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Flashcards in Head and Neck 2 Deck (386):
1

What are the treatment options for T1s, microinvasive, and Tl glottic carcinoma

Endoscopic surgical excision, laser excision, thyrotomy and cordectomy, or radiation.

2

What is immunologic gene therapy

Enhancement of an immune response specifically against tumor-associated antigens using viral vectors.

3

High expression of which growth factor receptor in head and neck SCCA can potentially predict lymph node metastasis

Epidermoid growth factor receptor (EGFR).

4

What are the boundaries of the pre-epiglottic space

Epiglottic cartilage posteriorly, thyrohyoid membrane and hyoid bone anteriorly, hyoepiglottic ligament superiorly.

5

What are the boundaries of the pre-epiglottic space

Epiglottic cartilage posteriorly, thyrohyoid membrane and hyoid bone anteriorly, hyoepiglottic ligament superiorly.

6

What structures are considered part of the supraglottis

Epiglottis, false vocal cords, aryepiglottic folds, and arytenoids.

7

What technique is most effective in preventing postoperative stenosis after VPL

Epiglottopexy.

8

What cells do mucoepidermoid tumors arise from

Epithelial cells of interlobar and intralobar salivary ducts.

9

According to Levine et al, SNUC is most likely a grade 4 variant of what tumor

Esthesioneuroblastoma or olfactory neuroblastoma.

10

What is the differential diagnosis of a small cell sinonasal tumor

Esthesioneuroblastoma, plasmacytoma, melanoma, lymphoma, sarcoma, poorly differentiated SCCA, Ewings sarcoma, PNET, and SNUC.

11

What is adoptive T -cell immunotherapy

Ex vivo enhancement of tumor immunogenicity; lymphocytes are removed from the patient then reinfused after in vitro activation against the patient's own tumor cells.

12

What is the most serious complication of lateral pharyngotomy

Excessive retraction on the great vessels leading to thrombosis or embolism.

13

What is the purpose of vestibulectomy during excision of early glottic cancer

Excision of the false vocal cord enhances intraoperative and postoperative visualization of the entire vocal cord.

14

What is the cell of origin of parotid gland SCCA

Excretory duct cell.

15

Which type of cancer is most sensitive to RT: exophytic, infiltrative, or ulcerated

Exophytic.

16

How does this gene work

Expresses a viral thymidine kinase that is foreign to mammalian cells but phosphorylates the drug ganciclovir into a compound that terminates DNA synthesis in tumor cells.

17

During resection, which vessel can be sacrificed in most cases

External carotid artery.

18

What factors are predictors of occult regional disease in parotid cancer

Extracapsular extension, preoperative facial paralysis, age >54 years, and perilymphatic invasion.

19

What 3 signs are classically present in patients with sinonasal neoplasms

Facial asymmetry, tumor bulge in the oral cavity, and nasal mass; the presence of all 3 is seen in about 50% of patients and is significant for advanced disease.

20

T/F: TEP is not effective in patients reconstructed with gastric pull-up

False, although the voice quality is poor.

21

T/F: Cells undergoing DNA synthesis in the S phase are much more radiosensitive than cells in other phases of the cell cycle

False, they are much more radioresistant in the S phase.

22

T/F: Tumor size is related to the likelihood of distant metastasis

False.

23

T/F: The degree of differentiation of the primary correlates with distant metastasis

False.

24

T/F: Proton beams have poorer skin-sparing properties than electron beams

False.

25

T/F: The size of the primary lesion is related to the incidence of lymph node metastases in tumors of the hypopharynx

False.

26

What are the risk factors for developing melanoma

Family history, multiple atypical or dysplastic nevi, Hutchinson's freckle, presence of large congenital nevi, blond or red hair, marked freckling on upper back, history of 3 or more blistering sunburns prior to age 20, presence of actinic keratoses.

27

What anatomic feature of the epiglottis facilitates extension of carcinoma into the pre-epiglottic space

Fenestrations/ dehiscences.

28

What anatomic feature of the epiglottis facilitates extension of carcinoma into the pre-epiglottic space

Fenestrations/ dehiscences.

29

What is the principle dose-limiting factor of RT

Fibrosis of the subcutaneous tissue and muscle.

30

What are the contraindications to VPL and laryngoplasty

Fixed vocal cord, involvement of the posterior commissure, invasion of both arytenoids, bulky transglottic lesions, invasion of the thyroid cartilage, subglottic extension >I em anteriorly (5 mm posteriorly), trans glottic lesions extending to the supraglottis.

31

What is unique about the path of growth of BCC

Follow the path of least resistance, which is typically along embryonic fusion planes.

32

When is stereotactic radiosurgery contraindicated in the treatment of recurrent glomus jugulare tumors

For larger tumors (>3.0 - 4.0 em).

33

When is a total rhinotomy approach most useful

For midline tumors where exposure of the cribriform plate and the bilateral ethmoids is necessary.

34

Which foramina of the skull lie in close proximity to the nasopharynx

Foramen lacerum, carotid canal, foramen spinosum, foramen ovale, foramen rotundum, hypoglossal canal, and jugular foramen.

35

What does the adenovirus vector do once it enters the host cell

Forms a nonreplicating, extrachromosomal entity called an episome that persists for 7 - 42 days.

36

What is the most common site of origin of nasopharyngeal cancer

Fossa of Rosenmi.iller.

37

What are the reconstructive options after total laryngectomy and total pharyngectomy

Free jejunal interposition graft, U-shaped pectoralis major + split thickness skin graft, tubed thin flap (radial forearm or de-epithelialized deltopectoral).

38

What is the classic physical finding of carotid body tumors

Freely moveable in the lateral direction but fixed in the cephalad-caudal direction.

39

What environmental factor is most strongly linked to NPC

Frequent consumption of dried salted fish.

40

What are the 3 subtypes of Schneiderian papillomas

Fungiform, inverting, and cylindrical.

41

What are the reconstructive options after total laryngopharyngectomy and cervical esophagectomy

Gastric pull-up, free jejunal graft.

42

What are the 5 histopathologic types of SCCA

Generic, adenoid, bowenoid, verrucous, and spindle-pleomorphic.

43

Which of these arises in areas of actinic change

Generic.

44

What are the two types of temporal bone paragangliomas

Glomus jugulare involving the adventitia of the jugular bulb and glomus tympanicum involving Jacobson's nerve Uugulotympanic glomus if unable to discern site of origin).

45

What is the most common site of laryngeal cancer

Glottis.

46

What is the most significant prognostic factor in patients with mesenchymal tumors

Grade of the tumor.

47

What is the significance of the number of pathologically positive nodes on prognosis

Greater than 3 pathologically positive nodes is a negative prognostic indicator.

