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MRCS B > Neck > Flashcards

Neck Flashcards

1
Q

What 3 nerves are at risk during excision of submandibular gland and how do you test them?

A

Marginal mandibular division of facial nerve - Supplies depressor labii inferioris, mentalis and depressor anguli oris - Distorted smile Lingual nerve - CN V3: somatic sensation to anterior 2/3 tongue - CN VII: Taste to anterior 2/3 tongue Hypoglossal - CN XII - All intrinsic tongue muscles - All extrinsic tongue muscles (genioglossus, styloglossus, hyoglossus). Except palatoglossus (CN X) Nerve to mylohyoid (V3)

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2
Q

Gland secretion type (parotid, SMG, SLG)

A
  • Parotid: Serous acini - Submandibular: Mucinous and serous acini - Sublingual: Mucinous acini
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3
Q

Parasympathetic innervation to SMG

A
  • Superior salivatory nucleus > CN VII (chorda tympani) > Submandibular ganglion > Lingual nerve (CN V3 + CN VII) to innervate SMG
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4
Q

Identify SMG duct. Where does it drain?

A
  • Wharton’s Duct - ~ 5cm long - Opens into floor of mouth, either side of frenulum
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5
Q

DDX SMG lump

A
  • STONES: Sialolithiasis - INFECTION: Acute siladenitis - NEOPLASIA: Malignant (Adenoid cystic), benign (pleomorphic adenoma) - NON-PARENCHYMAL: Lymph node, sebaceous cyst, lipoma
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6
Q

MC parotid cancer

A
  • Mucoepidermoid adenocarcinoma
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7
Q

Lymphatic drainage of parotid

A
  • Deep and superficial pre-auricular nodes - Drain into the deep cervical chain
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8
Q

Nerve supply to parotid

A
  • PARASYMPATHETIC: Auriculotemporal nerve from Otic ganglion (ISN > LPN > Otic > ATN) - SOMATIC SENSORY: • Gland > Auriculotemporal nerve • Capsule > Greater auricular nerve
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9
Q

Which cranial nerves carry parasympathetic fibers?

A

3, 7, 9, 10 • III: EWN > CN III > Ciliary Ganglion > Short ciliary nerves > Ciliary muscles > Pupillary constriction • VII: SSN > GPN (VII) > Pterygopalatine ganglion > Lacrimal gland SSN > Chorda tympani (VII) > Submandibular ganglion > lingual nerve > SMG IX: ISN > LPN (CN IX) > Otic > Auriculotemporal nerve > Parotid X >Parasympathetics to thoracic and abdominal viscera

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10
Q

Branches of greater auricular nerve?

A
  • Anterior > Capsule of parotid - Lobular > Ear lobe - Posterior > mastoid
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11
Q

Draw incision for parotidectomy

A
  • Incision posterior to mandible down to angle and parallel to anterior border of SCM - Small retroauricular portion > Risk to GAN - Pre-auricular incision (doesn’t risk GAN)
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12
Q

Sensory domain of GAN?

A
  • C2/3
  • Angle of mandible
  • Lobe of ear
  • Lower medial aspect of pinna
  • Parotid capsule
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13
Q

What is Frey’s syndrome

A
  • Syndrome characterised by gustatory sweating
  • Damage to auriculotemporal nerve (V3)
  • Auriculotemporal nerve carries parasympathetic fibers to parotid from otic ganglion
  • Damage may lead to cross innervation with sympathetic nerve fibres supplying sweat glands
  • Abnormal sweating/ salivation
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14
Q

Embryology of thyroid

A
  • Develops from 1st and 2nd pharyngeal pouches
  • Thyroglossal tract develops from foramen caecum (base oif tongue)
  • Descends inferiorly in the midline
  • Expansion of caudal end of tract gives rise to thyroid gland
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15
Q

Formation of thyroglossal cyst

A
  • Midline neck mass that moves up on swallowing and tongue protrusion
  • Patent thyroglossal duct
  • Mx: Sistrunk procedure. Resection of cyst, mid-portion of hyoid bone.
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16
Q

Overview of thyroxine production

A
  • Thyroid composed of follicles, outer layer of cuboidal epithelium and inner colloid
  • Follicles produce thyroxine
  • Pumping of iodide into follicular cell
  • TPO joins iodide to form iodine, iodine then joined to tyrosine on colloid
  • Forms monoiodotyrosine and diiodotyrosine
  • Combine to form T3 and T4 (thyroxine)
  • Stored in colloid bound to thyroglobulin
  • Released by exocytosis when needed
  • Parafollicular cells secrete calcitonin
17
Q

Which is more biologically active T4/T3?

