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Surgery > Lecture 7: Common Head and Neck Surgeries > Flashcards

Lecture 7: Common Head and Neck Surgeries Flashcards

1
Q

Tonsillectomy and Adenectomy (T&A)

A
  • Tonsillectomy: Removal of both palatine tonsils
  • Adenoidnectomy: Removal of adenoids. one of the MC surgical procedures on kids

Can do either or even both

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2
Q

How are tonsils graded?

A

Grade 0 to Grade 4

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3
Q

When is tonsillectomy indicated in peds? (3)

A
  • OSA - first line tx
  • Recurrent throat infections (see image below)
  • Peritonsillar abscess
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4
Q

Indications for adenoidectomy in peds (3)

A
  • Nasal obstruction 2/2 adenoid hypertrophy (OSA)
  • Chronic sinusitis
  • Recurrent OM with h/o tubes
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5
Q

Contraindications for T&A (3)

A
  • Cleft palate
  • Coagulopathies/anemia
  • Active infection
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6
Q

MCC of peritonsillar abscess

A

Group A strep

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7
Q

When is tracheostomy indicated? (3)

A
  • Unable to wean from invasive ventilation within 1-3 weeks
  • Critically ill pts
  • Medically induced coma
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8
Q

Pros of percutaneous trach

A
  • Quick
  • Cheap
  • No OR required
  • Greater risk for tracheal injury

Done by either a surgeon or intensivist (critical care or pulm)

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9
Q

Contraindications (relative) of percutaneous trach (4)

A
  • < 15yo
  • Uncorrectable bleeding diathesis
  • Gross distortion of neck
  • Infection
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10
Q

MC early complication of a trach

A

Obstruction, esp in percutaneous trachs

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11
Q

Worst complication seen late in percutaneous trach?

A

Tracheoarterial fistula

Massive hemorrhage

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12
Q

How often do you change a trach tube?

A
  1. Change initially after 1-2 weeks.
  2. Change every 1-3 months after.

No universal indications

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13
Q

Who can be decannulated from their trach? (3)

A
  • No upper airway obstruction
  • Must be able to clear their own secretions
  • Effective cough
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14
Q

How do we decannulate?

A
  • Downsize/capping trial first
  • Removal of tube
  • Closing the stoma
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15
Q

What diagnostic tests determine if we should operate or not on a thyroid mass?

A
  • FNA Biopsy
  • Thyroid scintigraphy (hot = non-malignant)
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16
Q

What are the 3 primary thyroid cancers?

A
  • Papillary (MC)
  • Follicular
  • Anaplastic (Most aggressive, least common)

Popular papillaries, angry anaplastics

17
Q

When are total thyroidectomies done?

A
  • Multifocal nodules
  • Nodule > 1cm
  • Nodule extending across the isthmus
  • Metastatic or anaplastic

Lobectomy is done for a single nodule < 1 cm

18
Q

Image of thyroidectomy

A
19
Q

Main complications of thyroidectomy

A
  • Recurrent laryngeal nerve injury (vocal cord paralysis)
  • Resection of parathyroids leading to Hypocalcemia
  • Hypothyroidism
20
Q

When is parotidectomy indicated?

A
  • Blockage of parotid duct d/t stone/mass
  • Parotid mass/tumor
21
Q

How do we dx parotid blockage/mass?

A
  • Enlargement of gland
  • US (limited)
  • CT w/ con is best first line
  • MRI if concerned for a vascular or malignant tumor
22
Q

Main complications of parotidectomy

A
  • Facial nerve paralysis
  • Seroma
  • Hematoma
  • Wound Infection
23
Q

Indications for carotid endarterectomy

A

Carotid stenosis w/ 70%-99% stenosis of carotid artery + > 5 yr of life expectancy + medically qualify

MC at the bifurcation

24
Q

Dx of carotid stenosis

A
  • Carotid angiography Gold
  • CTA/MRA
  • U/S initially
25
Q

What is the gold standard for diagnosing carotid stenosis?

A

Carotid angiography

26
Q

What is the initial scan to check for carotid stenosis?

A

U/S

27
Q

ABSOLUTE CIs for carotid endarterectomy + relative

A
  • Complete asymptomatic occlusion of carotid artery
  • Relative: neck radiation, trach, neck dissection, high risk
28
Q

Pre-op meds for carotid endarterectomy

A
  • ASA 81mg
  • Statins

An exception to the no asa before surgery rule

29
Q

Post-op Complications of carotid endarterectomy

A
  • MI (MC)
  • CVA
  • Cerebral hypoperfusion
  • Nerve Injury (hypoglossal/vagus/facial/Ansa cervicalis/recurrent laryngeal)
  • Hematoma
30
Q

Postop care for carotid endarterectomy

A
  • Neuro checks Q1h
  • BP checks Q2h (SBP: 100-150)
  • Cont asa/statins
  • 3-5 days
  • F/u U/S 3-6 weeks later

Surgery (8 decks)

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