Head and Neck Flashcards
A patient presents with an enlarged lymph node in the anterior compartment of the neck. An FNAB returns with a histologic diagnosis of epidermoid carcinoma. CT and panendoscopy fail to reveal a primary lesions. Which of the following is the MOST appropriate course of action?
A. Observation with expectant management
B. Excisional biopsy to confirm the diagnosis
C. Radiation therapy directed at the oropharynx and neck bilaterally
D. Chemotherapy combined with radiation therapy directed at the ipsilateral neck
E. Modified radical neck dissection followed by adjuvant radiation therapy directed at the ipsilateral neck
C. Radiation therapy directed at the oropharynx and neck bilaterally
See NCCN guidelines for occult lesions
A 75-year-old male pipe smoker presents with a 2.0cm ulcerated lesion along the vermillion border of his lower lip on the right side. There is no palpable adenopathy appreciated on physical exam. Computed tomography and panendoscopy are otherwise unrevealing. What is the MOST appropriate intervention?
A. Wide local excision only
B. Wide local excision with sentinel lymph node biopsy
C. Wide local excision with selective neck dissection containing levels I, II, and III
D. Wide local excision with modified radical neck dissection
E. Wide local excision with adjuvant radiation therapy
A. Wide local excision only
Lip cancer is very low for nodal mets.
You are called to evaluate a 67-year-old female who is postoperative day 14 from a tracheostomy. The patient’s nurse tells you that a few moments ago, she suctioned out a large amount of clotted blood from inside the patient’s tracheostomy and upper airway. Since then she has not noticed any further bleeding but is requesting that you evaluate the patient as soon as possible. Which of the following is the MOST likely source of bleeding?
A. Fistule between the trachea and carotid artery
B. Fistula between the trachea and innominate artery
C. Fistula between the trachea and esophagus
D. Bleeding from the skin edge of the tracheostomy site
E. Upper airway inflammation
B. Fistula between the trachea and innominate artery
Which of the following is the MOST appropriate next step for suspected (controlled) bleeding post-tracheostomy?
A. Overinflation of tracheostomy cuff
B. Digital compression of the bleeding source against the manubrium
C. Bronchoscopy
D. Digitial compression of the ipsilateral carotid artery
E. Immediate primary repair of the bleeding vessel in the operating room
A. Overinflation of tracheostomy cuff
If it is rebleeding/active
A 65-year-old woman comes to the office because she has swelling of the left side of her face with left-sided facial weakness. On examination, a left parotid mass is palpated. Fine-needle aspiration biopsy of the specimen shows few malignant epithelial cells. Which of the following is the MOST likely diagnosis?
A. Adenocarcinoma
B. Adenoid cystic carcinoma
C. Carcinoma ex pleomorphic adenoma
D. Mucoepidermoid carcinoma
E. Squamous cell carcinoma
D. Mucoepidermoid carcinoma
A 61-year-old male has a biopsy performed of a new mass located at the angle of the mandible. 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.
Which of the following is the BEST treatment for the patient?
A. Superficial parotidectomy with facial nerve preservation
B. Total parotidectomy with radical neck dissection
C. Superficial parotidectomy and adjuvant radiation therapy
D. Total parotidectomy with adjuvant radiation therapy
E. En bloc parotidectomy including resection of facial nerve
C. Superficial parotidectomy and adjuvant radiation therapy
Which of the following is an indication for a radical neck dissection for a parotid gland tumor?
A. Warthin’s tumor involving both parotid glands
B. High grade mucoepidermoid lesion with no palpable neck nodes
C. Pleomorphic adenoma with malignant transformation
D. Low grade adenoid cystic carcinoma with neural invasion
E. Basal cell adenoma
B. High grade mucoepidermoid lesion with no palpable neck nodes
Which of the following is the most common site of minor salivary gland malignancies?
A. Buccal mucosa
B. Floor of the mouth
C. Lip
D. Palate
E. Tongue
D. Palate
What are the borders of the posterior cervical triangle?
