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Surgery > Oral Cancer, Salivary Glands And Neck Swellings > Flashcards

Oral Cancer, Salivary Glands And Neck Swellings Flashcards

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1
Q

M/C site of oral cancers

A

Overall: Lateral border of tongue
India: Gingivo-buccal sulcus

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2
Q

Risk factors of Oral cancers

A
  1. Smoking
  2. Alcohol
  3. Betel quid
  4. Immunosuppression
  5. Sharp, ill-fitting denture
  6. Chronic infections (HPV: Oropharyngeal SCC&raquo_space; Oral SCC)
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3
Q

Risk factors for malignant transformation in pre-existing dysplastic lesions

A
  1. Female sex
  2. Non-smoker
  3. Lesion specific:
    > Size >200 mm2
    > Multiple
    > Non-homogenous
    > Site: Lateral border of tongue/floor of mouth
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4
Q

Types of Dysplastic lesions

A
  1. Leukoplakia
  2. Erythroplakia
  3. Chronic submucous fibrosis
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5
Q

Features of Leukoplakia

A
  1. White patch (Cannot be rubbed off)
  2. Inc risk of cancer by 3-5 times
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6
Q

Features of Erythroplakia

A
  1. Red patch
  2. Inc risk of cancer by 6-9 times
  3. Most aggressive form: Speckled
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7
Q

Features of Chronic submucous fibrosis

A
  1. Hypersensitivity reaction to betel nuts
  2. Inadequate mouth opening d/t fibrous deposition in oral cavity
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8
Q

Management of Leukoplakia and Erythroplakia

A

Stop risk factors for oral cancer
Biopsy (Confirmatory)

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9
Q

Management of Chronic submucous fibrosis

A

Intra-lesional triamcinolone

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10
Q

Other conditions that inc risk for malignancy
Just study

A
  1. Chronic hyperplastic candidiasis
  2. Oral lichen plants (Ulcerative)
  3. Secondary syphilis
  4. Plummer Vinson syndrome
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11
Q

What is Plummer-Vinson syndrome?

A

AKA Paterson Kelly Brown syndrome/Sideroplastic dysphagia:
Seen in perimenopausal women
C/F:
1. Iron deficiency anemia (Koilonychia +)
2. Angular stomatitis and glossitis
3. Post cricoid web or upper Esophageal web
Inc risk (d/t webs):
1. SCC Esophagus
2. Hypopharyngeal cancer

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12
Q

Investigations of Oral cancer

A

Biopsy:
1. Edge/wedge biopsy (Centre avoided d/t necrotic tissue)
2. Pattern of invasion: DOI is a prognostic factor
DOI: Depth of invasion

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13
Q

T staging of Oral cancer

A

Size (cm) + DOI (mm)
T1: <=2 + <=5
T2: <=2 + 5 to 10 OR 2 to 4 + <=10
T3: >4 OR >10
T4: Invasion of adjacent structures

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14
Q

N staging of Oral cancer

A

N0: No LN involved
N1: Single I/L LN <= 3 cm in size
N2:
1. N2a: Single I/L LN 3-6 cm in size
2. N2b: Multiple I/L LN, all <=6 cm in size
3. N2c: Any B/L OR C/L LN, all <=6 cm in size
N3:
1. N3a: Any LN >6 cm + ENE -
2. N3b: Any ENE +
ENE: Extra nodal extension

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15
Q

M/C site of distant metastasis of oral cancer

A

Lungs

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16
Q

Management of Oral cancer

A

Surgery:
1. Wide local excision (0.5 cm margin)
2. Mandibular resection (If involved)
3. Neck dissection (LN clearance)
All these: Commando procedure f/b reconstruction
Chemotherapy
Radiotherapy

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17
Q

Incision made in Neck dissection for Oral cancer

A

Modified Schobinger’s incision

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18
Q

Types of Neck dissection

A
  1. Radical ND
  2. Modified radical ND
  3. Selective ND
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19
Q

Structures removed in Radical ND

A
  1. Level 1-5 LN
  2. 3 extra-lymphatic structures:
    > Sternocleidomastoid
    > Internal jugular vein
    > Spinal accessory nerve
  3. Submandibular gland
  4. Tail of parotid
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20
Q

Structures removed in Modified radical ND

A
  1. Level 1-5 LN
  2. Atleast 1 extra lymphatic structure saved:
    > MRND I: SAN
    > MRND II: SAN + IJV
    > MRND III: All 3 saved (Functional ND)
  3. Submandibular gland
  4. Tail of parotid
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21
Q

Structures removed in Selective ND

A
  1. Central ND: Level 6 LN (Delphian LN)
  2. Supra omohyoid ND (SOHND): Level 1,2,3
  3. Extended SOHND: Level 1,2,3,4
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22
Q

