Otolaryngology: Head and Neck Surgery, C70 P586-620 Flashcards

Question

``` ANATOMY Define motor/sensory actions of the following cranial nerves: VI P567 ```

Answer 1

Lateral rectus muscle (lateral gaze)

Answer 2

Motor: facial muscles, lacrimal/ sublingual/submandibular glands Sensory: anterior tongue/soft palate, taste

Answer 3

Hearing, positioning

Answer 4

Motor: stylopharyngeus, parotid, pharynx Sensory: posterior tongue, pharynx, middle ear

Answer 5

Motor: vocal cords, heart, bronchus, GI tract Sensory: bronchus, heart, GI tract, larynx, ear

Answer 6

Motor: trapezius muscle, | sternocleidomastoid muscle

Answer 7

Motor: tongue, strap muscles (ansa | cervicalis branch)

Answer 8

1. Ophthalmic 2. Maxillary 3. Mandibular

Answer 9

When the patient sticks out the tongue, it deviates to the same side as the injury (wheelbarrow effect)

Answer 10

Wharton’s duct

Answer 11

Stensen’s duct

Answer 12

``` 1. Internal carotid artery: anterior and posterior ethmoidal arteries via ophthalmic artery 2. External carotid artery: superior labial artery (via facial artery) and sphenopalatine artery (via internal maxillary artery) ```

Answer 13

1. Ethmoid (perpendicular plate) 2. Vomer (Latin for “plow”) 3. Palatine (some also include maxillary crest)

Answer 14

1. Frontal 2. Zygoma 3. Maxillary 4. Lacrimal 5. Ethmoid 6. Palatine 7. Sphenoid

Answer 15

“TOSS”: 1. Thyrohyoid 2. Omohyoid 3. Sternothyroid 4. Sternohyoid

Answer 16

Digastric muscle

Answer 17

Ansa cervicalis (XII)

Answer 18

Two regions of the neck, divided by the | sternocleidomastoid muscle

Answer 19

Hypoglossal nerve

Answer 20

1. Malleus (hammer) 2. Incus (anvil) 3. Stapes (stirrup)

Answer 21

Eustachian tube, ossicle bones, tympanic | membrane (“ear drum”), mastoid air cell

Answer 22

Cochlea, semicircular canals, internal | auditory canal

Answer 23

Generalized infection involving the external ear canal and often the tympanic membrane

Answer 24

Prolonged water exposure and damaged squamous epithelium of the ear canal (e.g., swimming, hearing aid use)

Answer 25

``` Most frequently Pseudomonas, may be Proteus, Staphylococcus, occasionally Escherichia coli, fungi (Aspergillus, Candida), or virus (herpes zoster or herpes simplex) ```

Answer 26

Ear pain (otalgia); swelling of external ear, ear canal, or both; erythema; pain on manipulation of the auricle; debris in canal; otorrhea

Answer 27

Keep the ear dry; mild infections respond to cleaning and dilute acetic acid drops; most infections require complete removal of all debris and topical antibiotics with or without hydrocortisone (anti-inflammatory)

Answer 28

Fulminant bacterial otitis externa

Answer 29

Most common scenario: elderly patient with poorly controlled diabetes (other forms of immunosuppression do not appear to predispose patients to MOE)

Answer 30

Usually Pseudomonas aeruginosa

Answer 31

Nub of granulation tissue on the floor of the external ear canal at the bony–cartilaginous junction

Answer 32

Severe ear pain, excessive purulent | discharge, and usually exposed bone

Answer 33

``` 1. CT scan: shows erosion of bone, inflammation 2. Technetium-99 scan: temporal bone inflammatory process 3. Gallium-tagged white blood cell scan: to follow and document resolution ```

Answer 34

Invasion of surrounding structures to produce a cellulitis, osteomyelitis of temporal bone, mastoiditis; later, a facial nerve palsy, meningitis, or brain abscess

Answer 35

``` Control of diabetes, meticulous local care with extensive debridement, hospitalization and IV antibiotics (anti- Pseudomonas: usually an aminoglycoside plus a penicillin) ```

Answer 36

Squamous cell most common; occasionally, | basal cell carcinoma or melanoma

Answer 37

Auricle, but occasionally from the | external canal

Answer 38

Excessive sun exposure

Answer 39

Usually wedge excision

Answer 40

May require excision of the external ear | canal or partial temporal bone excision

Answer 41

Best treated by en bloc temporal bone | resection and lymph node dissection

Answer 42