A. SCM, trapezius, middle third of clavicle
B. Midline, hyoid, anterior digastric
C. Mandible, SCM, midline
D. SCM, clavicle, mandible
E. SCM, trapezius, mandible
A. SCM, trapezius, middle third of clavicle
Which of the following are true about leukoplakia of the vocal cords?
A. Up to 40% risk of progression to invasive carcinoma.
B. Ulceration is particularly suggestive of possible
malignancy.
C. Initial therapy includes antihistamines.
D. Biopsy should be considered only after 6 months of conservative therapy.
Answer: B
Leukoplakia of the vocal fold represents a white patch (which cannot be wiped off) on the mucosal surface, usually on the superior surface of the true vocal cord.
Rather than a diagnosis per se, the term leukoplakia describes a finding on laryngoscopic examination. The significance of this finding is that it may represent squamous hyperplasia, dysplasia, and/or car- cinoma.
Lesions exhibiting hyperplasia have a 1 to 3% risk of progression to malignancy. In contrast, that risk is 10 to 30% for those demonstrating dysplasia.
Furthermore, leukoplakia may be observed in association with inflammatory and reactive pathologies, including polyps, nodules, cysts, granulomas, and papillomas. Features of ulceration and erythroplasia are particularly suggestive of possible malignancy.
A history of smoking and alcohol abuse should also prompt a malignancy workup.
In the absence of suspected malignancy, conservative measures are used for 1 month. Any lesions that progress, persist, or recur should be considered for excisional biopsy specimen.
(See Schwartz 10th ed., p. 573.)
Factors associated with increased incidence of head and neck cancers include all of the following EXCEPT
A. Human papillomavirus (HPV) exposure
B. Ultraviolet light exposure
C. Plummer-Vinson syndrome
D. Reflux esophagitis
Answer: D
Human papillomavirus (HPV) is an epitheliotropic virus that has been detected to various degrees within samples of oral cavity squamous cell carcinoma.
Infection alone is not considered sufficient for malignant conversion; however, results of multiple studies suggest a role of HPV in a subset of head and neck squamous cell carcinoma.
Multiple reports reflect that up to 40 to 60% of current diagnoses of tonsillar carcinoma demonstrate evidence of HPV types 16 or 18.
Environmental ultraviolet light exposure has been associated with the development of lip cancer. The projection of the lower lip, as it relates to this solar exposure, has been used to explain why the majority of squamous cell carcinomas arise along the vermilion border of the lower lip.
In addition, pipe smoking also has been associated with the development of lip carcinoma.
Factors such as mechanical irritation, thermal injury, and chemical exposure have been described as an explanation for this finding.
Other entities associated with oral malignancy include Plummer-Vinson syndrome (achlorhydria, iron-deficiency anemia, mucosal atrophy of mouth, pharynx, and esophagus), chronic infection with syphilis, and immunocompromised status (30-fold increase with renal transplant).
(See Schwartz 10th ed., p. 579.)
Features of oral tongue carcinoma include all of the following EXCEPT
A. Presentation as ulcerated exophytic mass
B. May involve submandibular and upper cervical lymph nodes
C. Can result in contralateral paresthesias
D. CO2 laser useful for excision of small early tumors
Answer: C
Tumors of the tongue begin in the stratified epithelium of the surface and eventually invade into the deeper muscular structures.
The tumors may present as ulcerations or as exophytic masses. The regional lymphatics of the oral cavity are to the submandibular space and the upper cervical lymph nodes.
The lingual nerve and the hypoglossal nerve may be directly invaded by locally extensive tumors. Involvement can result in ipsilateral paresthesias and deviation of the tongue on protrusion with fasciculations and eventual atrophy.
Tumors on the tongue may occur on any surface, but are most commonly seen on the lateral and ventral surfaces.
Primary tumors of the mesenchymal components of the tongue include leiomyomas, leiomyosarcomas, rhabdomyosarcomas, and neurofibromas.
Surgical treatment of small (T1-T2) primary tumors is wide local excision with either primary closure or healing by sec- ondary intention.
