HEAD & NECK

Question 1

Zenkers Diverticulum - OR

Answer 1

Supine position with neck extended and head turned away
PLACE 40FR BOUGIE DILATOR
Transverse incision at level of cricoid cartilage
Develop subplatysmal flaps
Mobilize omohyoid
ID RLN in TE groove and dissect adjacent to anterior edge of carotid artery as retropharyngeal space is approached
Mobilize the diverticular sac from adjacent fibrofatty tissue
Myotomy performed 1-2 cm left of posterior midline and extend at least 2 cm
Transect sac using linear stapler after placing stay sutures at the mouth of the diverticulum
Thorough irrigation, placement of suction drains
Close in 2 alyers

Question 2

Excisional biopsy of head&neck suspicious lesions - margins?

Answer 2

1-3 mm

Wider margins may reduce accuracy of SLNB if needed

Question 3

Adjuvant XRT in what subset of melanoma patients

Answer 3

Desmoplastic melanoma
Mucosal
Positive nodal disease in neck after neck dissection

Question 4

Head & neck melanoma - send tumor specimen for what sort of testing

Answer 4

BRAF and c-KIT

Question 5

Awake tracheostomy for impending airway compromise (laryngeal mass)

Answer 5

Local anesthesia infiltrated into skin and SQ tissues below cricoid
Prep and drape neck
3 cm vertical skin incision in midline below cricoid
Carry out dissection to ID avascular plane of midline raphe between sternohyoid and sternothyroid neck muscles
Divide any overlying thyroid isthmus tissue
ID inferior border of cricoid and use hook to provide retraction
Tracheotomy made between 1st and 2nd tracheal rings