Head and Neck Flashcards
1
Q
What are the 6 triangles of the neck
A
Submandibular Submental Muscular Carotid Supraclavicular Occipital
2
Q
Whats in the submandibular triangle
A
Submandibular gland
3
Q
Whats in the submental triangle
A
Submental lymph
4
Q
Whats in the muscular triangle
A
Thyroid and parathyroid glands
5
Q
Whats in the carotid triangle
A
3 C’s
Carotid sheath
CN12
Ansa Cervicalis
6
Q
What is in the carotid sheath
A
CNX
Common carotid
IJV
7
Q
What is the ansa cervicalis
A
Part of the cervical plexus
Innervates most infrahyoids, except thyrohyoid
8
Q
Whats in the occipital triangle
A
Charlie Sheen = Epic Blow
CN9
SCA
EJV
Brachial plexus trunks
9
Q
what is the oropharynx
A
base of the tongue, tonsils and the soft palate + pharyngeal walls
10
Q
whats the hypopharynx
A
bottom of the throat
11
Q
what structures make up the layrnx
A
supraglottis, glottis, vocal cords and subglottis
12
Q
what is the most common salivary gland tumour and by how much
A
parotid - 80-90%
13
Q
What proportion of salivary gland tumours are benign
A
80-90%
14
Q
How does the type of salivary gland tumour affect it’s severity
A
ones that aren’t parotid ones are more likely to be cancerous
15
Q
How do you investigate a salivary gland tumour
A
FNAC
CT/MRI
16
Q
What should you do if an FNAC of a salivary gland tumour is inconclusive
A
excision biopsy
17
Q
Why should incisional biopsies be avoided for sampling salivary gland tumours
A
may lead to tumour seeding
18
Q
what are features of benign salivary gland tumours
A
Slow growing
painless
decreased chance of CN7 palsy
19
Q
what is the most common type of benign salivary gland tumour
A
pleomorphic adenoma
20
Q
whats the epidemiology of salivary gland tumours
A
F>M, incidence 1:100,000 - mostly adults `
21
Q
what cell is affected with pleomorphic adenomas
A
intercalated duct cell
22
Q
what is the treatment for pleomorphic adenomas
A
surgical excision
23
Q
apart from pleomorphic adenomas - what is the other type of benign salivary gland tumours seen
A
warthins’s tumour/adenolymphoma
24
Q
what are examples of mixed type salivary gland tumours
A
mucoepidermoid carcinoma
acinic cell carcinoma
25
what is the epidemiology for mucoepidermoid carcinoma
peaks in 40s, F>M, 2-4:1
26
what is the most common salivary gland carcinoma in children
mucoepidermoid carcinoma
27
whats the treatment for low and high grade mucoepidermoid carcinomas
low grade = local excision and follow up
| high grade = radical resection and adjuvant radiotherapy
28
whats the recurrence rate for mucoepidermoid carcinomas
30%
29
whats the 15 year survival for low and high grade mucoepidermoid carcinoma
50% low grade
25% mid-high
30
what proportion of parotid tumours are acinic cell carcinoma
2-4%
31
whats the epidemiology of acinic cell carcinoma
middle age- elderly
| F>M
32
whats the treatment for acinic cell carcinoma
local resection with cranial nerve7 preservation + prolonged follow up
33
What are features of malignant salivary gland tumours
rapidly growing swelling with pain +/- facial nerve palsy
although facial nerve palsy with a parotid tumour is almost diagnostic
34
What are the types of malignant salivary gland tumour
Adenoid cystic carcinoma
carcinoma ex pleomorphic adenoma
adenocarcinoma
lymphoma
35
what is the most common malignant salivary gland tumour
adenoid cystic carcinoma
36
what proportion of parotid tumours are adenoid cystic carcinoma
14%
37
where is adenoid cystic carcinoma found most commonly
sublingual 28%
then submandibular/minor (12%)
parotid (2%)
38
whats the epidemiology of adenoid cystic carcinoma
40-60 peak incidence F>M
39
what is the most common presentation of adenoid cystic carcinoma
slow growing invasive lump with palsy and pain
40
whats the treatment for adenoid cystic carcinoma
wide local resection - NON CN7 SPARING
41
whats the 15 year survival of adenoid cystic carcinoma
10-26%
42
whats the local recurrence rate for adenoid cystic carcinoma
50%
43
whats the 5 year survival of adenocarcinoma
10%
44
whats the most common salivary gland lymphoma
non hogkins
45
what is a feature of a lymphoma
firm rapidly enlarging mass
46
What are some common causes of salivary gland inflammatory disease
```
Viral Disease
sialadenitis
sialolithiasis
granulomatous disease
sjorens
```
47
what are the main 2 symptoms of salivary gland pathology
pain + swelling
48
what virus causes mumps
paramyxovirus
49
what are some viral causes of parotitis
mumps virus (paramyxovirus), echo (type of enterovirus) or coxsackie virus
50
whats the treatment for viral parotitis
analgesia + hydration
51
how do you diagnose a viral parotitis
