Head and neck surgery Flashcards
Histology of pleomorphic adenoma?
classic biphasic (mixed stromal and epithelial elements)
what is a pleomorphic adenoma?
80% parotid neoplasm
young patient
slow goring
lobular
poorly encapsulated
Mx of pleomorphic adenoma?
superficial parathyroidectomy
Innervation of submandibular gland?
parasympathetic (more serous secretions): chords tympani
sensory: lingual fibres of mandibular nerve
what is sialolithiasis?
salivary duct stone impaction
Features of sialolithiasis?
- 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
Investigation and management of sialolithiasis?
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
What is sialadenitis?
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
Most common malignant submandibular tumour?
adenoid cystic carcinoma
Features of Warthins tumour?
Warthins tumours are most common in elderly smokers
Benign indolent course
5% parotid neoplasm
most common bilateral benign neoplasm
M>F
60-80
Features of monomorphic adenoma?
slow growing
one monomorphic type
e.g.basal cell adenoma, canalicular adenoma, oncocytoma, myoepitheliomas
Features of parotid hemangioma?
90% of parotid tumours in child <1
hyper vascular imaging
spontaneous regression may occur
Features of mucoepidermoid carcinoma?
30% of all parotid malignancies
Usually low potential for local invasiveness and metastasis (depends mainly on grade)
Features of adenoid cystic carcinoma?
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%
Features of mixed parotid tumour?
malignancy involving a previous benign lesion
Treatment of parotid lesions?
Benign: superficial parotidectomy
Malignant: a radical or extended radical parotidectomy
Features of sarcoid?
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
Features of sjogren?
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
When is secondary haemorrhage most likely to occur post tonsillectomy?
5-10 days post surgery
When does primary haemorrhage most often occur post tonsillectomy?
6-8h
features of cholesteatoma?
ear discharge (foul Pseudomonas may occur resulting in foul smell to discharge)
headache, pain
CNVII involvement (vertigo, facial paralysis, deafness)
Complications of cholesteatoma?
Deafness
meningitis
cerebral abscess
What is cholesteatoma?
Destructive and expanding growth of keratinised squamous epithelium in middle ear
what does Superior laryngeal nerve (SLN) innervate?
cricothyroid muscle
. Abnormalities in pitch
b. Inability to sing with smooth change to each higher note (glissando or pitch glide)
What does Recurrent laryngeal nerve (RLN)/Inferior laryngeal nerve innervate?
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
What is malignant otitis externa caused by ?
pseudomonas
Features of cystic hygroma?
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
Features of branchial cyst?
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
From which region is epistaxis likely to originate?
Kiesselbachs plexus has an arterial supply derived from both the internal and external carotid arteries
commonest area for idiopathic epistaxis
What is an ameloblastoma?
Ameloblastomas are rare tumours of the odontogenic epithelium
palpation gives crepitus
Drugs causing parotid enlargement
Nerves at risk on branchial cyst excision?
Mandibular branch of facial nerve, greater auricular nerve and accessory nerve.
