Head and neck surgery Flashcards
Epidemiology of sjorgrens
Female
Post menopausal
Features of acute otitis external
Acute pain on moving the pinna
Conductive hearing loss if lesion is large
When rupture occurs pus will flow from ear
Features of acute otitis media
Most common in children and rare in adults
May present with symptoms elsewhere (e.g. vomiting) in children
Severe pain and sometimes fever
May present with discharge if tympanic rupture occurs
Feature of pleomorphic adenoma
Pleomorphic adenomas are the commonest tumours of the parotid gland and are often slow growing, smooth and mobile
Features of warthog tumour
Second most common benign parotid tumor (5%)
Most common bilateral benign neoplasm of the parotid
Marked male as compared to female predominance
Occurs later in life (sixth and seventh decades)
Presents as a lymphocytic infiltrate and cystic epithelial proliferation
multiple cysts and solid components consisting of lymphoid tissue
Features of monomorphic adenoma
Account for less than 5% of tumours
Slow growing
Consist of only one morphological cell type (hence term mono)
Include; basal cell adenoma, canalicular adenoma, oncocytoma, myoepitheliomas
Post thyroidectomy- difficulty speaking and stridor what damage?
Bilateral recurrent laryngeal nerve injury
Nerves involved in speach
Superior laryngeal nerve (SLN)
Innervates the cricothyroid muscle
Recurrent laryngeal nerve (RLN)/Inferior laryngeal nerve
Innervates intrinsic larynx muscles
Use of cricothyroid and pathology
Since the cricothyroid muscle is involved in adjusting the tension of the vocal fold for high notes during singing, SLN paresis and paralysis result in:
a. Abnormalities in pitch
b. Inability to sing with smooth change to each higher note (glissando or pitch glide)
Tenses laynrx- enlongating vocal cords
Small epithelial defect anterior to the left ear and is has been noted to discharge foul smelling material
Pre auricular sinus
Phayrngeal pouch features
posteromedial herniation between thyropharyngeus and cricopharyngeus muscles
Midline lump gurgles on palpation
Halitosis, regurgitation of undigested food, coughing at night and throat infections.
Foul smelling ear discharge and facial nerve weakness
Cholesteatoma
Cholestetoma features
Destructive and expanding growth of keratinised squamous epithelium
Patients often complain of chronic ear discharge
Infection with Pseudomonas may occur resulting in foul smell to discharge
Adenoid cystic carcinoma features
Infiltrates the facial nerve and may cause neuropathy and facial pain.
Drugs causing parotid gland enlargement
Carbimazole
isoprenaline, phenylbutazone,
high oestrogen dose contraceptive pills
CIPO
Wharton vs stensens duct
Parotid -stensens
Submandibular-Wharton
Sx of Sialolithiasis
Patients typically develop colicky pain and post prandial swelling of the gland
halitosis recently and he frequently complains of a dry mouth
Ethmoidal sinusitis features
headache and a sensation of pressure between the eyes
Ethmoidal sinusitis may spread to the periorbital tissues resulting in periorbital cellulitis
Sarcoid features
Bilateral parotid swelling with facial nerve involvement
Reduces with steroids
Mass in submandibular gland, CT shows solid lesion, FNA undiagnostic what next
Submandibular gland excision
Tx of pleomorphic adenoma
Superficial parotidectomy
Pleomorphic adenoma histology
Biphasic appearance of the lesion and mucinous connective tissue
mixed stromal and epithelial elements
Brachial cyst features
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
Ameloblastoma sx
Ameloblastomas are rare tumours of the odontogenic epithelium.
They are slow growing and expand with a rim of periosteum that surrounds them.
It is the palpation and disruption of this layer that gives rise to the crepitus.
Features of unilateral inferior laryngeal nerve injustice
Diplophonia which causes a gargling sound. This is associated with dysphagia
Cystic hygroma features
Posterior triangel
Transillumates
Where does the majority of epistaxis occur
Littles area / Kiesselbachs plexus
Arterial supply of nose
Anterior and posterior ethmoidal from internal carotid
- supply superior portion
Sphenopalatine (sup), greater palatine and superior labial
- external carotid
DM with severe deep seated otalgia and a facial nerve palsy, causative organism
Malignant otitis externa
Caused by pseudomonas
Nerves at risk during branchial cyst excision
Mandibular branch of facial nerve, greater auricular nerve and accessory nerve.