``` Usually the result of trauma (direct or indirect) or secondary to middle ear infection; often occurs secondary to slap to the side of the head (compression injury), explosions ```

Answer 43

Pain, bleeding from the ear, conductive | hearing loss, tinnitus

Answer 44

Clot in the meatus, visible tear in the TM

Answer 45

Keep dry; use systemic antibiotics if there | is evidence of infection or contamination

Answer 46

Most (90%) heal spontaneously, though larger perforations may require surgery (e.g., fat plug, temporalis fascia tympanoplasty)

Answer 47

Epidermal inclusion cyst of the middle ear or mastoid, containing desquamated keratin debris; may be acquired or congenital

Answer 48

``` Negative middle ear pressure from eustachian tube dysfunction (primary acquired) or direct growth of epithelium through a TM perforation (secondary acquired) ```

Answer 49

Chronic middle ear infection

Answer 50

Chronic ear infection with chronic, | malodorous drainage

Answer 51

Grayish-white, shiny keratinous mass behind or involving the TM; often described as a “pearly” lesion

Answer 52

``` Ossicular erosion, producing conductive hearing loss; also, local invasion resulting in: Vertigo/sensorineural hearing loss Facial paresis/paralysis CNS dysfunction/infection ```

Answer 53

Surgery (tympanoplasty/mastoidectomy) aimed at eradication of disease and reconstruction of the ossicular chain

Answer 54

Vesicular infection of the TM and | adjacent deep canal

Answer 55

Unknown; viral should be suspected because of frequent association with viral URI (in some instances, Mycoplasma pneumoniae has been cultured)

Answer 56

Acute, severe ear pain; low-grade fever; | and bloody drainage

Answer 57

Large, reddish blebs on the TM, wall of | the meatus, or both

Answer 58

Rarely; occasional reversible sensorineural | loss

Answer 59

Oral antibiotics (erythromycin if Mycoplasma is suspected); topical analgesics may be used, with resolution of symptoms usually occurring in 36 hours

Answer 60

Bacterial infection of the middle ear, often following a viral URI; may be associated with a middle ear effusion

Answer 61

Dysfunction of the eustachian tube that allows bacterial entry from nasopharynx; often associated with an occluded eustachian tube, although it is uncertain whether this is a cause or a result of the infection

Answer 62

Young age, male gender, bottle feeding, crowded living conditions (e.g., day care), cleft palate, Down’s syndrome, cystic fibrosis

Answer 63

``` 1. Streptococcus pneumoniae (33% of cases) 2. Haemophilus influenzae 3. Moraxella catarrhalis 4. Staphylococcus 5. -hemolytic strep 6. Pseudomonas aeruginosa 7. Viral/no culture ```

Answer 64

1. Staphylococcus aureus 2. E. coli 3. Klebsiella

Answer 65

Otalgia, fever, decreased hearing, infant pulls on ear, increased irritability; as many as 25% of patients are asymptomatic

Answer 66

Early, redness of the TM; later, TM bulging with loss of the normal landmarks; finally, impaired TM mobility on pneumatic otoscopy

Answer 67

TM perforation!

Answer 68

``` TM perforation, acute mastoiditis, meningitis, brain abscess, extradural abscess, labyrinthitis; if recurrent or chronic, OM may have adverse effects on speech and cognitive development as a result of decreased hearing ```

Answer 69

10-day course of antibiotics; amoxicillin is the first-line agent; if the patient is allergic to PCN, trimethoprim-sulfamethoxazole or erythromycin should be administered

