Head & Neck Flashcards
Submandibular triangle
Anterior part of neck
Post: posterior belly of digastric m. and stylohyoid m.
Ant: anterior belly of digastric m.
Sup: inferior border of mandible
Contains submandibular (salivary) gland and LNs
Facial artery and vein pass through this area
Submental triangle
Anterior part of neck
Inf: Hyoid bone
Post: anterior belly of digastric m.
Ant: midline of neck
Floor: mylohyoid m.
Contains submental LNs. Filter lymph from floor of mouth & parts of tongue
Carotid triangle
Anterior part of neck
Sup: posterior belly of digastric m.
Ant: superior belly of omohyoid m.
Post: medial border of SCM
Contains CCA, bifurcation into ICA/ECA, IJV, hypoglossal and vagus nerves
Muscular triangle
Anterior part of neck
Sup: hyoid bone
Ant: midline neck
Super/Post: Superior belly of omohyoid m.
Super/Inf: medial border of SCM
Contains infrahyoid m, pharynx, thyroid, parathyroid glands
Anterior triangle of neck
Midline neck, medial border of SCM, mandible
Contains: submandibular, carotid, submental, and muscular triangles
MEN 2
MEN 2A: MTC, pheo, Parathyroid hyperplasia
- Total thyroidectomy rec by age 6
MEN 2B: MTC, Marfanoid, pheo, mucosal neuromas, ganglioneuromas
- Total thyroidectomy rec by age 1
MC side for non-recurrent laryngeal nerve
right
Cause of L non-recurrent laryngeal nerve
right-sided aortic arch
Cause of R non-recurrent laryngeal nerve
aberrant subclavian artery that runs behind esophagus (arteria lusoria)
Dysphagia lusoria
Aberrant right subclavian artery coursing behind esophagus
dysphagia, chronic cough, unexplained ischemia of R arm
Plane that divides right and left lobe of liver
Cantlie line
(Anatomic landmark) middle hepatic vein
Extends from GB fossa to IVC
Lingual thyroid
posterior pharyngeal neck mass; incidental finding
located at base of tongue at location of foramen cecum
due to failure of descent by thyroid during embryologic development
Dx: radioiodine uptake scan (thyroid scintigraphy)
DeQuervain Thyroiditis (Subacute Thyroiditis)
Affects W > M (3.5:1) MC in younger pts After URI Neck pain, radiates to jaw \+fevers, myalgias, malaise Enlarged, painful thyroid High T3/T4, Low TSH, High ESR/CRP, min uptake on radiouptake scan Tx: NSAIDs (1st), prednisone
Phase I: initial hyperthyroid phase - stored thyroid hormone released
Phase II: brief euthyroid phase, no new hormone made
Phase III: hypothyroid phase, high TSH, resume TH synthesis
Phase IV: euthyroid phase, full recovery
Brachial Cleft Anomalies
Arise from 2nd pharyngeal arch
abnormal persistence of branchial apparatus
2nd MC neck anomaly found in kids
2nd brachial cleft cyst = MC branchial cleft anomaly
Tx: complete excision of mass and any fistulous tract
Pleomorphic adenoma
Isolated, firm, round tumor, surrounded by capsule
MC benign tumor of salivary gland.
Rarely assoc w/ malignant transformation
90% affecting parotid gland lie superficial to facial nerve
Initial tx: superficial parotidectomy
Recurrence tx: radiation
MC genetic alteration in thyroid cancer
BRAF V600E mutation
Assoc w/ increased recurrence and mortality
MC genetic alteration in anaplastic thyroid cancer
BRAF V600E mutation
FDA-approved meds for locally advanced/metastatic anaplastic thyroid cancers
Dabrafenib
Trametinib
External branch of superior laryngeal nerve
Purely motor nerve. Innervates cricothyroid muscle (one of the intrinsic muscles of larynx)
Travels with superior thyroid artery. Separates ~1cm proximal to superior pole thyroid
SLN branch of RLN.
Thyroglossal duct cyst
Remnant of thyroglossal duct. Connected foramen cecum to thyroid gland
Thyroid gland descends from foramen cecum at tongue base down to anatomic position in neck
Hyoid bone is MC location to find cyst
Best test: US & thyroid function test
Tx: remove cyst, tract, and central portion of hyoid bone (Sistrunk procedure)
Recurrent laryngeal nerve relation to inferior thyroid artery
RLN runs anterior to inferior thyroid artery on R and posterior to inferior thyroid artery on L
Course of RLN
Runs in tracheoesophageal groove posterior to thyroid lobe
RLN lies medial and anterior to superior parathyroid glands and then lateral and posterior to inferior thyroid glands.
Exposure of penetrating neck injury with suspected tracheal injury
Initial incision along anterior border of SCM muscle
1) exposes carotid sheath, pharynx, cervical esophagus
2) lengthened if necessary
3) bilateral exploration w/ separate SCM incisions then connected inferiorly in U-shape
Raising flap in subplatysmal plane, allows exposure to every structure in neck
