Surgery C - Oral & Maxillofacial Flashcards
Head and neck cancer is ther ____th most common cancer
Head and neck cancer is ther 8th most common cancer
- The major risk factors for head and neck cancer in the UK
are:
Smoking (tobacco)
Alcohol consumption
Human Papilloma Virus has also gained increased
recognition in terms of ____________ cancer
Human Papilloma Virus has also gained increased
recognition in terms of oropharyngeal cancer
Which type of cancer is associated with epstrin barr virus?
- Nasophayngeal
What are some Premalignant Lesions that can cause head and neck cancer?
Leukoplakia
Erythroplakia
Oral epithelial dysplasia
Oral Lichenoid lesions
Proliferative verrucous leukoplakia
Chronic Hyperplastic Candidiasis
What are some Premalignant conditions that can cause head and neck cancer?
Fanconi anaemia
Ataxia telangiectasia
Blooms syndrome
Li-Fraumeni syndrome
What type of Immunosuppression can cause head and neck cancer?
AIDS (Kaposi, non-Hodgkins)
Immunosuppressive therapy
What type of Premalignant lesion is this?
Leukoplakia
What type of Premalignant lesion is this?
Erythoplakia
What type of Premalignant lesion is this?
Proliferative verrucous leukoplakia
Clinical presentation of head and neck cancer in oral cavity
- Leukoplakia/Erythroplakia
*Persistent ulcer
*Pain
*Pain radiating to ear
*Submucosal swelling
*Speech/Swallow disturbance
*Enlarged lymph nodes - Cranial nerve involvement V, XII
Head and Neck Cancer Clinical presentation: Nasopharynx
- Obstruction
- Nasal discharge
*Blood stained discharge - Unilateral hearing loss
- Cervical lymphadenopathy
Head and Neck Cancer
Clinical presentation:
Oropharyngeal/Hypopharynx
- Sore throat
- Sensation of a foreign body in the throat
- Dysphonia
- Dysphagia
- Odynophagia
- Pain referred to ear
- Cervical lymphadenopathy
What is the head and neck clinical presentation?
Cervical lymphadenopathy
Head and Neck Cancers
Clinical presentation: Larynx
- Hoarseness
*Swallowing difficulties
*Pain - Cervical lymphadenopathy
*Airway compromise
Head and Neck Cancers
Clinical presentation: Salivary glands
- Lump in gland
*Pain (less common) - Facial nerve weakness
- Hypoglossal/lingual nerve impairment
- Lump in mouth
- Oropharyngeal mass
- Cervical lymphadenopathy
What is the head and neck clinical presentation?
Parotid mass
Diagnostics for head and neck cancer ?
- Clinical examination
- Thorough oral cavity exam- (good lighting)
*Exam of cervical lymph nodes (clinical skill)
*Examine scalp. - Cranial nerve exam
- Flexible naso endoscopy (FNE)
*Examination under Anaesthesia- Panendoscopy
Majority of head and
neck cancers are
Majority of head and
neck cancers are Squamous cell carcinoma
Head and neck cancers
What type of biopsies can you take for histology?
Incisional biopsy
Fine needle aspirate (fna)
Core biopsy
Imaging for head and neck cancer?
- Oral Cavity- MRI for soft tissue, CT if bony
- Oropharynx- MRI
- Nasopharynx- MRI
- Hypopharynx- MRI
- Larynx- MRI
*Salivary- MRI - To rule out metastasis- CT Chest
- Orthopantogram- for dental assessment
What type of cancer ultrasound is useful for
lymphadenopathy as can use US to characterize the neck
lump and attain an FNA
What type of cancer CT is useful for
CT scan useful for certain situations- i.e bony involvement,
parotid disease with query extension to stylomastoid
foramen, for surgical planning for bony extension
What type of cancer PET CT is useful for
Unknown primary, recurrence
WHat is in the MDT for head and neck cancer?
- Head and Neck surgeon (Maxillofacial/ENT)
- Radiologist
- Clinical Oncologist
- Histopathologist
- Clinical nurse specialist
*SALT - Dietician
- Restorative dentists
What are the treatment options for head and neck cancers?
