Head/Neck Surgery Flashcards
Tympanocentesis indications
C/S middle ear
AOM - toxic child, meningitis, immune deficiency
Tympanocentesis post op
strict water avoidance
Complications of tympanocentesis
Insult to the middle ear structures
Chronic TM perforation
Tympanocentesis can be performed with or without
sedation
tube placement
What does a comprehensive audiogram test
pure tone testing
speech reception
speech discrimination
Tympanoplasty indications
repair of tympanic membrane perforations
Ossicular chain intact and functional
Pre-op for tympanoplasty
Audiology suggested
Graft
Sites of graft for tympanoplasty
Fascia
Fat
Perichondrium
Vein
Homografts
Gelfoam
alloderm
cadaver
Post-op tympanoplasty
Strict water avoidance
Avoid nose blowing
Avoid constipation - use laxatives
do not disturb dressing, ok to reinforce
What is done in a mastoidectomy
removal of air cells of mastoid bone behind the eardrum
What is done in a tympanomastoidectomy
removal of air cells of mastoid bone behind the eardrum + tympanoplasty
What are the indication for a mastoidectomy
infection or cholesteatoma
What is the pre op for mastoidectomy
Audio and imaging
5 risks of middle ear/mastoid surgery
- Hearing loss/worsening
- Facial nerve paralysis
- Taste disturbance
- vertigo
- Tinnitus
indication for stapedotomy
otosclerosis
contraindication for stapedotomy
Minimal loss
risk-benefit ratio
degree of SNHL
Complications of stapedotomy
SNHL
Tinnitus
Facial nerve paralysis
Taste disturbance
Vertigo
TM perforation
What is done in a stapedotomy
Removal of stapes superstructure and placement of prosthesis
Tonsilectomy/adenoidectomy indications
Recurrent strep tonsillitis
Profound hypertropht/OSA/airway obstruction/dysphagia with FTT
Asymmetry/tumor
Tonsiliths
Peritonsilar abscess
T&A pre op
No labs
? sleep study
Partial vs traditional consideration
T&A post op
Restricted diet
Pain meds
Pain generally persists through 7-10 days and often gets worse before improving
Otalgia
T&A complications
Bleeding - immediate or delayed
Aspiration ETT vs LMA
Palatopharyngeal insufficiency
Nasopharyngeal stenosis
Torticollis
Endoscopic sinus surgery absolute indications
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
Endoscopic sinus surgery relative indications
Unsatisfactory improvement after medical therapy
Recurrent disease
septal deformity
Foreign body
Unilateral sinusitis
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
Endoscopic sinus surgery post op
Saline nasal irrigations
Packing typically not necessary
Resume usual med/routine
Endoscopic sinus surgery complications
Bleeding, infection
Periorbital ecchymosis
CSF leak
Anosmia, dysosmia
Nasolacrimal duct obstruction
Blindness… malpractice
How is endoscopic sinus surgery now done
Image-guided navigation systems and balloon sinuplasty
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
Tracheostomy pre op
Physical evaluation of pts neck
? labs, coag studies
Environment
Tracheostomy post op
CXR
Routine cleaning
Fresh trachs should not be changed for 3-4 days
Trach patient education
Tracheostomy complications
hemorrhage
PTX, pneumomediastinum
Subq emphysema
Malposition
Fistula
RLN paralysis
Cricoid injury
Tracheomalacia
Dysphagia
Aspiration
Tracheal stenosis
Vocal fold injury
Parotidectomy indications
Tumors:
- Pleomorphic adenoma
- Warthins
- Monomorphic adenoma
- lymphoma
- Adenocarcinoma
- Melanoma
- Adenoid cyst
- Mucoepidermoid**
Superficial vs total separated by facial nerve
Parotidectomy pre op
? FNA, scanning, labs
Any gland which is palpable is normal
Nerve monitoring
Parotidectomy post op
Would care
Avoidance of seroma
Parotidectomy complications
Facial nerve injury
Frey syndrome (20%)
Salivary fistula
What nerve is vulnerable/exposed in parotidectomy
facial nerve
Submandibulectomy indications
Same as parotidectomy, higher incidence of malignancy
Chronic sialoadenitis/lithiasis
submandibulectomy complications
Nerve injury:
- lingual
- marginal mandibular
- hypoglossal
Salivary fistula
Radical neck dissection indications
Metastatic carcinoma (usually from aerodigestive system)
Thyroid carcinoma
Non-carcinoma
Pre op for radical neck dissection
many labs and imaging, NGT, foley, type and cross, EKG, US, etc.
Radical neck dissection post op
Abx
Feedings
Labs
Blood loss +/- transfusions
DVT precautions
Intensive care bed
Radical neck dissection complications
Wound complications
Hemorrhage
Respiratory obstruction
Hypothyroidism
Hypoparathyroidism
Nerve injury
- Vagus
- Phrenic
- Lingual
- Hypoglossal
- Spinal accessory
- Brachial plexus
Stroke/carotid blowout
Common sites of head/neck cancer
oral
nasopharyngeal
laryngeal
subglottic
cervical esophageal
thyroid
cutaneous
Head and neck carcinoma risk factors
Smoking, chewing tobacco, cigar, pipe
Alcohol
GERD
HPV*
Staging and types of head and neck carcinoma
TNM classification
squamous cell
verrucous cell
Adenoid cystic
Lymphoma
More
Head and neck carcinoma treatment
Surgery
Radiation therapy
Chemo/immuno therapy
Combined RXT/Chemo
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
Epistaxis etiologies (different from already know)
neoplasia (males - juvenile angiofibroma)
Hematologic disorders
- blood dyscrasias
- Osler-Weber-Rendu
- Liver disease
Sites of posterior nose bleed
internal carotid (ant and post ethmoid)
External carotid (int maxillary - sphenopalatine arteries)
Complications of epistaxis packing
Perforation
CO2, obstruction
Hemorrhage
Sinusitis
What cysts are often found in the midline of the neck at or near the hyoid bone?
Thyroglossal duct cysts
What cyst can present in the midline of the submental region
dermoid cyst
What may cause significant cosmetic deformity and may impair respiration/alimentation
Lymphangiomas
Congenital anterior
BCC, Hygroma
Congenital midline
TGDC, BSS, Ranula, Dermoid
Congenital posterior
Lymphoepithelioma, lipoma
Infectious anterior
Lymphadenitis, TB, Carotidynia
Infectious midline
Dental abscess, thyroiditis, epidermal cyst/abscess
Infectious posterior
EBV, CMV, TB, lymphadenitis
Benign anterior
Lymph node, lipoma
Benign midline
Thyroid adenoma, laryngocele
Benign posterior
Lipoma, epidermal inclusion cyst
Malignant anterior
SCC
Lymphoma
Metastatic lymph nodes from aerodigestive tract
Thyroid CA - metastatic
Malignant midline
Thyroid cancer
Thyroglossal DG-CA
Lymphoma
Metastatic CA aerodigestive tract
Malignant posterior
Lymphoma
Melanoma
Where will you see a brachial cleft cyst
Upper neck below ear, around carotid arteries