Complications of surgery for Oral cancer

A
  1. Hemorrhage
  2. Carotid artery blowout: Max mortality
  3. Nerve injury:
    > Marginal mandibular nerve/ramus mandibularis (M/C injured)
    > Spinal accessory nerve
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23
Q

Nerve injury in surgery of Oral surgery

A
  1. Marginal mandibular nerve/ramus mandibularis (M/C injured):
    > Causes drooping of angle of mouth
    > Prevention: Incision should be 2 finger breadth below the mandible
  2. Spinal accessory nerve: Shoulder dysfunction
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24
Q

Flaps for reconstruction of buccal mucosa after Sx

A
  1. Deltopectoral flap
  2. Pectoralis major myocutaneous flap: M/C used by head and neck surgeons
  3. Radial artery forearm flap:
    > M/C used free flap + most versatile
    > Allen’s test done prior
  4. Free fibular flap: Mandibular reconstruction
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25
Indications of Adjuvant therapy
Major: ENE, margins involved +/- Minor: 1. Close margins 2. Multiple nodes involved 3. Largest node >3 cm 4. Lymphovascular invasion 5. Peri-neural invasion 6. T3/T4
26
Modalities of Adjuvant therapy
Radiotherapy: If 1 major + or 2 minor risk factors + Concurrent chemo-radiation: Cisplatin-based regimen (High risk patients) Immunotherapy: PDL-1 inhibitors (Recurrent/metastatic SCC)
27
What is Mucus retention cyst?
Blockade of minor salivary gland Mx: Excision
28
What is Ranula?
Mucus extravasation cyst of sublingual salivary gland
29
Site of Ranula
Floor of mouth
30
C/F of Ranula
Brilliantly transilluminant and fluctuant
31
Management of Ranula
1. Cyst + sublingual salivary gland excision (Best Rx) 2. Marsupiaalzation
32
Surgical complications of Ranula
M/C injured structure: Submandibular duct M/C nerve injury: Lingual nerve
33
What is Plunging Ranula?
Mucus retention cyst (Sublingual + Submandibular gland) Mx: Excision of Intra-oral swelling + Neck swelling aspiration
34
What is Parotid abscess?
Seen in immunocompromised patients Abscess in Parotid gland
35
C/F of Parotid abscess
Painful swelling + Fever on lateral parotid region
36
Management of Parotid abscess
Incision + Drainage (Avoid facial nerve injury)
37
What is Stafne bone cyst?
Mandibular cyst: M/C site of ectopic salivary tissue
38
What is Recurrent parotitis in childhood?
Rapid swelling of 1/both glands Aggravated by chewing Symptoms for 1 week f/b quiescent period Age: 3-6 years
39
X ray of Recurrent parotitis in childhood
Snowstorm appearance
40
Treatment of Recurrent parotitis in childhood
Long course of antibiotics + Repeated endoscopic washouts
41
M/C site of Sialolithasis
Submandibular > Parotid gland
42
Composition of Sialolithiasis
Calcium phosphate
43
C/F of Sialolithiasis
Post-prandial painful neck swelling
44
IOC for Sialolithiasis
NCCT
45
Management of Sialolithiasis
Fails. Fails Endoscopic Mx ————-> Duct slitting ———-> Excision
46
Site of Benign salivary gland tumors
Parotid > Submandibular > Sublingual > Minor
47
Site of Malignant salivary gland tumors
Minor > Sublingual > Submandibular > Parotid (Opp to Benign tumors)
48
System for reporting Salivary gland cytopathology
Milan system
49
Group I of Milan system
Diagnostic criteria: Non-diagnostic Mx: Repeat FNAC (IOC) with ultrasound guidance
50
Group II of Milan system
Diagnostic criteria: Non-neoplastic Mx: Follow up
51
Group III of Milan system
Diagnostic criteria: AUS (Atypia of undetermined significance) Mx: Repeat FNAC/Surgery
52
Group IV of Milan system
IVA: 1. Diagnostic criteria: Benign neoplasm 2. Mx: Surgery/follow up IVB: 1. Diagnostic criteria: SUMP (Salivary gland neoplasm of uncertain malignant potential) 2. Mx: Conservative surgery
53
Group V of Milan system
Diagnostic criteria: Suspicious of malignancy Mx: Surgery
54
Group VI of Milan system
Diagnostic criteria: Malignant Mx: Surgery (Dependent on extent)
55
C/F of Parotid tumors
90% benign Lateral facial swelling -> Lifts ear lobule If deep lobe enlarged -> Tonsillar fossa pushed medially