Young male with pancreatitis and painful parotid enlargement
Mumps
Timeframe when secondary haemorrhage occurs after tosinllectomy
5-10 days after surgery
Adenocarcinoma of paranasal sinuses and nasopharynx Rf
Wood exposure
Most ethmoidal
Visual defect with craniopharyngoma vs pituitary tumour
Cranio- lower bitemporal
Piuitary- upper
CN with parasympathetic innervation
3,7,9,10
Lymphatic drainage of tongue
Tip- submental then to deep
Mid- submandibular then to ipsilateral deep
Posterior- cross over- bilateral-deep cervical
Drainage of sphenoethmoidal recess
Superior meatus- posterior ethmoidal sinus
Middle meatus- frontal, maxillary, anterior and middle ethmoidal sinus
Inferior- nasolacrimal duct
Which structures pass through superior orbital fissure
Lacrimal
Frontal
Sup ophthalmic vein
Trochlear
Oculomotor sup
Nasal
Inf oculomotor
Abducens
Inferior ophthalmic vein
Which structures pass through inferior orbital fissure
Inferior ophthalmic vein
Ganglionic branches from ptyeropalatine ganglion to maxillary nerve
Infraorbotal nerve, artery, vein
Zygomatic nerve
Which structures pass through muscular ring
Superior oculomotor nerve
Nasocilliary
Inferior oculomotor
Abducens
Optic nerve
Ophthalmic artery
What is the umbo
Most depressed part of wher handle of malleus attaches to tympanic membrane
Cell layers of tympanic membrane
Lateral aspect- stratified squamous
Medial - mucous
Chorda tympani in relation to tympanic membrane
Runs medially to pars flaccida
Pars flaccida -
The part of the tympanic membrane above the malleolar prominence is not taut as it bridges the tympanic sulcus
chorda tympani branches off the facial nerve and enters the lateral wall of the tympanic cavity within the middle ear, where it runs across the tympanic membrane (from posterior to anterior) and medial to the neck of the malleus.
Artery that lies between sub mandibular and mandible
Facial artery
Often ligated in surgery
Level of hyoid
C3
Level of thyroid cartilage
C4
Level of Cricoid cartilage ends
C6
Level where inferior thyroid artery goes to thyroid
C6
Most superficial strecuture overlying parotid
Facial
Retromandibular next
Then External carotid
Relation of carotid sheath at C6
Anterior- hypoglossal and ansa cervicalis
Posterior- cervical symp chain
Boundaries of deep inguinal ring
Superolaterally - transversalis fascia
Inferomedially - inferior epigastric artery
Which nerve supplies styloglossus
Hypoglossal
Which nerve supplies stylohyoid
Facial
Nerve supplying cricothyroid
External laryngeal
What seperates subclavian artery and vein
Anterior scalene muscle
Which arteries do the arteries in littles area drain into
Sphenopalatine- to maxillary
Ethmoid- to opthalmic
Greater palatine- maxillary
Superior labial - facial
Parasympathetic nerves from lacrimal gland originate from
Pterygoipalatine ganglion
4 parasympathetic ganglia of head and neck and nerves
Ciliary - 3- sphincter pupillae (contracts the pupil) and the ciliary muscles (accommodates for near vision).
