Head and Neck, Skin and Soft Tissue Surgery Flashcards
Glands that make up the salivary glands
Major paired glands
- parotid
- submandibular
- sublingual
Minor glands (in mucosal lining of upper digestive tract)
General rule about salivary tumours
The smaller the gland from which it originates, the greater the chance that it will become malignant
Types of salivary tumours
- adenomas
- carcinomas
- non-epithelial
- malignant lymphomas
- secondary mets
- unclassified
- tumour-like lesions
Which nerve is associated with the parotid gland?
Facial nerve
Where in the parotid gland are most tumours found?
In the superficial lobe
Top 3 parotid malignancies in South Africans
- squamous cell carcinoma of the skin
- mucoepidermoid carcinoma
- malignant melanoma of the skin
Clues if a parotid gland tumour is malignant
- previous skin cancer of head and neck
- irradiation of parotid region
- rapid growth
- pain
- local invasion (trismus, skin infiltration, fixity, facial nerve involvement, mets to lymph/lungs)
Potential investigations for parotid tumours
- imaging
- fine needle aspiration cytology
- Trucut and open biopsy
When is FNAC useful for parotid tumour?
- exclude inflammatory disease
- exclude lymphoma
- exclude mets
- patients who dont want surgery
- inoperable tumours
Potential consequences of parotidectomy
- scar
- greater auricular nerve (loss of sensation, neuroma)
- facial nerve (Temp weakness)
- Frey’s syndrome (gustatory sweating)
Why does Frey’s syndrome occur?
- sweating over the area while eating
- short-circuiting of secretomotor nervers that supply the parotid and the nerves that innervate the sweat glands
Presentation of submandibular gland neoplasms
Mass projecting into the neck or the lateral floor of the mouth
Differentials for submandibular neoplasm
- sialolithiasis
- sialadenitis
- enlarged lymph nodes
Nerves that pass close to the submandibular glands
- hypoglossal
- lingual
- marginal mandibular
Diagnosis of submandibular neoplasm
- FNAC
- resection
Management of sublingual gland neoplasm
- biopsy in the oral cavity (significant likelihood of malignancy)
When to suspect HIV parotid lymphoepithelial cysts
- multiple
- bilateral
- associated cervical lymph nodes
- HIV positive
Treatment of HIV lymphoepithelial cysts
- antiretrovirals
- aspirate and inject sclerosant
Regions of the neck
1 = submandib gland, nodes, 2 = upper jug nodes, carotid body 3 = mid-jug nodes 4 = inferior jug nodes, Virchow Trossier node, thyroid 5 = nodes 6 = thyroid, parathyroid
Differentials for central neck masses
- thyroglossal duct remnant
- dermoid cyst
- cervical lymphadenopathy
- lipoma
- haemandioma
- fibroma
- thyroid/-related
Special investigation of neck lumps
- biopsy
- FNAC
- CXR
- barium swallow
Operation to remove thyroglossal duct cyst
Sistrunk operation
Where do inclusion dermoid cysts present?
Between the cricoid bone and suprasternal notch
How can branchial cleft remnants present?
- cyst
- sinus
- fistulae