48

What is Shamblin's classification system for carotid body tumors

Group I: small and easily excised. Group I I: adherent to the vessels; resectable with careful subadventitial dissection. Group Ill: encase the carotid; require partial or complete vessel resection

49

What is most common hormonal deficiency after RT for NPC

Growth hormone deficiency.

50

Which of these are classically associated with adenocarcinoma

Hardwood dusts and leather tanning substances.

51

What is the most common complication of parotidectomy

Hematoma.

52

What is the most commonly used gene for cytotoxic gene therapy

Herpes simplex virus-thymidine kinase gene (HSV -tk).

53

What are the indications for postoperative radiation after parotidectomy

High probability of residual microscopic disease; positive margins; advanced stage; high grade ~ deep lobe tumors; recurrent tumors; presence of regional metastases; angiolymphatic invasion.

54

Radiation is not as effective for tumors with which characteristics

High volume, cartilage-destroying, with bulky lymph node disease.

55

Which salivary gland tumors have the worst prognosis (5)

High-grade mucoepidermoid, adenocarcinoma, squamous cell carcinoma, undifferentiated carcinoma, and carcinoma ex-pleomorphic adenoma.

56

What is the gold standard for identification of subclinical disease

Histologic examination of the surgical specimen.

57

What are the risk factors for developing osteosarcoma in the mandible or maxilla

History of ionizing radiation, fibrous dysplasia, retinoblastoma, prior exposure to thorium oxide (radioactive scanning agent).

58

What histological pattern is characteristic of this tumor

Homer-Wright rosettes.

59

Which virus is thought to play a role in the etiology of sinonasal tumors

HPV, particularly types 6 and 12.

60

What electrolyte problem is disproportionately associated with gastric pull-up

Hypocalcemia secondary to impaired calcium absorption and inadvertent parathyroid resection during thyroidectomy.

61

Where are most synovial sarcomas of the head and neck located

Hypopharynx and parapharyngeal space.

62

What are the 3 most important factors leading to osteoradionecrosis (ORN)

Hypovascularity, hypocellularity, and hypoxia (the "3H's").

63

What % of patients undergoing supraglottic laryngectomy and unilateral neck dissection will fail in the contralateral neck

I 6°/o, despite receiving XRT to the area.

64

What % of patients with carcinoma in situ of the vocal cord will develop invasive SCCA after a single excisional biopsy

I in 6 (16.7%).

65

What % of patients with carcinoma in situ of the vocal cord will develop invasive SCCA after a single excisional biopsy

I in 6 (16.7%).

66

During endoscopic evaluation of a tumor of the hypopharynx, what 4 questions must be answered

I. Can the larynx be saved 2. Is a partial or total pharyngectomy necessary 3. Is a partial or total esophagectomy necessary 4. Does the tumor extend into the prevertebral fascia

67

When is total esophagectomy indicated

If the inferior margin during resection of a postcricoid tumor extends below the mediastinal inlet or if a second primary is present in the distal esophagus.

68

When should the submandibular gland be removed with the tumor

If the lesion involves the cheek, zygomatic area, nasolabial fold, or upper lip.

69

What are the indications for parotidectomy in addition to resection of the tumor

If the lesion involves the lateral forehead, temporal scalp, preauricular skin, or anterior ear.

70

What is the purpose of using a STSG to cover a small defect after excision of a tonsil cancer

If the pterygoid muscles are exposed during resection, placing a STSG will help prevent muscle fibrosis and trismus.

71

In which circumstance can a hemilaryngectomy be performed in the presence of vocal cord fixation

If the tumor does not extend through the cricothyroid membrane or the perichondrium of the thyroid cartilage.

72

What is Ohngren 's line and how is it significant

Imaginary line from the medial canthus to the angle of the mandible; tumors below the line have a better prognosis than tumors above the line (with the palate as an exception).

73

What are the next 3 most common sites of metastasis

In order of frequency, mediastinal lymph nodes, skeletal system, and liver.

74

What are the 2 most common reasons for tumor recurrence after hemilaryngectomy

Inability to recognize the inferior tumor margin and spread of tumor through the cricothyroid membrane.

75

What is the best organ-sparing treatment for a patient with stage III SCCA of the supraglottis

Induction chemotherapy followed by radiation therapy.

76

How should this flap be modified if reconstruction with a deltopectoral flap is planned

Inferior incision should be as low as possible.

77

What is the venous drainage of the cervical esophagus

Inferior thyroid vein.

78

In the staging system described by Ho, poorer prognosis is associated with cervical metastases to which area of the neck

Inferior to a plane spanning from the contralateral sternal head of the clavicle to the ipsilateral superior margin of the trapezius muscle.

79

What are the boundaries of the parapharyngeal space

Inferior: hyoid bone. Superior: petrous bone. Medial: soft palate, tonsils, superior pharyngeal constrictor. Lateral: medial pterygoid muscle, ramus of the mandible, posterior belly of the digastric. Dorsal: vertebral column and paravertebral muscles. Ventral: pterygomandibular raphe.

80

What type of resection would be best for a tumor confined to the floor of the maxillary antrum

Infrastructure maxillectomy.

81

That being said, which areas of the face are most susceptible to BCC

Inner canthus, philtrum, mid-lower chin, nasolabial groove, preauricular area, and retroauricular sulcus.

82

What is Whitnall's tubercle

Insertion site of the lateral canthal tendon.

83

How does it appear on MRI

Intermediate intensity on T- I and T -2 weighted images, permeates sinus walls without gross displacement.

84

What is the most common cause of death in osteosarcoma of the head and neck

Intracranial extension.

85

How does one assess for involvement of the prevertebral fascia

Intraoperative evaluation is most accurate. During endoscopy, one can attempt to mobilize the posterior pharyngeal wall to assess for involvement. Video esophagography and CT scan are also helpful.

86

What is "microinvasive" SCCA of the vocal cord

Invades through the basement membrane but not into the vocalis muscle.

87

What is "microinvasive" SCCA of the vocal cord

Invades through the basement membrane but not into the vocalis muscle.

88

What factors make a tumor of the nose or paranasal sinuses unresectable

Invasion into the frontal lobe, prevertebral fascia, bilateral optic nerves, or • cavernous smus.

89

What is the significance of vocal cord fixation in laryngeal carcinoma

Invasion of the vocalis muscle has occurred, and lymph node metastasis is more likely.

90

What is the most common benign sinonasal neoplasm

Inverting papilloma.

91

What are the contraindications to VPL for treatment of postradiation tumor recurrence

Involvement of both vocal cords, involvement of body of arytenoid, subglottic extension >5 mm, fixed vocal cord, cartilage invasion, different tumor type from original primary.