Answer 70

Symptoms usually resolve in 24 to 36 hours

Answer 71

``` 1. Persistent middle ear effusion over 3 months 2. Debilitated or immunocompromised patient 3. More than three episodes over 6 months (especially if bilateral) ```

Answer 72

Pneumatic Equalization tube (tube placed | across tympanic membrane)

Answer 73

Abscess behind the superior attachment of the sternocleidomastoid muscle resulting from extension of a mastoid infection

Answer 74

Mixed, S. aureus, P. aeruginosa

Answer 75

Otorrhea and hearing loss

Answer 76

Genetic disease characterized by abnormal spongy and sclerotic bone formation in the temporal bone around the footplate of the stapes, thus preventing its normal movement

Answer 77

Autosomal dominant with incomplete | one-third penetrance

Answer 78

Painless, progressive hearing loss (may be | unilateral or bilateral), tinnitus

Answer 79

Second through fourth decade

Answer 80

Normal TM with conductive hearing loss and no middle-ear effusion (though may be mixed or even sensorineural if bone of cochlea is affected)

Answer 81

Erythema around the stapes from | hypervascularity of new bone formation

Answer 82

``` Frequently surgical (stapedectomy with placement of prosthesis), hearing aids, or observation; sodium fluoride may be used if a sensorineural component is present or for preoperative stabilization ```

Answer 83

``` Supranuclear—paralysis of lower face only, forehead muscles are spared because of bilateral corticobulbar supply Intratemporal bone—paralysis of upper and lower face, decreased tearing, altered taste, absent stapedius reflex Distal to stylomastoid foramen—paralysis of facial muscles only ```

Answer 84

``` Bell’s palsy Trauma Cholesteatoma Tumor (carcinoma, glomus jugulare) Herpes zoster inflammation of geniculate ganglion (Ramsay-Hunt syndrome) Peripheral lesions are usually parotid gland tumors ```

Answer 85

Lyme disease (Borrelia burgdorferi)

Answer 86

Sudden onset, unilateral facial weakness or paralysis in absence of CNS, ear, or cerebellopontine angle disease (i.e., no identifiable cause)

Answer 87

Acute onset, with greatest muscle | weakness reached within 3 weeks

Answer 88

Most common cause of unilateral facial | weakness/paralysis

Answer 89

Unknown; most widely accepted hypothesis is viral etiology (herpes virus); ischemic and immunologic factors are also implicated

Answer 90

Pathology is related to swelling of the facial nerve; may present with total facial paralysis, altered lacrimation, increased tearing on affected side, change in taste if region above chorda tympani is affected, dry mouth, and hyperacusis

Answer 91

``` Usually none is required, as most cases resolve spontaneously in 1 month; protect eye with drops and tape closed as needed; most otolaryngologists advocate steroids and acyclovir Surgical decompression of CN VII is indicated if paralysis progresses or tests indicate deterioration ```

Answer 92

Overall, 90% of patients recover completely; if paralysis is incomplete, 95% to 100% will recover without sequelae

Answer 93

Hearing loss from a lesion occurring in the cochlea or acoustic nerve, rather than the external or middle ear

Answer 94

Distortion of hearing, impaired speech | discrimination, tinnitus

Answer 95

``` Air conduction is better than bone conduction (positive Rinne test), Weber lateralizes to the side without the defect; audiogram most commonly shows greatest loss in high-frequency tones ```

Answer 96

Weber: tuning fork on middle of head (lateral louder = either ipsilateral conductive loss or contralateral sensorineural) Rinne: tuning fork on mastoid and then next to ear (conductive loss louder on mastoid)

Answer 97

``` Aging (presbycusis)—leading cause Acoustic injury from sudden or prolonged exposure to loud noises Perilymph fistula Congenital (TORCHES: maternal TOxoplasmosis, Rubella, CMV, HErpes, and Syphilis) Ménière’s disease Drug/toxin-induced Acoustic neuroma Pseudotumor cerebri CNS disease Endocrine disorders Sarcoidosis ```

Answer 98

Meningitis (bacterial)

Answer 99

Treatment of underlying cause, hearing | aids, lip reading, cochlear implant

Answer 100

Sensation of head/body movement, or movement of surroundings (usually rotational)

Answer 101

Asymmetric neuronal activity between | right and left vestibular systems

Answer 102

Severe vertigo, nausea, vomiting, always accompanied by horizontal or rotatory nystagmus (fast component almost always to side opposite disease), other evidence of inner ear disease (tinnitus, hearing loss)

Answer 103

Frequently associated with a previously operated ear, a chronic draining ear, barotrauma, or head trauma

Answer 104

Found in brainstem or cerebellum: insidious onset, less intense and more subtle sensation of vertigo; occasionally, vertical nystagmus

Answer 105

