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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
Endoscopic sinus surgery pre op
CT scan of the paranasal sinuses is GS ? Allergy immunology consult ? Labs, chest xray, PFTs Medical therapy maximized Systemic steroids
26
Endoscopic sinus surgery post op
Saline nasal irrigations Packing typically not necessary Resume usual med/routine
27
Endoscopic sinus surgery complications
Bleeding, infection Periorbital ecchymosis CSF leak Anosmia, dysosmia Nasolacrimal duct obstruction Blindness... malpractice
28
How is endoscopic sinus surgery now done
Image-guided navigation systems and balloon sinuplasty
29
Tracheostomy indications
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
Tracheostomy pre op
Physical evaluation of pts neck ? labs, coag studies Environment
31
Tracheostomy post op
CXR Routine cleaning Fresh trachs should not be changed for 3-4 days Trach patient education
32
Tracheostomy complications
hemorrhage PTX, pneumomediastinum Subq emphysema Malposition Fistula RLN paralysis Cricoid injury Tracheomalacia Dysphagia Aspiration Tracheal stenosis Vocal fold injury
33
Parotidectomy indications
Tumors: - Pleomorphic adenoma - Warthins - Monomorphic adenoma - lymphoma - Adenocarcinoma - Melanoma - Adenoid cyst - Mucoepidermoid**** Superficial vs total separated by facial nerve
34
Parotidectomy pre op
? FNA, scanning, labs Any gland which is palpable is normal Nerve monitoring
35
Parotidectomy post op
Would care Avoidance of seroma
36
Parotidectomy complications
Facial nerve injury Frey syndrome (20%) Salivary fistula
37
What nerve is vulnerable/exposed in parotidectomy
facial nerve
38
Submandibulectomy indications
Same as parotidectomy, higher incidence of malignancy Chronic sialoadenitis/lithiasis
39
submandibulectomy complications
Nerve injury: - lingual - marginal mandibular - hypoglossal Salivary fistula
40
Radical neck dissection indications
Metastatic carcinoma (usually from aerodigestive system) Thyroid carcinoma Non-carcinoma
41
Pre op for radical neck dissection
many labs and imaging, NGT, foley, type and cross, EKG, US, etc.
42
Radical neck dissection post op
Abx Feedings Labs Blood loss +/- transfusions DVT precautions Intensive care bed
43
Radical neck dissection complications
Wound complications Hemorrhage Respiratory obstruction Hypothyroidism Hypoparathyroidism Nerve injury - Vagus - Phrenic - Lingual - Hypoglossal - Spinal accessory - Brachial plexus Stroke/carotid blowout
44
Common sites of head/neck cancer
oral nasopharyngeal laryngeal subglottic cervical esophageal thyroid cutaneous
45
Head and neck carcinoma risk factors
Smoking, chewing tobacco, cigar, pipe Alcohol GERD HPV*
46
Staging and types of head and neck carcinoma
TNM classification squamous cell verrucous cell Adenoid cystic Lymphoma More
47
Head and neck carcinoma treatment
Surgery Radiation therapy Chemo/immuno therapy Combined RXT/Chemo
48
Head and neck carcinoma post treatment consideration
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
Epistaxis etiologies (different from already know)
neoplasia (males - juvenile angiofibroma) Hematologic disorders - blood dyscrasias - Osler-Weber-Rendu - Liver disease
50
Sites of posterior nose bleed
internal carotid (ant and post ethmoid) External carotid (int maxillary - sphenopalatine arteries)
51
Complications of epistaxis packing
Perforation CO2, obstruction Hemorrhage Sinusitis
52
What cysts are often found in the midline of the neck at or near the hyoid bone?
Thyroglossal duct cysts
53
What cyst can present in the midline of the submental region
dermoid cyst
54
What may cause significant cosmetic deformity and may impair respiration/alimentation
Lymphangiomas
55
Congenital anterior
BCC, Hygroma
56
Congenital midline
TGDC, BSS, Ranula, Dermoid
57
Congenital posterior
Lymphoepithelioma, lipoma
58
Infectious anterior
Lymphadenitis, TB, Carotidynia
59
Infectious midline
Dental abscess, thyroiditis, epidermal cyst/abscess
60
Infectious posterior
EBV, CMV, TB, lymphadenitis
61
Benign anterior
Lymph node, lipoma
62
Benign midline
Thyroid adenoma, laryngocele
63
Benign posterior
Lipoma, epidermal inclusion cyst
64
Malignant anterior
SCC Lymphoma Metastatic lymph nodes from aerodigestive tract Thyroid CA - metastatic
65
Malignant midline
Thyroid cancer Thyroglossal DG-CA Lymphoma Metastatic CA aerodigestive tract
66
Malignant posterior
Lymphoma Melanoma
67
Where will you see a brachial cleft cyst
Upper neck below ear, around carotid arteries

Fall 2024 (34 decks)

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