do a mumps titre and see results
52
what causes bacterial parotitis
Staphylococcal
53
how does bacterial parotitis present
unilateral pain/swelling with dehydration
54
whats the treatment for bacterial parotitis
sialogogues, drain pus
55
what causes fungal parotitis and when would you suspect it
candiasis
| immunosuppression
56
What is sialadenitis
inflammation/infection of parotid and submandibular gland
57
what are symptoms of sialadenitis
pyrexia, systemic upset and visible pus (parotid)
58
what is a submandibular presentation of sialadenitis
odematous/swollen floor of mouth
59
whats the treatment for sialadenitis
high dose antibiotics, rehydration and oral hydgeine
sialogogues if required
60
what is an example of a sialogogue
citric acid/citrus mouthwash
61
what happens if you dont treat sialadenitis
abscess forms and sugery is required
62
what are features of and how do you treat chronic sialadenitis
pain/swelling after meals
excision of the gland
63
what is sialolithiasis
calculi forming in salivary gland
64
what is sialolithiasis commonly associated with
chronic sialadenitis
65
where does sialolithiasis mostly occur and why
submandibular gland due to its thicker secretions
66
whats the presentation of sialolithiasis
post-prandial swelling after eating + pain _/- recurrent infections
67
what imaging is used to find a sialolithiasis
X-ray
68
whats the treatment of sialolithiasis
oral fluids and sialogogues
stones usually pass themselves
surgery can be done if it needs removing
69
what is sialectasis
dilation, stenosis and necrosis of acini forming cysts
70
what is sialectasis a complication of
sialolithiasis
71
whats the treatment of sialectasis
removal of calculus or gand
72
What is Sjorens Syndrome
autoimmune disorder with multiple autoantibodies, including anti-ro, anti-la, rheumatoid factor, anti-nuclear and anti-cyclic citrullinated peptides
73
what are some symptoms of sjorens syndrome
primary - xerostoma + xeropthalmia (dry mouth and eyes), glossitis, stomatitis, dental cavities, dry vagina
secondary - primary + connective tissue disease (mostly RA)
74
what proportion of sjorens patients have parotid enlargement
40%
75
what does parotid enlargement in sjorens indiciate
increased chance of lymphoma
76
what are some associated conditions for sjorens
```
primary biliary cirrhosis
chronic hepatitis
vasculitis
cryoglobinaemia
hypergammaglobinaemia purpura
polyarteritis
pancreatitis
waldenstroms macroglobinaemia
```
77
how many people with sjorens have thyroiditis
15%
78
how do you investigate a suspected sjorens case
HLA-A1, B8, DR3
Anti-Ro/Anti-la antigens
Schirmers test for lacrimation (-ve = normal)
carlsson-crittendon test for salivary flow
labial biopsy - DIAGNOSTIC
79
what proportion of sjorens sufferers develop Non-hogkins lymphoma
1 in 6
80
what is the treatment for sjorens
steroids for any parotid swelling
| artificial tears/saliva
81
what divides the parotid gland into its constituent lobes, and what are the lobes
CN7
superficial (80%) + deep (20%)
82
what is the largest salivary gland
parotid
83
what kind of secretion does the parotid gland produce
watery/serous saliva
84
where is the parotid gland situated
between the mastoid process and the mandible , antero-superiorly to the tyloid process and carotd sheath
85
what is another name for the parotid duct
stensons duct
86
where does the parotid duct drain
2nd upper molar teeth
87
what anterior, posterior and superior relatioships does the parotid gland have
post: tympanic bone, external ear canal, stylomastoid fssa, mastoid process, upper 1/4 of SCM
ant: posterior 1/2 of masseter
sup: zygomatic arch
88
what structures are within the parotid gland
CN7 and its 5 branches (temporal, zygomatic, buccal, cervical and mandibular)
retromandibular vein, ECA and its division into superficial temporal and maxillary aa
parotid/stensons duct
secretomotor and sympathetic nerve fibres
89
what type of secretion is the submandibular gland responsible for
mixed serous and mucus secretions
90
where is the submandibular gland
in triangular space behind the mylohyoid muscle
91
what lobes does the submandibular gland have and where do they articulate
superfcial lobe that lies on mylohyoid and a deep lobe that articulates with the floor of the mouth
92
what are 3 important nerve interactions the submandibular gland has
hypoglossal and lingual nerves are associated with the deep portion
Marginal mandibular branch of the CN7 runs in skin overlying the gand
93
what structures are in the submandibular gland
```
submandibular duct