``` Depends on probability of central versus peripheral; careful neurologic and otologic examinations are required May need FTA/VDRL (syphilis), temporal bone scans/CT scan/MRI, ENG, position testing, audiometric testing ```

Answer 106

Benign Paroxysmal Positional Vertigo (BPPV); history of brief spells of severe vertigo with specific head positions

Answer 107

``` Central: vertebral basilar insufficiency (often in older patients with DJD of spine), Wallenberg syndrome, MS, epilepsy, migraine Peripheral: BPPV, motion sickness, syphilis, Ménière’s disease, vestibular neuronitis, labyrinthitis, acoustic neuroma, syphilis, perilymph fistula ```

Answer 108

Induction of vertigo by loud noises; | classically, result of otosyphilis

Answer 109

Disorder of the membranous labyrinth, causing fluctuating sensorineural hearing loss, episodic vertigo, nystagmus, tinnitus, and aural fullness, N/V

Answer 110

Hearing loss, Tinnitus, Vertigo (H, T, V)

Answer 111

Obscure, but most experts believe excessive production/defective resorption of endolymph

Answer 112

Salt restriction, diuretics (thiazides), antinausea agents; occasionally diazepam is added; 80% of patients respond to medical management, antihistamines

Answer 113

Surgery is offered to those who fail medical treatment or who have incapacitating vertigo (60%–80% effective)

Answer 114

``` 1. Shunt from membranous labyrinth to subarachnoid space 2. Vestibular neurectomy 3. Severe cases with hearing loss: labyrinthectomy ```

Answer 115

``` Benign, slow-growing tumors arising in glomus bodies found in the adventitial layer of blood vessels; often associated with cranial nerves IX and X in the middle ear ```

Answer 116

Middle ear, jugular bulb, course of CN | IX to XII

Answer 117

Most common benign tumor of the | temporal bone

Answer 118

Surgical resection, radiation therapy for poor operative candidates or for recurrences

Answer 119

Bleeding from the nose

Answer 120

Trauma, “nose picking,” sinus infection, allergic or atrophic rhinitis, blood dyscrasias, tumor, environmental extremes (hot, dry climates; winters)

Answer 121

Rupture of superficial mucosal blood vessels (Kiesselbach’s plexus if anterior, sphenopalatine artery if posterior)

Answer 122

Anterior (90%); usually the result of | trauma

Answer 123

Posterior; usually occurs in the elderly or is associated with a systemic disorder (hypertension, tumor, arteriosclerosis)

Answer 124

Direct pressure; if this fails, proceed to anterior nasal packing with gauze strips, followed if necessary by posterior packing with Foley catheter or lamb’s wool; packs must be removed in <5 days to prevent infectious complications

Answer 125

``` Ligation or embolization of the sphenopalatine artery (posterior) or ethmoidal artery (anterior) ```

Answer 126

Toxic shock syndrome: fever, shock, rash caused by exotoxin from Staphylococcus aureus

Answer 127

Supportive with removal of nasal packing, IV hydration, oxygen, and antistaphylococcal antibiotics

Answer 128

Inflammation of nasal mucous membrane

Answer 129

``` URI infection; rhinovirus is the most common agent in adults (other nonallergic causes: nasal deformities and tumors, polyps, atrophy, immune diseases, vasomotor problems) ```

Answer 130

Nasal stuffiness; watery rhinorrhea; paroxysms of morning sneezing; and itching of nose, conjunctiva, or palate

Answer 131

Early onset (before 20 years of age), familial tendency, other allergic disorders (eczema, asthma), elevated serum IgE, eosinophilia on nasal smear

Answer 132

``` Pale, boggy, bluish nasal turbinates coated with thin, clear secretions; in children, a transverse nasal crease sometimes results from repeated “allergic salute” ```

