Flashcards in Fiser ABSITE Ch. 19 Head and Neck Deck (110):
The anterior neck triangle contains the carotid sheath. What are the borders?
SCM muscle, sternal notch and inferior border of the digastric muscle
The posterior neck triangle contains the spinal accessory nerve and the brachial plexus. What are the borders?
posterior border of SCM muscle, trapezius muscle and the clavicle
In the neck, on what muscle does the phrenic nerve sit?
anterior scalene muscle
Three glands in the mouth can be identified by their secretions:
____ glands - secrete mostly serous fluid.
___ glands - secrete mostly mucin.
___ glands - 50/50
In the larynx, where are the false vocal cords located in relation to the true vocal cords?
What are the three branches of the trigeminal nerve?
ophthalmic, maxillary, mandibular
What nerve provides motor function to face? and sensory?
What nerve provides sensory to posterior tongue. Motor to stylpharngeus. Injury affects swallowing?
Hypoglossal nerve provides motor to all of tongue except what muscle?
Recurrent laryngeal nerve innervates all of larynx except which muscle? What is it innervated by?
cricothyroid is innerved by superior thyroid nerve
What syndrome occurs after parotidectomy; injury of auriculotemporal nerve that then cross-innervates with sympathetic fibers to sweat glands of skin • Symptom: gustatory sweating?
What are the 5 branches of the thyrocervical trunk with mnemonic?
STAT, suprascapular artery, transverse cervical artery, ascending cervical artery, inferior thyroid artery
What is the 1st branch of the external carotid artery?
superior thyroid artery
What artery is the trapezius flap based on?
transerve cerivcal artery
What aretery is pectoralis major based on?
___ - congenital bony mass on upper palate of mouth. Tx: nothing ;
___ - similar to above but on the anterior lingual surface of the mandible
Torus palatini; Torus mandibular
What procedure takes accessory nerve (CN XII), sternocleidomastoid, internal jugular, omohyoid, submandibular gland, sensory nerves C2-C5, cervical branch of facial nerve, and ipsilateral thyroid • Most morbidity occurs from accessory nerve resection.
Radical neck dissection
What procedure takes omohyoid, submandibular gland, sensory nerves C2-C5, cervical branch of facial nerve, ipsilateral thyroid?
Modified radical neck dissection
What is the most common cancer of the oral cavity, pharynx, and larynx?
squamous cell CA
What are the two biggest risk factors for squamous cell CA of the oral cavity, pharynx and larynx?
tobacco and ETOH
What is considered more pregmalignant, leukoplakia or erythroplakia?
What is the most common site for oral cavity CA?
What location for oral cavity cancer has the lowest survival rate because it is hard to resect?
hard palate tumors
Glossitis, cervical dysphagia from esophageal web, spoon fingers, iron deficiency anemia and increased oral cavity CA
In the tx for oral cavity CA. Wide resection if tumor is less than ___, need 1-2 cm margins.;
If larger or if clinically positive nodes do what?
2 cm; MRND
What is the postop tx for oral cavity CA for advanced lesions (>2 cm, positive margins, nerve/vascular/lymphatic invasion)?
What location with lip CA is associated with more aggressive lesions?
Well-differentiated tumor of the cheek • Not aggressive • Tx: full cheek resection +/− flap; no MRND
What is the tx for cancer of the maxillary sinus?
What is the primary tx for nasopharyngeal SCCA? and what for tumors > 2 cm or clinically positive nodes?
XRT, MRND with postop chemo for advanced disease
What is the #1 tumor of the nasopharynx in children and what is the tx?
What is the most common benign neoplasm of the nose/paranasal sinuses?
What is the best way to bx tonsillary CA?
Benign tumor • Presents in males
What is the most common benign lesion of the larynx?
What are the three locations for laryngeal cancer?
What is the tx for small laryngeal cancer?
XRT or conservative surgery (glottic is laser or chordectomy with recurrence)
What are the three treatments for large laryngeal cancer?
laryngectomy, MRND, post op XRT
With glottic laryngeal cancer, what treatment is required for fixed cords?
What is the most frequent salivary gland for malignant tumor?
Is a mass in a large salivary gland more likely benign or malignant? and a small salivary gland?
mass in large gland is more likely benign
What is the #1 type of malignant tumor of the salivary gland?
What is the #2 type of malignant tumor of the salivary glands and the #1 malignant salivary tumor of the minor salivary glands?
Adenoid cystic CA
Tx for malignant tumor of the salivary gland is resection of the gland and if high grade or SCCA what are 2 other additional treatments?
prophylactic MRND and postop XRT
With parotidectomy when should the facial nerve be sacrificed?
facial nerve should be sacrificed only for direct tumor invasion or for preexisting facial paralyses
What is the #1 benign tumor of the salivary glands? what
What percentage of pleomorphic adenoma have malignant degeneration?
What is the difference in tx for pleomorphic adenoma and one with malignant degeneration?
superficial parotidectomy for pleomorphic adenoma and total parotidectomy with malignant degeneration with MRND if high grade
What is the #2 benign tumor of the salivary glands?
What sex preference for Warthin's tumor? what percent are bilateral?
What is the tx for Warthin's tumor?
What is the most common injured nerve with parotid surgery and what is the sx?
greater auricular nerve, numbness over lower portion of auricle
For submandibular gland resection what three nerves need to be found?
mandibular branch of the facial nerve, lingual nerve and hypoglossal nerve
What is the most common salivary gland tumor in children?
