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Surgery literally enochs + stuff that I can't remember > 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

Dx: clinical assesment demonstrating recurrent infections
sleep study (+) OSA

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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

percutaneous trach….whats good about it???? also, what does it increase your risk of??

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

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

Comfort, weaning from ventilation

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9
Q

Contraindications (relative) of percutaneous trach (4)

A
  • < 15yo
  • Uncorrectable bleeding diathesis
  • Gross distortion of neck (hematoma, tumor, thyromegaly, scarring)
  • Infection
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10
Q

MC early complication of a trach

A

Obstruction, esp in percutaneous trachs
Sub-Q emphysema/pneumothorax

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11
Q

Worst complication seen late in percutaneous trach?

A

Tracheoarterial fistula

Massive hemorrhage

Trachial stenosis and malacia, reduced phonation also seen

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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)

What is a failed decannulation associated with?

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

age, greater severity of illness, renal failure and shorter duration of spontaneous breathing prior to decannulation

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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

What increases your risk of malignancy for thyroid cancer?

A
  1. Children, adults <30 or >60
  2. h/o head and neck irradiation
  3. Family h/o thyroid CA
18
Q

When are total thyroidectomies done? (4)

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

Lobectomy is done for a single nodule < 1 cm

19
Q

Image of thyroidectomy

A
20
Q

Main complications of thyroidectomy

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

make sure to start patient on levothyroixine!!! +check serum calcium levels + monitor voice

21
Q

S/Sx of hypocalcemia? +what PE would you see?

A

muscle spasms, tetany, dementia, seizures
Chvostek’s and Trousseau’s sign

Chvostek’s=cheek sign

22
Q

When is parotidectomy indicated?

A
  • Blockage of parotid duct d/t stone/mass
  • Parotid mass/tumor
23
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
24
Q

Main complications of parotidectomy

A
  • Facial nerve paralysis
  • Seroma
  • Hematoma
  • Wound Infection
25
Q

Facial nerve review

A

love dis

26
Q

what is a carotid endarterectomy?

A

surgical procedure to remove a build up of fatty deposits (plaque) which were narrowing your carotid omg

27
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

28
Q

Dx of carotid stenosis

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

PE: auscultation of carotids

29
Q

What is the gold standard for diagnosing carotid stenosis?

A

Carotid angiography

30
Q

What is the initial scan to check for carotid stenosis?

A

U/S

31
Q

ABSOLUTE CIs for carotid endarterectomy + relative

A
  • Complete asymptomatic occlusion of carotid artery
  • Relative: neck radiation, tracheostomy, neck dissection, high risk
32
Q

Pre-op meds for carotid endarterectomy

A
  • ASA 81mg
  • Statins

An exception to the no asa before surgery rule

33
Q

Post-op Complications of carotid endarterectomy

A
  • MI (MC)
  • CVA (ischemia, plaque emboli, platelet aggregates)
  • Cerebral hypoperfusion
  • Nerve Injury (hypoglossal/vagus/facial/Ansa cervicalis/recurrent laryngeal)
  • Hematoma
34
Q

Postop care for carotid endarterectomy

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

Surgery literally enochs + stuff that I can't remember (7 decks)

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