Answer 133

``` Allergen avoidance, antihistamines, decongestants; steroids or sodium cromylate in severe cases; desensitization via allergen immunotherapy is the only “cure” ```

Answer 134

Previously healthy patient with unrelenting progression of a viral URI or allergic rhinitis beyond the normal 5- to 7-day course

Answer 135

Periorbital pressure/pain, nasal obstruction, nasal/postnasal mucopurulent discharge, fatigue, fever, headache

Answer 136

Tenderness over affected sinuses, pus in the nasal cavity; may also see reason for obstruction (septal deviation, spur, tight osteomeatal complex); transillumination is unreliable

Answer 137

``` Thought to be secondary to decreased ciliary action of the sinus mucosa and edema causing obstruction of the sinus ostia, lowering intrasinus oxygen tension and predisposing patients to bacterial infection ```

Answer 138

``` Up to 50% of patients have negative cultures and cause is presumably (initially) viral; pneumococcus, S. aureus, group A streptococci, and H. influenzae are the most common bacteria cultured ```

Answer 139

14-day course of antibiotics (penicillin G, amoxicillin, Ceclor®, and Augmentin® are commonly used), topical and systemic decongestants, and saline nasal irrigation

Answer 140

``` Fungal sinusitis is commonly caused by Mucor and seen in immunosuppressed patients; treatment is IV antifungals (e.g., amphotericin or caspofungin) and surgical débridement of all necrotic tissue ```

Answer 141

Infection of nasal sinuses lasting longer than 4 weeks, or pattern of recurrent acute sinusitis punctuated by brief asymptomatic periods

Answer 142

``` Permanent mucosal changes secondary to inadequately treated acute sinusitis, consisting of mucosal fibrosis, polypoid growth, and inadequate ciliary action, hyperostosi ```

Answer 143

Chronic nasal obstruction, postnasal drip, mucopurulent rhinorrhea, low-grade facial and periorbital pressure/pain

Answer 144

``` Usually anaerobes (such as Bacteroides, Veillonella, Rhinobacterium); also H. influenzae, Streptococcus viridans, Staphylococcus aureus, Staphylococcus epidermidis ```

Answer 145

``` Medical management with decongestants, mucolytics, topical steroids, and antibiotics; if this approach fails, proceed to endoscopic or external surgical intervention ```

Answer 146

Functional Endoscopic Sinus Surgery

Answer 147

Orbital cellulitis (if ethmoid sinusitis), meningitis, epidural or brain abscess (frontal sinus), cavernous sinus thrombosis (ethmoid or sphenoid), osteomyelitis (a.k.a. Pott’s puffy tumor if frontal)

Answer 148

Maxillary sinus (66%) Nasal cavity Ethmoid sinus Rarely in frontal or sphenoid sinuses

Answer 149

Squamous cell (80%) Adenocellular (15%) Uncommon: sarcoma, melanoma

Answer 150

Esthesioneuroblastoma; usually arises high in the nose (cribriform plate) and is locally invasive

Answer 151

``` Early—nasal obstruction, blood-tinged mucus, epistaxis Late—localized pain, cranial nerve deficits, facial/palate asymmetry, loose teeth ```

Answer 152

CT scan can adequately identify extent of the disease and local invasion; MRI is often also used to evaluate soft-tissue disease

Answer 153

Surgery with or without x-ray therapy

Answer 154

5-year survival for T1 or T2 lesions | approaches 70%

Answer 155

Most commonly encountered vascular mass in the nasal cavity; locally aggressive but nonmetastasizing

Answer 156

Adolescent boys who present with nasal obstruction, recurrent massive epistaxis, possibly anosmia

Answer 157

Site of origin is the roof of the nasal cavity at the superior margin of sphenopalatine foramen

Answer 158

Fibrosarcoma (rare cases reported)

Answer 159

Carotid arteriography, CT scan; biopsy is contraindicated secondary to risk of uncontrollable hemorrhage

Answer 160

Surgery via lateral rhinotomy or sublabial maxillotomy with bleeding controlled by internal maxillary artery ligation or preoperative embolization, in the setting of hypotensive anesthesia; preoperative irradiation has also been used to shrink the tumor

Answer 161

``` Acute or chronic infection of the nasopharynx or oropharynx and/or Waldeyer’s ring of lymphoid tissue (consisting of palatine, lingual, and pharyngeal tonsils and the adenoids) ```

Answer 162

Acute attacks can be viral (adenovirus, enterovirus, coxsackievirus, Epstein-Barr virus in infectious mononucleosis) or bacterial (group A -hemolytic streptococci are the leading bacterial agent); chronic tonsillitis often with mixed population, including streptococci, staphylococci, and M. catarrhalis

Answer 163

