Lecture 7: Common Head and Neck Surgeries Flashcards
Tonsillectomy and Adenectomy (T&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
How are tonsils graded?
Grade 0 to Grade 4
When is tonsillectomy indicated in peds? (3)
- OSA - first line tx
- Recurrent throat infections (see image below)
- Peritonsillar abscess
Dx: clinical assesment demonstrating recurrent infections
sleep study (+) OSA
Indications for adenoidectomy in peds (3)
- Nasal obstruction 2/2 adenoid hypertrophy (OSA)
- Chronic sinusitis
- Recurrent OM with h/o tubes
Contraindications for T&A (3)
- Cleft palate
- Coagulopathies/anemia
- Active infection
MCC of peritonsillar abscess
Group A strep
When is tracheostomy indicated? (3)
- Unable to wean from invasive ventilation within 1-3 weeks
- Critically ill pts
- Medically induced coma
percutaneous trach….whats good about it???? also, what does it increase your risk of??
- 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
Contraindications (relative) of percutaneous trach (4)
- < 15yo
- Uncorrectable bleeding diathesis
- Gross distortion of neck (hematoma, tumor, thyromegaly, scarring)
- Infection
MC early complication of a trach
Obstruction, esp in percutaneous trachs
Sub-Q emphysema/pneumothorax
Worst complication seen late in percutaneous trach?
Tracheoarterial fistula
Massive hemorrhage
Trachial stenosis and malacia, reduced phonation also seen
How often do you change a trach tube?
- Change initially after 1-2 weeks.
- Change every 1-3 months after.
No universal indications
Who can be decannulated from their trach? (3)
What is a failed decannulation associated with?
- 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
How do we decannulate?
- Downsize/capping trial first
- Removal of tube
- Closing the stoma
What diagnostic tests determine if we should operate or not on a thyroid mass?
- FNA Biopsy
- Thyroid scintigraphy (hot = non-malignant)
What are the 3 primary thyroid cancers?
- Papillary (MC)
- Follicular
- Anaplastic (Most aggressive, least common)
Popular papillaries, angry anaplastics
What increases your risk of malignancy for thyroid cancer?
- Children, adults <30 or >60
- h/o head and neck irradiation
- Family h/o thyroid CA
When are total thyroidectomies done? (4)
- Multifocal nodules
- Nodule > 1cm
- Nodule extending across the isthmus
- Metastatic or anaplastic
Lobectomy is done for a single nodule < 1 cm
Image of thyroidectomy
Main complications of thyroidectomy
- 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
S/Sx of hypocalcemia? +what PE would you see?
muscle spasms, tetany, dementia, seizures
Chvostek’s and Trousseau’s sign
Chvostek’s=cheek sign
When is parotidectomy indicated?
- Blockage of parotid duct d/t stone/mass
- Parotid mass/tumor
How do we dx parotid blockage/mass?
- Enlargement of gland
- US (limited)
- CT w/ con is best first line
- MRI if concerned for a vascular or malignant tumor
Main complications of parotidectomy
- Facial nerve paralysis
- Seroma
- Hematoma
- Wound Infection
Facial nerve review
love dis
what is a carotid endarterectomy?
surgical procedure to remove a build up of fatty deposits (plaque) which were narrowing your carotid omg
Indications for carotid endarterectomy
Carotid stenosis w/ 70%-99% stenosis of carotid artery + > 5 yr of life expectancy + medically qualify
MC at the bifurcation
Dx of carotid stenosis
- Carotid angiography Gold
- CTA/MRA
- U/S initially
PE: auscultation of carotids
What is the gold standard for diagnosing carotid stenosis?
Carotid angiography
What is the initial scan to check for carotid stenosis?
U/S
ABSOLUTE CIs for carotid endarterectomy + relative
- Complete asymptomatic occlusion of carotid artery
- Relative: neck radiation, tracheostomy, neck dissection, high risk
Pre-op meds for carotid endarterectomy
- ASA 81mg
- Statins
An exception to the no asa before surgery rule
Post-op Complications of carotid endarterectomy
- MI (MC)
- CVA (ischemia, plaque emboli, platelet aggregates)
- Cerebral hypoperfusion
- Nerve Injury (hypoglossal/vagus/facial/Ansa cervicalis/recurrent laryngeal)
- Hematoma
Postop care for carotid endarterectomy
- Neuro checks Q1h
- BP checks Q2h (SBP: 100-150)
- Cont asa/statins
- IP 3-5 days
- F/u U/S 3-6 weeks later