The CO2 laser may be used for excision.
(See Schwartz 10th ed., p. 583.)
Branchial cleft cysts, if enlarged, should be removed because of which of the following
A. Prone to becoming secondarily infected
B. Prone to cause acute airway obstructions
C. Possible premalignant concerns
D. Association with severe halitosis
Answer: A
Congenital branchial cleft remnants are derived rom the branchial cleft apparatus that persists after fetal development.
There are several types, numbered according to their corresponding embryologic branchial cleft.
First branchial cleft cysts and sinuses are associated intimately with the external auditory canal (EAC) and the parotid gland.
Second and third branchial cleft cysts are found along the anterior border of the sternocleidomastoid (SCM) muscle and can produce drainage via a sinus tract to the neck skin.
Secondary infections can occur, producing enlargement, cellulitis, and neck abscess that requires operative drainage.
(See Schwartz 10th ed., p. 598.)
All of the following are FALSE about salivary gland neoplasms EXCEPT
A. Account or less than 2% of all head and neck neoplasms
B. If in minor salivary glands, less likely to be malignant than if in the parotid gland
C. Computed tomography (CT) scanning is more accurate than magnetic resonance imaging (MRI) in detecting lesions
D. Oncocytomas are usually malignant
Answer: A
Tumors of the salivary gland are relatively uncommon and represent less than 2% of all head and neck neoplasms.
About 85% of salivary gland neoplasms arise within the parotid gland. The majority of these neoplasms are benign, with the most common histology being pleomorphic adenoma (benign mixed tumor).
In contrast, approximately 50% of tumors arising in the submandibular and sublingual glands are malignant.
Tumors arising from minor salivary gland tissue carry an even higher risk for malignancy (75%).
Diagnostic imaging is standard for the evaluation of salivary gland tumors. Magnetic resonance imaging (MRI) is the most sensitive study to determine soft tissue extension and involvement of adjacent structures. Benign epithelial tumors include pleomorphic adenoma (80%), monomorphic adenoma, Warthin tumor, oncocytoma, or sebaceous neoplasm.
(See Schwartz 10th ed., p. 599.)
All of the following are true about tracheostomy EXCEPT
A. Should be performed in patients anticipated to be intubated more than 2 weeks
B. Improves patient discomfort as compared to long term
oropharyngeal intubation
C. Usually spontaneously close within 2 months of removal
D. Does not obligate patient to loss of speech
Answer: C
The avoidance of prolonged orotracheal and nasotracheal intubation decreases the risk of laryngeal and subglottic injury and potential stenosis, facilitates oral and pulmonary suctioning, and decreases patient’s discomfort.
When the tracheostomy is no longer needed, the tube is removed and closure of the opening usually occurs spontaneously over a 2-week period.
Placement of a tracheostomy does not obligate a patient to loss of speech.
When a large cuffed tracheostomy tube is in place, expecting a patient to be capable of normal speech is impractical. However, after a patient is downsized to an uncuffed tracheostomy tube, intermittent finger occlusion or Passy-Muir valve placement will allow a patient to communicate while still using the tracheostomy to bypass the upper airway.
(See Schwartz 10th ed., p. 602.)
Discuss the nodal levels.
Level I: Submandibular and submental triangles
Level II-IV: Jugular chain of nodes
Level V: Posterior triangle
Level VI: Central compartment (located at the anterior neck area, inferior to the thyroid gland)
Management of patients with nodal SCCA, with unknown primary?
Do Radical Neck Dissection of the involved side, and postoperative radiation from the nasopharynx to the entire neck.
Types of Neck Dissections?
1) Radical Neck Dissection
Removal of all lymph-bearing tissues in the neck, from levels I-V, together with the SCM, IJV, and SAN.
2) Modified Radical Neck Dissection
Removal of all lymph bearing tissues in the neck from levels I-V, with preservation of the SCM, IJV, and SAN.
3) Extended Radical Neck Dissection
Same with RND, plus removal of other tissues (strap muscles, trachea, etc.)
