Head and neck surgery

Question 1

Histology of pleomorphic adenoma?

Answer 1

classic biphasic (mixed stromal and epithelial elements)

Question 2

what is a pleomorphic adenoma?

Answer 2

80% parotid neoplasm
young patient
slow goring
lobular
poorly encapsulated

Question 3

Mx of pleomorphic adenoma?

Answer 3

superficial parathyroidectomy

Question 4

Innervation of submandibular gland?

Answer 4

parasympathetic (more serous secretions): chords tympani
sensory: lingual fibres of mandibular nerve

Question 5

what is sialolithiasis?

Answer 5

salivary duct stone impaction

Question 6

Features of sialolithiasis?

Answer 6

• 80% submandibular gland (Whartons)
• 70% of the these calculi are radio-opaque
• usually composed of calcium phosphate or calcium carbonate
• Patients typically develop colicky pain and post prandial swelling of the gland
• impact in parotid duct = stensons

Question 7

Investigation and management of sialolithiasis?

Answer 7

sialography to demonstrate the site of obstruction and associated other stones
Stones impacted in the distal aspect of Whartons duct may be removed orally, other stones and chronic inflammation will usually require gland excision

Question 8

What is sialadenitis?

Answer 8

inflammation of salivary gland
usually A. aureus infection

Pus may be seen leaking from the duct, erythema may also be noted

Submandibular abscess and airway occlusion serious complication

Question 9

Most common malignant submandibular tumour?

Answer 9

adenoid cystic carcinoma

Question 10

Features of Warthins tumour?

Answer 10

Warthins tumours are most common in elderly smokers
Benign indolent course

5% parotid neoplasm
most common bilateral benign neoplasm
M>F
60-80

Question 11

Features of monomorphic adenoma?

Answer 11

slow growing
one monomorphic type
e.g.basal cell adenoma, canalicular adenoma, oncocytoma, myoepitheliomas

Question 12

Features of parotid hemangioma?

Answer 12

90% of parotid tumours in child <1
hyper vascular imaging
spontaneous regression may occur

Question 13

Features of mucoepidermoid carcinoma?

Answer 13

30% of all parotid malignancies
Usually low potential for local invasiveness and metastasis (depends mainly on grade)

Question 14

Features of adenoid cystic carcinoma?

Answer 14

Unpredictable growth pattern
Tendency for perineural spread - to facial nerve
Nerve growth may display skip lesions resulting in incomplete excision
Distant metastasis more common (visceral rather than nodal spread)
5 year survival 35%

Question 15

Features of mixed parotid tumour?

Answer 15

malignancy involving a previous benign lesion

Question 16

Treatment of parotid lesions?

Answer 16

Benign: superficial parotidectomy
Malignant: a radical or extended radical parotidectomy

Question 17

Features of sarcoid?

Answer 17

Carotid involvement occurs in 6% of patients with sarcoid
Bilateral in most cases
Gland is not tender
Xerostomia may occur
Management of isolated parotid disease is usually conservative

Question 18

Features of sjogren?

Answer 18

parotid enlargement, xerostomia and keratoconjunctivitis sicca
90% of cases occur in females
Second most common connective tissue disorder
Bilateral, non tender enlargement of the gland is usual
Histologically, the usual findings are of a lymphocytic infiltrate in acinar units and epimyoepithelial islands surrounded by lymphoid stroma
Treatment is supportive
There is an increased risk of subsequent lymphoma

Question 19

When is secondary haemorrhage most likely to occur post tonsillectomy?

Answer 19

5-10 days post surgery

Question 20

When does primary haemorrhage most often occur post tonsillectomy?

Answer 20

6-8h

Question 21

features of cholesteatoma?

Answer 21

ear discharge (foul Pseudomonas may occur resulting in foul smell to discharge)
headache, pain
CNVII involvement (vertigo, facial paralysis, deafness)

Question 22

Complications of cholesteatoma?

Answer 22

Deafness
meningitis
cerebral abscess

Question 23

What is cholesteatoma?

Answer 23

Destructive and expanding growth of keratinised squamous epithelium in middle ear

Question 24

what does Superior laryngeal nerve (SLN) innervate?

Answer 24

cricothyroid muscle

. Abnormalities in pitch
b. Inability to sing with smooth change to each higher note (glissando or pitch glide)

Question 25

What does Recurrent laryngeal nerve (RLN)/Inferior laryngeal nerve innervate?

Answer 25

Innervates intrinsic larynx muscles

a. Opening vocal folds (as in breathing, coughing)
b. Closing vocal folds for vocal fold vibration during voice use
c. Closing vocal folds during swallowing

Question 26

What is malignant otitis externa caused by ?

Answer 26

pseudomonas

Question 27

Features of cystic hygroma?

Answer 27

A congenital lymphatic lesion (lymphangioma) typically found in the neck, classically on the left side
Most are evident at birth, around 90% present before 2 years of age

Question 28

Features of branchial cyst?

Answer 28

An oval, mobile cystic mass that develops between the sternocleidomastoid muscle and the pharynx
Develop due to failure of obliteration of the second branchial cleft in embryonic development
Usually present in early adulthood

Question 29

From which region is epistaxis likely to originate?

Answer 29

Kiesselbachs plexus has an arterial supply derived from both the internal and external carotid arteries

commonest area for idiopathic epistaxis

Question 30

What is an ameloblastoma?

Answer 30

Ameloblastomas are rare tumours of the odontogenic epithelium

palpation gives crepitus

Question 31

Drugs causing parotid enlargement

Question 32

Nerves at risk on branchial cyst excision?

Answer 32

Mandibular branch of facial nerve, greater auricular nerve and accessory nerve.