Pterygopalatine - 7 greater petrosal- largest- lacrimal, nasal, palate
Submandibular - 7- sublingual and submandibular gland
Otic -9 lesser petrosal- (hitchhike across auriculotemporal) parotid
Nerves most at risk in carotid endarectomy
Hypoglossal
Greater auricular
Superior laynrgeal
Where do you find torus tubarius and choana
Choana- separates Nasal cavity and nasopharynx
Torub tubarius - is an elevation of the mucous membrane of the nasal part of the pharynx formed by the underlying base of the cartilaginous portion of the Eustachian tube
Medial branch of external carotid
Ascending pharyngeal
Damage to what can lead to parasthesia anterolateral aspect of tongue
Lingual nerve at 3rd molar
Content of posterior triangle
Nerves- 4 branches of cervical plexus Supraclavicular nerve, transverse cervical nerve, great auricular nerve, lesser occipital nerve
Three trunks of the brachial plexus-sup, middle, inf
2 other nerves
Accessory nerve
Phrenic nerve
Vessels - 1 vein- external jugular vein
1 artery- Subclavian artery
Muscles - 1/2 muscle- inferior belly of omo
Scalene
Cause of pneumoparotid
Hypotonia of the buccinator muscle, hypertrophy of the masseter muscle or temporary obstruction of the Stensens duct by mucous
Which muscles inserts into greater Cornu of hyoid
Middle pharyngeal constrictor
Hyoglossus
Sensory Nerves of cervical plexus, route and fucntion
Sensory
Greater auricular - angle of jaw, skin over parotid and inferior external ear
Transverse cervical - curves around post aspect of SCM to provide sensation to ant neck
Lesser occipital- curves around the accessory nerve, and passes superiorly, close to the posterior border of the sternocleidomastoid- innervates posterosuperior scalp
Supraclacicular nerves- posterior border of sternocleidomastoid, and provide sensation to the skin overlying the supraclavicular fossa and upper thoracic region and sternoclavicular joint.
Motor nerves of cervical plexus
Motor
Nervs to genio and thyrohyoid
Ansa cervicalis - 4 branches:
Superior belly of the omohyoid muscle
Inferior belly of omohyoid muscle
Sternohyoid
Sternothyroid
Phrenic
Only cranial nerve to cross over
Trochlear
Action of inferior oblique
Abduct and elevate
Action of superior and inferior rectus
Superior -adduct and elevate
Inferior- adduct and depress
Borders of orbit
Roof (superior wall) – Formed by the frontal bone and the lesser wing of the sphenoid.
Floor (inferior wall) – Formed by the maxilla, palatine and zygomatic bones.
Medial wall – Formed by the ethmoid, maxilla, lacrimal and sphenoid bones.
Lateral wall – Formed by the zygomatic bone and greater wing of the sphenoid.
Which nerves go through ciliary ganglion without synapsing
Sympathetic nerves from the internal carotid plexus – innervate the dilator pupillae muscle
Sensory fibres from the nasociliary nerve (a branch of the ophthalmic division of the trigeminal nerve) – innervate the cornea, ciliary body and iris.
Layers to cut through on tracheostomy
Skin
Superficial and platysma
2 Anterior jugular veins - avoid
Deep
Strap - sternohyoid and sternothyroid
Pre tracheal
Thyroid isthmus
Trachea
Tongue muscles action and innervation
Genio- depression and protrusion- hypoglossal
Hyoglossus- depression and retraction- hypoglossus
Styloglossus- elevation and retraction- hypo
Palatoglossus- elevation of post tongue- vagus
Innervation of the larynx
Vagus
Superior- external and internal
Interanl sensory above vocal cords and autonomic, External- cricothyroid
Recurrent- all laryngeal muscles, sensory below vocal cords
Which muscles does V3 supply
Muscles of mastication; medial pterygoid, lateral pterygoid, masseter, temporalis
Anterior belly of the digastric muscle and the mylohyoid muscle (these are suprahyoid muscles)
Tensor veli palatini
Tensor tympani
Which parasymp fibres does V3 carry
Submandibular and sublingual VII- lingual
Parotid from IX- by auriculotemporal
Which parasymp fibres does V1 and V2 carry
Lacrimal gland: Post ganglionic fibres from the pterygopalatine ganglion (derived from the facial nerve), travel with the zygomatic branch of V2 and then join the lacrimal branch of V1. The fibres supply parasympathetic innervation to the lacrimal gland.
Nasal glands: Parasympathetic fibres are also carried to the mucous glands of the nasal mucosa. Post-ganglionic fibres travel with the nasopalatine and greater palatine nerves (branches of V2)
Branches of mandibular nerve
Nerve to medial pterygoid muscle → Nerve to tensor veli palatini,
nerve to tensor tympani
Anterior division
Buccal nerve
Masseteric nerve
Deep temporal nerves
Nerve to lateral pterygoid muscle
Posterior division
Auriculotemporal nerve
Lingual nerve
Inferior alveolar nerve → nerve to mylohyoid muscle → muscular branch to anterior belly of digastric muscle
Function of auricletemporal nerve
Branch of V3
Superior
Sensory to
Anterior part of the auricle
Lateral part of the temple
Anterior external meatus
Anterior tympanic membrane
Inferior
carries secretory-motor parasympathetic fibres, originating from CN IX, to the parotid gland.
