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Fall 2024 > Head/Neck Surgery > Flashcards

Head/Neck Surgery Flashcards

1
Q

Tympanocentesis indications

A

C/S middle ear
AOM - toxic child, meningitis, immune deficiency

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2
Q

Tympanocentesis post op

A

strict water avoidance

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3
Q

Complications of tympanocentesis

A

Insult to the middle ear structures
Chronic TM perforation

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4
Q

Tympanocentesis can be performed with or without

A

sedation
tube placement

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5
Q

What does a comprehensive audiogram test

A

pure tone testing
speech reception
speech discrimination

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6
Q

Tympanoplasty indications

A

repair of tympanic membrane perforations
Ossicular chain intact and functional

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7
Q

Pre-op for tympanoplasty

A

Audiology suggested
Graft

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8
Q

Sites of graft for tympanoplasty

A

Fascia
Fat
Perichondrium
Vein
Homografts
Gelfoam
alloderm
cadaver

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9
Q

Post-op tympanoplasty

A

Strict water avoidance
Avoid nose blowing
Avoid constipation - use laxatives
do not disturb dressing, ok to reinforce

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10
Q

What is done in a mastoidectomy

A

removal of air cells of mastoid bone behind the eardrum

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11
Q

What is done in a tympanomastoidectomy

A

removal of air cells of mastoid bone behind the eardrum + tympanoplasty

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12
Q

What are the indication for a mastoidectomy

A

infection or cholesteatoma

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13
Q

What is the pre op for mastoidectomy

A

Audio and imaging

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14
Q

5 risks of middle ear/mastoid surgery

A
  1. Hearing loss/worsening
  2. Facial nerve paralysis
  3. Taste disturbance
  4. vertigo
  5. Tinnitus
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15
Q

indication for stapedotomy

A

otosclerosis

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16
Q

contraindication for stapedotomy

A

Minimal loss
risk-benefit ratio
degree of SNHL

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17
Q

Complications of stapedotomy

A

SNHL
Tinnitus
Facial nerve paralysis
Taste disturbance
Vertigo
TM perforation

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18
Q

What is done in a stapedotomy

A

Removal of stapes superstructure and placement of prosthesis

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19
Q

Tonsilectomy/adenoidectomy indications

A

Recurrent strep tonsillitis
Profound hypertropht/OSA/airway obstruction/dysphagia with FTT
Asymmetry/tumor
Tonsiliths
Peritonsilar abscess

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20
Q

T&A pre op

A

No labs
? sleep study
Partial vs traditional consideration

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21
Q

T&A post op

A

Restricted diet
Pain meds
Pain generally persists through 7-10 days and often gets worse before improving
Otalgia

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22
Q

T&A complications

A

Bleeding - immediate or delayed
Aspiration ETT vs LMA
Palatopharyngeal insufficiency
Nasopharyngeal stenosis
Torticollis

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23
Q

Endoscopic sinus surgery absolute indications

A

Extensive obstructive polyposis with complications
Invasive disease
CSF leak
Dx tumor
Complication w/:
- subperiosteal, orbital, or brain abscess
- Pott’s puffy tumor
- Meningitis
- Mucocele-mucopyocele

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24
Q

Endoscopic sinus surgery relative indications

A

Unsatisfactory improvement after medical therapy
Recurrent disease
septal deformity
Foreign body
Unilateral sinusitis

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25
Q

Endoscopic sinus surgery pre op

A

CT scan of the paranasal sinuses is GS
? Allergy immunology consult
? Labs, chest xray, PFTs
Medical therapy maximized
Systemic steroids

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26
Q

Endoscopic sinus surgery post op

A

Saline nasal irrigations
Packing typically not necessary
Resume usual med/routine

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27
Q

Endoscopic sinus surgery complications

A

Bleeding, infection
Periorbital ecchymosis
CSF leak
Anosmia, dysosmia
Nasolacrimal duct obstruction
Blindness… malpractice

28
Q

How is endoscopic sinus surgery now done

A

Image-guided navigation systems and balloon sinuplasty

29
Q

Tracheostomy indications

A

Respiratory insufficiency:
- Prolonged intubation
- Bronchopulmonary toilet
- Mechanical ventilation
Airway obstruction:
- Tumor
- angioedema
- OSA
- Epiglottitis/croup
Abscess
- Ludwig, parapharyngeal, retro, deep neck
Facial/chest trauma
Vocal fold paralysis
Neuromuscular conditions
- ALS
- MS

30
Q

Tracheostomy pre op

A

Physical evaluation of pts neck
? labs, coag studies
Environment

31
Q

Tracheostomy post op

A

CXR
Routine cleaning
Fresh trachs should not be changed for 3-4 days
Trach patient education

