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Surgery Revision > Head and Neck, Skin and Soft Tissue Surgery > Flashcards

Head and Neck, Skin and Soft Tissue Surgery Flashcards

1
Q

Glands that make up the salivary glands

A

Major paired glands

  • parotid
  • submandibular
  • sublingual

Minor glands (in mucosal lining of upper digestive tract)

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2
Q

General rule about salivary tumours

A

The smaller the gland from which it originates, the greater the chance that it will become malignant

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3
Q

Types of salivary tumours

A
  • adenomas
  • carcinomas
  • non-epithelial
  • malignant lymphomas
  • secondary mets
  • unclassified
  • tumour-like lesions
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4
Q

Which nerve is associated with the parotid gland?

A

Facial nerve

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5
Q

Where in the parotid gland are most tumours found?

A

In the superficial lobe

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6
Q

Top 3 parotid malignancies in South Africans

A
  • squamous cell carcinoma of the skin
  • mucoepidermoid carcinoma
  • malignant melanoma of the skin
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7
Q

Clues if a parotid gland tumour is malignant

A
  • 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)
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8
Q

Potential investigations for parotid tumours

A
  • imaging
  • fine needle aspiration cytology
  • Trucut and open biopsy
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9
Q

When is FNAC useful for parotid tumour?

A
  • exclude inflammatory disease
  • exclude lymphoma
  • exclude mets
  • patients who dont want surgery
  • inoperable tumours
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10
Q

Potential consequences of parotidectomy

A
  • scar
  • greater auricular nerve (loss of sensation, neuroma)
  • facial nerve (Temp weakness)
  • Frey’s syndrome (gustatory sweating)
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11
Q

Why does Frey’s syndrome occur?

A
  • sweating over the area while eating

- short-circuiting of secretomotor nervers that supply the parotid and the nerves that innervate the sweat glands

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12
Q

Presentation of submandibular gland neoplasms

A

Mass projecting into the neck or the lateral floor of the mouth

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13
Q

Differentials for submandibular neoplasm

A
  • sialolithiasis
  • sialadenitis
  • enlarged lymph nodes
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14
Q

Nerves that pass close to the submandibular glands

A
  • hypoglossal
  • lingual
  • marginal mandibular
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15
Q

Diagnosis of submandibular neoplasm

A
  • FNAC

- resection

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16
Q

Management of sublingual gland neoplasm

A
  • biopsy in the oral cavity (significant likelihood of malignancy)
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17
Q

When to suspect HIV parotid lymphoepithelial cysts

A
  • multiple
  • bilateral
  • associated cervical lymph nodes
  • HIV positive
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18
Q

Treatment of HIV lymphoepithelial cysts

A
  • antiretrovirals

- aspirate and inject sclerosant

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19
Q

Regions of the neck

A 
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
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20
Q

Differentials for central neck masses

A
  • thyroglossal duct remnant
  • dermoid cyst
  • cervical lymphadenopathy
  • lipoma
  • haemandioma
  • fibroma
  • thyroid/-related
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21
Q

Special investigation of neck lumps

A
  • biopsy
  • FNAC
  • CXR
  • barium swallow
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22
Q

Operation to remove thyroglossal duct cyst

A

Sistrunk operation

23
Q

Where do inclusion dermoid cysts present?

A

Between the cricoid bone and suprasternal notch

24
Q

How can branchial cleft remnants present?

A
  • cyst
  • sinus
  • fistulae
25
Q

Where are cystic hygromas found?

A
  • in the anterior and posterior triangles of the neck

- may extend into the mouth

26
Q

Features of a cystic hygroma

A
  • soft
  • irregular
  • compressible
  • transilluminate
27
Q

What is a pharyngeal pouch?

A
  • a pulsion diverticulum
  • behind the pharynx
    between the thyro-pharyngeus and crico-pharyngeaus muscles
28
Q

Best way to diagnose a pharyngeal pouch

A

Barium swallow

29
Q

Where is a carotid body tumour found?