4) Selective Neck Dissection*
* The first three types are used in staging the neck (clinical N0)
a. Supraomohyoid Neck Dissection (SOHND)
- Removal of levels I-III
- For oral cavity, facial, salivary gland lesions
b. Lateral Neck Dissection
- Removal of levels II-IV
- For pharyngeal and laryngeal lesions
c. Central Node Compartment Dissection
- Removal of level VI
- For thyroid CA cases wherein a total thyroidectomy is performed
d. Posterolateral Neck Dissection
- Removal of level II-V together with the occipital and posterior auricular nodes
- Scalp lesions
Most common cancer types in the scalp?
1) SCCA
2) Basal Cell CA
3) Soft tissue sarcoma
Surgical margins for excision?
SCCA = 1cm
Basal Cell CA = 1cm
What diagnostic tools are needed for scalp lesions suspicious for cancer?
If movable, no need for any labs.
If fixed, do at least a skull x-ray.
How do you confirm the diagnosis for scalp lesions suspicious for cancer?
SCCA: Punch or incision biopsy
Basal Cell CA and Soft Tissue Sarcoma: Tru-cut biopsy
How do you assess the neck for scalp lesions?
SCCA: Drains through lymphatics hence neck dissection is needed.
- For lesions in the occipital area, drainage would be to the occipital and posterior auricular nodes.
- For lesions in the temporal, parietal and frontal areas, drainage would be to the peri-parotid nodes.
Basal cell CA and sarcomas generally do not metastasize through lymphatics, hence there is no need for a neck dissection.
How do you treat SCCA of the scalp?
Wide excision with 1cm margins.
If the mass is movable, leave the periosteum intact. Reconstruct with skin graft.
If the mass is fixed, check for bony involvement. An outer table craniectomy may be needed, or in less invasive types, removal of the periosteum is required. Reconstruct with rotational scalp flap plus skin graft to donor site.
For the neck:
- Occipital lesions: Posterolateral neck dissection
- Temporal, parietal, and frontal lesions: parotidectomy and neck dissection
What is the 2/3 rule for salivary gland tumors?
2/3 of all lesions in the salivary glands would be benign.
2/3 of these lesions would be a pleomorphic adenoma.
2/3 of these will be located in the parotid gland.
What are the major salivary glands?
Parotid
Submandibular
Sublingual
How many minor salivary glands does the oral cavity have?
700 - 1000 minor salivary glands
What is the treatment for benign salivary gland lesions?
Parotid
- If mass is big enough to extend beyond the facial nerve, do a total parotidectomy. Otherwise, do a superficial parotidectomy.
- A pleomorphic adenoma has a pseudocapsule. There are finger-like projections extending beyond the visible capsule. Hence if there is no significant margin during resection, there is a very high recurrence rate.
Submandibular gland
- Once a tumor grows, remove the entire submandibular gland.
What is the treatment for malignant lesions of the salivary glands?
No need to do biopsy. Basis for diagnosis would be clinical– look for:
- fixation/mobility
- consistency (hard)
- facial nerve involvement
- nodal involvement
- skin involvement
- extension to the oral cavity.
Determine two things: size and grade.
Only 3 types of malignancies have a low-grade and a high-grade component:
1) Mucoepidermoid carcinoma
2) Acinic cell carcinoma
3) Adenocarcinoma
T1: ≤2cm
T2: >2cm, but ≤4cm
T3: >4cm
T4: Extension to adjacent structures
For T1-T2 (low-grade): Superficial parotidectomy or submandibular gland excision
T3-T4 (low-grade), any T, high grade lesions with no clinically palpable neck nodes (N0):
Total Parotidectomy + SOHND + Postoperative RT to the wall
*Remember that submandibular gland removal is part of level I dissection.
How to determine the histologic type of malignancy?
You could opt to do frozen section.
What are the complications of surgery for the salivary gland tumors?
Submandibular Gland Excision
- injury to the nerve causing loss of taste (chorda tympanii of facial nerve CN VII) and sensation (lingual nerve of trigeminal CN V3)
- injury to the marginal mandibular branch of the facial nerve.