Where should strap muscles be divided
In their upper half
Since nerve supply from ansa cervicalis is from bottom
Vessel lateral to inferior parathyroid
Common carotid
Where does anterior and posterior inferior cerebellar artery arise
Anteirior- basillar
Posteiror- Vertebral
Which arteries does the oculomotor nerve pass between
Superior cerebellar and posterior cerebral
Where does labyrinthine artery arise from
AICA from Basillar
Sx if Mekels cave is damage
Whole trigeminal located there
- causing mastication weakness
-loss of sensation
aperture in the medial portion of the middle cranial fossa
Nerves at the cerebellopontine angle
Facial, vestibulocochlear, trigeminal, abducens
Lesion of acoustic neuroma
VIII
Then if massive facial too
Function of tense tympani and stapedius and innervation
Dampen loud sounds
TT- trigeminal
Stap- VII
Cause of otalgia post tonsillectomy
Referred pain from IX
Horners syndrome proximal vs distal, location and symptoms
Proximal lesions occur along the hypothalamospinal tract- can affect entire face
Distal lesions are usually post ganglionic e.g. at level of internal carotid artery or beyond- anhidrossi mild
Roots of ansa cervicalis
C1,2,3
Arterial supply of lacrimal apparatus
Ophthalmic artery
Which vessel lies posterolateral to external carotid at origin
Internal carotid
Innervation of external nose
Lateral- Lateral nasal branches of the anterior ethmoidal nerve. The ethmoidal nerve is a branch of the nasociliary nerve (V1)
Nostrils- Infraorbital
Branches of maxillary nerve and innervation
Zygomatic- ant and post- innervates zygoma and aids communication of facial to lacrimal
Pterygopalatine nerves- go to PT ganglion and branch to
Nerve to nasal cavity
and Palatine nerves- greater/lesser palatine innervate hard palate
Posterior superior alveolar branches
Infraorbital nerve- branches to after foramen
-External nasal branches that innervate the skin that covers the side of the nose
-Internal nasal branches which provide sensory innervation to the nasal septum
-Superior labial branches that innervate the upper lip
-Inferior palpebral branches that provide innervation for the lower eyelid
Then anterior and middl superior alveolar- teeth of the upper jaw.
The space between the vocal cords is referred to as ?
Rima glottis
Origin of CN and exiting CNS
1,2 cerebrum
3,4- Midbrain
5 -Pons
6-8- Ponto-medullary junction
9-12- medulla (11 spinal)
CNs with long course intracranial , most likely to be damaged in raised ICP
Trochlear
Abducens does too
What separates subclavian artery and vein
Scalenus anterior
Describe circle of willis
Vertebral- PICA branch
Forms basilar- AICA, pontine and superior cerebellar artery
Basillar form PCA
PCA connects to MCA via posterior communicating
Internal splits into MCA and ACA
ACA connected by communicating
Lateral medullary vs lateral potine syndrome
Lateral medullary -PCIA- PIKA can’t Chew
Dysphagia
Ipsilateral ataxia, nystagmus,
Contralateral limb sensory loss
Lateral pontine -AICA (FACIAL)
Facial droop
Ipsilateral ataxia, nystagmus,
Contralateral limb sensory loss
Otherwise both get
What does the buccal facial branch supply
Zygomaticus minor
Buccinator
Levator anguli fris
Orbicularis
Nasalis
Structures passing through parotid
Facial nerve and branches
External carotid artery (and its branches; the maxillary and superficial temporal)
Retromandibular vein
Auriculotemporal nerve
Where does anterior pituitary develop from
Rathkes pouch
Middle meningeal artery ligated, which nerve might be damaged
Auriculotemproal
During a radical neck dissection, division of which of the following fascial layers will expose the ansa cervicalis?
Pre tracheal
What is encountered in submandibular removal after deep fascia
Facial vein
The facial vein is encountered first in this surgical approach because the incision is made 4cm below the mandible (to avoid injury to the marginal mandibular nerve).
