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Head N Neck > Lecture 17 - Thyroid Head, Neck Cancers And Cervical Plexus > Flashcards

Lecture 17 - Thyroid Head, Neck Cancers And Cervical Plexus Flashcards

1
Q

What is the route of the left recurrent laryngeal nerve?

A

Branches from vagus nerve
Wraps around the aortic arch
Ascends to larynx in the Tracheoesophageal groove running under the thyroid

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2
Q

What is the route of the right recurrent laryngeal nerve?

A

Branches from the vagus nerve
Wraps around the right subclavian artery and ascends to larynx in the Tracheoesophageal groove passing under the thyroid

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3
Q

What are the 2 main arteries supplying the thyroid?

A

Superior thyroid artery
Inferior thyroid artery

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4
Q

Where does the superior thyroid artery branch from?

A

First branch of the external carotid artery

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5
Q

What artery does the inferior thyroid artery branch from?

A

Thyrocervical trunk

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6
Q

What does the thyrocervical trunk branch from?

A

Subclavian arteries

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7
Q

Describe the blood supply to the thyroid:

A

External carotid artery gives of its first branch called the superior thyroid artery

Subclavian arteries give of the thyrocervical trunk which then branches to the inferior thyroid artery

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8
Q

What 3 veins drain the thyroid?

A

Superior thyroid vein
Middle thyroid vein
Inferior thyroid vein

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9
Q

What vein do both the superior and middle thyroid vein drain into?

A

Internal jugular vein

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10
Q

What vein does the inferior thyroid vein drain into?

A

Left brachiocephalic vein

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11
Q

Go to the last slide and label image 1:

A

1 = vagus nerve
2 = superior laryngeal nerve (external + internal)
3 = internal superior laryngeal nerve
4 = external superior laryngeal nerve
5 = thyroid gland
6 = right recurrent laryngeal nerve
7 = arch of aorta
8 = left recurrent laryngeal nerve
9 = left subclavian
10 = thyrocervical trunk
11 = inferior thyroid artery
12 = left common carotid artery
13 = internal carotid artery
14 = external carotid artery
15 = superior thyroid artery
16 = right subclavian artery

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12
Q

Go to the last slide and label the venous drainage of the thyroid (2)

A

1 = superior thyroid vein
2 = internal jugular vein
3 = middle thyroid vein
4 = inferior thyroid vein
5 = left brachiocephalic vein

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13
Q

What membrane do the recurrent laryngeal nerves penetrate??

A

Cricothyroid membrane

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14
Q

What is the general shape of the thyroid gland?
How many lobes are there?
What is the bridge called that joins the 2 lobes of the thyroid gland called?

A

Butterfly shape
2 lobes

Isthmus = bridge joining the left and right lobe

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15
Q

What is the main type of tumour in head and neck cancers?

A

Squamous cell carcinomas

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16
Q

What nerves innervate the thyroid gland?

A

Sympathetics

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17
Q

What investigation method can we use to go through the nose and visualise the pharynx and larynx?

A

Flexible nasoendoscopy

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18
Q

What are the main risk factors for Head and Neck cancers?

A

SMOKING + TOBACCO (betal nut chewing)
ALCOHOL
Dental hygiene
Viruses like HPV
Premalginant changes

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19
Q

What are some premalignant changes that can be seen before head and neck cancers?

A

Leukoplakia

Erythroplakia

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20
Q

What is leukoplakia?

A

White plaques on the tongue

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21
Q

Whta is erythroplakia?

A

Red plaques on the tongue

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22
Q

What virus increases thee risk of oropharyngeal cancer?

A

HPV

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23
Q

What are some risk factors for specifically developing thyroid cancers?

A

Iridation exposure

FHx and inherited conditions like Familial Adenomatous Polyposis (FAP)

Lumps in < 20yrs lumps in >70yrs

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24
Q

Go to the last slide and what premalignant change is image 3 and 4 showing?