92

What are the contraindications to laser excision of early glottic carcinoma

Involvement of the anterior or posterior commissure, subglottic extension.

93

According to Larson, what are the indications for orbital exenteration

Involvement of the periorbita, posterior ethmoid sinuses or orbital apex.

94

What are the contraindications to radical maxillectomy

Involvement of the sphenoid, nasopharynx, middle cranial fossa, or extensive infratemporal fossa; presence of bilateral cervical metastases or distant metastases.

95

What are the clinical features of Plummer-Vinson syndrome

Iron deficiency anemia, upper esophageal web, hypothyroidism, glossitis/cheilitis, gastritis, and dysphagia.

96

What histologic characteristic of recurrent basal cell cancers has prognostic significance

Irregularity in the peripheral palisade.

97

What happens to the carotid sheath with deep lobe parotid tumors extending into the parapharyngeal space

It is displaced posteriorly.

98

How does metastasizing pleomorphic adenoma differ from carcinoma ex-pleomorphic adenoma

It is histologically benign, lacking malignant epithelial components.

99

What is the relationship of the fossa of Rosenmuller to the parapharyngeal space

It lies at the convergence of the fascial planes that separate the parapharyngeal space into its three compartments (prestyloid, retrostyloid, and retropharyngeal).

100

Is melanoma radiosensitive

It may be sensitive to large dose fractions (600cGy) but not to standard fractionation radiotherapy ( 180 - 200cGy).

101

When SCCA grossly invades the adventitia of the carotid artery, how will resection of the artery affect survival

It will not improve long-term survival.

102

How does using cisplatinum avoid this problem

Its toxicity (hematologic) does not overlap with that of radiation therapy (mucositis).

103

Where does supraglottic carcinoma most often begin

Junction of the epiglottis and false cords.

104

Where is the fossa of Rosenmiiller

Just posterior-superior to the torus tubarius of the eustachian tube orifice.

105

What are the histologic features of SCCA of the skin

Keratin pearls in well-differentiated lesions; poorly-differentiated lesions may require identification with a cytokeratin or vimentin.

106

What is the name for a skin lesion, most commonly located on the nose, characterized by rapid growth with a central area of ulceration followed by spontaneous involution

Keratoacanthoma.

107

Which of these is the most aggressive

Keratotic.

108

What are the problems with physical methods of gene transfer

Lack of specificity and extremely low efficiency.

109

What EBV product is likely to play a role in malignant transformation of nasopharyngeal epithelium

Latent membrane protein (LMP-1 ).

110

Where do these tumors most often originate

Lateral nasal wall, adjacent to the middle turbinate.

111

Where do inverting papillomas most commonly arise

Lateral nasal wall.

112

What are other surgical approaches to the nasopharynx

Lateral rhinotomy with facial disassembly, trans palatal split, lateral cervical approach with mandibular swing, transparotid temporal bone approach, infratemporal fossa approach.

113

What are the three basic transfacial approaches to these procedures

Lateral rhinotomy, total rhinotomy, mid face degloving.

114

What are the three basic transfacial approaches to these procedures

Lateral rhinotomy, total rhinotomy, mid face degloving.

115

What is the most common site of recurrent/persistent NPC

Lateral wall of the nasopharynx.

116

What factors, described by Ho and Neel, are regarded as important adverse prognostic indicators in patients with NPC

Length and symptomatology of disease, extension of tumor outside of the nasopharynx, presence of inferior cervical adenopathy, keratinizing histologic architecture, cranial nerve and skull base extension, presence of distant metastases, and low A DCC titers.

117

How do most glomus jugulare tumors respond to external beam radiation

Less than 50% show tumor regression radiographically; lack of tumor growth is more common.

118

What is the somnolence syndrome

Lethargy, nausea, headache, cranial nerve palsies, ataxia presenting 2 - 3 months after R T and lasting 2 - 4 weeks.

119

What are the levels defined in Clark's system

Level I: epidermis. Level II: invasion of basal lamina into the papillary dermis. Level III: fill the papillary dermis. Level IV: invasion into the reticular dermis. Level V: invasion into subcutaneous fat.

120

What happens if the orbital septum is violated during resection of a sinonasal tumor

Lid shortening and ectropion.

121

What is the primary limitation of the midface degloving approach

Limited exposure of the skull base and anterior ethmoid sinuses.

122

What is the Weber-Fergusson incision

Lip-splitting extension of the lateral rhinotomy incision that permits exposure for a radical maxillectomy.

123

What is the Weber-Fergusson incision

Lip-splitting extension of the lateral rhinotomy incision that permits exposure for a radical maxillectomy.

124

What is the most common cause of treatment failure

Local recurrence.

125

Patients with supraglottic cancer who undergo both surgery and radiation therapy (versus surgery alone) are at a significantly higher risk for what

Long-term gastrostomy feeding.

126

Other than UV light and genetics, what are some other factors that increase the risk of cutaneous malignancy

Long-term immunosuppression after organ transplantation, long-term treatment of psoriasis with photosensitizing chemicals, chronic ulcers, low-dose irradiation.

127

How does this assay predict survival

Low levels are associated with worse prognosis.

128

How is an altered fractionated schedule different

Lower dose per fraction, 2 or more fractions QD, decreased overall treatment time, with total dose same or higher.

129

What is the primary advantage of stereotactic radiosurgery for treatment of recurrent glomus jugulare tumors compared to surgery and conventional radiation

Lower incidence of cranial nerve injury.

130

How are the low-grade and high-grade varieties of adenoid cystic carcinoma defined

Low-grade tumors have less than 30°/o solid anaplastic histology; high-grade tumors have more than 30°/o solid anaplastic histology.

131

What is the most common cause of death from synovial sarcoma of the head and neck

Lung metastases.

132

What is the most common site of distant metastasis for adenoid cystic carcinoma

Lung.

133

What is the most common site of distant metastasis from laryngeal carcinoma

Lungs.

134

What is the greatest single cause of failure of supraglottic laryngectomy

Lymph node metastasis.

135

After SCCA, what is the 2"d most common malignant tumor of the nasopharynx

Lymphoma.

136

Which neck dissection incision results in the best cosmetic outcome

MacFee incision.

137

What are some known head and neck tumor antigens

MAGE is seen in 71 °/o; others include mutated CASP-8, SCCAg, cytokeratin fragment I 9.

138

What clinical factors increase the risk of radiation injury

Male gender, extremes of age, higher doses and fractions, comorbidities.

139

What is the most common type of skin sarcoma

Malignant fibrous histiocytoma.

140

Which salivary gland tumor contains both benign and malignant cells

Malignant lymphoepithelioma.

141

Which salivary gland tumor is more common in Eskimos

Malignant oncocytoma.