Parotidectomy
- Frey’ syndrome: aka auriculotemporal syndrome, characterized by gustatory sweating and flushing. Diagnosed by a minor starch-iodine test. The starch-iodine test consists of painting the patient’s postsurgical affected region with iodine, in which the starch turns blue/brown in the presence of iodine and sweat. Treated with topical antiperspirants and botulinum toxin A.
- Fistula formation: Treatment is conservative with application of pressure dressings. Problem is in failure to ligate Stensen’s duct.
Risk factors for oral cavity cancers?
Smoking (chronic irritation)
Alcohol intake
Ill-fitting dentures
Premalignant lesion: Leukoplakia
Principles in treatment of oral cavity cancer?
T1-T2: Wide excision
T3-T4: Wide excision + SOHND (if cN0) + Postop radiotherapy
*Same as salivary gland lesions.
How do you confirm your diagnosis for oral cavity cancers?
Punch biopsy.
But your major concern is the extent of the primary cancer. By size and proximity, check for mandibular involvement using a panorex view.
If only periosteum is involved, do a marginal mandibulectomy (1cm inferior portion of the mandible is left in place, 1cm because any smaller and the bone will weaken and fracture).
What is the principle behind this? The periosteum is a very good barrier against tumor invasion. The malignant cells will slide over it and enter the bone through the natural openings for tooth growth.
If there is gross bony involvement, do segmental mandibulectomy.
Management of cancers of the floor of the mouth and tongue?
The floor of the mouth and tongue are both considered to be midline structures. Therefore, lymphatic spread is to both sides of the neck.
T3-T4 lesions with N0 neck:
Bilateral SOHND
One side N0, other side N+:
Do SOHND in the N0 side, and a full neck dissection in the N+ side.
Both N+:
Do a full neck dissection on both sides.
Never do bilateral Radical Neck Dissection. Removal of both IJVs will cause cerebral edema. Only ONE IJV can be removed.
The tongue is notorious for having skip node metastases. They may have enlarged nodes in level V, even without palpable nodes in level I-IV. Hence tongue malignancies warrant a bilateral full neck dissection.
How is reconstruction done for the oral cavity?
Soft tissue defects can be restored with myocutaneous flaps.
Bony defects can be restored with titanium plates, bone grafts, and wires.
Bone grafts can only be used in defects <6cm. It can not be used for larger defects because the bone will resorb.
Management of laryngeal lesions?
As in the pharynx, the newest treatment modality involves chemotherapy and radiotherapy for all stages, because of the emphasis on organ preservation. However, it is yet to be adapted in our local setting.
Remember that the larynx is divided into 3 regions: supraglottic, glottic and subglottic, with SUBGLOTTIC having the POOREST prognosis.
Glottic lesions do NOT metastasize to the neck, because there are NO lymphatic channels in this area.
Agents for chemotherapy in head and neck cancers?
Chemotherapy is used to downgrade tumors, making them more amenable for surgery.
Agents: Cisplatin and 5-FU
Dosage: Cisplatin 50mg/kg/dose
5-FU 50mg/kg/day
What to check prior to administration:
1) WBC count
2) BUN/Crea (Nephrotoxic)
Administration: IV, ensure patient is well-hydrated prior to starting it
- Cisplatin given on Day 1 x 4 hours
- 5-FU given for 5 straight days as bolus.
What is the procedure of choice for the mandible in patients with oral cavity cancer with periosteal involvement of the mandible on panorex?