56
M/C Parotid tumor
Pleomorphic adenoma
57
M/C malignant parotid tumor
Mucoepidermoid carcinoma
58
Types of Benign Parotid gland
1. Pleomorphic adenoma 2. Warthin’s tumor
59
Features of Pleomorphic adenoma
1. Benign, slow growing 2. A/w PLAG- I mutation
60
Lobe involved in Pleomorphic adenoma
Superficial lobe
61
Investigations of Pleomorphic adenoma
IOC: FNAC Imaging: CT/MRI
62
Treatment of Pleomorphic adenoma
Superficial parotidectomy
63
HPE findings of Pleomorphic adenoma
Triphasic tumor with epithelial cells in myxoid backgrounds
64
Complication of Pleomorphic adenoma
Carcinoma ex Pleomorphic adenoma (Malignant transformation)
65
Features of Warthin’s tumor
1. 2nd M/C tumor, mostly B/L 2. M > F
66
Lobe involved in Warthin’s tumor
Superficial lobe
67
Investigation of Warthin’s tumor
IOC: FNAC
68
Treatment of Warthin’s tumor
Superficial parotidectomy
69
HPE findings of Warthin’s tumor
1. 2 layers of cells (Mitochondria rich) 2. Lymphocytic infiltration
70
Types of Malignant parotid tumors
1. Mucoepidermoid carcinoma 2. Adenoid cystic carcinoma 3. Carcinoma ex Pleomorphic adenoma/Mixed malignant tumor
71
2nd M/C parotid tumor
Adenoid cystic carcinoma
72
Perineural invasion of Adenoid cystic carcinoma
Extremely painful Inc recurrence rate
73
HPE of Adenoid cystic carcinoma
Swiss cheese appearance
74
Signs of Malignant change in Parotid tumors
1. Rapid inc in size 2. Painless -> Painful (D/t capsular stretching) 3. Ulceration 4. Facial nerve involvement 5. LN enlargement
75
IOC of Mixed malignant tumor
FNAC
76
Management of Mixed malignant tumor
Surgery f/b radiotherapy
77
Indications of Adjuvant therapy in Parotid tumors
1. Stage 3 and 4 2. High grade tumors 3. Positive margins 4. PNI + 5. ENE +
78
Elective SOHND is done in
T3/T4 tumors and high grade tumors
79
Types of Parotidectomy
1. Superficial 2. Total (Superficial + deep lobe removed) > Conservative (Facial nerve spared) > Radical (Facial nerve removed): Cable graft (Sural N > Greater auricular N)
80
Incision made in Parotidectomy
Lazy S incision/Modified Blair’s incision
81
Complications of Parotidectomy
1. Hemorrhage 2. Nerve injury 3. Parotid fistula 4. Frey’s syndrome
82
Nerve injury in Parotidectomy
1. Facial nerve 2. Greater auricular nerve: Anesthesia over beard region 3. Marginal mandibular branch > Cervical branch of Facial nerve: Drooping of angle of mouth
83
What is Frey’s syndrome?
Gustatory sweating Auriculotemporal nerve involved: Supplies Post ganglionic parasympathetic fibers —————-> Skin glands -> Sweating over parotid region
84
Investigation of Frey’s syndrome
Starch iodine test
85
M/C Submandibular tumor
Pleomorphic adenoma
86
M/C malignant submandibular tumor
Adenoid cystic carcinoma
87
C/F of Submandibular tumor
O/E: Bimanual palpation 1. Submandibular gland: Palpable 2. Submandibular LN: Not palpable
88
IOC of Submandibular tumor
FNAC
89
Management of Submandibular tumors
Submandibular excision
90
Complications of Submandibular excision
1. Hemorrhage 2. Nerve injury 3. Injury to other structures: > Anterior facial vein > Facial artery
91
Nerve injury in Submandibular excision
1. Marginal mandibular nerve (M/C) 2. Lingual nerve 3. Hypoglossal nerve
92
M/C Sublingual tumor
Adenoid cystic carcinoma
93
Minor salivary gland tumors Just study
M/C tumor: Adenoid cystic carcinoma M/C site: Hard palate
94
Dermoid cyst is formed in
Lines of embryonic fusion
95
Site of Dermoid cyst
Post auricular/outer canthus of eye
96
O/E of Dermoid cyst
Fluctuant swelling
97
Imaging of Dermoid cyst is done when?
Prior Sx, to rule out intracranial extension
98
Management of Dermoid cyst
Surgery
99
Management of Tubercular cervical LN
AKA Collar stud/cold abscess Anti-gravity aspiration Avoid dependent aspiration to prevent sinus/fistula formation
100
Management of Frey’s syndrome
TOC: Tympanic neurectomy 1st line: Botox and anti-perspirants Prevention: SCM flap/digastric muscle flap to cover parotid bed

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