142

Where in the head and neck are osteogenic sarcomas most commonly found

Mandible.

143

Which bone in the head and neck is most commonly affected by ORN

Mandible; it has a relatively tenuous blood supply, and it is stress-bearing.

144

Which branch of the facial nerve is most commonly paretic after parotidectomy

Marginal mandibular.

145

Which nasal masses should not be biopsied in the clinic

Masses in children or adolescents and masses suspicious for angiofibroma... some also recommend delaying biopsy of any nasal mass until after imaging has been obtained.

146

Where is it most commonly found in the head and neck

Maxilla.

147

What are the most common locations of sino nasal SCCA

Maxillary sinus, followed by the nasal cavity, then ethmoid sinuses.

148

What is the role of ascertaining EBV titers in patients with NPC

May be a valuable screening tool in high-risk populations and can help establish the diagnosis of NPC in the patient with an unknown primary. In patients with type I disease, EBV titers are not elevated and have no prognostic significance.

149

How do you test for multiple myeloma in these patients

Measure serum M-protein and urine Bence Jones protein; bone survey; bone marrow biopsy.

150

How do you test for multiple myeloma in these patients

Measure serum M-protein and urine Bence Jones protein; bone survey; bone marrow biopsy.

151

What is the most common presentation of a parapharyngeal space tumor

Medial displacement of the lateral oropharyngeal wall or as a palpable mass beneath the angle of the mandible.

152

What is the gold standard of treatment for inverting papillomas

Medial maxillectomy via lateral rhinotomy.

153

What are the four basic surgical procedures used to resect tumors of the mid face

Medial maxillectomy, suprastructure maxillectomy, infrastructure maxillectomy, and radical maxillectomy.

154

What are the four basic surgical procedures used to resect tumors of the mid face

Medial maxillectomy, suprastructure maxillectomy, infrastructure maxillectomy, and radical maxillectomy.

155

What structures are found in the prestyloid compartment of the parapharyngeal space

Medial pterygoid muscle, fat, lymphatics, minor nerves and vessels.

156

What cells are melanomas comprised of

Melanocytes, which are derived from neural crest cells.

157

Which adnexal skin carcinoma arises from a pluripotential basal cell within or around the hair cells

Merkel cell carcinoma.

158

What factor is most related to the chance of recurrence for inverting papilloma

Method of removal.

159

In which areas of the world is the incidence of esophageal cancer highest

Middle East, southern and eastern Africa, and northern China.

160

What is the most common site of a malignant salivary gland neoplasm

Minor salivary glands (60%; of these, 40% occur on the palate).

161

In patients who undergo resection of inverting papilloma via lateral rhinotomy/medial maxillectomy, what is the most important factor related to risk for recurrence

Mitotic index.

162

How does melanoma of the nose differ from cutaneous melanoma

More aggressive with a worse prognosis and an unpredictable course... local recurrence is the most common cause of failure.

163

How do these tumors differ clinically from carotid body tumors

More common in females, less likely to secrete catecholamines or metastasize, and are more radiosensitive.

164

What are the indications for MOHS surgery

Morpheaform BCC, recurrent BCC, and BCC in cosmetically-sensitive locations.

165

Which of these commonly resembles a scar

Morpheaform.

166

What is the histologic appearance of pleomorphic adenoma

Morphologically diverse with mucoid, chondroid, osseous, and myxoid elements.

167

Which of these is most common in North America? Least common

Most common is type lll (70%); least common is type II (10%).

168

What are the clinical features of salivary duct carcinomas

Most commonly involve the parotid gland and present as an asymptomatic mass; higher incidence in males; distant metastases are the most common cause of death.

169

What is the most common malignant tumor of the parotid gland in adults

Mucoepidermoid carcinoma.

170

Which salivary gland tumor is more common in women with a history of breast cancer

Mucoepidermoid carcinoma.

171

What are the 2 most common malignant tumors of the parotid gland in children younger than 12

Mucoepidermoid is the most common, followed by acinic cell.

172

What is the most common salivary gland malignancy following radiation

Mucoepidermoid.

173

What are the layers of the posterior pharyngeal wall, from superficial to deep

Mucosa, constrictor muscles, longus colli, retropharyngeal space, prevertebral fascia.

174

What are the 3 most common malignant bone tumors of the paranasal sinuses

Multiple myeloma, osteogenic sarcoma, chondrosarcoma.

175

What are the indications for postoperative radiation after neck dissection

Multiple nodes or extracapsular spread.

176

What are the indications for postoperative radiation therapy

Multiple nodes, extracapsular spread, positive/inadequate margins, or node > 3 em.

177

How does metastatic disease to the lungs normally present

Multiple small lesions less than 3 mm that are difficult to detect on x-ray.

178

What can be done to prevent functional dysphagia due to neuromuscular incoordination

Myotomy of the jejunal musculature.

179

What is the most common presenting symptom of sinonasal neoplasms

Nasal obstruction (50%).

180

Where is melanoma most commonly found in the nose and paranasal sinuses

Nasal septum.

181

What is the mortality rate for stomal recurrence

Nearly 100%.

182

T/F: Almost all cases of ORN are secondary to overlying soft tissue

necrosis. True.

183

What are the histologic features of glomus tumors

Nests of chief cells with neurosecretory granules, surrounded by fibrovascular stroma and sustentacular cells that are S-1 00 positive. Chief cells are positive on immunohistochemistry for chromogranin, synaptophysin and neuron-specific enolase neurofilaments.

184

Which type of radiation therapy does adenoid cystic carcinoma respond best to

Neutron beam.

185

Which substances are thought to predispose to sinonasal neoplasms

Nickel, chromium, isopropyl oils, volatile hydrocarbons, organic fibers from wood, shoe, and textile refineries.

186

Which of these is classically associated with SCCA

Nickel.

187

What was the outcome of this study

No significant difference in survival among the three arms.

188

What is the role of induction chemotherapy

No survival advantage has been proven.

189

If a marginal mandibulectomy is performed and the bony margin is positive, does one irradiate the remaining bone

No, as bone is relatively hypoxic and cannot generate many free radicals with XRT; the patient should be taken back to the OR for mandibulectomy.

190

Are elective neck dissections warranted in patients with sino nasal SCCA

No, as the incidence of occult cervical metastases is 10%.

191

What are the 5 main types of BCC

Nodular, cystic, superficial multicentric, morpheaform, keratotic.

192

Which of these is most common

Nodular.

193

What is the most common type of lymphoma of the nose and paranasal sinuses

Non-Hodgkin's.

194

What is the pathophysiology of fibrous dysplasia

Normal medullary bone is replaced by collagen, fibroblasts, and osteoid.