``` Acute—Sore throat, fever, local lymphadenopathy, chills, headache, malaise Chronic—Noisy mouth breathing, speech and swallowing difficulties, apnea, halitosis ```

Answer 164

Viral—Injected tonsils and pharyngeal mucosa; exudate may occur, but less often than with bacterial tonsillitis Bacterial—Swollen, inflamed tonsils with white-yellow exudate in crypts and on surface; cervical adenopathy

Answer 165

CBC, throat culture, Monospot test

Answer 166

``` Peritonsillar abscess (quinsy), retropharyngeal abscess (causing airway compromise), rheumatic fever, poststreptococcal glomerulonephritis (with -hemolytic streptococci) ```

Answer 167

``` Viral—Symptomatic → acetaminophen, warm saline gargles, anesthetic throat spray Bacterial—10 days PCN (erythromycin if PCN-allergic) ```

Answer 168

``` Sleep apnea/cor pulmonale secondary to airway obstruction, suspicion of malignancy, hypertrophy causing malocclusion, peritonsillar abscess, recurrent acute or chronic tonsillitis ```

Answer 169

Acute or delayed hemorrhage

Answer 170

Inadequately treated recurrent acute or | chronic tonsillitis

Answer 171

Mixed aerobes and anaerobes (which | may be PCN resistant)

Answer 172

Begins at the superior pole of the tonsil

Answer 173

Severe throat pain, drooling dysphagia, odynophagia, trismus, cervical adenopathy, fever, chills, malaise

Answer 174

“Hot-potato voice”

Answer 175

Bulging, erythematous, edematous tonsillar pillar; swelling of uvula and displacement to contralateral side

Answer 176

IV antibiotics and surgical evacuation by incision and drainage; most experts recommend tonsillectomy after resolution of inflammatory changes

Answer 177

``` Infection and inflammation of the floor of the mouth (sublingual and submandibular) ```

Answer 178

Dental infection

Answer 179

Antibiotics, emergency airway, I & D

Answer 180

Squamous cell (90% of cases)

Answer 181

Lip, tongue, floor of mouth, gingiva, | cheek, and palate

Answer 182

Linked to smoking, alcohol, and smokeless tobacco products (alcohol and tobacco together greatly increase the risk)

Answer 183

Depends on size of tumor and ranges from 10% to 60%, usually to jugular and jugulodigastric nodes, submandibular nodes

Answer 184

Infrequent

Answer 185

``` Full history and physical examination, dental assessment, Panorex or bone scan if mandible is thought to be involved, CT scan/MRI for extent of tumor and nodal disease, FNA (often U/S guided) ```

Answer 186

``` Radiation, surgery, or both for small lesions; localized lesions can usually be treated surgically; larger lesions require combination therapy, possible mandibulectomy and neck dissection ```

Answer 187

``` Depends on stage and site: Tongue: 20% to 70% survival Floor of mouth: 30% to 80% survival Most common cause of death in successfully treated head and neck cancer is development of a second primary (occurs in 20%–40% of cases) ```

Answer 188

``` Parotid gland (80%) Submandibular gland (15%) Minor salivary glands (5%) ```

Answer 189

``` Greatest in minor salivary gland tumors (80% are malignant) and least in parotid gland tumors (80% are benign); the smaller the gland, the greater the likelihood of malignancy ```

Answer 190

``` Benign—mobile, nontender, no node involvement or facial weakness Malignant—painful, fixed mass with evidence of local metastasis and facial paresis/paralysis ```

Answer 191

FNA; never perform excisional biopsy of a parotid mass; superficial parotidectomy is the procedure of choice for benign lesions of the lateral lobe

Answer 192

Involves adequate surgical resection, sparing facial nerve if possible, neck dissection for node-positive necks

Answer 193

Postoperative radiation therapy if highgrade cancer, recurrent cancer, residual disease, invasion of adjacent structures, any T3 or T4 parotid tumors

