Head and neck Flashcards
(131 cards)
1
Q
Where does the trachea run from and to?
A
Interiorly:
C6 to T4/5 where it bifurcates
Surface anatomy:
Ant Inf margins of cricoid cartilage to manubriosternal angle
2
Q
Where is the thyroid located?
A
Just superior to the jugular notch
3
Q
What marks the superior end of the oesophagus and trachea?
A
Cricoid cartliage
4
Q
What structure spans the space between the thyroid and cricoid cartilage?
A
cricothyroid ligament
5
Q
Where do the carotid arteries bifurcate?
A
Superior edge of thyroid cartilage (along with the carotid body and sinus)
6
Q
What are the broad types of cervical lymph nodes?
A
superficial and deep
7
Q
Where are the superficial cervical lymph nodes located?
A
along the course of the external jugular vein on the superficial surface of the sternocleidomastoid
8
Q
Where do the superficial cervical lymph nodes drain to?
A
They send lymphatic vessels to the deep cervical lymph nodes.
9
Q
Where are the deep cervical lymph nodes located?
A
Along the internal jugular vein (same surface anatomy as the superficial ones)
10
Q
What is a branchial cyst and where do they form?
A
congential epithelial cysts within lymphoid tissue
in the middle 3rd of sternocleidomastoid region
11
Q
Which age group to branchial cysts occur in?
A
below 30 yrs
12
Q
What investigations should be done if a branchial cyst is suspected and what result would you expect?
A
fine-needle aspiration cytology (FNAC)
Expect:
a pus-like aspirate
rich in cholesterol crystals
13
Q
What is the treatment for a branchial cyst?
A
surgical excision
14
Q
Where does the thyroid cartilage originate from in an embryo?
A
The tongue base
15
Q
What are thyroglossal cysts?
A
A fibrous cyst that forms from a persistent thyroglossal duct
16
Q
When do thyroglassal cysts present?
A
NOT generally at birth
Childhood or adulthood
17
Q
Where does the thyroglossal duct (in embryo) run from and to?
A
The foramen caecum of the tongue to
the thyroid gland
18
Q
Where on the surface are thyroglossal cysts usually found?
A
In the midline
19
Q
How can you check if a lump is likely to be a thyroglossal cyst?
A
Ask the pt to stick out their tongue and the cyst should move upwards.
20
Q
How are thyroglossal cysts treated?
A
Surgical removal of the whole thyroglossal tract to prevent recurrance (they usually reoccur otherwise)
21
Q
What are the two broad categories of thyroid enlargement?
A
Benign
Malignant
22
Q
What are the two main types of goitre?
A
Diffuse enlargement
Nodular enlargement
23
Q
What are the usual causes of diffuse goitre?
A
Grave’s disease
Iodine deficiency
Pregnancy
24
Q
What is the hormonal cause of diffuse goitre and how does this link to Grave’s disease?
A
Excess TSH
This links to Grave’s as Grave’s produces thyroid stimulating immunoglobulin (TSI) which is very similar to TSH
25
What are the risk with nodular goitres?
They are higher risk of malignancy than diffuse
26
What are less concerning causes of multinodular goitres? (why may you still perform surgery)
alternating episodes of deficiency of
iodine or
TSH hyper secretion
(for cosmetic reasons)
27
What is a hot nodule in the thyroid region?
A part of the tyroid that takes up excess radioactive iodine on a scan
28
What chemicals are used to determine "hot" nodules?
It will take up radioiodine or technetium.
29
What is more dangerous a "hot" or "cold" ademona of the thyroid gland?
A cold ademona as 10-20% will in fact be malignant
30
What are the causes of neck lumps?
Thyroglossal cysts
Branchial cyst
Goitres (benign or malignant)
31
What are the types of non-cancerous salivary gland disease?
```
viral infection
sialadenitis
sialolithiasis
granulomatous disease
Sjogren’s syndrome
```
32
What are the two main symptoms of salivary gland disease?
Pain and swelling
33
What are the main salivary glands?
Parotid
Sublingual
Submandibular
34
What is the most common cause of bilateral parotid gland enlargement? (where-else can it rarely affect?)
Mumps (caused by paramyxovirus)
| rarely affects the submandibular gland
35
Which age group most commonly get mumps?
Children
36
What is the name of the virus which causes mumps?
paramyxovirus
37
What are the symptoms of mumps?
Bilateral parotid swelling
Pain (due to stretched parotid capsule)
Systemically unwell
38
Which infection increases ones risk of salivary gland infection?
HIV
39
What is sialadenitis?
Acute infection of the salivary glands
40
How does sialadenitis present?
Pain and swelling of the gland
41
What is a risk factor for acute parotitis?
Old age
Dehydration
Poor oral hygiene
42
What are the sings/symptoms of parotitis (aka parotid sialadenitis)?