Lymph drainage of larynx
Supraglottic- upper deep
Glottic- low rate of lymphatic spread, attributed to an inadequate submucosal lymphatic supply.
Sub glottic part drains to the pre laryngeal, pre tracheal and inferior deep cervical nodes
aryepiglottic and vestibular folds have a rich lymphatic drainage and will metastasise early.
Muscles of larynx and action
Posterior cricoarytenoid- abducts
Lateral cricoarytenoid- adducts
Thyroarytenoid- relaxes
These 3 attach to muscular process of arytenoid
Transverse and oblique arytenoids- closure of intercartilagenous part of the rima glottidis
Arytenoid cartilage to contralateral
Vocalis- relax post, tense ant
Cricothyroid- tense vocal fold
Cricoid to Inferior margin and horn of thyroid cartilage
Age of Warthalin tumour vs pleomorphic adenoma
Warthalin- older age smokers
Pleomorphic- younger
Indication for surgery in primary hyperparathyroid
Elevated serum Calcium > 1mg/dL above normal
Hypercalciuria > 400mg/day
Creatinine clearance < 30% compared with normal
Episode of life threatening hypercalcaemia
Nephrolithiasis
Age < 50 years
Neuromuscular symptoms
Reduction in bone mineral density of the femoral neck, lumbar spine, or distal radius of more than 2.5 standard deviations
Level dural sac terminate
S1-2
Transition between pharynx and oesophagus level
C6
Vein damaged at vertex of head
Superior sagittal
Which nerve lies medially to the lobes of the thyroid gland, in the groove between the oesophagus and trachea?
RLN
Where does brachial plexus lie in relation to scalene
Roots and trunks in between SA and SM
Content of anterior triangle
Digastric triangle Submandibular gland
Submandibular nodes
Facial vessels
Hypoglossal nerve
Muscular triangle Strap muscles
Jugular vein
superior thyroid artery, the anterior jugular and inferior thyroid veins
Carotid triangle -border, of diagstric, omo, scm
Carotid sheath (Common carotid, vagus and internal jugular vein)
Ansa cervicalis
What drains into the sphenoethmoidal recess
Sphenoidal sinus
Things that the vertebral artery has to transverse
Vertebral canal
Foreman magnum
Transverse processes foremen
Ligamentum nuchae attachement
Triangle, from skull to spinous process until C7
Tectorial membrane of Atlanta axial joint
With V Canal - upper part of posterior ligament
From C2 to skull base
Mx of nasal fracture
After 5 days- reduction
Child has hearing loss, difficulty speaking, recent URTI
Glue ear
Biggest RF for NP carcinoma and para nasal
Nasal P- EBV
Para nasal- Woodwork ethmoidal
Malignant submandibular tumour type
Adenoid cystic carcinoma
Sialadenitis organism and features
taphylococcus aureus infection
Pus may be seen leaking from the duct, erythema may also be noted
Development of a sub mandibular abscess is a serious complication as it may spread through the other deep fascial spaces and occlude the airway
Stones in sialothiasis
Stones are usually composed of calcium phosphate or calcium carbonate
Ix and mx of colicky pain in mouth
sialography
Stones impacted in the distal aspect of Whartons duct may be removed orally, other stones and chronic inflammation will usually require gland excision
Mass in submandibular gland mx
In view of the high prevalence of malignancy, all masses of the submandibular glands should generally be excised.
Mx of parotid gland tumour
For nearly all lesions this consists of surgical resection, for benign disease this will usually consist of a superficial parotidectomy. For malignant disease a radical or extended radical parotidectomy is performed. The facial nerve is included in the resection if involved.
Cyst in parotid with HIV
Lymphoepithelial cysts associated with HIV occur almost exclusively in the parotid
Typically presents as bilateral, multicystic, symmetrical swelling
Most common parotid malignancy
Mucoepidermoid carcinoma
Mucoepidermoid carcinoma features
mucus-secreting cells (muco-)
squamous cells (-epidermoid)
lymphoid infiltrate often also present
Epistaxis management
Subject should sit upright and forward and pinch nose firmly, spit bloods out
Compress softer cartilage for 20mins
Simple anterior epistaxis may be managed using silver nitrate cautery.