195

What is the primary limitation of the gastric pull-up

Obtaining enough length to achieve a tension-free closure.

196

When embolized preoperatively, communication between the external and internal carotid circulation may occur through which vessel

Occipital artery.

197

Which mandibular tumor or cyst produces white, keratin-containing fluid

Odontogenic keratocyst.

198

How does it appear on MRI

On T-1 weighted MRI, mildly hyperintense to hypointense with mild to moderate enhancement; on T-2 weighted MRl, markedly homogenous and hypointense (ground glass appearance).

199

What are the advantages of transoral laser resection of early supraglottic cancer

Oncologically sound, no tracheostomy or feeding tube is usually necessary, early discharge, rapid resumption of deglutition, more cost effective.

200

What percentage of incompletely excised basal cell cancers will recur

One-third.

201

What are five adjunctive procedures to the above dissections

Orbital exenteration, infratemporal fossa dissection, craniotomy, contralateral maxillectomy, rhinectomy.

202

What are five adjunctive procedures to the above dissections

Orbital exenteration, infratemporal fossa dissection, craniotomy, contralateral maxillectomy, rhinectomy.

203

What structures are preserved with an infrastructure maxillectomy that would be resected with a total maxillectomy

Orbital floor and sometimes the infraorbital nerve.

204

What are the poor prognostic factors for SNUC tumors

Orbital involvement and neck metastases; tumors in the paranasal sinuses have a worse prognosis than those arising in the nasal cavity.

205

What are the characteristics of skeletal metastases

Osteolytic lesions most frequently found in the lumbosacral spine and ribs.

206

What are the complications from radiation overdosage in the treatment of NPC

Osteoradionecrosis, brain necrosis, transverse myelitis, hearing loss, hypopituitarism, hypothyroidism, optic neuritis.

207

What can cause postoperative pneumocephalus

Overly aggressive drainage of CSF via a lumbar drain or ball-valve action of the flaps used to reconstruct the skull base.

208

What are the two most common tumor suppressor genes under investigation for treatment of head and neck cancers

p53 and p 16.

209

Where is adenoid cystic carcinoma of the head and neck most commonly found

Palate, followed by major salivary glands, then paranasal sinuses.

210

What is the most common manifestation of acute injury to the peripheral nervous system

Paraesthesias.

211

What is the primary site of lymphatic drainage from subglottic tumors

Paratracheal nodes.

212

What is the least common site of a malignant salivary gland neoplasm

Parotid gland (32°/o).

213

What is the most common site of a salivary gland neoplasm

Parotid gland (73°/o).

214

Which salivary gland has the best prognosis for malignant tumors

Parotid gland.

215

What procedure is performed for resection of these lesions

Partial laryngopharyngectomy.

216

What is the supraglottic swallow

Patient inhales, takes food into mouth, performs Valsalva to close the glottis, coughs to clear debris from the glottis, swallows, and then exhales.

217

What is the most common tumor of the parotid gland

Pleomorphic adenoma in adults, hemangioma in children.

218

What is the most common tumor of the parapharyngeal space

Pleomorphic adenoma.

219

What can happen if the free jejunal graft is too long

Pooling of secretions and dysphagia.

220

What is the primary problem of using concomitant chemotherapy

Poor patient tolerance requiring treatment breaks; split-course radiation therapy has been shown to result in decreased survival compared with continuous course radiotherapy.

221

What are the contraindications to craniofacial resection

Poor surgical candidate, presence of multiple distant metastases, invasion of the prevertebral fascia, cavernous sinus (by a high-grade tumor), carotid artery (in a high-risk patient), or bilateral optic nerves/optic chiasm.

222

What are the histopathologic features of synovial sarcoma of the head and neck

Poorly differentiated, high grade malignant neoplasms arising from pluripotential mesenchymal cells; biphasic cellular pattern containing spindle cells and epithelioid cells; microcalcifications in 30 - 60%; the existence of monophasic forms, containing either spindle or epithelioid cells, is controversial.

223

What are other significant prognostic factors for supraglottic tumors

Positive surgical wound washings, nearness of neoplastic involvement to the margins of surgical resection, stomal recurrence after laryngectomy, regional and distant metastases.

224

In which of these sites is cancer more common in females

Postcricoid area.

225

Which site of the hypopharynx drains bilaterally into levels IV and VI

Postcricoid area.

226

In patients with Plummer-Vinson syndrome, where is SCCA of the esophagus most likely to occur

Post-cricoid area.

227

What area of the sinonasal tract is better visualized with endoscopy as opposed to medial maxillectomy

Posterior ethmoid cells, particularly those lateral to the sphenoid sinus and around the optic nerve.

228

What can be done to improve the results of salvage neck dissection

Postoperative brachytherapy via hollow tubes placed at the time of surgery.

229

Which compartment are neurogenic tumors most likely to arise in

Poststyloid compartment.

230

What is the treatment for SNUC

Preoperative chemoradiation, followed by surgical resection for those tumors without distant metastases or extensive intracranial involvement.

231

When must the facial nerve be sacrificed during parotidectomy

Preoperative facial nerve weakness or paralysis; adenoid cystic carcinoma abutting the nerve; malignant tumor infiltrating the nerve.

232

According to Levine et al, what treatment protocol has improved both functional and survival outcome for sinonasal malignancies

Preoperative radiation (50Gy) +/chemotherapy (Cytoxan, vincristine) followed by craniofacial resection.

233

What are the contraindications to surgical resection

Presence of distant metastases; involvement of prevertebral fascia, trachea, or carotid arteries.

234

What is the primary advantage of the midline mandibular osteotomy for resection of oropharyngeal tumors compared to the lateral mandibulotomy

Preservation of the inferior alveolar and lingual nerves.

235

Parapharyngeal tumors arising from the deep lobe of the parotid will involve which compartment

Prestyloid compartment.

236

What are the reconstructive options after partial pharyngectomy

Primary closure (if 3 or more em of tissue is available), skin graft, SCM flap, radial forearm free flap or deltopectoral flap with a de-epithelialized pedicle.

237

What are the reconstructive options after total laryngectomy and partial pharyngectomy

Primary closure if more than 40% of the pharyngeal circumference is left in situ, regional flap (pectoralis major, deltopectoral), radial forearm free flap, gastric patch, free jejunal patch, tongue base rotation flap.

238

What are the differences between primary and secondary subglottic tumors

Primary tumors are less common, usually present with stridor or dyspnea and at a more advanced stage, and have a worse survival time than secondary tumors.

239

What features of hypopharyngeal tumors distinguish them from other head and neck tumors

Propensity for early submucosal spread and skip lesions.

240

What structure in the hypopharynx marks the location of the cricoarytenoid joint

Pyriform apex.