a. marginal mandibulectomy
b. hemimandibulectomy
c. segmental mandibulectomy
d. total mandibulectomy
a. marginal mandibulectomy
A 1.5 cm mass at the anterior left side of the tongue turns out to be malignant on biopsy. The appropriate management is:
a. Hemiglossectomy with radiation to the ipsilateral neck
b. Hemiglossectomy with modified neck dissection
c. Wide excision plus radiation to the ipsilateral neck
d. Wide excision
d. Wide excision
A 47-year old woman underwent surgery for a 2.5 cm follicular neoplasm diagnosed by FNAB. The frozen section turned to be benign and a lobectomy was carried out. The final histopath however is follicular carcinoma. In this patient:
a. No further surgery is immediately indicated
b. RAI therapy should be instituted
c. Completion thyroidectomy should be done
d. Thyroid suppression therapy is indicated
c. Completion thyroidectomy should be done
A 50-yr old female presented with a small neck mass, cardiac arrhythmia, recurrent dehydration, weakness, weight loss, and microhematuria. The most important diagnostic procedure in this case is:
a. Renal and ureteral ultrasonography
b. FNAB of the neck mass
c. Serum calcium and parathormone
d. Ultrasonography of the neck
c. Serum calcium and parathormone
Order of thoracic outlet neurovascular structures (anterior to posterior):
Subclavian vein, phrenic nerve, anterior scalene muscle, subclavian artery, middle scalene muscle
What nerve runs posterior to the middle scalene muscle?
Long thoracic nerve
What nerve(s) runs in the posterior neck triangle?
Accessory nerve and the brachial plexus
Which muscles are innervated by the accessory nerve?
Sternocleidomastoid, trapezius, and platysma
Name the nerve that crosses the internal carotid artery 1 to 2 cm above the carotid bifurcation:
Hypoglossal nerve
The hypoglossal nerve supplies motor innervation to all of the muscles of the tongue except:
Palatoglossus
The phrenic nerve lies on top of what muscle?
Anterior scalene
Name the branches of the facial nerve:
Temporal, zygomatic, buccal, marginal mandibular, cervical branches
Which branch of the facial nerve is most often injured in carotid surgery?
Marginal mandibular nerve
Name the branches of the trigeminal nerve:
Ophthalmic (V1), maxillary (V2), mandibular (V3)
What nerve is found within the carotid sheath?
Vagus
The recurrent laryngeal nerve innervates all of the muscles of the larynx except:
Cricothyroid muscle
Which nerve is responsible for sensory innervation of the larynx above the level of the vocal folds?
Internal branch of the superior laryngeal nerve
Which nerve is responsible for sensory innervation of the larynx below the level of the vocal folds?
Recurrent laryngeal nerve
Name the branches of the thyrocervical trunk:
STAT:
Suprascapular artery. Transverse cervical artery. Ascending cervical artery. inferior Thyroid artery
What ls the first branch of the external carotid artery?
Superior thyroid artery
Name the blood supply to the nose:
Anterior/posterior ethmoidal arteries off the ophthalmic artery
Superior labial artery from the facial artery
Sphenopalatine artery off the internal maxillary artery
What nerve innervates the strap muscles?
Ansa cervicalis
Define the regions of the cervical lymph nodes:
Level I: submental and submandibular nodes Level II: upper jugular nodes Level III: middle jugular nodes Level IV: lower jugular nodes Level V: posterior triangle Level VI: anterior compartment Level VII: upper mediastinal nodes
What structure divides the parotid gland into superficial and deep lobes?
Facial nerve
What is the name of the duct in the parotid gland?
Stenson duct
What is the name of the duct in the submandibular gland?
Wharton duct
What is the most common nerve injured in parotid surgery?
Greater auricular nerve
What is the most common type of cancer of the oral cavity, pharynx, and larynx?
Squamous cell carcinoma
What are the biggest risk factors for head and neck cancer?
Tobacco and alcohol
What is the most common location for an oral cavity cancer?
Lower lip
What head and neck cancer is Epstein-Barr virus infection associated with?
Nasopharyngeal squamous cell carcinoma
What is the treatment for nasopharyngeal squamous cell carcinoma associated with Epstein-Barr virus?
Primary radiation
Oral cavity cancer is most likely to spread to which regional lymph nodes?
Submental and submandibular (level I}
What is the most common benign head and neck tumor in adults?
Hemangioma
What is the most common tumor of the nasopharynx in children?
Lymphoma
What is the most common benign neoplasm of the nose and paranasal sinuses?