secretomotor fibres (salivary nucleus, corda tympani, nervus intermedius, lingual nerve)
sympathetic fibres (superior cervical gangion)
```
94
what is the smallest salivary gland
sublingual gland
95
what secretion is the sublingual gland responsible for
mucus
96
how do salivary glands work
acini produce fluid, then striated portion actively secretes/exchanges nutrients and proteins
97
how much saliva is produced in 24 hours
1-1.5 litres
98
what stimulates saliva production
```
smell
taste
psychic stimuli (thinking about food)
mastication
parasympathomimetic drugs
```
99
what spinal level is the trachea on
C6 to T4/5
100
what are the surface anatomy demarcations of the trachea
adams apple to the manubrostenial angle
101
how do you palpate the thyroid
palpate thyroid prominence/cricoid cartilage and feel posterolateral
102
what spinal level is the thyroid cartilage at
C3/4
103
what spinal level is the hyoid bone on
C3
104
where does the common carotid bifurcate
at superior edge of thyroid cartilage (C3)
105
where is the carotid sinus found
at the point of bifurcatio
106
what nerves are close to the carotid sinus
CN9, 10, 12
107
what are the branches of the External carotid artery
1. superior thyroid
2. ascending pharyngeal
3. lingual
4. facial
5. posterior auricular
6. superior temporal
7. maxillary
8. occipital
108
what spinal level is the cricoid bone
C6
109
what does the cricoid bone indicate
superior end of oesophagus
110
why is the cricoid bone important surgically
allows identification of cricothyroid ligament, through which the surgical airway is created
111
what are the articulations of the SCM
mastoid process sternal head and clavicular head
112
What is a branchial cyst
congenital epithelial cyst of the neck, characteristically in the anterior triangle just in front of the SCM
113
what age are branchial cysts found at
<30
114
what would an FNAC of a branchial cyst show
pus-like aspirate, rich in cholesterol
115
whats the treatment of a branchial cyst
excision
116
what is a thyroglossal duct cyst
congenital cyst present in childhood/adulthood rather than birth
found in the midline
117
what is a characteristic feature of thyroglossal duct cysts
move up when the tongue is stuck out
118
what is the treatment of thyroglossal duct cysts
excision of thyroglossal tract and hyoid bone
119
what are causes for goitres
graves
iodine deficiency
pregnancy
120
what kind of goitre is more likely to be malignant
nodular
121
what are the types of thyroid cancer + the proportions
Papillary (50%)
Follicular (25%)
Anpastic (20%)
Medullary (5%)
122
what age does papillary carcinoma present at usually
40-50
123
what is the prognosis of papillary carcinoma
90% if confined to a gland
60% if not
124
Treatment of papillary carcinoma
tota thyroidectomy + radioactive iodine
125
what ages does follicular thyroid carcinoma usually present at
50-60
126
how do you treat follicular carcinoma
total thyroidectomy + radioactive iodine
127
what is the prognosis of anplastic thyroid carcinoma
1 year survival = 8%
128
what are cardinal features of anplastic thyroid carcinoma
rapidly enlarging mass, ear pain, laryngea/oesophageal/tracheal invasion
129
what is the only cure for anplastic thyroid carcinoma
radical radiotherapy - but recurrence is common
130
who is anplastic carcinoma usually seen in
elderly women with long term thyroid enlargement
131
what kind of cell is affected in medullary carcinoma
parafollicular cells
132
what do parafollicular cells do
secrete calcitonin
133
what is a haemotological feature of medullary carcinoma
increased calcitonin levels
134
how do you treat medullary carcinoma
total thyroidectomy + radiotherapy
135
what is a feature of an actively secreting benign adenoma
takes up radioiodine/technetium
136
what does an actively secreting benign adenoma result in
thyrotoxicosis
137
what percentage of non functioning benign adenomas become malignant
10-20%
138
What is the definition of head and neck cancer
```
tumour coming from:
oral cavity
pharynx
paranasal sinus
nasal cait
larynx
salivary glands
```
139
what type of head and neck cancer (histologically) is more common in smokers and alcoholics
SCC
140
what are risk factors for developing head and neck cancer
```
smoking - anything
alcohol intake
chewing tobacco
increased sun exposure
certain chemical/wood inhalation
leukoplakia (cancerous in 1/3)
```
141
what are some common symptoms of head and neck cancer
```
pain in the throat
odynophagia
dysphagia
persistent hoarseness
referred ear pain
mouth/throat bleeding
increased node size
leukoplakia, erythroplakia, ulceration
thickening of oral tissues
