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#DAY3_SURGERY > Head and Neck > Flashcards

Head and Neck Flashcards

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1
Q

most common preventable risk factor in the head and neck CA

A

tobacco and alcohol

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2
Q

It is a second tumor detected within 6 months of the diagnosis of the initial primary lesion

A

synchronous neopllasm

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3
Q

It is a second tumor detected more than 6 months of the diagnosis of the initial primary lesion

A

metachronous neoplasm

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4
Q

What is the initial evaluation of patients with primary CA of head and neck

A

panendoscopy

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5
Q

Most common location of squamous cell CA of the lip

A

lower lip BCCA - upper lip

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6
Q

What nerve is involved when there is paresthesia of the lips

A

mental nerve

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7
Q

treatment of squamous cell cancer of the lip

A

T1 - T2: resection = radiation T3 - T4: surgical excision with histologic confirmation of tumor free margin and post operative radiation

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8
Q

Selective neck dissection

A

o Supraomohyoid dissection (I, II, and III) - for oral cavity malignancies o Lateral neck dissection (II, III, and IV) - for laryngeal malignancies o Posterolateral neck dissection (II,III,IV, and V) - for thyroid malignancies NOTES FROM ANATOMY: • Primary tumors within the Oral cavity and Lip metastasize to nodes in levels I, II and III • Oropharynx, Hypopharynx and Larynx to levels II, III and IV • Nasopharynx and Thyroid – level V

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9
Q

Tongue cancer with lingual nerve involvement causes

A

ipsilateral paresthesia

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10
Q

Tongue cancer with hypoglossal nerve involvement causes

A

deviation of tongue on protrussion and fasciculations

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11
Q

Most common location of tongue cancer

A

lateral and ventral surfaces

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12
Q

Treatment of tongue cancer

A

T1 - T2 - wide local excision Base of Tongue - partial glossectomy with supraomohyoid dissection (N0) or MRND (N+)

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13
Q

Featurs of plummer vinson syndrome

A

• dysphagia atrophic oral mucosa, spoon-shaped fingers with brittle nails, and chronic anemia • occurs in middle age edentulous women • esophageal web: drug induced lesion (FeSO4) • pre malignant lesion (SCCA)

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14
Q

Treatment of tumor of alveolus and gingiva

A
  1. minimal bone invasion - mandibular resection 2. medullary cavitiy invasion - segmental mandibulectomy
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15
Q

Treatment of tumors of nasopharynx

A

chemotherapy

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16
Q

Most common nasophryngeal malignancy in the pedatric age group

A

lymphoma

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17
Q

Lymphatic spread of nasopharynx

A
  1. bilateral regional 2. posterior triangle (level 5)
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18
Q

Lymphatic spread of oropharynx

A
  1. upper and lower cervical lymphatics (level 2, 3, 4) 2. retropharyngeal spread
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19
Q

Lymphatic spread of hypopharynx

A
  1. bilateral regional 2. mid and lower cervical lymphatics (level 3, 4)
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20
Q

Tumors of the oropharynx are radiosensitive

A

Tumors of the oropharynx are radiosensitive

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21
Q

Where does larngeal granuloma usually occur?