Pyrexia
Swollen + tender gland
Pus leaking from the parotid papilla into the mouth
43
What are the symptoms of submandibular sialadenitis?
similar as to parotitis but with a different location
44
What is the treatment of sialadenitis?
High-dose antibiotics
Rehydration
Oral hygiene
Citrus mouthwash (it increases saliva flow)
45
What are the potential outcomes of sialadenitis?
Resolves with treatment
Abscess formation and then require drainage.
Recurring inflammation, infection and scarring leading to loss of architecture and subsequent excision is required.
46
What is Sialolithiasis?
Stones (calculi) within the salivary glands
47
What is the common precipitant for sialolithiasis?
chronic sialadenitis
48
What type of saliva is produced by the parotid gland?
serous, watery secretion
49
What type of saliva is produced by the submandibular gland?
mixed serous and mucous secretion
50
What type of saliva is produced by the sublingual gland?
mucous secretion
51
Which gland produces the most saliva daily and what % is it?
submandibular 60-70%
52
Where does sialolithiasis occur most often and why?
In the submandibular glands as they produce the most saliva and it is thicker than parotid saliva.
53
How does sialolithiasis usually present?
postprandial swelling
| painful gland
54
What would be found o/e of sialolithiasis?
painful
swollen
gland
maybe able to palpate the stone
55
How are sialolithiasis investigated?
Using dye injection to image
56
How are sialolithiasis treated?
oral fluids and
sialogogues (e.g. lemon drops which stimulate secretions)
If the situation becomes worse
the stone
or the gland can be surgically removed
57
What can causes granulomatous disease swelling in the neck?
Both tuberculosis and non-tuberculous
They can infect the salivary gland and cause:
cold abscess of adjacent lymph nodes
58
What is Sjogren’s syndrome?
Autoimmune destruction of the bodies exocrine glands (specifically the salivary and lacrimal glands)
59
What are the symptoms of 1ry Sjogren’s syndrome?
```
Dry mouth (xerostomia)
Dry eyes (keratoconjunctivitis sicca/xerophthalmia)
```
60
What are the signs of Sjogren’s syndrome?
diffuse parotid gland enlargement
61
How is Sjogren’s syndrome diagnosed and treated?
Dx biopsy
Tx is symptomatic relief with steroids
62
What can increase suspicion that a parotid mass may be malignant?
If there is a facial nerve palsy (it is almost diagnostic)
63
Are salivary malignancies normally painful?
yes
64
Where are the most common places to get a salivary gland malignancy?
Sublingual gland
and
minor salivary glands
(thus swellings in these areas are highly suspicious)
65
Where are the minor salivary glands located?
throughout the oral and nasal cavities (thus tumours can occur anywhere)
66
What is the most common malignant tumour of savliary glands?
Mucoepidermoid tumours
67
What is the prognosis of mucoepidermoid tumours?
it can vary from good to bad depending on their grade.
68
Where do adenoid cystic carcinomas often invade into?
The nerves
69
What is the prognosis of adenoid cyctic carcinoma?
Long-term it is poor
however its slow growing so a pt can live with it for many years
70
Where is the most common place for a salivary gland neoplasm?
85% will arise in the parotid gland
71
What proportion of parotid masses will be benign?
85%
72
How should salivary gland tumours be investigated and treated?
Fine needle aspiration (FNA) and excision
as incisional excision could lead to spread
73
How do benign salivary gland tumours present?
slow growing (they may have been there for a long time)
painless masses
74
What tends to push a salivary gland tumour away form suspicion of malignancy?
No nerve palsy
Smooth,
subcutaneous swelling
with no skin attachment
no pain
75
What are the most common salivary gland tumour?
Pleomorphic adenoma
76
Where do pleomorphic adenomas most commonly arise?
Usually in the parotid gland
77
What is the risk with pleomorphic adenomas?
If they have been present for years they may become malignant.
78
What is the treatment for pleomorhpic ademomas?
Surgical excision
with a healthy margin to prevent recurrance
79
What is a Warthin's tumour?
a benign
cystic tumor
of the salivary glands
containing abundant lymphocytes
80
What is Warthin's tumour also known as?
adenolymphoma
monomorphic adenoma
81
Where do Warthin's tumours usually develop and in whom?
In the parotid tail
In older men
82
What is unusual in Warthin's tumours?
They occasionally occur bilaterally
83
What is the treatment for Warthin's tumour?
Surgical excision
84
Where does the parotid duct open in to?
Cheek opposite the second molar
85
What structure pass through the parotid gland?
```
Facial nerve (more superficial)
External carotid artery (deeper)
```
86
Where does the submandibular duct open?
a papilla next to the frenulum of the tongue
87
What important structures pass through the submandibular gland?
The hypoglossal nerve
Lingual nerve a branch of the mandibular nerve of (CN 5)
marginal mandibular branch of CN 7
88
Where does the sublingual gland lie?
Along the course of the submandibular duct.
89
How does the sublingual gland secrete saliva into the mouth?