A

Arising from the sympathetic baroreceptor at the carotid bifurcation
- asymptomatic mass at the angle of the jaw

30
Q

Features of a carotid body tumour

A
  • moves from side to side
  • transmits pulsation
  • referral to vascular for doppler and excision
31
Q

Who gets acute lymphadenitis?

A

Children - secondary to tonsillar, ear or scalp infections

32
Q

What is cervical tuberculous lymphadenitis?

A

Matted glands with overlying oedema

33
Q

What is scrofula?

A

Late cervical tuberculous lymphadenitis where the glands caseate and cause sinus formation

34
Q

Where do melanocytes originate?

A

The neural crest

35
Q

Natural history of benign melanocyte lesions

A
  • junctional naevus
  • compound naevus
  • intradermal naevus
  • spindle-cell naevus/ halo naevus
36
Q

Where are dysplastic naevi typically found?

A
  • on the trunk

- also scalp, buttocks and breast

37
Q

Clinical diagnosis of malignant melanoma

A
  • change in size
  • change in outline
  • change in colour
  • change in elevation
  • change in surface characteristics
  • change in surrounding tissues
  • intermittent itching/tingling
  • recurrent minor bleeding
38
Q

Clinicopatholofical types of melanoma

A
  • superficial spreading melanoma
  • lentigo maligna melanoma
  • nodular melanoma
  • acral lentiginous melanoma
39
Q

Classification of melanoma

A

Clark classification by depth

40
Q

High risk areas for melanomas with poor prognosis/ high recurrence

A

BANS region

  • upper back
  • posterolateral arm
  • posterior neck
  • posterior scalp
41
Q

Requirements for a skin biopsy of possible melanoma

A
  • full thickness of skin
  • 3mm margin
  • some subcutaneous tissue
42
Q

Management of disseminated melanoma disease

A
  • chemo
  • radiation
  • immunotherapy
  • surgery
43
Q

Criteria for urgernt referral for a soft tissue lesion

A
  • mass >5cm
  • painful lump
  • lump that is increasing in size
  • lump that is deep to muscle fascia
  • recurrence of a lump after previous excision
44
Q

What are desmoid tumours?

A

Neoplasms of fibroblastic tissue that lack the ability to metastasize

45
Q

Who is prone to desmoid tumours?

A
  • sporadic
  • pregnant women (abdo wall)
  • FAP (mesenteric root): highest mortality
46
Q

From where do sarcomas arise?

A

The mesoderm

  • muscle
  • fat
  • fascia
  • synovium
47
Q

Genetic associations with sarcoma

A
  • neurofibromatosis
  • Gardners syndrome
  • Li-Fraumeni syndrome
  • lymphoedema
  • irradiation
  • Kaposi’s sarcoma
48
Q

Sarcoma sites of develoment

A

80% soft tissue

  • 20% bone
  • usually site of bulk (upper thigh, shoulder, retroperitoneu
49
Q

Pathological classification of sarcomas

A
  • sarcoma
  • lipsarcoma
  • leiomyosarcoma
  • synovial sarcoma
  • malignant nerve sheath tumour
50
Q

Grades of sarcoma

A
  • low: excision only
  • intermediate (atypia): excision and radiotherapy
  • high (necrosis): wide excision and radiotherapy and chemotherapy
  • disseminated: palliative
51
Q

Clinical presentation of sarcoma

A
  • painless mass in lumb, trunk or retro-peritoneum
  • pain or immobility of joint
  • paraneoplastic phenomena
52
Q

Differentials for sarcoma

A
  • haematoma
  • ruptures muscle
  • benign soft tissue tumour
  • cold abscess
  • false aneurysm
  • incarcerated hernia
53
Q

Investigations for sarcoma

A
  • aspiration cytology (Exclude haematoma)
  • TruCut core biopsy
  • CT for staging
  • MRI
54
Q

Treatment modalities for sarcoma

A
  • surgery (palliative or curative)
  • radiotherapy (external beam)
  • chemo (Adjuvant

Surgery Revision (8 decks)

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