241

What are the most common and least common sites of tumor involvement in the hypopharynx

Pyriform sinus is the most common site (75%); postcricoid area is the least common site (3-4%).

242

What are the 3 subsites of the hypopharynx

Pyriform sinus, postcricoid area, and posterior pharyngeal wall.

243

What is the primary treatment modality for nasopharyngeal cancer

Radiation therapy to the nasopharynx (66-70 Gy) and neck (60 Gy).

244

What is the primary modality of treatment for extramedullary plasmacytomas

Radiation.

245

What is the primary modality of treatment for extramedullary plasmacytomas

Radiation.

246

What is the recommended treatment for neck disease after radiation therapy

Radical neck dissection.

247

What are the three most common odontogenic cysts

Radicular cyst (65%), odontogenic keratocyst, dentigerous cyst.

248

How is isotretinoin effective in the treatment of SCCA of the head and neck

Reduces the incidence of second primary tumors.

249

What are the most common presenting symptoms in patients with tumor of the retromolar trigone (RMT)

Referred otalgia and trismus.

250

What are the most common complications of gastric pull-up

Regurgitation, cervical dysphagia, stricture, anastomotic leak.

251

What are the treatment options for recurrent/persistent NPC at the primary site

Reirradiation with larger therapeutic dose than initial treatment; stereotactic radiotherapy; brachytherapy with split palate implantation of radioactive gold surgical resection.

252

What are 5 major approaches of gene transfer, and which is most common

Replacement of mutated tumor suppressor genes, introduction of toxic/suicide genes, immunomodulation (most common), delivery of antisense nucleotides, and cytolytic viral therapy.

253

Which nodal groups does nasopharyngeal cancer spread to

Retropharyngeal nodes of Rouviere, jugulodigastric nodes, spinal accessory chain.

254

What space does the parapharyngeal space communicate with dorsally

Retropharyngeal space.

255

What is the blood supply to the gastric pull-up

Right gastroepiploic and right gastric arteries.

256

How do RT failures differ from surgical failures in site of recurrence

RT failures often occur in the center of areas that were grossly involved with cancer initially; surgical failures often occur at the periphery of the original tumor.

257

Which sinonasal neoplasms remodel rather than erode bone

Sarcomas, minor salivary gland carcinomas, hemangiopericytomas, extramedullary plasmacytomas, large cell lymphomas, and olfactory neuroblastomas.

258

Which sinonasal neoplasms remodel rather than erode bone

Sarcomas, minor salivary gland carcinomas, hemangiopericytomas, extramedullary plasmacytomas, large cell lymphomas, and olfactory neuroblastomas.

259

What are the indications for a prophylactic neck dissection

SCC A > 4 em with deep invasion arising on the cheek, upper neck, or scalp.

260

What is the most common malignant sinonasal neoplasm

SCCA, comprising 80% of malignant sinonasal neoplasms.

261

Cancer of the cervical esophagus is usually what type

SCCA.

262

Why are patients prone to aspiration after supraglottic laryngectomy

Secondary to loss of epiglottis and closure of false cords, to decrease in laryngeal elevation and loss of afferent stimulation to the vocal cords with tracheostomy, and to decrease in sensation from loss of superior laryngeal nerves during tumor resection.

263

What are the characteristics of an ideal oncolytic virus

Selective for infection and lysis of cancer cells; stimulates a potent antitumor response with limited local/systemic toxicity.

264

What effects does RT have on the ears

Serous OM; possibly SNHL, although this controversial.

265

What is its significance

Serves as a pathway for tumor extension into the thyroid cartilage.

266

What does continuous facial nerve monitoring during parotidectomy prevent

Short-term paresis.

267

What impact does hyperfractionated therapy have on locoregional control and survival rates compared to conventional therapy

Significantly higher locoregional control and survival rates.

268

What is a SNUC

Sinonasal undifferentiated carcinoma... a very aggressive small cell sinonasal tumor.

269

Which has a steeper dose-response curve: small well-vascularized tumors or bulky tumors

Small well-vascularized tumors.

270

How does chondrosarcoma of the mandible appear radiographically

Soft tissue mass with amorphous "popcorn" calcifications.

271

Which of these is the least common

Spindle-pleomorphic.

272

What is the classic finding on arteriogram of carotid body tumors

Splaying of the carotid bifurcation by a well-defined tumor blush ("lyre sign").

273

What is Bowen's disease

Squamous cell carcinoma-in-situ of the skin.

274

What is the most important prognostic factor for malignant salivary gland neoplasms

Stage.

275

What is the function of IL-2

Stimulates T and NK cells.

276

Compared to supraglottic and glottic tumors, subglottic tumors are at a much higher risk for developing what

Stomal recurrence.

277

What are the 5 layers of the epidermis from deep to superficial

Stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum

278

Why is the clinically negative neck treated

Studies have shown improved local control and disease-free survival for prophylactic irradiation of the cJinicalJy negative neck in patients with NPC.

279

What are the incisions used for the midface degloving approach

Sublabial; intercartilaginous; complete transfixion.

280

What is the least common site of a salivary gland neoplasm

Submandibular gland (I 1 %).

281

Which salivary gland has the worst prognosis for malignant tumors

Submandibular gland.

282

How does osteosarcoma of the mandible appear radiographically

Sunburst appearance, radiating periosteal new bone.

283

Which of these is more commonly found on the extremities or trunk

Superficial multicentric.

284

What are the 4 types of melanoma

Superficial spreading, lentigo maligna, acral lentiginous, and nodular sclerosing.

285

Which is the most common

Superficial spreading.

286

Which has the best prognosis

Superficial spreading.

287

What is the blood supply to the jejunum

Superior mesenteric arterial arcade.

288

What are the boundaries of the pyriform fossa

Superiorly, the inferior margin of the hyoid; anteriorly, the junction of the anterior and posterior halves of the thyroid cartilage; posteriorly, the posterior edge of the thyroid cartilage; apex, the cricoarytenoid joint.

289

Which type of laryngeal cancer is mostly likely to metastasize distally

Supraglottic.

290

What is the most direct approach for resection of all other posterior pharyngeal wall tumors

Suprahyoid.

291

What is the optimal treatment for osteosarcoma of the head and neck

Surgery and radiation therapy.

292

What is the role of concomitant chemotherapy

Survival advantage has been found using cisplatinum and 5-tlourouracil.

293

What is the stage of a transglottic tumor without vocal cord fixation, cartilage invasion, or extension beyond the larynx

T2.

294

What are 2 important techniques to prevent postoperative fistula formation

Tension-free closure and perioperative antibiotics.

295

What are "carpet carcinomas"

Term used by Kleinsasser to describe laryngeal carcinomas with diffuse mucosal spread and limited submucosal infiltration.