Answer 194

``` Pleomorphic adenoma (benign mixed tumor) 66% Think: Pleomorphic = Popular ```

Answer 195

Parotid gland

Answer 196

They are well delineated and slow | growing

Answer 197

Warthin’s tumor (1% of all salivary gland | tumors)

Answer 198

95% are found in parotid; 3% are | bilateral

Answer 199

Slow-growing, cystic mass is usually located in the tail of the superficial portion of the parotid; it rarely becomes malignant

Answer 200

``` Mucoepidermoid carcinoma (10% of all salivary gland neoplasms) Think: Mucoepidermoid = Malignant Most common parotid malignancy Second most common submandibular gland malignancy ```

Answer 201

Adenoid cystic carcinoma; most common malignancy in submandibular and minor salivary glands

Answer 202

1. Glottis: begins halfway between the true and false cords (in the ventricle) and extends inferiorly 1.0 cm below the edge of the vocal folds 2. Supraglottis: extends from superior glottis to superior border of hyoid and tip of epiglottis 3. Subglottis: extends from lower border of glottis to inferior edge of cricoid cartilage

Answer 203

``` Vagus nerve: superior laryngeal and recurrent laryngeal nerves; superior laryngeal supplies sensory to supraglottis and motor to inferior constrictor and cricothyroid muscle; recurrent laryngeal supplies sensory to glottis and subglottis and motor to all remaining intrinsic laryngeal muscles ```

Answer 204

Viral infection of the larynx and trachea, | generally affecting children (boys > girls)

Answer 205

Parainfluenza virus | Think: crouP = Parainfluenza

Answer 206

6 months to 3 years of age

Answer 207

Yes; outbreaks most often occur in | autumn

Answer 208

Usually preceded by URI

Answer 209

Barking (seal-like), nonproductive cough

Answer 210

Respiratory distress, low-grade fever

Answer 211

Tachypnea, inspiratory retractions, prolonged inspiration, inspiratory stridor, expiratory rhonchi/wheezes

Answer 212

Epiglottitis, bacterial tracheitis, foreign body, diphtheria, retropharyngeal abscess, peritonsillar abscess, asthma

Answer 213

A-P neck x-ray shows classic “steeple sign,” indicating subglottic narrowing; ABG may show hypoxemia plus hypercapnia

Answer 214

Keep child calm (agitation only worsens obstruction); cool mist; steroids; aerosolized racemic EPI may be administered to reduce edema/airway obstruction

Answer 215

If airway obstruction is severe or child | becomes exhausted

Answer 216

Resolves in 3 to 4 days

Answer 217

Secondary bacterial infection | streptococcal, staphylococcal

Answer 218

Severe, rapidly progressive infection of | the epiglottis

Answer 219

Haemophilus influenzae type B

Answer 220

Children 2 to 5 years of age

Answer 221

``` Sudden onset, high fever (40C); “hot-potato” voice; dysphagia (Sudden onset, high fever (40C); “hot-potato” voice; dysphagia ( → drooling); no cough; patient prefers to sit upright, lean forward; patient appears toxic and stridulous ```

Answer 222

Can usually be made clinically and does not involve direct observation of the epiglottis (which may worsen obstruction by causing laryngospasm)

Answer 223

Involves immediate airway support in the O.R.: intubation or possibly tracheostomy, medical treatment is comprised of steroids and IV antibiotics against H. influenzae

Answer 224

Accounts for ≈2% of all malignancies, | more often in males

Answer 225

Glottis (66%)

Answer 226

Supraglottis (33%)

Answer 227

Subglottic tumors (infrequent)

Answer 228

Tobacco, alcohol

Answer 229

90% are squamous cell carcinoma

Answer 230

Hoarseness, throat pain, dysphagia, odynophagia, neck mass, (referred) ear pain

Answer 231

Laryngeal surface of epiglottis

Answer 232

Pre-epiglottic space

Answer 233

Tend to remain confined to supraglottic region, though may extend to vallecula or base of tongue

Answer 234

High propensity for nodal metastasis

Answer 235

Early stage = XRT | Late stage = laryngectomy

Answer 236

Anterior part of true cords

Answer 237

May invade thyroid cartilage, cross midline to invade contralateral cord, or invade paraglottic space