A

3 = leukoplakia
4 = erythroplakia

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25
Q

What strucutres can have cancers on in the lip/oral cavity?

A

Lip
Tongue
Floor of mouth
Cheeks

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26
Q

What are the 3 regions of the larynx?

A

Supraglottis
Glottis
Subglottis/infra-glottis

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27
Q

Who have thyroid goitres more commonly, men or women?

A

Women

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28
Q

What is the staging system for head and neck cancers?

A

TNM

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29
Q

What are the 4 types of thyroid cancer?

A

Papillary thyroid adenocarcinoma

Follicular thyroid adenocarcinoma

Medullary carcinoma

Anaplastic carcinoma

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30
Q

What is the worst type of thyroid cancer?

A

Anaplastic thyroid carcinoma

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31
Q

What cartilage does the thyroid gland sit below?

A

Thyroid cartilage

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32
Q

How does a thyroid cancer present?

A

Lump in neck (not normally thyroid status issue)

Compression symptoms:
-Dysphagia
-feeling like being strangled

Potential voice change

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33
Q

What investigations are done if suspected thyroid cancer?

A

Hx
Ex

Fine needle aspiration cytology

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34
Q

How are thyroid cancers treated?

A

Thyroidectomy

Radioactive iodine (only part of body that uses iodine)

Radio/chemotherapy

35
Q

What are the general principles of managing head and neck cancers?

A

Chemo/radiotherapy
Surgical
Sample/biopsy

Supportive

MDT approach

36
Q

What are some supportive treatments needed for Head and Neck cancers?

A

Help with:
-swallowing
-feeding
-voice rehab
-pain

37
Q

How do cancers of the lip/oral cavity present?

A

Lump
Pain (can have refered EAR PAIN)
Fixation of tongue (speech issue)
Bleeding
Dysphagia
Odynophagia (pain on swallowing)

38
Q

What Investigations can be done for suspected lip/oral cavity cancer?

A

Biopsy

CT or MRI

Possible PET

39
Q

How do PET scans work?

A

Patient consumes radioactive glucose
Glucose used up my highly metabolically active tissues

40
Q

How do you treat a lip/oral cavity cancer?

A

Small tumours can be excised

Radiotherapy

May need glossectomy/hemiglossectomy for large tumours

41
Q

How do pharyngeal cancers present?

A

Lump
Pain (can get Otalgia)
Dysphagia
Odynophagia
Weight loss

Often present late

42
Q

What investigations are done for pharyngeal cancers?

A

Imaging:
-CT
-MRI (include chest)

43
Q

What is usually given to patients with pharyngeal cancer to aid with feeding?

A

Gastrostomy tube

44
Q

What treatment is given for pharyngeal cancers?

A

Small tumours excised
Radiotherapy

Larger tumours not responding to radiotherapy need extensive surgery:
Mandibular split
Pharyngectomy
Robotic procedure

45
Q

What are the 3 key functions of the larynx?

A

Protecting trachea from food
Breathing
Speech

46
Q

How do laryngeal cancers present?

A

VOICE CHANGES (DYPHONIA)
Dysphagia
Refered otalgia
Globus (feels like lump in throat)
Neck lump
Weight loss
Cacexia

47
Q

What investigations are done for laryngeal cancers?

A

Imaging:
-CT (with Cx)
-PET
-Biopsy

48
Q

What issues do patients with laryngeal cancer usually have after treatment?

A

Long term voice issues
Swallowing problems

49
Q

How do you treat laryngeal cancer?

A

Small tumours excised
Medium sized tumours radio/chemotherapy
Large tumours that don’t respond to RT need extensive surgery like LARYNGECTOMY

50
Q

What is a laryngectomy?

A

Total removal of the larynx

The trachea no longer communicates with the pharynx so you ventilate straight through a hole in the neck called a stoma

51
Q

Why cant you speak normally after a laryngectomy?

A

Vocal cords have been removed

52
Q

What is a tracheostomy?