Papilloma
What is the most common benign lesion of the larynx?
Papilloma
What is the treatment for an early glottic squamous cell carcinoma?
Primary radiation versus conservative surgical resection-laser versus endoscopic (if recurs, perform cordectomy)
What is the treatment for an advanced glottic squamous cell carcinoma (stages 3 and 4)?
Laryngectomy,
modified radical neck dissection, and
postoperative radiation
Where do head and neck tumors most often distantly metastasize?
Lung
Which disorder involves dysphagia, esophagitis, iron-deficiency anemia, spoon fingers, and an increased incidence of oral cavity cancer?
Plummer-Vinson syndrome
What are the indications for a radical neck dissection?
Clinically positive lymph nodes
Fixed cervical mass
High rate of suspicion for metastatic disease
In oral cavity cancer, when is a modified radical neck dissection indicated?
Clinically positive nodes
Bone invasion
Tumor size >4 cm
Which structures are taken in a radical neck dissection?
Accessory nerve, cervical branch of the facial nerve, internal jugular vein, ipsilateral thyroid, omohyoid, stemocleidomastoid muscle, submandibular gland, sensory nerves C2 to C5
What is spared in a modified radical neck dissection?
Type I: spinal accessory nerve
Type II: spinal accessory nerve, internal jugular vein
Type III: spinal accessory nerve, internal jugular vein, sternocleidomastoid (SCM)
What percentage of salivary tumors are benign?
80%
What percentage of salivary tumors are in the parotid?
80%
What is the most common benign salivary tumor?
Pleomorphic adenoma
What percentage of pleomorphic adenomas undergo malignant degeneration?
5%
What is the second most common benign tumor of the salivary glands?
Warthin tumor
What percentage of Warthin tumors are bilateral?
10%
What is the most common salivary gland tumor in children?
Hemangioma
What is the most common malignant tumor of the salivary glands?
Mucoepidermoid carcinoma
What is the second most common malignant salivary gland tumor?
Adenoid cystic carcinoma
What is an important oncologic feature of adenoid cystic carcinoma?
Very sensitive to radiation; therefore, it can be considered as the treatment modality, although resection is the mainstay of treatment.
What is the name ofthe vascular plexus located in the anterior portion of the nasal septum, which is responsible for 90% of epistaxis?
Kiesselbach plexus
What percentage of epistaxis can be controlled with anterior or combined anterior and posterior nasal packing?
95%
Which arteries can be ligated in order to control epistaxis?
Ethmoid artery, internal maxillary artery
Why does a nasal septa! hematoma require emergent treatment?
The accumulation of blood in the nasal septum may deprive the septal cartilage of its blood supply from the perichondrium.
It requires immediate incision and drainage, septal splinting, and antibiotics to prevent avascular necrosis of the septal cartilage and subsequent saddle nose deformity.
What is the initial management for a traumatic cerebrospinal fluid (CSF) leak?
Head elevation
Avoid nose blowing/straining
With/without antibiotics
Which diagnostic test can be used to confirm whether fluid ls CSF?
B2-transferrin
What is the treatment for a persistent CSF leak (>4-6weeks)?
Surgical repair
What ls the treatment for a CSF leak associated with meningitis?
Surgical repair
What is the most common cause of laryngeal stenosis?
Trauma
Most common location for an esophageal foreign body:
Upper esophagus at the thoracic inlet
Above what level should a tracheostomy be placed to avoid the complication of a tracheo-innominate fistula?
Above the third tracheal ring
What is the initial treatment for a peritonsillar abscess?
IV antibiotics and needle aspiration
What is the treatment for a retropharyngeal abscess?
IV antibiotics and surgical drainage through the posterior pharynx or neck
What is the treatment for a parapharyngeal abscess?
IV antibiotics, incision and drainage through the lateral neck, and leave a drain in place
What is the initial treatment for acute suppurative parotitis?
Antibiotics, IV fluids, sialogogues, warm compresses
When is it necessary to operate on acute suppurative parotitis?
When there is no clinical improvement after 12 hours of treatment