Surgery
Radiotherapy
Chemotherapy
What treatment can be considered a first line treatment for early cancers in
some subsites
radiotherapy
For oral cavity- ________ remains gold standard curative option
For oral cavity- surgery remains gold standard curative option
Radiotherapy is Delivered over a _ week period
Delivered over a 6 week period
Radiotherapy
*Side effect profile – Acute
Mucositis
Skin erythema or ulceration
Loss of taste
Impaired nutrition
Bleeding
Infection
Lymphoedema
Radiotherapy
Side effect profile – Late:
Impaired healing
Osteoradionecrosis
Impaired swallow/speech/taste
Xerostomia
Dental caries
Loss of hair
Radiation induced tumours
Cataracts
TRUE OR FALSE
Chemotherapy alone cannot cure head and neck cancer
TRUE
What is the predominant use of chemotherapy in head and neck cancers?
Predominant use is as an adjuvant treatment for locally
advanced, recurrent and metastatic disease
Important points to know about the chemotherapy in the head and neck cancers?
*Predominantly cisplatin based
* Targeted biological agents such as cetuximab has a role in
locally advanced and metastatic disease
* Neoadjuvant or induction chemo at present has not shown to
have a role
What is the follow up like for head and neck cancer?
- Treatment has a significant impact on patients quality of life
*Patients undergo regular follow up over 5 years - First 2 years seen as high risk time for recurrence
- Regular support needed- Head and neck nurse specialist
Is head and neck cancer more common in men or women?
men
Contusions and abrasions are the medical words for?
grazes and brusies
An incised wound is caused by?
Sharp object
A laceration is caused by?
Blunt object
What is a wound?
An injury in which the skin is divided or its continuity broken
Important points to remember about incision wound?
- Sharp instrument
- Scalpel
- Knife
- Glass
- Clean straight edges
- Linear
- Single
- Multiple
- Often deeper than appear
- Fine scaring
Important points to remember about Laceration wound?
- Blunt injury
- Crushing force
- Explosion
- Irregular edge
- Associated with bruising
- Often underlying hard
tissue injury - Often poor healing
- Secondary revision
What are the four main groups of mid face fractures?
- Naso-maxillary
- Maxilla / Upper jaw
-Le Fort Fractures - Naso-ethmoid
- Orbit
Name some soft tissue injury?
Wound
Contusion
Laceration
Abrasion
Incised wound
Definitions of
Wound
Contusion
Laceration
Abrasion
Incised wound
Wound – not specific injury
* Contusion – bruising beneath skin
* Laceration – cut caused by blunt trauma
- Almost always down to bone
- Some degloving lacerations only involve skin
* Abrasion – graze caused by abrasive surface
* Incised wound – caused by sharp object
What is the most common type of fracture in the mid face
cheek bone fracture
What are the three types of cheek bone fractures
- Fronto-zygomatic suture, greater wing of sphenoid, to
inferior orbital fissure (LINE) - Orbital floor, orbital rim, infra-orbital foramen, anterior
maxilla, zygomatic buttress, posterior maxilla to inferior
orbital fissure (CIRCLE) - Zygomatic arch (STICK)
What is the eye-brow sign
air in the orbit or above
-dark line of air above the eyeball
What is the assessment for cheek bone/orbit injury
Check visual acuity first – nothing else really counts
Ask about how many thumps
* Single punch not on nose / nerve and nose bleed/numb
* Always = fracture
Lay on your hands – compare one side with other
* Feeling a dent or step may be only sign of arch fracture
* If you can’t notice a difference, operation unlikely
* But refer to OMFS just in case
What is the term LeFort fractures
The term LeFort fractures is applied to transverse fractures of the midface. Rene’ LeFort described three transverse weak lines through the midfacial skeleton
type I is a horizontal injury, type II is a pyramidal injury, and type III is a very extensive transverse injury that often results in a craniofacial dislocation.
Name the different parts of the mandible
What are some signs of mandible fracture
If their teeth do not fit together as before
Numbness when nerve not bashed
* Blood
* Significant dysfunction/deformity
* Pain where they were not hit
* Altered sensation
* Air where it should not be
* Mobility
Bloody SPAAM is the big 6 symptoms and signs of fractures
What are they?