A

When a hole is made through the skin with a plastic pipe inserted into the trachea

53
Q

What lymph nodes undergo lymphadenopathy first when a head and neck cancer begins to spread?

A

Cervical lymph nodes

54
Q

What is the spinal nerve roots of the Cervical Plexus?

A

C1-C4

55
Q

What fibres of C1-C4 make up the cervical plexus?

A

Anterior fibres/rami

56
Q

Where is the cervical plexus located?

A

Halfway up on top of Sternocleidomastoid in the prevertebral fascial layer in the posterior neck triangle

57
Q

Where are the muscular branches of the cervical plexus locatated relative to the sensory branches?

A

Muscular branches deep to sensory branches

58
Q

What are the 3 main branches of the cervical plexus?

A

Phrenic nerve
Nerve to geniohyoid and thyrohyoid
Ansa cervicalis

59
Q

What are the spinal nerve roots of the phrenic nerve?

A

C3, C4, C5

60
Q

What is the spinal nerve roots of the nerve to geniohyoid and thyrohyoid?

A

C1

61
Q

What are the spinal nerve roots for the Ansa cervicalis?

A

C1, C2, C3

62
Q

What does the phrenic nerve innervate?

A

Diaphragm

63
Q

What route does the phrenic nerve take?

A

Travels down anterior scalene muscle to thorax passing in front of lung roots

64
Q

What is the nerve route of the geniohyoid and thyrohyoid nerve?

A

With hypoglossal nerve

65
Q

What is the nerve route of the hypoglossal nerve?

A

Medulla -> posterior cranial fossa ->hypoglossal canal

66
Q

What is the function of the geniohyoid muscle?

A

Move hyoid supero-anteriorly

67
Q

What is the function of the thyrohyoid?

A

Depress hyoid and elevates larynx

68
Q

What is the function of the Ansa cervicalis?

A

Innervates Infrahyoid muscles which depress hyoid

69
Q

What are the 4 muscular branches of the Ansa cervicalis?

A

Superior belly of omohyoid
Inferioir belly of omohyoid
Sternohyoid
Sternothryoid

70
Q

What are the 4 sensory branches of the cervical plexus?

A

Greater auricular nerve
Transverse cervical nerve
Lesser occipital nerve
Supraclavicular nerve

71
Q

What are the nerve roots of the 4 sensory branches of the cervical plexus?
Greater auricular nerve
Transverse cervical nerve
Lesser occipital nerve
Supraclavicular nerve

A

Greater auricular nerve C2-C3

Transverse cervical nerve C2-C3

Lesser occipital nerve C2-C3

Supraclavicular nerve C3-C4

72
Q

What does the greater auricular nerve innervate?

A

External ear + skin over parotid gland

73
Q

What does the transverse cervical nerve innervate?

A

Anterior neck

74
Q

What does the lesser occipital nerve innervate?

A

Posterosuperior scalp

75
Q

What does the Supraclavicular nerve innervate?

A

Supraclavicular fossa, upper thoracic region and Sternoclavicular joint

76
Q

What is Eros point and what is its clinical relevance?

A

Point halfway up midpoint of SCM where anaesthetics can be injected in to cause a cervical plexus nerve block

77
Q

What is the most common cause of hyperthyroidism?

A

Graves’ disease

78
Q

What is a cause of hypothyroidism?

A

Hashimoto’s disease

79
Q

Why does the thyroid gland move up on swallowing?

A

Thyroid gland ensheathed in pre-tracheal fascia which attaches to the hyoid bone

80
Q

What muscles overlie the thyroid gland?

A

Strap/infrahyoid muscles

81
Q

What is the most likely cause of a soft tissue mass that moves up when the patient swallows and sticks their tongue out?

A

Thyroglossal duct cyst

Normally the duct obliterates

82
Q

What anatomical structure does the Ansa cervicalis overlie?

A

Carotid sheath

83
Q

What muscles do the Ansa cervicalis innervate?

A

Infrahyoids

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