Recurrent laryngeal route

A

Vagus ant to subclavian artery -> then recurrent laryngeal wraps behind subclavian to tracheoesophageal groove

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8
Q

What innervates the cricothyroid muscle?

A

Superior laryngeal nerve

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9
Q

L Recurrent laryngeal route

A

Vagus runs anterior to aortic arch btw cca and subclavian -> then recurrent laryngeal wraps behind around arch and up to tracheoesophageal groove

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10
Q

What happens if you cut the superior laryngeal nerve?

A

Difficulties with tone, hitting high notes

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11
Q

Squamous cell of neck

A

5th most common cancer
Men to women 5:1
Alcohol/Tobacco synergistic risk factors
HPV risk factor

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12
Q

Local squamous cell with no + nodes, no distant mets

A

Stage I and II

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13
Q

Locally agressive III or distant mets squamous IV

A

Stage III and Stage IV

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14
Q

Stage I and II

A

Tumor board
Wide local exicision if resectable
Radiation if non resectable

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15
Q

Stage III and IV

A

Multimodality

Surgery (local excision with modified radical neck dissection) + Radiation and/or Chemo

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16
Q

Oral squamous cell size cut offs?

A

4 cms or node involvement/bone invasion

Need: Surgery (local excision with modified radical neck dissection) + Radiation

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17
Q

More malignant salivary tumors smaller glands or larger glands?

A

Smaller more malignant (submandibular)

Larger more benign (Parotid)

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18
Q

MC malignant salivary tumor

A

Mucoepidermoid cancer

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19
Q

MC benign salivary tumor

A

Pleomorphic adenoma

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20
Q

Mucoepidermoid cancer treatment

A

“Resection” + total parotidectomy + facial nerve preservation + “modified radical neck dissection” on that side + “post op radiation”

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21
Q

Adenoid cystic tumor - treatment

A

Resection + modified radical + post op radiation

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22
Q

Adenoid cystic treatment if invading facial nerve

A

Just radiation - sensitive to it

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23
Q

Palpable lymph node -> biopsy -> malignant, can’t find primary, what do you do

A 
Head and neck exam
Fiberoptic nasopharynx/larynx
FNA of any nodes available
CTA head neck chest +/- PET
OR regardless of finding something: Direct laryngoscopy, esophagoscopy, IPSILATERAL TONSILLECTOMY (MC site) base of tongue is second MC, modified radical; bilateral xrt
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24
Q

How to biopsy melanoma

A

Punch or exicisional biopsy, not shaved

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25
Q

Margins of melanoma

A

1 cm margin for lesions < 1 mm in depth
2 cm margin for lesions > 1 mm in depth
Adjust margins if abutting facial nerve
Confirm negative margins prior to reconstruction -> mohs

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26
Q

Lymphadenectomy of melanoma -> how determine where nodes are

A

Get lymphosyntigraphy -> then do modified radical neck etc

27
Q

Sentinel nodes for melanoma

A

If clinically node negative then for > 1 mm in depth

28
Q

If primary lesion anterior to tragus line

A

Drains anterior to parotid basin

Do superficial parotidectomy and anterior lymph node basin dissection

29
Q

If primary lesion posterior to tragus line

A

Drains posterior to parotid basin

Do superficial parotidectomy and posterior lymph node basin dissection

30
Q

Melanoma adjuvant therapy

A

INF-Alpha -> especially if mets
Salvage radiation therapy -> esp if regional positive nodes
Monoclonal antibodies/oncogene inhibitors

31
Q

Painless mass on roof of mouth

A

Toris pallatinus - overgrowth of cortical bone

Tx: Nothing, unless interferes with dentures -> resect

32
Q

Oral cavity cancer MC site

A

Lower lip

33
Q

Reconstruction for lower lip if:

A

> 50% of lip resected need flap reconstruction

34
Q

EBV

A

Nasopharyngeal squamous cell

Tx: primary radiation

35
Q

Tx for pleomorphic adenoma

A

superficial parotidectomy

36
Q

Gustatory sweating

A

Frey’s syndrome

Injury to auriculotemporal nerve -> cross innervates with facial nerve fibers

37
Q

Post op fever, pain, large swelling at angle of jaw

A

Suppurative parotiditis
Staph aureus
Antibiotics, possible I and D if abscess

38
Q

Post op from tracheostomy -> bleeding from site

A

Tracheoinominate fistula
Tx: Place finger in tracheostomy and hold finger against sternum, take to OR, median sternotomy w/ resection of inominate, close hold in trachea with strap muscle flap (DO NOT place synthetic graft, do not reconstruct)

