Head and Neck

Question 1

What is the most common presentation of nasopharyngeal carcinoma ?

Answer 1

Painless neck mass

Question 2

What is Frey Syndrome?

What is the pathophysiology?

What is the treatment?

What should it NOT be confused with?

Answer 2

Flushing and sweating when eating.
Post parotidectomy. The postganglionic parasympathetc fibers of parotid (auriculotemporal nerve) are damaged and rewire to the sympathetic fibers that supply the sweat glands on the ipsilateral side.
antiperspirant to the affected skin

If severe and refractory can perform tympanic neurectomy.

Felty syndrome - arthritis, splenomegaly, and granulocytopenia

Question 3

What are the most common tumors of head/neck? (Name 3 types)

Answer 3

1. Parotid:
   Malignant - mucoepidermoid carcinoma - regional metastatic invasion but distant mets are rare

Second is Adenoid cystic carcinoma - perineural invasion and distant mets more common. Can lay dormant for decades. Aggressive resection!

Acinic cell carcinoma - resection + radiation. If no invasion then just superficial resection + radiation

2. Submandibular glands:
   Malignant - Adenoid cystic carcinoma - predisposed for perineural invasion, distant mets more common
3. Salivary glands:
   Benign - pleomorphic adenoma - high recurrence rates with enucleation. Superficial parotidectomy.

Question 4

Most minor salivary gland malignancies are what kind of tumor?

Answer 4

Adenoid cystic carcinomas and most originate on the palate

Question 5

What is another name for Warthin’s Tumor?

What are common features?

What does FNA show?

Answer 5

Papillary cystadenoma lymphomatosum.

2nd most common (benign) salivary tumor
10% bilateral and 10% multicentric
Significant because neoplasms rarely bilateral so Warthin more likely.

FNA usually shows a thick turbid non-diagnostic fluid.

Question 6

All high-grade malignant tumors of the parotid need what?

Answer 6

Radical neck dissection.

Question 7

All SCC of the parotid lobes need what?

Answer 7

Radical neck dissection

Question 8

Malnourished elderly patients with prolonged intubation are most at risk for?
What is most common cause?

Answer 8

Post-operative parotitis.

Staph aureus.

Question 9

Treatment for acinic cell carcinoma?

Answer 9

Resection and adjuvant radiation

If no invasion then just superficial resection + radiation

Question 10

What are the borders of the submental triangle?

Answer 10

Anterior belly of the digastrics - lateral border
hyoid bone - inferior
Mandibular symphysis (symphysis menti) - apex
mylohyoid - floor