A
  • More T4 is produced although T3 more biologically active
18
Q

Why does thyroid move up on swallowing?

A
  • Berry’s ligament
  • Attaches thyroid gland to trachea
19
Q

Blood supply to thyroid

A
  • Superior thyroid artery > First branch of ECA
  • Inferior thyroid artery > Thyrocervical trunk (branch of SCA)
20
Q

Venous drainage THYROID

A
  • Superior thyroid vein  IJV
  • Middle thyroid vein  IJV
  • Inferior thyroid vein  Left brachiocephalic vein
21
Q

Nerves at risk during thyroidectomy, what vessels are close by

A
  • SLN > near superior thyroid artery (External branch, motor to cricothyroid)
  • RLN > near inferior thyroid artery
22
Q

Which vessels of thyroid related to sympathetic trunk?

A
  • Inferior thyroid artery (branch of TCT) runs posterior to sympathetic chain
23
Q

Describe course of recurrent laryngeal nerves

A
  • Branches of the vagus nerve (CN X)
  • Motor supply to all muscles of larynx and sensation below vocal cords
  • Right RLN hooks under the right subclavian artery and ascends in trachea-oesophageal groove
  • Left RLN hooks under arch of aorta by the ligamentum arteriosum (ductus arteriosus remnant) and ascends in left trachea-oesophageal groove
24
Q

Lymphatic drainage thyroid

A
  • Paratracheal and deep cervical
25
Q

Which thyroid cancer spreads via lymph

A
  • Papillary
  • MC thyroid cancer
26
Q

Cell of origin of medullary carcinoma

A
  • Parafollicular C-cells
  • Produced calcitonin
27
Q

Where would you perform cricothyroidotomy

A
  • Incision is made through cricothyroid membrane to establish a surgical airway if failed ETT
  • Laryngeal prominence = superior border of thyroid cartilage
  • Immobilise larynx
  • Vertical skin incision on anterior larynx
  • Blunt dissection using finger down to cricothyroid membrane
  • Horizontal stab incision through CTM
  • Insert bougie, confirm position with tracheal clicks felt as bougie passes over tracheal rings
  • Pass tracheal tube over bougie
  • Remove bougie, inflate cuff and secure. Confirm position with capnography
28
Q

Why does bronchial carcinoma cause a hoarse voice?

A
  • Vocal cord paralysis due to pressure effect on RLN
29
Q

Where are parathyroid glands?

A
  • 2 parathyroid glands on each side of neck (superior and inferior)
  • Deep to lateral aspect of thyroid gland
  • Superior = lateral to RLN at level of 1st tracheal ring
  • Inferior = medial to RLN at variable position
30
Q

Development of parathyroid glands?

A
  • Superior from 4th pharyngeal pouch
  • Inferior from 3rd pharyngeal pouch
31
Q

Blood supply parathyroid glands

A
  • Both supplied by inferior thyroid artery
32
Q

Commonest location of ectopic parathyroid gland?

A
  • Tail of thymus
  • Also found in mediastinum and in the thyroid
  • Intra-op PTH levels useful for localising single adenoma (cause of primary hyperPTH in 80%)
33
Q

Fascial layers of neck and contents

A
  • Investing > SCM and trapezius
  • Pre-tracheal > Strap muscles, thyroid, trachea, oesophagus
  • Pre-vertebral > Verebrae, scalene muscles, deep muscles of back and pre-vertebral muscles
  • Carotid sheath > CCA, vagus, IVJ

MRCS B (6 decks)

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