HEAD AND NECK

Question 1

what are the structures of the thoracic outlet, anterior to posterior?

Answer 1

subclavian v => phrenic nerve => anterior scalene => subclavian artery => middle scalene

Question 2

boundaries of anterior neck triangle

Answer 2

anterior - midline of neck 
posterior - SCM 
inferior - sternal notch 
superior - lower border of the mandible 
CONTAINS: carotid sheath

Question 3

boundaries of the POSTERIOR neck triangle

contents?

Answer 3

anterior - SCM
posterior - trapezius
base - middle 1/3 of the clavicle
contents: spinal accessory nerve

Question 4

muscles innervated by recurrent laryngeal nerve

Answer 4

innervates muscle of larynx (except cricothyroid - superior laryngeal nerve)

Question 5

Recurrent laryngeal nerve course on Right side

Answer 5

loops around the subclavian a., travels in TE groove

Question 6

Recurrent laryngeal nerve course on Left side

Answer 6

loops under the aorta, travels in the TE groove

Question 7

what muscle does the superior laryngeal nerve innervate

Answer 7

cricothyroid

Question 8

MC cancer of the head and neck

Answer 8

squamous cell cancer

Question 9

risk factors for SCC of the head and neck

Answer 9

alcohol and tobacco, HPV

Question 10

staging of SCC of the head and neck

Answer 10

Stage I & II - local disease

stage III and IV - locally aggressive or distant mets

Question 11

treatment for stage I or II SCC of head and neck

Answer 11

surgery vs radiation based on location (ex radiation for vocal cord lesion, WLE for intraoral lesions)

Question 12

treatment for stage III or IV SCC of head and neck

Answer 12

surgery followed by radiation +/- chemo

Question 13

treatment of oral SCC >4cm ( or +nodes/bone invasion)

Answer 13

resection with MRND followed by postop radiation

Question 14

are tumors or the small or large salivary glands more likely to be malignant?

Answer 14

small salivary glands more likely to be malignant (sublingual>submandibular>parotid)

Question 15

MC malignant salivary gland tumor

Answer 15

mucoepidermoid cancer

Question 16

treatment of mucoepidermoid tumor

Answer 16

resection (parotidectomy with MRND +/- XRT)

Question 17

treatment of adenoid cystic cancer (malignant)

Answer 17

resection (parotidectomy with MRND +/- XRT)

very sensitive to XRT, do not resect if concern for morbidity

Question 18

type of biopsy to diagnose melanoma of Head and neck

Answer 18

with FULL THICKNESS biopsy - excisional, incisional, punch

Do not perform shave biopsy

Question 19

how to you determine the lymph node drainage basin of melanoma of head and neck

Answer 19

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

Question 20

painless mass on roof of mouth: what is the diagnosis and treatment?

Answer 20

torus palatinus - overgrowth of cortical bone

Tx: do nothing

Question 21

most common cancer of the lower lip ?

Answer 21

SCC

if >1/2 of lip resected, will need flap

Question 22

MC cancer of the upper lip?

Answer 22

basal cell CA

Question 23

EBV related head and neck cancer?

Answer 23

nasopharyngeal SCC

Question 24

Tx of nasopharyngeal SCC

Answer 24

XRT

Question 25

MC benign salivary gland tumor?

Answer 25

pleomorphic adenoma

Question 26

Tx of pleomorphic adenoma

Answer 26

superficial parotidectomy - do not enucleate

Question 27

what is the cause of gustatory sweating after parotidectomy?

Answer 27

Frey’s syndrome. injury to the auriculotemporal nerve that cross innervates with sympathetic fibers

Question 28

organism causing suppurative parotiditis

Answer 28

Staphylococcus

Question 29

Tx of suppurative parotiditis

Answer 29

hydration and abx. I&D if abscess

Question 30

elderly patient with post op fever, pain, and swelling at angle of jaw

Answer 30

Suppurative parotiditis

Question 31

management of bleeding at tracheostomy site

Answer 31

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