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Absite Behind the Knife > Head and Neck > Flashcards

Head and Neck Flashcards

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1
Q

Neck structures anterior to posterior beneath clavicle

A 
Subclavian Vein
Phrenic nerve
Anterior Scalene
Subclavian Artery
Middle Scalene
Long Thoracic
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2
Q

Anterior Triangle

A

Midline of neck
Ant SCM
Apex: Sternal notch
Base: Lower border of body of mandible

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3
Q

Posterior Triangle

A

Post SCM
Trapezius muscle
Middle third of clavicle

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4
Q

What does anterior triangle contain?

A

Carotid Sheath - common carotid, internal jugular, vagus nerve

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5
Q

What does posterior triangle contain?

A

Spinal accessory nerve

Brachial plexus

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6
Q

What is recurrent laryngeal a branch of?

A

Vagus

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7
Q

R Recurrent laryngeal route

A

Vagus ant to subclavian artery -> then recurrent laryngeal wraps behind subclavian to tracheoesophageal groove

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8
Q

What innervates the cricothyroid muscle?

A

Superior laryngeal nerve

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9
Q

L Recurrent laryngeal route

A

Vagus runs anterior to aortic arch btw cca and subclavian -> then recurrent laryngeal wraps behind around arch and up to tracheoesophageal groove

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10
Q

What happens if you cut the superior laryngeal nerve?

A

Difficulties with tone, hitting high notes

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11
Q

Squamous cell of neck

A

5th most common cancer
Men to women 5:1
Alcohol/Tobacco synergistic risk factors
HPV risk factor

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12
Q

Local squamous cell with no + nodes, no distant mets

A

Stage I and II

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13
Q

Locally agressive III or distant mets squamous IV

A

Stage III and Stage IV

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14
Q

Stage I and II

A

Tumor board
Wide local exicision if resectable
Radiation if non resectable

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15
Q

Stage III and IV

A

Multimodality

Surgery (local excision with modified radical neck dissection) + Radiation and/or Chemo

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16
Q

Oral squamous cell size cut offs?

A

4 cms or node involvement/bone invasion

Need: Surgery (local excision with modified radical neck dissection) + Radiation

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17
Q

More malignant salivary tumors smaller glands or larger glands?

A

Smaller more malignant (submandibular)

Larger more benign (Parotid)

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18
Q

MC malignant salivary tumor

A

Mucoepidermoid cancer

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19
Q

MC benign salivary tumor

A

Pleomorphic adenoma

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20
Q

Mucoepidermoid cancer treatment

A

“Resection” + total parotidectomy + facial nerve preservation + “modified radical neck dissection” on that side + “post op radiation”

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21
Q

Adenoid cystic tumor - treatment

A

Resection + modified radical + post op radiation

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22
Q

Adenoid cystic treatment if invading facial nerve

A

Just radiation - sensitive to it

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23
Q

Palpable lymph node -> biopsy -> malignant, can’t find primary, what do you do

A 
Head and neck exam
Fiberoptic nasopharynx/larynx
FNA of any nodes available
CTA head neck chest +/- PET
OR regardless of finding something: Direct laryngoscopy, esophagoscopy, IPSILATERAL TONSILLECTOMY (MC site) base of tongue is second MC, modified radical; bilateral xrt
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24
Q

