Head and Neck Surgery Flashcards
Describe Branchial cysts
Congenital epithelial cysts, occurring laterally due to failure of obliteration of the 2nd branchial cleft in embryonic development
Describe Cystic hygromas
Cystic lymphatic lesion that occurs in the POSTERIOR triangle of the neck. Most present at birth or before 2 years. (They are transillumable)
Where do branchial cysts typically form
Anterior to the SCM near the angle of the mandible
How does branchial cyst appear on echo
Anechoic
Describe dermoid cysts
- Derived from pleuripotent stem cells and are located in the midline
- Usually in a suprahyoid location
- Contain variable amounts of calcium and fat
Describe a ranula
Mucocele in the floor of the mouth originating from the sublingual glands
How are ranulas treated
Surgical excision inclusive of the sublingual glands
Describe a Laryngocele
Air pocket that arises from the deepest point of the laryngeal ventricle that can bulge internally into the larynx
Describe Pharyngeal pouch
Posteromedial herniation between thyropharyngeus and cricopharyngeus muscles - Killian’s dehiscence (acquired diverticulum)
How are pharyngeal pouches classified
Lahey classification:
- Type 1 = small mucosal protrusion
- Type 2 = definite pouch
- Type 3 = large pouch (oesophagus is pushed forwards)
Distribution of salivary stone disease
- 80-90% Submandibular
- 10-20% Parotid
Risk factors for salivary stone disease
- Dehydration
- Gout
- Diabetes
- HTN
Composition of salivary gland stones
- Calcium phosphate
- Calcium carbonate
GOLD standard investigation for salivary gland stones
Sialography (contraindicated in those with iodine allergy)
Describe the management of salivary stone disease
Gland excision, unless distally sited and mobile in Wharton’s duct in which case endoscopy can be attempted
What typically causes Sialadenitis
Staphylococcus aureus
What complicates Sialedentiis
Development of a submandibular abscess may spread through the deep fascial spaces and occlude the airway
Most common submandibular gland tumour
Adenoid cystic carcinoma
How are submandibular tumours diagnosed
FNAC
What is the most common parotid neoplasm
Benign pleomorphic adenoma (benign mixed tumour)
Describe a Warthin tumour
- Most common bilateral benign neoplasm of the parotid
- Lymphocytic infiltrate and cystic epithelial proliferation
- Associated with smoking
Describe parotid Haemangioma
- Consider with parotid mass in a child (accounts for 90%)
- Hypervascular on imaging
Most common type of oral cancer
SCC
Risk factors for oral SCC
- Smoking and alcohol
- Betel nut
- Leukoplakia
- Dental caries
- Chronic glossitis
- Malnutrition
- Cirrhosis
- HIV
How are oral cavity tumours investigated
- EUA and biopsy
- Panendoscopy
- Plain x-ray
- CT to assess nodal status
Management of T1 and T2 <3cm oral tumours
Surgery OR Radiotherapy
Management of large volume T2, T3 and T4 oral tumours
- Surgery
- Adjuvant radiotherapy
How is lymph node disease managed in oral cancer
Modified radical or extended neck dissection
Risk factors for oropharyngeal SCC
- Smoking
- Alcohol
- Betel nut and tobacco chewing
- Dental sepsis
- Ionising radiation
- HPV 8 and 16
- Submucosal fibrosis of the palatine arch
How are oropharyngeal tumours investigated
- FNAC
- Panendoscopy and bilateral tonsillectomy
- CT neck and chest
- Liver USS
Outline the management for base of tongue cancerous lesions
- T1 = radical radiotherapy
- T2-4 = chemoradiotherapy or resection with free flap reconstruction and bilateral neck dissection with postoperative radiotherapy
Outline the management of tonsillar cancerous lesions
- T1-2 = transoral surgery or radical radiotherapy
- T3-4 = radical resection with neck dissection and reconstruction (pectoralis flap or free radial flap, fibular flap if section of mandible is removed)
Define level 1 lymph nodes in the neck
Submental and submandibular
Define level 2 lymph nodes in the neck
Upper jugular from skull base to hyoid
Define level 3 lymph nodes in the neck
Middle jugular from the hyoid to the cricoid cartilage
Define level 4 lymph nodes in the neck
Lower jugular from cricoid to clavicle
Define level 5 lymph nodes in the neck
Posterior triangle
Define level 6 lymph nodes in the neck
Anterior compartment nodes from the hyoid bone to the suprasternal notch, bounded laterally by the medial border of the carotid sheath
Define level 7 lymph nodes in the neck
Nodes in the superior mediastinum
How do nasopharyngeal tumours typically present
- Epistaxis
- Nasal obstruction
- Neck lump
- Otalgia
- Otitis media with effusion
Risk factors for nasopharyngeal tumours
- HLA-A2 gene
- Positive family history
- EBV infection
- Salt-preserved fish (nitrosamines)
- Vitamin C deficiency
- Male predominance
How are nasopharyngeal tumours managed
Curative radiotherapy (surgery has no place)
Origin of pleomorphic adenomas
Myoepithelial cells and intercalated duct cells
How is benign parotid disease such as pleomorphic adenoma treated
Superficial parotidectomy
What parotid tumour typically invades the facial nerve
Adenoid cystic carcinoma
Why may otalgia develop following tonisllectomy
Referred along glossopharyngeal nerve
What drugs are associated with parotid gland enlargement
Thiouracil, isoprenaline, phenylbutazone, COCP
Cellular contents of pleomorphic adenoma
Epithelial and stromal elements
How are salivary gland tumours investigated
- MRI to delineate nerve involvement
- FNAC