- Blood in funny places
- Significant change in appearance/function
- Including visual acuity or double vision
- Pain where there was no direct injury
- Altered feeling/numbness not explained by direct
trauma to nerve - Air where it should not be
- Mobility where none should be
Name some examples of blood in funny places
- Unilateral epistaxis with no trauma to nose
- Zygoma
- Orbital blow-out
- Anterior Maxillary Fracture
- Sub-conjunctival haemorrhage no posterior border
- Zygoma
- Orbit
- Le Fort II or II
- Sub-lingual haematoma
- Blood from behind a wisdom tooth
- Bleeding from lingual gingival tear
- Bilateral epistaxis with no trauma to nose
- Le Fort I or bilateral zygomas
- Bruises around greater palatine foramen
- Pathognemonic of maxillary fracture (I, II, or III)
What does significant decrease in function mean?
Significant Decrease in function (4 Ds)
* Dents, steps and bone deformity (always a #)
* Decrease in visual acuity
- Most important change in facial function
* Double vision (usually but not always a #)
- Remember to check acuity first
* Deranged occlusion (usually but not always a #)
- Could also be damaged/displaced tooth
- Effusion or haemarthrosis of TMJ
Examples of Pain or tenderness where no direct injury
- Buttress tenderness (hard place to hit!!)
- Zygoma, le Fort I and II
- Tenderness at condylar neck of mandible
- Fracture of condylar neck or base.
- Tenderness on orbital rim or FZ region
- Zygoma/ le fort II /III (esp. if on clenching teeth)
Examples of Altered sensation not by direct nerve injury
- Lip numbness if no blow to mental foramen
- Fracture must be between mental and ID foramen
- Infra-orbital nerve - if no direct blow to ION
- Zygoma, blow-out, naso-maxillary fracture
- Numbness of maxillary teeth and gum
- Anterior maxillary wall and Le Fort fractures
Examples of Air where it should not be
- Forced out under pressure from
sinuses - Sudden swelling without bruising: My eye just closed when I blew my nose
- Air emphysema: Crackling of air under the skin
- May also be seen on radiographs
-“Eye-brow” sign on OM views - Pockets of air on CT scan
name some Maxillofacial Emergencies
- Airway compromise
- Severe Bleeding
- Retro-bulbar Haemorrhage
sight threatening - White eye blow-out fracture
- Avulsed tooth
What are the three zones in the neck
What is retrobulbar hemorrhage?
Retrobulbar hemorrhage (RBH) is a rapidly progressive, sight-threatening emergency that results in an accumulation of blood in the retrobulbar space
what is a White eye blow-out
White-eyed blowout fracture is often found in pure orbital floor blowout fracture among pediatric patients. Unlike common orbital blowout fractures with apparent clinical signs, the diagnosis of white-eyed orbital blowout fractures is difficult because of minimal soft-tissue signs.
what is an Avulsed Tooth
An avulsed tooth occurs when a tooth is completely dislodged from its socket. Avulsed teeth are dental emergencies and require immediate treatment. To save your tooth, try reinserting your tooth right away. Teeth treated within 30 minutes to one hour have the best chance of success
What is Craniosynostosis
Craniosynostosis is a birth defect in which the bones in a baby’s skull join together too early. This happens before the baby’s brain is fully formed. As the baby’s brain grows, the skull can become more misshapen
What is a normal head shape?
- wide and round at the back
- high at the back
- narrows and lowers to the front
- flat at the front
- vertex above bregma
Premature fusion of the metopic suture can cause?
Trigonocephaly
What is Trigonocephaly
Trigonocephaly is the premature closure of the metopic suture causing the inability of the frontal bones to grow laterally, thus forming a triangular forehead with an obvious or subtle osseous ridge.
What is the most common of the non syndromic cranial synostoses
scaphocephaly
What is scaphocephaly
boat shaped head
sagittal synostosis
What type of shape does positional plagiocephaly have?
parallelogram
TRUE OR FALSE postional plagicephaly does not need surgery
TRUE
what is unicoronal craniosynostosis
Unicoronal craniosynostosis is a type of non-syndromic craniosynostosis and occurs when one of the two coronal sutures fuses before birth
what is syndromic craniosynostosis
Craniosynostosis is the premature fusion of one of the cranial sutures, which results in restricted head growth and an abnormal head shape. Most cases involve a single suture and have no other abnormalities.
what is a crouzon syndrome
Crouzon syndrome is a genetic disorder characterized by the premature fusion of certain skull bones (craniosynostosis). This early fusion prevents the skull from growing normally and affects the shape of the head and face. Many features of Crouzon syndrome result from the premature fusion of the skull bones
