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ABSITE Flashcards > Head & Neck > Flashcards

Head & Neck Flashcards

(49 cards)

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1
Q

Anterior to posterior structures

A

Subclavian vein
Phrenic nerve
Anterior scalene
Subclavian artery

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2
Q

Parotitis

A

Staph
Elderly, dehydrated
Tx with abx, I&D

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3
Q

Painless mass on roof of mouth

A

Torus

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4
Q

Leukoplakia vs erythroplakia

A

Erythoplakia - pre-malignant

Retinoids can reverse leukoplakia nad reduce chance of 2nd head and neck malignancy

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5
Q

Nasopharyngeal SCC features

A

Drain to posterior neck nodes

EBV

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6
Q

Glottic cancer tx

A

XRT if cords not fixed

If fixed-surgery + XRT

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7
Q

Lip CA features

A 
lower>upper incidence
epidermoid carcinoma
tx: <1/2 lip - primary closure
>1/2 lip - flaps
Radical neck dissection if node +
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8
Q

Tongue CA tx

A

surgery + XRT

Increased in plummer vinson

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9
Q

Large salivary glands (parotid) sign of?

A

More likely tumor is benign

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10
Q

MC malignant salivary tumor

A

mucoepidermoid carcinoma

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11
Q

MC malignant salivary tumor of submandibular /minor salivary glands

A

adenoid cystic carcinoma

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12
Q

MC benign parotid tumor

A

Pleomorphic adenoma

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13
Q

Tx of pleomorphic adenoma

A

Superficial parotidectomy

If malignant - take whole parotid with CN7, if high grade - radical neck dissection

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14
Q

Warthin’s tumor

A

2 bengin tumor

10% bilateral
70% of bilateral parotid tumors
Tx: superfical parotidectomy

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15
Q

Radical neck dissection takes?

A

CN XII (most morbid)
SCM
IJ
Submandibular gland

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16
Q

Juvenile nasopharyngeal angiofibroma

A

Benign in teen males
Presents w/obstruction, epistaxis
Tx-embolize (internal maxillary a, then extirpate)

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17
Q

Frey’s syndrome

A

Auriculotemporal nerve injury

Gustatory sweating

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18
Q

Tracheo-innominate fistula

A

massive bleeding from trach

small heraldic bleed

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19
Q

Work up of an enlarged neck node

A

FNA

Endoscopy/possible open biopsy

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20
Q

Pleomorphic adenoma

Study These Flashcards
A

Benign parotid mass
Most common benign mass
90% are superficial to facial nerve

21
Q

Warthin’s tumor

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A

2nd MC benign parotid mass
A/w tobacco use
10% bilateral

22
Q

Mucoepidermoid carcinoma

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A

MC malignant parotid mass

23
Q

Treatment of the benign parotid mass

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A

Surgical resection - resect facial nerve if involved

Can usually be enucleated or undergo superifical parotidectomy

24
Q

Treatment of malignant parotid mass

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A

Superficial lobe without involvement of facial nerve: superficial parotidectomy with adjuvant XRT
Deep lobe: Total parotidectomy
Adjuvant XRT for high grade cancer, neural invasion, invasion into surrounding structures, or mets

25
Complications of parotidectomy
Frey syndrome: gustatory sweating secondary to parasympathetic damage to auriculotemporal nerve Facial nerve dysfunction Recurrence Salivary fistula Sensory loss in lower third of external ear (from transecting greater auriculur nerve)
26
Palpable LN in the neck with unknown primary
FNA Endoscopy CT scan If all negative, proceed with modified radical neck dissection with ipsi XRT
27
Dx and tx of Frey syndrome
Dx: Minor starch/iodine test Tx: antiperspirant application to the affected skin
28
Laryngeal cancer categories and most common presenting symptom
Glottic, subglottic, supraglottic | Otalgia is most common presenting symptom
29
Le Fort fracture
Separation of maxilla from skull base | Results in mid face mobility on bi-manual exam
30
Injury to greater auricular nerve is associated with
sensory to preauricular/postauricular area difficulty shaving, wearing earrings usually resolves within a few months
31
Tuberculous lymphadenitis
MC in the cervical LN, MC extra-pulmonary TB form Most patients have no systemic symptoms and a normal CXR TB in this form is contagious Tx: 6 months of TB antibiotic therapy
32
Intraoperative nerve monitoring or direct visualization of RLN - which is better?
No statistical difference in incidence of RLN palsy with either method
33
Spinal accessory nerve course
Exits jugular foramen with CN IX and X Passes anterior to jugular vein Then enters posterior SCM Exits cephaled to Erb point (bundle of sensory nerves emerges from SCM posteriorly)
34
When should emergent cricothyroidotomies be converted to trachs?
Within 24-48hrs to avoid risk of subglottic laryngeal stenosis
35
At what level should tracheostomies be placed?
2nd or 3rd tracheal ring Any lower puts patient at risk of erosion of tube or cuff into inominate artery = TI fistula
36
Bethesda FNA categories
I: insufficient for diagnosis II: benign, manage according to FNA results alone III: atypical or follicular lesion of uncertain signficance IV: follicular neoplasm V: suspicious for malignancy, manage according to FNA results alone VI: definitely malignant Category III and IV: can do gene expression panel assay to predict benign behavior accurately
37
Inherited non-medullary thyroid cancer syndromes
``` FAP Cowden Carney Pendred Werner ```
38
Cowden syndrome features
Autosomal dominant Oral hamartomas Large head circumference Familial thyroid cancers
39
First step when TI fistula begins to bleed
Overinflate the cuff Direct digital pressure towards the sternum Definitive surgical management: ligate fistulous portion of inominate artery
40
Recurrence rate after thyroglossal duct cyst excision
10% recurrence rate
41
Chyle leak management
Low output (<1 L/day): strict fat-free diet, medium chain TG diet, surgical drain should be left in place High volume or persistent chyle leaks: surgery - open or thoracoscopic ligation of the thoracic duct in the chest, embolization of the thoracic duct by IR
42
Where does thoracic duct empty?
Left subclavian vein
43
Risk factors for pharyngeal cancer
``` HPV (high risk subtype 16) EBV Plummer-Vinson syndrome Metabolic polymorphisms Malnutrition Mutagenic agent exposure ```
44
High risk BCC features
Head and neck location, >6 mm Recurrent tumors Tumor in area that was previously radiated Ill-defined borders Morpheaform Aggressive growth patterns Immunocompromised, especially transplant patients (MC malignancy in transplant patients) Needs wider margins 6 mm or greater
45
Central neck node dissection borders
Superior: hyoid Lateral: carotid sheath Medial: tracheal midline Inferior: thoracic inlet
46
What test should be done before excision of thyroglossal duct cyst?
Neck ultrasound to confirm that is not the patient's only source of thyroid tissue
47
What cranial nerves are at risk of injury during CEA?
VII, IX, X, XI, XII
48
MC CN injury during CEA?
Hypoglossal close to the carotid bifurcation injury causes tongue deviation to ipsi side
49
Common nerve injuries during CEA
Hypoglossal: ipsi deviation of the tongue Vagus/non-recurrent laryngeal nerve: hoarseness, vocal cord palsy Superior laryngeal nerve: loss of high pitch, projection Marginal mandibular branch of facial nerve: between platysma and deep carotid fascia - drooping of mouth to ipsi side Glossopharyngeal: especially during division of posterior belly of digastric and styloid process - impaired swallowing and loss of taste sensation, gag reflex impaired on ipsi side Spinal accessory: winging of scapula, possibly by traction to SCM

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