The facial nerve runs between what two lobes of the parotid gland?
superficial and deep
What is the physiology of cauliflower ear? and tx?
undrained hematomas that organize and calcify; need to be drained to avoid this
What is the name of a vascular tumor of the middle ear (paraganglionoma), tx: surgery and +/- XRT
CN VIII, tinnitus, hearing loss, unsteadiness; can grow into cerebellar/pontine angle. Tx: craniotomy and resection; XRT is alternative to surgery
Epidermal inclusion cyst of ear; slow growing but erode as they grow; present with conductive hearing loss and clear drainage from ear. Tx: surgical excision.
20% of Ear SCCA metastasize to where?
What is the most common childhood aural malignancy (although rare) of the middle or external ear?
What is the tx for septal hematoma?
need to drain to avoid infection and necrosis of septum
What is the tx for nasal fractures?
set after swelling decreases
CSF rhinorrhea usually indicates what fracture?
CSF rhinorrhea tx is conservative for how long? then try epidural catheter, may need transethmoid repiar.
What percentage of epistaxis is anterior and can be controlled with packing?
Persistant posterior epistaxis, consider ligation (direct or angiographically) of what two arteries?
internal maxillary artery or ethmoid artery
Slow-growing odontogenic malignancy; soap bubble appearance on xray; can have metastases. Tx: wide-local excision.
Treatment for TMJ dislocation?
What nerve damage can cause lip numbness?
inferior alveolar nerve
What is the tx for Stensen's duct laceration? why not ligation?
repair over catheter stent. Ligation can cause painful parotid atrophy and facial asymmetry
What is the most common organism is suppurative parotitis?
Tx for suppurative parotitis includes fluids, salivation, antibiotics; and ___ if abscess develops or pt not improving.
Acute inflammation of the salivary gland related to a stone in the duct; most calculi near orifice. Recurrent is thought to be due to ascending infection from the oral cavity. 80% of the time affects the submandibular or sublingual glands.
What is the tx for sialoadenitis? and for recurrent disease?
incise duct and remove stone, gland excision may eventually be necessary for recurrent diesease
What age group is peritonsillar abscess more common? and retropharyngeal abscess?
older kids (>10 years), younger kids (
Which is an airway emergency peritonsillar abscess or retropharyngeal abscess?
Retropharyngeal abscess is usually seen in younger kids but can be seen in the elderly with what disease?
What is the 1st tx for peritonsillar abscess? and if no relief in 24 hrs?
Needle aspiration 1st, then drainage through tonsillar bed if no relief in 24 hours May need to intubate to drain; will self-drain with swallowing once opened
Retropharyngeal abscess is an airway emergency. What is the tx?
Intubate the patient in a calm setting; drainage through posterior pharyngeal wall; will self-drain with swallowing once opened.
What age group does parapharyngeal abscess occur in?
all age groups
Morbitity in parapharyngeal abscess comes from ___ and mediastinal spread via prevertebral and retopharyngeal spaces.
Tx for parapharyngeal abscess includes drainage through lateral neck to avoid damaging what 2 structures? will need to leave drain in.
internal carotid and internal jugular veins
Acute infection of the floor of the mouth, involves mylohyoid muscle • Most common cause is dental infection of the mandibular teeth • May rapidly spread to deeper structures and cause airway obstruction • Tx: airway control, surgical drainage, antibiotics
All lumps near ear are what until proven otherwise?
What is the most common distant metastases location for head and neck tumors?
With posterior neck masses, if no obvious malignant epithelial tumor, considered to have what until proven otherwise? and how to dx?
Hodgkin's lymphoma, FNA or open bx
Neck mass workup:
• 1st - history and exam, laryngoscopy, antibiotics if thought to be inflammatory, ___ if hard
• 2nd - panendoscopy with multiple random biopsies, neck and chest CT
• 3rd - still cannot figure it out → perform ____; need to be prepared for MRND
FNA, excisional biopsy
Adenocarcinoma found in neck mass workup suggests what 3 possible primaries?
breast, GI or lung
Epidermoid CA found in cervical node without known primary
• 1st - ___ with random biopsies
• 2nd - CT scan
• 3rd - still cannot find primary → ipsilateral MRND, ipsilateral tonsillectomy, bilateral ___
What is the most common location for esophageal foreign body (95%)?
just below the cricopharyngeus
Perforation risk with esophageal foreign body increases with what?
length of time in the esophagus
Fever and pain after rigid EGD for esophageal foreign body. What next?
CXR and gastrografin followed by barium swallow to rule out perforation
Laryngeal foreign body, what might be needed as a last resort to secure airway?
Lip lacerations - apposition of the ___ is key. ___ closure is preferred
vermillion border, Layered
Prolonged intubation - can lead to ___, which is treated with laser, dilatation, possible excision
Tracheostomy should be considered in any pt who will require intubation for more than how many days?
Tracheostomy decreases secretions, provides easier ventilation, and decreases what other risk?
Rapid exsanguination after tracheostomy, think what? and do what?
tracheo-innominate fistula, median sternotomy
Tracheo-innominate fistula can be avoided by keeping tracheostomy above what?
3rd tracheal ring
Median rhomboid glossitis is failure of tongue fusion. What is the tx?
Cleft lip should be repaired at how many weeks, how many pounds and with a Hgb of what? Repair nasal deformities at the same time.
10 weeks, 10 lb, Hgb 10.
Cleft palate should be repaired at what age?
What is the most common benign head and neck tumor in adults?
Thumbprint sign on lateral neck film indicates what?
Why is epiglottits rare?
H. influenzae type B vaccine
What is the tx for epiglottitis?
early control of airway and abx
What are the most common sites for Kaposi's sarcoma?
oral and pharyngeal mucosa
What is the most common neoplasm in pts with AIDS?