A

posterior larynx on the arytenoid mucosa

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22
Q

Most common cause of vocal cord paralysis

A

iatrogenic

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23
Q

Treatment of early stage glottic and supraglottic cancer

A

Radiation therapy

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24
Q

Treatment of small glottic cancer

A

partial laryngectomy

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25
Treatment of supraglottic cancer without arytenoid or vocal cord extension
supraglottic laryngectomy
26
Treatment of advanced laryngeal tumor with extension
total laryngectomy with post op RT
27
Treatment of subglottic cancer
total laryngectomy
28
Pattern of spread from primary tumor of oral cavity and lip
I, II, III
29
Pattern of spread from primary tumor of oropharynx, hypopharynx and larynx
II, III, IV
30
Pattern of spread from primary tumor of nasopharynx and thyroid
V
31
Pattern of spread from primary tumor of nasopharynx, soft palate, and lateral and posterior walls of the oropharynx and hypopharynx
Retropharyngeal lymph nodes
32
Pattern of spread from primary tumor of hypopharynx, cervical esophagus and thyroid
VII
33
Pattern of spread from advanced tumor of glottis with subglottic spread
delphian node
34
What is a radical neck dissection or CRILE method
1. removal of level I to V lymph nodes 2. SCM 3. IJV 4. Spinal accesory nerve
35
What is a modified radical neck dissections also called functional neck dissection
o removes levels I to V cervical lymphatics but preserves the spinal accessory nerve, the IJV and the sternocleidomastoid muscle
36
What is a supraomohyoid neck dissection
1. removal of level I to III 2. oral cavity malignancy
37
What is a lateral neck dissection
1. removal of level II to IV 2. laryngeal malignancy
38
What is a posterolateral neck dissection
1. removal of II to V 2. thyroid cancer
39
What is the procedure of choice for thyroglossal duct cyst
Sistrunk procedure 1. removal of cyst, tract, and central portion of hyoid bone 2. removal of portion of the tongue base up to the foramen cecum
40
Most common gland involved in salivary gland tumor
parotid gland
41
most common benign tumor of salivary gland
pleomorphic adenoma
42
most common malignant tumor of salivary gland
mucoepidermoid carcinoma
43
Most frequently injured nerve in parotid surgery
greater auricular nerve - will produce numbness of the lower portion of the auricle and periauricular skin
44
The syndrome when the auriculotemporal nerve is injured
Frey's syndrome - postoperative gustatory sweating
45
What are the nerves at risk in submandibular gland removal
lingual and hypoglossal nerve
46
What crosses the recurrent laryngeal nerve
inferior thyroid artery
47
What innervates the cricothyroid muscle
external laryngeal nerve of the superior laryngeal nerve of the vagus nerve
48
What is a sensitive marker for medullary thyroid cancer
Serum calcitonin N: 0 - 4 pg/ml
49
Treatment of lingual thyroid
1. exogenous oral thyroid hormone 2. RAI 3. hormone replacement
50
Most common GI symptom of grave's disease
diarrhea
51
Absolute contraindication of RAI
1. pregnant 2. breastfeeding
52
Relative contraindication of RAI
1. young people 2. thyroid nodule 3. ophthalmopathy
53
TOXIC ADENOMA (SOLITARY TOXIC NODULE) treatment
Unilateral lobectomy + Isthmusectomy
54
Treatment of TOXIC MULTINODULAR GOITER (PLUMMER DISEASE)
Near total/Total thyroidectomy \* signs and symptoms are similar to Graves’ disease but extra thyroidal manifestations are absent
55
This is a self limiting PAINFUL thyroiditis usually occurs in 30 - 40 y.o women
Subacute Thyroiditis De quervain's thyroiditis • viral in origin or post viral inflammatory response • occurs in 30-40 yrs. old women • history of preceding URTI • self-limited • Tx: symptomatic short term thyroid hormone replacement thyroidectomy reserved for failure of medical management
56
Treatment of de quervain's thyroiditis
NSAID since it is self limiting
57
• or invasive fibrous thyroiditis • associated with auto-immune diseases and other focal sclerosing syndromes • Presentation: o painless, hard anterior neck mass o progress to compressive symptoms in weeks • PE: hard, woody thyroid gland
REIDEL THYROIDITIS • Dx: open thyroid biopsy • Tx: wedge excision of the thyroid isthmus o L-thyroxine o steroids
58
The most common presentation of this thyroid disease is minimally or moderately enlarged firm granular gland or the awareness of painless anterior neck mass
Hashimoto's thyroiditis Chronic Thyroiditis
59
What is seen in microscopic examination of hashimoto's thyroiditis?
Hurthle cell or Askanazy cell
60
This thyroid disease is characterized by replacement of all or part of the thyroid tissue parenchyma by fibrous tissue
Reidel's thyroiditis
61
single most important test in the evaluation of thyroid nodules
Fine Needle Aspiration Biopsy (FNAB)
62
Solitary Thyroid nodule management
63
Most common site of metastasis in papillary thyroid CA
Lungs
64
What is the type of spread in papillary thyroid CA
lymphatics
65
What is the most important prognostic factor in determining long term survival of papillary CA
age
66
Treatment of papillary CA
1. \< 1.5 cm - lobectomy + isthmusectomy 2. multicentric - near total or total thyroidectomy 3. with cervical lymph node - MDRD
67
Most common route of spread of follicular CA
Hematogenous
68
More common cancer in iodine deficient countries
follicular cancer
69
Most common site of metastasis in follicular thyroid CA
lung and bone
70
Treatment of follicular CA
1. Follicular lesion - lobectomy + isthmusectomy 2. Follicular lesion \> 4 cm - total thyroidectomy 3. Thyroid cancer - total thyroidectomy 4. Positive lymph node - MDRD
71
Usual site of medullary thyroid cancer
superolateral in the thyroid lobes
72
Where does medullary thyroid cancer arise from
parafollicular cells C cells
73
Disease associated with men 2A
1, pheochromocytoma 2. parathyroid hyperplasia
74
Disease associated with men 2B
1. pheochromocytoma 2. neuroma
75
Treatment of MTC
Total thyroidectomy with bilateral central node dissection
76
Most common site of minor salivary gland tumor
junction of hard and soft palate

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