How to biopsy melanoma

A

Punch or exicisional biopsy, not shaved

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25
Margins of melanoma
1 cm margin for lesions < 1 mm in depth 2 cm margin for lesions > 1 mm in depth Adjust margins if abutting facial nerve Confirm negative margins prior to reconstruction -> mohs
26
Lymphadenectomy of melanoma -> how determine where nodes are
Get lymphosyntigraphy -> then do modified radical neck etc
27
Sentinel nodes for melanoma
If clinically node negative then for > 1 mm in depth
28
If primary lesion anterior to tragus line
Drains anterior to parotid basin | Do superficial parotidectomy and anterior lymph node basin dissection
29
If primary lesion posterior to tragus line
Drains posterior to parotid basin | Do superficial parotidectomy and posterior lymph node basin dissection
30
Melanoma adjuvant therapy
INF-Alpha -> especially if mets Salvage radiation therapy -> esp if regional positive nodes Monoclonal antibodies/oncogene inhibitors
31
Painless mass on roof of mouth
Toris pallatinus - overgrowth of cortical bone | Tx: Nothing, unless interferes with dentures -> resect
32
Oral cavity cancer MC site
Lower lip
33
Reconstruction for lower lip if:
> 50% of lip resected need flap reconstruction
34
EBV
Nasopharyngeal squamous cell | Tx: primary radiation
35
Tx for pleomorphic adenoma
superficial parotidectomy
36
Gustatory sweating
Frey's syndrome | Injury to auriculotemporal nerve -> cross innervates with facial nerve fibers
37
Post op fever, pain, large swelling at angle of jaw
Suppurative parotiditis Staph aureus Antibiotics, possible I and D if abscess
38
Post op from tracheostomy -> bleeding from site
Tracheoinominate fistula Tx: Place finger in tracheostomy and hold finger against sternum, take to OR, median sternotomy w/ resection of inominate, close hold in trachea with strap muscle flap (DO NOT place synthetic graft, do not reconstruct)
39
Parotid gland function
Secretes mostly serous fluid
40
Sublingual Gland function
Secretes mostly mucin
41
Submandibular gland function
50/50 serous/mucin
42
Laryngeal/tracheal anatomy - Where are false cords related to true cords - What makes up the trachea
- False cords are superior to true cords | - Trachea has U shaped cartilage anterior, and membranous portion posterior
43
Relation of nerves to other structures - Vagus in carotid sheath? - Phrenic? - Long thoracic?
- Vagus is btw medial CC and lateral IJ and is more post in sheath - On top of anterior scalene musc - Post to middle scalene
44
CN head/neck functions - CN V trigeminal - CN VII Facial - CN IX glosspharyngeal - CN XII hypoglossal
- CN V = sensation to face; motor to muscles of mastication, motor corner of mouth (Marg mand nerve); taste ant 2/3 tongue - CN VII = temporal, zygomatic, buccal, mm, cervical branches motor - CN IX = taste to post 1/3 tongue, motor stylopharg, involved in swallowing - CN XII = motor to tongue
45
Neck nerve functions - Recurrent laryngeal - Superior laryngeal
- Recurrent laryngeal - Motor to strap muscles except cricothyroid - Sup laryngeal - Cricothyroid
46
Frey's syndrome
Symptom - gustatory sweating | After parotidectomy -> injured auriculotemporal nerve cross innervates with sympthetic sweat glands of skin
47
Thyrocervical trunk arteries?
Suprascapular Transverse cervical Ascending cervical inferior Thyroid
48
External carotid branches?
Some anatomists like freaking out poor medical students ``` S: superior thyroid artery. A: ascending pharyngeal artery. L: lingual artery. F: facial artery. O: occipital artery. P: posterior auricular artery. M: maxillary artery. S: superficial temporal artery. ```
49
Which artery is responsible for blood supply to trapezius flap?
Transverse cervical
50
Which two areteries are responsible for blood supply to pect major flap?
Internal mammary | Thoracoacromial artery
51
Torus palatini
Congenital bony mass in upper palate of mouth | Tx: Nothing
52
Torus mandibular
Congenital bony mass on lingual surface of mandible | Tx: Nothing
53
What does a modified radical neck dissection involve?
Omohyoid, submandibular gland, C2-C5 sensory nerves, cervical branch of facial, ipsilateral thyroid No MORTALITY diff when compared with radical dissection
54
What does a radical neck dissection involve?
MRND + CN XI, SCM, IJ resection
55
Head and neck chemotherapy?
5FU and cisplatin
56
MC oral cavity cancer
Squamous cell
57
- #1 RF oral cancer
Tobacco, EtOH | (separately there is inc risk in people with Plummer-Vinson Syndrome
58
MC site for oral cavity cancer
Lower lip
59
Which tumors have the lowest survival rates
Hard palate tumors -> difficult to resect
60
Oral cavity cancer treatment
Wide resection (1 cm margin) MRND for tumors > 4cm, positive nodes, bone invasion Postop XRT if > 4cm, + nodes, bone invasion
61
Lip CA Tongue CA Maxillary sinus CA Tonsillar Ca
L - Commissure is more aggressive (flap if >1/3 removed) T - Commando procedure if jaw invasion M - Maxillectomy T - Tonsillectomy (80% have LN mets by diagnosis)
62
Nasopharyngeal SCCA - Etiology - Nodal mets to... - Tx: - Misc facts
Eti: EBV; usually Asian; presents with nose bleed/obstruction Nodal mets to posterior cervical nodes Tx: XRT primary tx Misc: Lymphoma is MC NP cancer in kids; Papilloma is MC benign neoplasm of nose/paranasal sinuses
63
Oropharyngeal SCCA - Symptoms - Nodal mets to.... - Tx: - Misc facts
- Sx: Neck mass, sore throat - Nodal mets to post cervical nodes - Tx: XRT for tumors < 4 cm w/o nodes/bone invasion - Tx: Wide res/MRND/XRT for > 4 cm/nodes/bones

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