Head & Neck Part 2

Question 1

Describe cancer of the base of the tongue

Answer 1

Usually at an advanced stage on diagnosis, and has a strong propensity for LN mets

Question 2

Treatment for cancer of the base of the tongue

Answer 2

Early lesions: surgery or RT + BILATERAL neck dissection

Advanced lesions: TOTAL resection of tongue base +/- laryngectomy

Question 3

Indications for adjuvant radiotherapy for cancer of the tongue

Answer 3

Margins at operated side
Perineural invasion
Nodal involvement

Question 4

Treatment of cancer of hypopharyngeal area

Answer 4

T1 - radiotherapy
T2 and T3 - chemorad
*surgery
—last resort; must not involve apex of pyriform sinus and vocal cord; adequate pulmonary reserve

Question 5

T1 in HNSCC

Answer 5

2cm or less, confined to site of origin

Question 6

T2 of HNSCC

Answer 6

2.1 to 4cm

Question 7

T3 of HNSCC

Answer 7

Greater than 4cm

Question 8

T4 of HNSCC

Answer 8

Massive tumor with invasion of surrounding structures

Question 9

Treatment of cancer of the larynx

Answer 9

Supraglottic/glottic: 
Early lesiosns - radiotherapy
Eadvanced lesions - surgery + RT
Subglottic
Total laryngectomy + neck dissection (regardelss of N status because of poor prognosis)

Question 10

Warthin tumor

Answer 10

Papillary cystadenoma lymphomatosum

• 2nd most common benign tumor of the parotid gland (almost exclusively)
• bilateral in 20% of cases
• has double layer of oncocytic epithelial cells: eosinophilic granular cytoplasm and large nuclei with prominent nucleoli
• smoking is a notalble risk factor

Question 11

How to find the facial nerve

Answer 11

1. External auditory canal cartilage - a triangle that points to the facial nerve, 1cm deep and inferior to the “tragal pointer”
2. STYLOID PROCESS - deep to the nerve (lateral lies the nerve)
3. POSTERIOR BELLY OF DIGASTRIC - superficial and parallel to the nerve
4. TYMPANOMASTOID SUTURE - 6-8mm deep to this suture
5. GROOVE BETWEEN MASTOID AND BONY EAC - bisected by facial nerve

Question 12

Branches of the facial nerve

Answer 12

Temporal - raises the eyebrows
Zygomatic branch - closes the eyes
Buccal - compresses the cheek and moves the upper lip
Marginal mandibular - moves the lower lip
Cervical - pulls lower lip and angle of mouth down

Question 13

Most commonly injured branch of the facial nerve

Answer 13

Marginal mandibular branch, followed by the temporal then buccal branches

Question 14

Most common malignant salivary gland tumor

Answer 14

Muco-epidermoid carcinoma

Question 15

2nd most comon salivary glands in adults

Answer 15

Adenoid cystic carcinoma

• has propensity for neural spread
• has indolent growth, but high propensity for distant mets

Question 16

2nd most comon malignant alivaary gland tumor in children

Answer 16

Acinic cell carcinoma

Question 17

Aggressive tumor arising from benign mixed tumo

Answer 17

Carcinoma ex pleomorphic adenoma

Question 18

When do we sacrifice the facial nerve?

Answer 18

Encased by tumor

Non-functional pre-op

Question 19

What to preserve in resectiotn of the submandibular gland?

Answer 19

Lingual nerve

Hypoglossal nerve

Question 20

What muscle divides the submandibular gland into superficial and deep lobes

Answer 20

Mylohyoid