39
Q

Parotid gland function

A

Secretes mostly serous fluid

40
Q

Sublingual Gland function

A

Secretes mostly mucin

41
Q

Submandibular gland function

A

50/50 serous/mucin

42
Q

Laryngeal/tracheal anatomy

  • Where are false cords related to true cords
  • What makes up the trachea
A
  • False cords are superior to true cords

- Trachea has U shaped cartilage anterior, and membranous portion posterior

43
Q

Relation of nerves to other structures

  • Vagus in carotid sheath?
  • Phrenic?
  • Long thoracic?
A
  • Vagus is btw medial CC and lateral IJ and is more post in sheath
  • On top of anterior scalene musc
  • Post to middle scalene
44
Q

CN head/neck functions

  • CN V trigeminal
  • CN VII Facial
  • CN IX glosspharyngeal
  • CN XII hypoglossal
A
  • CN V = sensation to face; motor to muscles of mastication, motor corner of mouth (Marg mand nerve); taste ant 2/3 tongue
  • CN VII = temporal, zygomatic, buccal, mm, cervical branches motor
  • CN IX = taste to post 1/3 tongue, motor stylopharg, involved in swallowing
  • CN XII = motor to tongue
45
Q

Neck nerve functions

  • Recurrent laryngeal
  • Superior laryngeal
A
  • Recurrent laryngeal - Motor to strap muscles except cricothyroid
  • Sup laryngeal - Cricothyroid
46
Q

Frey’s syndrome

A

Symptom - gustatory sweating

After parotidectomy -> injured auriculotemporal nerve cross innervates with sympthetic sweat glands of skin

47
Q

Thyrocervical trunk arteries?

A

Suprascapular
Transverse cervical
Ascending cervical
inferior Thyroid

48
Q

External carotid branches?

A

Some anatomists like freaking out poor medical students

S: superior thyroid artery.
A: ascending pharyngeal artery.
L: lingual artery.
F: facial artery.
O: occipital artery.
P: posterior auricular artery.
M: maxillary artery.
S: superficial temporal artery.
49
Q

Which artery is responsible for blood supply to trapezius flap?

A

Transverse cervical

50
Q

Which two areteries are responsible for blood supply to pect major flap?

A

Internal mammary

Thoracoacromial artery

51
Q

Torus palatini

A

Congenital bony mass in upper palate of mouth

Tx: Nothing

52
Q

Torus mandibular

A

Congenital bony mass on lingual surface of mandible

Tx: Nothing

53
Q

What does a modified radical neck dissection involve?

A

Omohyoid, submandibular gland, C2-C5 sensory nerves, cervical branch of facial, ipsilateral thyroid
No MORTALITY diff when compared with radical dissection

54
Q

What does a radical neck dissection involve?

A

MRND + CN XI, SCM, IJ resection

55
Q

Head and neck chemotherapy?

A

5FU and cisplatin

56
Q

MC oral cavity cancer

A

Squamous cell

57
Q
  • # 1 RF oral cancer
A

Tobacco, EtOH

(separately there is inc risk in people with Plummer-Vinson Syndrome

58
Q

MC site for oral cavity cancer

A

Lower lip

59
Q

Which tumors have the lowest survival rates

A

Hard palate tumors -> difficult to resect

60
Q

Oral cavity cancer treatment

A

Wide resection (1 cm margin)
MRND for tumors > 4cm, positive nodes, bone invasion
Postop XRT if > 4cm, + nodes, bone invasion

61
Q

Lip CA
Tongue CA
Maxillary sinus CA
Tonsillar Ca

A

L - Commissure is more aggressive (flap if >1/3 removed)
T - Commando procedure if jaw invasion
M - Maxillectomy
T - Tonsillectomy (80% have LN mets by diagnosis)

62
Q

Nasopharyngeal SCCA

  • Etiology
  • Nodal mets to…
  • Tx:
  • Misc facts
A

Eti: EBV; usually Asian; presents with nose bleed/obstruction
Nodal mets to posterior cervical nodes
Tx: XRT primary tx
Misc: Lymphoma is MC NP cancer in kids; Papilloma is MC benign neoplasm of nose/paranasal sinuses

63
Q

Oropharyngeal SCCA

  • Symptoms
  • Nodal mets to….
  • Tx:
  • Misc facts
A
  • Sx: Neck mass, sore throat
  • Nodal mets to post cervical nodes
  • Tx: XRT for tumors < 4 cm w/o nodes/bone invasion
  • Tx: Wide res/MRND/XRT for > 4 cm/nodes/bones

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