HEAD AND NECK Flashcards
what are the structures of the thoracic outlet, anterior to posterior?
subclavian v => phrenic nerve => anterior scalene => subclavian artery => middle scalene
boundaries of anterior neck triangle
anterior - midline of neck posterior - SCM inferior - sternal notch superior - lower border of the mandible CONTAINS: carotid sheath
boundaries of the POSTERIOR neck triangle
contents?
anterior - SCM
posterior - trapezius
base - middle 1/3 of the clavicle
contents: spinal accessory nerve
muscles innervated by recurrent laryngeal nerve
innervates muscle of larynx (except cricothyroid - superior laryngeal nerve)
Recurrent laryngeal nerve course on Right side
loops around the subclavian a., travels in TE groove
Recurrent laryngeal nerve course on Left side
loops under the aorta, travels in the TE groove
what muscle does the superior laryngeal nerve innervate
cricothyroid
MC cancer of the head and neck
squamous cell cancer
risk factors for SCC of the head and neck
alcohol and tobacco, HPV
staging of SCC of the head and neck
Stage I & II - local disease
stage III and IV - locally aggressive or distant mets
treatment for stage I or II SCC of head and neck
surgery vs radiation based on location (ex radiation for vocal cord lesion, WLE for intraoral lesions)
treatment for stage III or IV SCC of head and neck
surgery followed by radiation +/- chemo
treatment of oral SCC >4cm ( or +nodes/bone invasion)
resection with MRND followed by postop radiation
are tumors or the small or large salivary glands more likely to be malignant?
small salivary glands more likely to be malignant (sublingual>submandibular>parotid)
MC malignant salivary gland tumor
mucoepidermoid cancer
treatment of mucoepidermoid tumor
resection (parotidectomy with MRND +/- XRT)
treatment of adenoid cystic cancer (malignant)
resection (parotidectomy with MRND +/- XRT)
very sensitive to XRT, do not resect if concern for morbidity
type of biopsy to diagnose melanoma of Head and neck
with FULL THICKNESS biopsy - excisional, incisional, punch
Do not perform shave biopsy
how to you determine the lymph node drainage basin of melanoma of head and neck
if anterior to imaginary line from one tragus to the other, it will drain to the parotid basin.
superficial parotidectomy and anterior neck dissection
if posterior - perform selective posterior neck dissection
painless mass on roof of mouth: what is the diagnosis and treatment?
torus palatinus - overgrowth of cortical bone
Tx: do nothing
most common cancer of the lower lip ?
SCC
if >1/2 of lip resected, will need flap
MC cancer of the upper lip?
basal cell CA
EBV related head and neck cancer?
nasopharyngeal SCC
Tx of nasopharyngeal SCC
XRT
MC benign salivary gland tumor?
pleomorphic adenoma
Tx of pleomorphic adenoma
superficial parotidectomy - do not enucleate
what is the cause of gustatory sweating after parotidectomy?
Frey’s syndrome. injury to the auriculotemporal nerve that cross innervates with sympathetic fibers
organism causing suppurative parotiditis
Staphylococcus
Tx of suppurative parotiditis
hydration and abx. I&D if abscess
elderly patient with post op fever, pain, and swelling at angle of jaw
Suppurative parotiditis
management of bleeding at tracheostomy site
if small amount, bronchoscopy to r/o tracheoinominate fistula
if large amount - place finger into tracheostomy and holf manual pressure against sternum then go straight to OR. Median sternotomy and resection of innominate artery. primary closure of trachea site and cover with strap muscle. do not put synthetic interposition graft - it gets infected and blows out