32
Q

Tracheostomy complications

A

hemorrhage
PTX, pneumomediastinum
Subq emphysema
Malposition
Fistula
RLN paralysis
Cricoid injury
Tracheomalacia
Dysphagia
Aspiration
Tracheal stenosis
Vocal fold injury

33
Q

Parotidectomy indications

A

Tumors:
- Pleomorphic adenoma
- Warthins
- Monomorphic adenoma
- lymphoma
- Adenocarcinoma
- Melanoma
- Adenoid cyst
- Mucoepidermoid**
Superficial vs total separated by facial nerve

34
Q

Parotidectomy pre op

A

? FNA, scanning, labs
Any gland which is palpable is normal
Nerve monitoring

35
Q

Parotidectomy post op

A

Would care
Avoidance of seroma

36
Q

Parotidectomy complications

A

Facial nerve injury
Frey syndrome (20%)
Salivary fistula

37
Q

What nerve is vulnerable/exposed in parotidectomy

A

facial nerve

38
Q

Submandibulectomy indications

A

Same as parotidectomy, higher incidence of malignancy
Chronic sialoadenitis/lithiasis

39
Q

submandibulectomy complications

A

Nerve injury:
- lingual
- marginal mandibular
- hypoglossal
Salivary fistula

40
Q

Radical neck dissection indications

A

Metastatic carcinoma (usually from aerodigestive system)
Thyroid carcinoma
Non-carcinoma

41
Q

Pre op for radical neck dissection

A

many labs and imaging, NGT, foley, type and cross, EKG, US, etc.

42
Q

Radical neck dissection post op

A

Abx
Feedings
Labs
Blood loss +/- transfusions
DVT precautions
Intensive care bed

43
Q

Radical neck dissection complications

A

Wound complications
Hemorrhage
Respiratory obstruction
Hypothyroidism
Hypoparathyroidism
Nerve injury
- Vagus
- Phrenic
- Lingual
- Hypoglossal
- Spinal accessory
- Brachial plexus
Stroke/carotid blowout

44
Q

Common sites of head/neck cancer

A

oral
nasopharyngeal
laryngeal
subglottic
cervical esophageal
thyroid
cutaneous

45
Q

Head and neck carcinoma risk factors

A

Smoking, chewing tobacco, cigar, pipe
Alcohol
GERD
HPV*

46
Q

Staging and types of head and neck carcinoma

A

TNM classification
squamous cell
verrucous cell
Adenoid cystic
Lymphoma
More

47
Q

Head and neck carcinoma treatment

A

Surgery
Radiation therapy
Chemo/immuno therapy
Combined RXT/Chemo

48
Q

Head and neck carcinoma post treatment consideration

A

Nutritional, showering, etc.
Voice and dysphagia therapy
Deformity
Nerve defects i.e. spinal accessory nerve
Xerostomia, mucositis
Hair loss
Loss of taste/smell
Blood loss, neutropenia
Fever, immunocompromised

49
Q

Epistaxis etiologies (different from already know)

A

neoplasia (males - juvenile angiofibroma)
Hematologic disorders
- blood dyscrasias
- Osler-Weber-Rendu
- Liver disease

50
Q

Sites of posterior nose bleed

A

internal carotid (ant and post ethmoid)
External carotid (int maxillary - sphenopalatine arteries)

51
Q

Complications of epistaxis packing

A

Perforation
CO2, obstruction
Hemorrhage
Sinusitis

52
Q

What cysts are often found in the midline of the neck at or near the hyoid bone?

A

Thyroglossal duct cysts

53
Q

What cyst can present in the midline of the submental region

A

dermoid cyst

54
Q

What may cause significant cosmetic deformity and may impair respiration/alimentation

A

Lymphangiomas

55
Q

Congenital anterior

A

BCC, Hygroma

56
Q

Congenital midline

A

TGDC, BSS, Ranula, Dermoid

57
Q

Congenital posterior

A

Lymphoepithelioma, lipoma

58
Q

Infectious anterior

A

Lymphadenitis, TB, Carotidynia

59
Q

Infectious midline

A

Dental abscess, thyroiditis, epidermal cyst/abscess

60
Q

Infectious posterior

A

EBV, CMV, TB, lymphadenitis

61
Q

Benign anterior

A

Lymph node, lipoma

62
Q

Benign midline

A

Thyroid adenoma, laryngocele

63
Q

Benign posterior

A

Lipoma, epidermal inclusion cyst

64
Q

Malignant anterior

A

SCC
Lymphoma
Metastatic lymph nodes from aerodigestive tract
Thyroid CA - metastatic

65
Q

Malignant midline

A

Thyroid cancer
Thyroglossal DG-CA
Lymphoma
Metastatic CA aerodigestive tract

66
Q

Malignant posterior

A

Lymphoma
Melanoma

67
Q

Where will you see a brachial cleft cyst

A

Upper neck below ear, around carotid arteries

Fall 2024 (34 decks)

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