difficulty moving tongue
numbness of tongue/mouth
```
142
where do 50% of head and neck cancers originate
oral cavity
143
what should cause suspicion of oral cavity cancer
oral lesions lasting for >2 weeks
144
what is a common symptom of cancer that is unusual in H+N cancer
weight loss
145
what is the most common type of head and neck cancer
mouth cancer
146
what is the most common subtype of mouth cancer
SCC
147
what type of person most commonly has mouth cancer
smokers/alcoholics
148
what is the treatment for mouth cancer
surgery with skin grafts
149
what types of cancer is commonly seen with nasopharyngeal cancer
SCC
| lymphoepithelioma
150
what is a risk factor for nasopharyngeal cancer
Nickel/hard wood dust inhalation
151
what is oropharynx
soft palate, base of tongue and tonsils
152
what is SCC of the tonsils strongly associated with
HPV
153
what is the difference in prognosis between HPV + ve and HPV -ve oropharyngeal cancers
HPV positive cancers have a better outcome
154
what are common signs of oropharyngeal cancer
lump in throat
sore throat
difficulty swallowing
trismus (lockjaw)
155
what are some causes for oropharyngeal cancer
```
betel nut chewing
radiation
IDA
HPV
smoking/alcohol abuse
```
156
what is the histological breakdown of oropharyngeal cancers
SCC 90%
8% NHL
2% minor salivary gland tumours
157
what is the hypopharynx
between the oropharynx and oesophagus/trachea
158
what is the prognosis of hypopharyneal cancers and why
they tend to be the most advanced at the point of diagnosis and threfore have the worst prognosis of all the pahryngeal cancers - they also metastasise early due to extensive lymph networks around the larynx
159
what type of cancers are hypopharyngeal cancers
SCC almost exclusively
160
what are risk factors for hypopharyngeal cancers
```
Betel-nut chewing
IDA
Radiation
HPV
Smoking + acohol abuse
```
161
whats the presenting complaint of hypopharyngeal cancers
```
sore throat
odynophagia
dysphagia
otalgia
haemoptysis
hoarsensess
stridor
neck mass
W/L if advanced
```
162
what is the anatomical distribution of laryngeal cancers
supragottic 40%
glottic 50%
infraglottic 5%
163
whats the presenting complaint for laryngeal cancer
```
voice change
difficulty/pain when swallowing
noise breathlessness
SOB
persistent cough
lump/swelling of neck
```
164
what is laryngeal cancer strongly associated with
smoking
165
what surgery is done for laryneal cancer
laser excision of small vocal cord lesion
partial laryngectomy
total laryngectomy
166
what kind of cancer are laryngeal cancers
95% SCC
Sarcoma
minor salivary gland
neuroendocrine tumours
167
what are the signs of nose/sinus cancer
unilateral persistent blocked nose
epistaxis
decreased smell
mucus running down nose/throat
168
How is nodal status assessed for the TMN staging criteria for head and neck cancer
Nx - nodal status not assessed
N0 no nodal mets
N1 - mets in singe ipsilateral lymph node <3cm
N2a - mets in single ipsilateral lymph node 3cm-6cm
N2b - mets in multiple ipsilateral lymphs all <6cm
N2c - mets in ipsilateral or contralateral lymph <6cm
N3 - any mets >6cm
169
How is metastases status assessed for the TMN staging criteria for head and neck cancer
Mx - presence of mets cannot be assessed
M0 - no evidence of distant mets
M1 - distant mets present
170
How does the staging differ based on T+N status
```
T4 = instant stage 4a, if T4N3 its 4b
T3N2a and above = stage 4b
N3 = instant stage 4b
if N0staging follows the T number
if N1 stage is automatically 3 minimum
```
171
what does the presence of M1 indicate for staging
immediate 4c staging
172
what is the T staging criteria for supraglottic tumours
T1 - confined to site/origin, normal vocal cord mobility
T2 - supra/subglottic extension
T3 - larynx confinement with VC fixation
T4 - Massive tumour with extra-larygeal extensioin + thyroid cartilage
173
what is the T staging criteria for subglottic tumours
T1 - confined to subglottic area
T2 - V/c extension
T3 - confined to arynx with cord fixation
T4 - similar to previous
174
what is leukoplakia
unmovable white patches of hyperkeratosis adhering to submucosa of mouth
175
what proportion of leukoplakias become malignant
3%
176
how do you manage leukoplakias
retinoids help reduce irritation
| surgery if that bad
177
what is erythroplakia
red patches in mouth without obvious cause
| almost always dysplasia and represents a precancerous lesion
178
how do you manage erythroplakia
biopsy and surgical excision
179
what is globus
feeling of something in throat causing dysphagia
diagnosis of exclusion - no throat pathology present (linked to anxiety)