10-15 ducts secrete either
directly into the mouth or
into the submandibular duct
90
Is radiotherapy used in salivary gland tumours?
Yes in highly malignant salivary tumours
91
What is Frey's syndrome?
Post-surgery
secretormotor fibres redirect to the sweat glands and activate during meals
thus sweat over parotid during meals
92
What is the association of otalgia and head + neck malignancies?
Otalgia may actually be referred pain from the tumour
93
How is a diagnosis of leukoplakia made?
It is a diagnosis of exclusion.
94
What is leukoplakia?
white patches adhering to the oral mucosa
that cannot be removed by rubbing
and represents a hyperkeratosis of the oral epidermis
95
What can cause leukoplakia?
Local irritation e.g. smoking, alcohol, dentures, etc
96
What is the prognosis of leukoplakia?
1/3 will become cancerous
97
What is the prevelance of leukoplakia?
1%
98
What is the epidemiology of leukoplakia?
Common in
50-70 y/o's
twice as common in men
99
Where is leukoplakia normally found?
On the tongue
100
What are the lesions of leukoplakia like?
Bright
raised
sharply defined
101
What is a sign that leukoplakia is undergoing malignant change?
If there are erosions or ulcerations
102
What is the treatment for leukoplakia?
Stop potential irritants (e.g. smoking)
Also potentially:
Retinoids (chemically related to Vit A)
Surgical excision
103
What is hairy leukoplakia?
leukoplakia but with a hairy appearance
associated with EBV and HIV
104
How can hairy leukoplakia be treated
Antivirals
Retinoids
Surgery
Vigorous brushing
105
What is erythroplakia?
A red patch in the mouth that cannot be accounted for by any reason.
106
How would you describe erythroplakia?
Erythematous
macular/papular
well defined
velvety texture
107
What is the risk of erythroplakia?
It if often associated with dysplasia and
hence a precancerous lesion
108
What is the treatment for erythroplakia?
Biopsy and
surgical excision
109
What is the role of the trigeminal nerve (CN V)?
Sensation
and pain of the face
muscles of mastication
corneal reflex
110
What is the role of the facial nerve (CN 7)?
Facial muscles
Taste of anterior 2/3 of tongue
111
What is the role of the glossopharyngeal and vagus nerves (CN 9+10)?
Taste to posterior 1/3 of tongue
sensation of soft palate
swallowing
gag reflex
uvula displacement (to normal side)
vocal cords.
112
What is the role of the spinal accessory nerve (CN 11)?
Trapezius muscle
Sternocleidomastoid muscle
113
What is the role of the hypoglossal nerve (CN 12)?
Muscles of the tongue with deviation towards the affected side
114
What type of cancers are most common in the head and neck?
SCCs
115
Where do half of all head and neck cancers originate from?
The mouth
116
How long should you wait before referring someone with a white or erythematous patch?
2 weeks
117
Is weight loss common in head and neck cancers?
No very common, more likely due to the actual obstruction of the oesophagus is present.
118
How much saliva is produced in 24 hours?
1-1.5 litres
119
Which medications increase salivation?
Parasympathomimetics e.g. Pilocarpine (used in glaucoma)
120
What bacteria is most common to infect the parotid gland?
Staphylococcus
121
What initially does sialolithiasis cause?
Sialectasis - a cystic dilation of the ducts of salivary glands
122
What symptoms occur in 2ry Sjogrens syndrome?
```
Dry mouth (xerostomia)
Dry eyes (keratoconjunctivitis sicca/xerophthalmia)
Connective tissue disease (50% of the time it is RA)
```
123
What is the risk of Sjogrens syndrome?
1 in 6 will develop non-hodgekin's B-cell lymphoma
124
What is the most common site of salivary tumours?
80% in the parotid
125
Are benign or malignant tumours of the salivary gland more common?
80% are benign
126
Which salivary glands have more malignant tumours than in other glands?
only 60% of submandibular gland tumours are benign
| only 30% of minor salivary gland tumours are benign
127
What are the antigens specific to Sjogren's syndrome?
Anti-Sjögren’s-syndrome-related antigen A (SSA)
| Anti-Sjögren’s-syndrome-related antigen B (SSB)
128
What are the types and frequencies of malignant thyroid tumours
Papillary carcinomas - 75%
Follicular carcinomas - 20%
Medullary carcinoma (parafollicular cells) - less than 5%
Anaplastic thyroid cancer - less than 5%
129
What are the types of malignant salivary gland tumour in order of frequency?
Adenoid cystic carcinoma
Carcinoma ex pleomorphic adenoma
Adenocarcinoma
Lymphoma
130
What are the tumours of variable malignancy in the salivary glands?
Mucoepidermoid carcinoma
| Acinic cell carcinoma
131
What are the benign tumours of the salivary gland?
Pleomorphic adenomas
| Warthin's tumour (a.k.a. adenolymphoma, however not actually a type of lymphoma)