296

What were the results from the EORTC 22851 study comparing accelerated split-course XRT to conventional XRT

The accelerated course resulted in significantly higher late side effects without significant locoregional control or survival advantage.

297

What feature distinguishes low-grade from high-grade mucoepidermoid carcinoma

The amount of mucin in the tumor.

298

What are the advantages of postoperative RT

The anatomic extent of the tumor can be determined surgically, making it easier to define the treatment portals required; a greater dose can be given postoperatively than preoperatively; the total dose to be given can be determined on the basis of residual tumor burden after surgery; surgical resection is easier and healing is better in non-irradiated tissue.

299

What structure courses through the foramen ovale

The mandibular nerve (V3 ).

300

What is the anterolateral surgical approach to the nasopharynx

The maxillary antrum attached to an anterior cheek flap is developed as an osteocutaneous flap and swung laterally.

301

Which factors determine the probability of local control with RT

The number of malignant cells and the proportion of hypoxic cells.

302

What can be done for a large discrepancy between the circumference of the pharyngeal stoma and the jejunal segment

The proximal jejunum can be opened longitudinally along its antimesenteric border or a redundant piece of jejunum can be inserted into the proximal segment to widen the lumen.

303

What conclusions can be made based on meta-analysis of these studies

The surgical patients had slightly higher (but not significant) survival advantage (6%). Among patients receiving chemotherapy, 58% were able to keep their larynx. Better outcomes were seen in patients with hypopharyngeal cancer who underwent chemotherapy than in those with laryngeal cancer.

304

What was the first published randomized trial for organ preservation

The VA trial for SCC A of the larynx.

305

How does one differentiate between a benign and a malignant paraganglioma

There are no clear histologic characteristics of malignancy; malignant lesions are defined by the presence of metastases.

306

What problems may result from insertion at this location

This location is associated with chronic B-cell leukemias and integration into both copies of chromosome 19 may lead to cell death.

307

What were the results from the RTOG 9003 study evaluating accelerated treatments with concomitant boost

This protocol resulted in significantly higher locoregional control and survival rates with somewhat higher rate of late side effects compared to conventional XRT.

308

What is the arterial supply to the cervical esophagus

Thyroid branch of the thyrocervical trunk.

309

What is the difference between hemilaryngectomy and vertical partial laryngectomy (VPL)

Thyroid perichondrium is preserved in VPL and excised in hemilaryngectomy.

310

Why is the superior limb placed 1 em inferior to the mandible

To hide the scar in the shadow of the mandible.

311

Why should the inferior turbinate be removed during resection of a sinonasal tumor

To prevent interference with a palatal prosthesis.

312

What are the risk factors for developing esophageal cancer

Tobacco, alcohol, achalasia, Plummer-Vinson syndrome, prior head and neck cancer, tylosis, Barrett's disease.

313

What is the treatment of choice for primary subglottic cancer

Total laryngectomy, bilateral neck dissection, near total thyroidectomy, paratracheal node dissection and postoperative radiation to the superior mediastinum and stoma; if the anterior cervical esophageal wall is involved, then laryngopharyngectomy with cervical esophagectomy instead of total laryngectomy.

314

What is the treatment of choice for metastatic cutaneous SCCA to the parotid

Total parotidectomy with preservation of VII (unless invaded by tumor) and postoperative radiation therapy to the parotid area and ipsilateral neck.

315

What is the best surgical approach for removal of parapharyngeal tumors

Transcerv i cal.

316

What effects does RT have on the brain or spinal cord

Transient radiation myelopathy, transverse myelitis.

317

What is the primary blood supply to the skin flaps raised in a neck dissection

Transverse cervical artery and facial artery.

318

T /F: The dose of radiation necessary to kill hypoxic cells is 2.5 - 3.0 times greater than that required to kill well-oxygenated cells.

True, as free radical formation requires oxygen.

319

T/F: Embryologically, the supraglottis (SG) and glottis are separate entities

True.

320

T/F: CT scan of the larynx underestimates the stage of laryngeal cancer

True.

321

T/F: Once invasion of the laryngeal framework occurs, the ossified portions of cartilage have the least resistance to tumor spread

True.

322

T/F: Any laryngeal tumor with vocal cord fixation is at least stage T3

True.

323

T/F: No correlation with distant spread has been found with the age, sex, or general clinical condition of the host

True.

324

T/F: Stage I lesions of the supraglottis can be controlled equally well with radiotherapy or surgery

True.

325

T/F: Extension of a tumor in the pyriform sinus below the plane of the laryngeal ventricle is an absolute contraindication to supraglottic laryngectomy

True.

326

T/F: Chemosensitive tumors are usually radiosensitive

True.

327

T/F: It takes the same amount of radiation to reduce a cell population from 100 to 10 cells as it does to reduce it from 10 billion to 1 billion cells

True.

328

T/F: The cells responsible for acute radiation injuries are rapidly cycling

True.

329

T/F: Surgery is more effective in salvaging RT failures than RT is in salvaging surgical failures

True.

330

T/F: Disease-free, but not overall, survival is improved in patients with early oral tongue cancer who undergo elective neck dissection

True.

331

T/F: Neck dissections removed in continuity with the tumor specimen are associated with a significantly higher incidence of survival than those removed separate from the tumor

True.

332

T/F: The involvement of the medial (as opposed to lateral) wall of the pyriform sinus significantly increases the likelihood of bilateral cervical metastasis

True.

333

T/F: Due to the high incidence of cervical metastases, treatment of the neck is necessary in all patients with hypopharyngeal cancer

True.

334

T/F: Superficial lesions of the posterior pharyngeal wall can be resected endoscopically with a laser and left to mucosalize by secondary intention

True.

335

T/F: Due to shrinkage, at least 8 - 10 mm of in-situ margin must be taken to achieve a 5 mm pathologically clear margin for tumors of the oral cavity

True.

336

T/F: There is a much lower risk of distant metastases with osteosarcoma of the head and neck than that of the long bones

True.

337

T/F: A patient with T3N2aMO SCCA of the BOT has a complete response to external-beam RT both at the primary site and the neck. A planned neck dissection should be done to increase the rate of regional control

True.

338

T /F: Adnexal carcinomas of the skin are very aggressive and have a poor prognosis.

True.

339

Reconstruction should be delayed after excision of Merkel cell carcinoma until permanent section results are back.

True.

340

T/F: Squamous cell carcinoma (SCCA) arising in sun-exposed areas tend to behave less aggressively than those arising de novo

True.

341

T/F: Women with melanoma have a better prognosis than men regardless of tumor depth

True.

