HEADnNECK

Question 1

Test to evaluate recurrent laryngeal nerve

Answer 1

direct/indirect laryngoscopy

Question 2

Grading of laryngoscopy views

Answer 2

Cormack-Lehane Grading
1 = full view glottis
2 = partial
3 = only epiglottis, none glottis
4 = neither

Question 3

LN compartments of the neck: borders of level 1? involved nodes?

Answer 3

inferior: hyoid bone
lateral: posterior aspect of submandibular gland
nodes: submental + submandibular

Question 4

LN compartments of the neck: borders of level 6? includes what structure?

Answer 4

superior: hyoid bone
lateral: carotid sheath
inferior: clavicular head
structure: thyroid gland

Question 5

LN compartments of the neck: levels that include SCM?

Answer 5

2, 3, and 4

Question 6

LN compartments of the neck: borders of level 3? includes what structure?

Answer 6

lateral: lateral aspect of SCM
superior: hyoid bone
inferior: crycoid cartilage
medial: carotid sheath
structure: carotid artery, internal IJ vein, vagus nerve

Question 7

LN compartments of the neck: borders of level 5? includes what nerve?

Answer 7

medial: lateral aspect of SCM
lateral: trap
nerve: spinal accessory nerve

Question 8

LN compartments of the neck: what nodes of level 7?

Answer 8

LN immediately behind manubrium in anterior mediastinum

Question 9

MC salivary gland tumor

Answer 9

pleomorphic adenoma - low malignant potential but very aggressive

Question 10

Pleomorphic adenoma MC occurs in what demographic?

Answer 10

female in 50’s

Question 11

2nd MC salivary gland tumor

Answer 11

Warthin tumor (papillary cystadenoma lymphomatosum)

Question 12

Warthin tumor MC has strong association with what demographic?

Answer 12

middle-aged men who smoke

Question 13

Presentation of Warthin tumor

Answer 13

• 10% bilateral, 10% multicentric
• FNA usually not dx - see fluid bc cystic
• surgical specimen dx

Question 14

If pt smoking + parotid mass + bilateral … think?

Answer 14

Warthin tumor (papillary cystadenoma lymphomatosum)

Question 15

MCC parotitis

Answer 15

Staph aureus

Question 16

Cx from where for parotitis

Answer 16

Cx fluid from Stensen duct

Question 17

Mgmt parotitis

Answer 17

vanc + warm packs + mouth irrigation +/- surgical drainage if continues to progress

Question 18

Posterior vs. anterior triangle of neck (borders)

Answer 18

posterior: SCM (anterior), trap (posterior), clavicle (inferior)
anterior: 3 zones

Question 19

Borders of submental triangle

Answer 19

• anterior belly of digastric
• hyoid bone
• symphysis menti (midline)
• floor: mylohyoiod muscle

Question 20

Plummer-Vinson syndrome associated with…

Answer 20

• anemia

- oral cancer

Question 21

Borders of submandibular triangle

Answer 21

• anterior belly diagastric
• posterior belly “”
• mandible

Question 22

How to repair trachea injury

Answer 22

Single layer interrupted absorbable sutures + tissue buttress (w/ strap muscles or SCM). Tracheostomy should not be performed in same area as injury.

Question 23

Penetrating injuries to neck are divided into 2 triangles… and their borders?

Answer 23

Anterior: (3 zones) anterior border of SCM
Posterior: posterior SCM (anterior), trapezius (posterior), clavicle (inferior)

Question 24

3 zones of anterior neck and their contents

Answer 24

Zone I (clavicle - cricoid): lung apex, trachea, brachiocephlic/subclavian vessels, nerve roots, esophagus
Zone II (cricoid - mandible): carotid and vertebral arteries, jugular veins, esophagus, trachea
Zone III (mandible - skull base): external/internal carotid, jugular, cranial nerves, hypopharyngeal

Question 25

Indications for emergent operation for neck injuries

Answer 25

• unstable
• hard signs vascular injury (bruit, thrill, expanding or pulsatile hematoma)
• tracheal injury (subQ air or bubbling from wound)

Question 26

Can you do crichothyroidotomy in children <10-12yo?

Answer 26

No - cricothyroid membrane too delicate

Question 27

Steps for open cricothyrotomy

Answer 27

1. Longitudinal skin incision
2. Blunt dissection
3. Transverse incision over cricothyroid membrane
4. Dilate incision
5. Placement of number 5 or 6 tracheostomy tube or ET tube
6. Inflate cuff

Question 28

What is jet insufflation? Disadvantage?

Answer 28

Type of high-frequency ventilation, low tidal volume ventilation via cricothyroid membrane (vs. cricothryoidotomy)
Disadvantage: highly specialized equipment + risk of aspiration