If difficult to manage then custom manufactured packs may be inserted
Posterior packing or tamponade may be achieved by passing a balloon tamponade/foley Catheter device and inflating It.
Nasal packs should be left in-situ for 24 hour
Surgical after- ligation
Progressive conductive deafness dx and mx
Otosclerosis
Secondary to fixation of the stapes in the oval window
Treatment is with stapedectomy and insertion of a prosthesis
Signs of malignancy of sinuses
loose teeth, cranial nerve palsies and lymphadenopathy.
Most common in lateral nasal wall
What do superior cerebral veins drain to
Superior sagittal
What does the cavernous sinus drain
Sup and inf opthalmic(sup opthalmic anastomoses with facial vein)
Sphenopariteal
Superficial middle cerebral
Superior petrosal sinus links
Cavernous to transverseI
Inferior petrosal sinus function
Drains cavernous meetin gsignoid to form jugular
Where is ethmoidal bulla located
Middle meatus
Where does sphenopalatine branch and what does it supply
branches at superior meatus
Lateral and septum
What passes through pterygomaxillary fissure
Posterior superior alveolar nerve and artery
What passes through an opening in the diaphragm sellae
Infundibulum
Attachments of scalene
Anterior - C3-6 1st rib
Middle- C2-7 1st
Posterior- C5-7 2nd rib
Where does middle meningeal artery branch off maxillary
Infratemproal fossa
Division of carotid relative to thyroid cartilage
Upper border- C4
Where does transverse cervical drain
External jugular
Which bone does carotid canal sit in
Temporal- petrous
Level facial muscle sit in
Same as platysma
Subcutaneous
Systemic effects of bilateral ligation of ITA
HypoPTH and lower Ca not enough to get symptoms
What is the carotid sheath seperated by with the parotid
Styloid process and muscles
Stensens duct relative to masseter
Anteriorly and superficial
Denituclate ligament
Part of the Pia mater connecting spinal cord to arachnoid and dura
What is in line with when the trachea starts
Cricoid at C6
Where are the vocal cords formed
Superior free edge of conus elasticus
Which is the lateral part of cricothyroid
Which fossa does facial nerve cross
Posterior
What does lesser petrosal pass through
Originate from and innervate
Ovale
IX
Parotid
Branches of anterior mandibular nerve
Lateral pterygoid, masseter, temporalis, buccal skin
Branches of posterior mandibular nerve
Auriculotemporal
Lingual
Inferior alveolar - myohyoid and anterior digastric
TMJ joint type, lining and anterior of
Synovial joint
Fibrous cartilage- atypical
Anterior to squamous tympanic fissure
Waldeyers ring
They collectively form a ringed arrangement, known as Waldeyer’s ring:
Pharyngeal tonsil
Tubal tonsils (x2)
Palatine tonsils (x2)
Lingual tonsil
What muscle bounds to the palatine tonsil
Superior constrictor
Internal carotid, facial, IJV and external jugular relative to middle ear
IC- anterior and inferior
IJV- inferior
EJ- Medially and superior
Facial- medial
What separates anterior and posterior chambers and segments of eye
Chambers- iris
Segments- lens
Posteiror- vitreous humour and optic nerve and retina
Facial and lingual nerve relative to submandibular gland
Facial- inferior and superficial
Lingual- lateral- looping under gland to anteromedial
Sx of marginal mandibular nerve lesion
Drooling and unable to close mouth
Which part of skull does Eustachian tube penetrate
Petrous part of temporal
What forms straight sinus
Inferior sagittal and great cerebral
Where does posterior ethmoid drain
sphenoethmoidal recess in superior meatus
What drains into infundibulum of middle meatus
Frontal and anterior ethmoidal- leads to semi lunar hiatus
What drains into semilunar hiatus of middle meatus
Frontal, maxillary, anterior ethmoidal
What areas of face could lead to cavernous sinus thrombosis
Upper lip, lower part of nose and surroundings- due to anterior facial vein
Location of lingual tonsil
Posterior third midline
What does RLN run between in neck
Trachea and oesophagus
Where does trachea start
Cricoid C6
