HEADnNECK Flashcards
Test to evaluate recurrent laryngeal nerve
direct/indirect laryngoscopy
Grading of laryngoscopy views
Cormack-Lehane Grading 1 = full view glottis 2 = partial 3 = only epiglottis, none glottis 4 = neither
LN compartments of the neck: borders of level 1? involved nodes?
inferior: hyoid bone
lateral: posterior aspect of submandibular gland
nodes: submental + submandibular
LN compartments of the neck: borders of level 6? includes what structure?
superior: hyoid bone
lateral: carotid sheath
inferior: clavicular head
structure: thyroid gland
LN compartments of the neck: levels that include SCM?
2, 3, and 4
LN compartments of the neck: borders of level 3? includes what structure?
lateral: lateral aspect of SCM
superior: hyoid bone
inferior: crycoid cartilage
medial: carotid sheath
structure: carotid artery, internal IJ vein, vagus nerve
LN compartments of the neck: borders of level 5? includes what nerve?
medial: lateral aspect of SCM
lateral: trap
nerve: spinal accessory nerve
LN compartments of the neck: what nodes of level 7?
LN immediately behind manubrium in anterior mediastinum
MC salivary gland tumor
pleomorphic adenoma - low malignant potential but very aggressive
Pleomorphic adenoma MC occurs in what demographic?
female in 50’s
2nd MC salivary gland tumor
Warthin tumor (papillary cystadenoma lymphomatosum)
Warthin tumor MC has strong association with what demographic?
middle-aged men who smoke
Presentation of Warthin tumor
- 10% bilateral, 10% multicentric
- FNA usually not dx - see fluid bc cystic
- surgical specimen dx
If pt smoking + parotid mass + bilateral … think?
Warthin tumor (papillary cystadenoma lymphomatosum)
MCC parotitis
Staph aureus
Cx from where for parotitis
Cx fluid from Stensen duct
Mgmt parotitis
vanc + warm packs + mouth irrigation +/- surgical drainage if continues to progress
Posterior vs. anterior triangle of neck (borders)
posterior: SCM (anterior), trap (posterior), clavicle (inferior)
anterior: 3 zones
Borders of submental triangle
- anterior belly of digastric
- hyoid bone
- symphysis menti (midline)
- floor: mylohyoiod muscle
Plummer-Vinson syndrome associated with…
- anemia
- oral cancer
Borders of submandibular triangle
- anterior belly diagastric
- posterior belly “”
- mandible
How to repair trachea injury
Single layer interrupted absorbable sutures + tissue buttress (w/ strap muscles or SCM). Tracheostomy should not be performed in same area as injury.
Penetrating injuries to neck are divided into 2 triangles… and their borders?
Anterior: (3 zones) anterior border of SCM
Posterior: posterior SCM (anterior), trapezius (posterior), clavicle (inferior)
3 zones of anterior neck and their contents
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
Indications for emergent operation for neck injuries
- unstable
- hard signs vascular injury (bruit, thrill, expanding or pulsatile hematoma)
- tracheal injury (subQ air or bubbling from wound)
Can you do crichothyroidotomy in children <10-12yo?
No - cricothyroid membrane too delicate
Steps for open cricothyrotomy
- Longitudinal skin incision
- Blunt dissection
- Transverse incision over cricothyroid membrane
- Dilate incision
- Placement of number 5 or 6 tracheostomy tube or ET tube
- Inflate cuff
What is jet insufflation? Disadvantage?
Type of high-frequency ventilation, low tidal volume ventilation via cricothyroid membrane (vs. cricothryoidotomy)
Disadvantage: highly specialized equipment + risk of aspiration
