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Head and Neck + Plastic > Neck Dissection > Flashcards

Neck Dissection Flashcards

1
Q

DDX for central neck mass

A

Thyroglossal cyst
Thyroid mass (isthmus)
Parathyroid gland
Skin lesion
Lipoma

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2
Q

DDx of anterior triangle

A

Cervical lymph node
Carotid body tumor
Carotid body aneurysm
Branchial cyst

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3
Q

DDX of posterior triangle

A

Cervical LN
Cystic hygroma
Neurogenic tumor
Pharyngeal pouch
Cervical rib

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4
Q

Boundaries of anterior triangle

A

Midline
Anterior border of SCM
Inferior border of mandible

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5
Q

Boundaries of posterior triangle

A

Posterior border of SCM
Anterior border of trapezius
Clavicle

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6
Q

What is a branchial cyst?

A

Congenital epithelial cysts, due to failure of obliteration of branchial cleft during embyronic development

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7
Q

What is cystic hygroma?

A

Cystic lymphatic lesion that are benign lymphatic malformations that can arise anywhere

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8
Q

Drainage of level 1 (submental + submandibular) lymph nodes

A

Lower lip
Oral cavity
Salivary gland
Anterior tongue
Anterior nasal cavity

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9
Q

Drainage of Level 2 LN (upper jugular)

A

Oral cavity
Nasal cavity
Pharynx (naso/oro/hypo)
Larynx
Parotid Gland

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10
Q

Drainage of Level 3 LN( middle jugular group)

A

Oral cavity
Pharynx (naso/oro/hypo)
Larynx

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11
Q

Drainage of the Level 4

A

Hypopharynx
Cervical Oesophagus
Larynx

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12
Q

Drainage of Level 5 LN (posterior triangle)

A

Nasopharyx
Oropharynx
Thyroid gland

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13
Q

Drainage of Level 6

A

Thyroid gland
Glottic/subglottic larynx
Pyriform sinus
Cervical oesophagus

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14
Q

Boundaries of Level 1a

A

Both sides of anterior belly of digastric
Hyoid

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15
Q

Boundaries of Level Ib

A

Anterior belly of digastric
Posterior belly of digastric
Mandible (superior)

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16
Q

Boundaries of Level II

A

Superior: skull base
Inferior: hyoid bone (horizontal plane along inferior border)
Anterior: stylohyoid
Posterior: posterior border of SCM
Division of a/b: vertical plane of spinal accessory nerve

17
Q

Boundaries of the Level III

A

Superior: hyoid horizontal plane
Inferior: inferior border of cricoid cartilage
Anterior: sternohyoid
Posterior: Posterior border of SCM

18
Q

Boundaries of Level 4 (lower jugular)

A

Superior: plane of lower border of cricoid cartilage
Inferior: clavicle
Anterior: sternohyoid
Posterior: posterior body of SCM

19
Q

What separates 5a and 5b?

A

Horizontal plane from inferior arch of cricoid cartilage

20
Q

What lymph nodes due level 6 contain?

A

Pre-tracheal
Para-tracheal
Pre-cricoid
Peri-thyroidal

21
Q

What is the boundaries of level 6?

A

Superior: hyoid
Inferior: suprasternal notch
Lateral: common carotid artery

22
Q

Define radical neck dissection

A

Removal of all lymphatic tissue in levels 1-5 along with spinal accessory nerve, internal jugular vein and sternocleidomastoid muscle

23
Q

Define extended radical neck dissection

A

Removal of additional lymph node groups in addition to radical neck dissection (level 1-5)

24
Q

Define modified radical neck dissection

A

Removal of lymphatic tissue in levels 1-5 while preserving any or all of the three non-lymphatic structures (spinal accessory nerve, internal jugular vein, sternocleidomastoid muscle)

25
Q

Modified Radical Neck Dissection
1) Type 1
2) Type 2
3) Type 3
Preservation of which non-lymphatic structures

A

1) spinal accessory nerve (SAN)
2) SAN and internal jugular vein (IJV)
3) SAN, IJV and sternocleidomastoid

26
Q

Central neck dissection

A

Level 6

27
Q

Anterior neck dissection

A

Level 6

28
Q

Lateral neck dissection

A

Level 2,3,4

29
Q

Posterolateral neck dissection

A

Level 2,3,4,5

30
Q

Define selective neck dissection

A

Dissection of lymphatic tissue in less than level 1-5 with preservation of SAN, IJV, and SCM

31
Q

Indications for modified radical neck dissection

A
  • N0 in Upper aerodigestive tract SCC, esp hypopharyx or larynx
  • N1 neck with mobile nodes <3cm
  • Well differentiated thyroid cancer with lymph nodes in posterior triangle
32
Q

Indications for supra-omohyoid neck dissection

A
  • Oral cavity cancer with N0
33
Q

Indications for bilateral supra-omohyoid neck dissection

A
  • Anterior tongue cancer
34
Q

Supraomohyoid neck dissection

A

Level 1, 2, 3

35
Q

Indications for supraomohyoid dissection + parotidectomy

A

Melanoma of cheek

SCC of cheek

36
Q

Indications for lateral neck dissection

A

N0 neck in

  • CA oropharynx
  • CA hypopharynx
  • CA larynx
  • CA supraglottis
37
Q

Indications of posterolateral neck dissection

A
  • Melanoma
  • Skin SCC
  • Soft tissue sarcoma of neck and scalp
38
Q

Indications for anterior neck dissection

A
  • Thyroid cancer
  • Parathyroid cancer
  • Sub-glottic cancer
  • Cervical oesophageal cancer
  • Laryngeal cancer with subglottic extension
39
Q

Complications of modified radical neck dissection

A
  • Hematoma
  • Infection
  • Skin flap necrosis
  • Chyle fistula
  • Marginal mandibular nerve injury
  • Carotid artery rupture
  • Shoulder syndrome (if SAN preserved)
  • Cosmetic neck deformity (if loss of SCM)
  • Facial edema (if IJV ligated)
  • Apnea (carotid body denervation if bilateral dissection)
  • Jugular vein thrombosis or blowout if subsequent radiotherapy

Head and Neck + Plastic (4 decks)

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