342

T/F: The presence of unilateral compared with bilateral nodal disease in patients with NPC has no prognostic significance

True.

343

T/F: Smoking by itself is not a significant etiologic factor for sinonasal tumors

True.

344

T/F: Hypopharyngeal cancer has the worst prognosis of all head and neck cancers

True; 70°/o of patients present with advanced disease (stage III and IV) and the 5-year disease-specific survival is only 33%.

345

T /F: RT should not be delayed in the presence of a fistula, open wound, or bony exposure.

True; as long as the carotid artery is not exposed, radiation treatments should never be delayed.

346

What is the role of the MHC (major histocompatability complex) in the development of head and neck cancer

Tumor cells can escape early detection by the patient's immune system via decreased expression of class I MHC antigens.

347

What is the primary contraindication to nasopharyngectomy

Tumor involvement of the cavernous sinus or cranial nerves.

348

What are the two most important factors predicting lymph node metastasis in laryngeal cancer

Tumor size and location.

349

What are the most important prognostic factors in patients with osteosarcoma

Tumor size, grade, and surgical margin status.

350

What factors increase the likelihood of regional metastasis of SCCA

Tumors arising on the ear, diameter >2 em or >4 mm thickness, poorly differentiated histology, and recurrent tumors.

351

What is the significance of tumor size on the incidence of complications with resection

Tumors larger than 5 em are associated with a significantly higher rate of complications with removal (67°/o for tumors >5 em vs 15% for tumors

352

How does the behavior of pyriform sinus tumors differ from postcricoid and posterior pharyngeal wall tumors

Tumors of the pyriform sinus tend to infiltrate deeply at early stages~ those of the postcricoid area and posterior pharyngeal wall tend to remain superficial until achieving an advanced stage.

353

What factors increase the likelihood of recurrence for SCCA

Tumors on the midface, diameter >2 em or thickness >4 mm, perineural invasion, or regional metastases.

354

What are the classifications of nasopharyngeal cancer designated by the WHO

Type 1: well-differentiated, keratinizing SCCA. Type II: poorly differentiated, nonkeratinizing SCCA. Type Ill: lymphoepithelioma or undifferentiated.

355

What are the 2 primary cells of paragangliomas

Type I granule-storing chief cells and type II Schwann-like sustentacular cells arranged in a cluster called a Zellballen.

356

What are the three types of ORN

Type I occurs soon after radiation therapy; Type II occurs long after radiation therapy and is induced by trauma; Type III occurs long after radiation therapy and occurs spontaneously.

357

Which of these is not associated with positive EBV titers

Type I.

358

Which of these is characterized by syncytia (fused multinuclear giant cells)

Type Ill.

359

What factor, other than tumor thickness, influences regional metastasis in melanoma

Ulceration.

360

Which kind of supraglottic cancers are more likely to extend inferiorly to the anterior commissure or ventricle... ulcerative or exophytic

Ulcerative lesions.

361

What is the significance of positive margins after laryngeal surgery

Unclear; no correlation exists between recurrence rate and the type of involved margin (gross, close, intraepithelial). Some advocate careful followup instead of further treatment.

362

What can be said of the presence of level V cervical metastases from SCCA of the upper aerodigestive tract

Uncommon (7%), and if present, most likely to occur in the presence of level IV metastases.

363

In what region of the world is Plummer-Vinson syndrome most common

United Kingdom and Scandinavia... rare in the US.

364

What are the advantages of planned preoperative RT

Unresectable tumors may be made resectable; the extent of surgical resection may be diminished; the treatment portals preoperatively are usually smaller than those used postoperatively; microscopic disease is more radiosensitive preoperatively due to better blood supply; the viability of tumor cells that may be disseminated by surgical manipulation is diminished.

365

What percentage of sinonasal tumors can be attributed to occupational exposures

Up to 44%.

366

What % of patients treated with 50 - 60 Gy of RT to the head and neck complain of ageusia

Up to 50°/o.

367

What are the 3 major randomized studies on organ preservation as treatment for laryngeal cancer

VA, GETTEC, EORTC.

368

How can one differentiate a vagal paraganglioma from a carotid body tumor

Vagal paragangliomas displace the internal carotid anteriorly and medially.

369

What anatomic structure serves as a natural barrier to the inferior extension of supraglottic cancers

Ventricle (embryologic development is completely separate from the false cord).

370

Which of these is more common in the oral mucosa

Verrucous

371

What is Ackerman's tumor

Verrucous carcinoma, thought to be less radiosensitive and less likely to metastasize than SCCA.

372

What is Ackerman's tumor

Verrucous carcinoma, thought to be less radiosensitive and less likely to metastasize than SCCA.

373

When is XRT considered in lieu of surgery for treatment of carotid body tumors

Very large tumors, recurrent tumors, or poor surgical candidates.

374

What are the 2 main categories of gene delivery agents

Viral and nonviral/physical.

375

What are the contraindications to supraglottic laryngectomy

Vocal cord fixation, extension to apex of pyriform sinus, bilateral arytenoid involvement, extensive involvement of BOT, involvement of the anterior commissure, invasion of the thyroid cartilage, invasion into the interarytenoid space.

376

What is Broyles' tendon

Vocalis muscle tendon that inserts into the thyroid cartilage.

377

Which benign parotid gland tumors are recognized by a high concentration of mitochondria on electron microscopy

Warthin's tumor and oncocytoma.

378

How does cemento-ossifying fibroma appear radiographically

Well-circumscribed lesion with a dense core and lucent rim; the core enlarges and rim diminishes with maturation.

379

What are the recommended indications for elective neck dissection by the National Cancer Comprehensive Network

When expected incidence of microscopic or subclinical disease surpass 20% (though many use 25% or 30% as the criteria).

380

What is the primary mode of treatment

Wide surgical excision and postoperative radiation therapy.

381

What significance do these features have on treatment

Wide surgical margins (4-6 em inferior to gross, 2-3 em superior to gross) and wide radiation therapy ports are necessary.

382

What are the disadvantages of planned preoperative RT

Wound healing is more difficult, and the dose that can be safely delivered preoperatively is less than that which can be given postoperatively.

383

What are some other genetic disorders that are associated with a high risk of cutaneous malignancies

Xeroderma pigmentosum, albinism, epidermodysplastic verruciformis, epidermolysis bullosa dystrophica, and dyskeratosis congenital

384

Which cranial nerve is most commonly damaged by RT to the head and neck

XII.

385

\'our patient has a mucoepidermoid carcinoma of the parotid gland. Histologic evaluation of the biopsy specimen reveals a scant amount of mucin. There is no clinical evidence of regional metastasis. Do you treat the neck

Yes.

386

Should the NO neck be treated in patients with Merkel cell carcinoma

Yes.