Nerve most likely to get damaged in thyroidectomy
External laryngeal
As ligation of superior thyroid
Muscle protruding and depressing jaw
Lateral ptyergoid
Nerve suppling trachea
Recurrent laryngeal
Berrys ligament attachment
Thyroid to cricoid ligament and upper trachea
What muscle attaches to Eustachian tube
Tensor veli plantini
Eustachian tube in swallowing
Opens due to tensor plalati and salpingopharyngeus
Which artery is the RLN closely related to
Inferior thyroid
What artery runs through submandibular
Facial
Arteries from internal carotid that contribute to scalp
Supraorbital and supratrochelar
Where must flaps be raised for tracheostomy
Deep to platysma
Innervation, cells covering, arterial supply of tubal tonsils
Located as eustachian tube opening x2
V2 and IX
Ciliated
Ascending pharyngeal
Innervation, cells covering, arterial supply of pharyngeal tonsil
x1- roof of nasopharynx, adenoid
X IX
Ciliated
Ascending pharyngeal and others
Innervation, cells covering, arterial supply of palatine tonsils
Non ker squamous
V2 IX
Tonsillar- facial
Innervation, cells covering, arterial supply of lingual tonsils
Post 1/3 of tongue
Non ker
IX
Lingual artery
External palatine venous
Which gland is affected by stones the most
Submandibular
Midline neck swelling ddx
Thyroglossal
Subhyoid bursa
Pharyngeal pouch
Laryngocele
What is a chemodectoma
Carotid body tumour
Most common location of laryngeal tumour and form of benign
On vocal cords
Papilloma
Management of chyle leak
Adequate drainage and pressure dressing
Serial aspiration and nutritional modifications
What should be conducted before cervical node biopsy
Nasoendoscopy
CXR
What should you measure with a person with epistaxis
BP
Most common oral malignancy
Tongue
What is Pott’s puffy tumour
Subperiosteal abscess
Rare complication of acute sinusitis
CT head, drainage and IV abx
Lateral neck swelling, vertigo and syncope
Chemodectoma
Tumour of gloms jugular
One child has cleft lip chance of next
4%
Tx of acute sinusitis
If systemically unwell or >10d of onset of sx
Co-amox
Mx of leukoplakia
Biopsy and regular FU
Mx of cholesteoma and risks if not managed
Surgical removal
Invasive- menigntiis, abscess, hearing loss, sinus thrombosis, facial palsy
Depressed air conduction but normal bone conduction
Damage to ossicles or tympanic membrane
As cochlea embedded in bone- vibration can be directly transferred to cochlear fluid
Head and neck cancer causing otalgia
Carcinoma of epiglottis
Features of vestibular schwannoma
Vertigo, tinnitus
Late disease may affect trigeminal
No otalgia
Patient develops osteomyelitis from sinusitis which sinus is most likely
Frontal
Lump on posterior triangle, cannot be separated from skin
Sebaceous cyst
Cause of leukoplakia in HIV
EBV
Pre op workup for salivary masses
FNA- cytology
Why is sudden loud sound worse then slow developing
Latent period before attenuation reflex
Damage is to cochlea
Stabbed in neck, now getting loud buzzing and dizziness, dx and mx
Post traumatic AV fistula, surgical excision and repair of artery and vein
HIV patient with headache and facial nerve palsy
Malignant otitis externa
Cysts are painless and don’t cause facial nerve palsy
RF of oral cancer
HPV
Ix of chemodectoma
CT angio
Man from Sudan with parotid, submandibular swelling, biopsy giant cell and granuloma
TB
Jaw cyst tx
Enucleation
Severe headache, VI palsy, papilodema recent ear infection, dx
Optic hydrocephalus
Primary and secondary haemorrhage in tonsillectomy
Primary <24 hrs
Secondary >24 hrs
Secondary self limiting
TNM for head and neck cancers
T1 <2cm
2- 2-4cm
3- >4cm
4- local invading
N0-none
N1- <3cm
N2- 3-6cm
N3- >6m
Feature suggesting malignant change of pleomorphic adenoma
Rapid increase in size
Trachy location in adults and children
1-2 tracheal rings adults
2-3 children
Usually 2cm transverse incision 2cm above sternal notch with blunt incision
Brachial cyst aspiration
Straw colour, sqamous cells
Cholesterol crystals
Audible wheeze weeks after trachy removed
Subglottic stenosis