Answer 238

Rare nodal metastasis

Answer 239

Early stage = XRT | Late stage = laryngectomy

Answer 240

Congenital (branchial cleft cysts, | thyroglossal duct cysts)

Answer 241

Inflammatory (cervical adenitis is #1), | with congenital also possible

Answer 242

Malignancy (squamous is #1), especially | if painless and immobile

Answer 243

In general, 80% of neck masses are benign in children; 80% are malignant in adults older than 40 years of age

Answer 244

Dysphagia, odynophagia, hoarseness, stridor (signifies upper airway obstruction), globus, speech disorder, referred ear pain (via CN V, IX, or X)

Answer 245

``` Full head and neck examination, indirect laryngoscopy, CT scan and MRI, FNA for tissue diagnosis; biopsy contraindicated because it may adversely affect survival if malignant ```

Answer 246

Inflammatory: cervical lymphadenitis, cat-scratch disease, infectious mononucleosis, infection in neck spaces Congenital: thyroglossal duct cyst (midline, elevates with tongue protrusion), branchial cleft cysts (lateral), dermoid cysts (midline submental), hemangioma, cystic hygroma Neoplastic: primary or metastatic

Answer 247

Triple endoscopy (laryngoscopy, esophagoscopy, bronchoscopy) and blind biopsies

Answer 248

Surgical excision for congenital or neoplastic; two most important procedures for cancer treatment are radical and modified neck dissection

Answer 249

Postoperative chemotherapy/XRT

Answer 250

``` Classically, removal of nodes from clavicle to mandible, sternocleidomastoid muscle, submandibular gland, tail of parotid, internal jugular vein, digastric muscles, stylohyoid and omohyoid muscles, fascia within the anterior and posterior triangles, CN XI, and cervical plexus sensory nerves ```

Answer 251

1. Clinically positive nodes that likely contain metastatic cancer 2. Clinically negative nodes in neck, but high probability of metastasis from a primary tumor elsewhere 3. Fixed cervical mass that is resectable

Answer 252

1. Distant metastasis 2. Fixation to structure that cannot be removed (e.g., carotid artery) 3. Low neck masses

Answer 253

Spinal accessory nerve preserved

Answer 254

Spinal accessory and internal jugular vein | preserved

Answer 255

Spinal accessory, IJ, and | sternocleidomastoid nerves preserved

Answer 256

``` Increased postoperative function and decreased morbidity (especially if bilateral), most often used in NO lesions; these modifications are usually intraoperative decisions based on the location and extent of tumor growth ```

Answer 257

May result in increased mortality from | local recurrence

Answer 258

Gross disfigurement, pain, malocclusion, | drooling

Answer 259

Trismus, fragment mobility and lacerations of gingiva, hematoma in floor of mouth

Answer 260

Malunion, nonunion, osteomyelitis, TMJ | ankylosis

Answer 261

Open or closed reduction MMF = MaxilloMandibular Fixation (wire jaw shut)

Answer 262

Careful physical examination and CT scan

Answer 263

Transverse maxillary fracture above the dental apices, which also traverses the pterygoid plate; palate is mobile, but nasal complex is stable

Answer 264

Fracture through the frontal process of the maxilla, through the orbital floor and pterygoid plate; midface is mobile

Answer 265

Complete craniofacial separation; differs from II in that it extends through the nasofrontal suture and frontozygomatic sutures

Answer 266

``` Fracture of the zygomatic complex; involves four fractures: 1. Frontozygomatic suture 2. Inferior orbital rim 3. Zygomaticomaxillary suture 4. Zygomaticotemporal suture ```

Answer 267

Orbital fracture with “blowout” of supporting bony structural support of orbital floor; patient has enophthalmos (sunken-in eyeball)

Answer 268

``` Orbital fracture with “entrapment” of periorbital tissues within the fracture opening, including entrapment of extraocular muscles; loss of extraocular muscle mobility (e.g., lateral tracking) and diplopia (double vision) ```

Answer 269

Fracture of the orbit with palpable “step off” of bony orbital rim (inferior or lateral)

Answer 270

No; because the mandible forms an anatomic ring, >95% of mandible fractures have more than one fracture site

Answer 271

Septal hematoma; must drain to remove | chance of pressure-induced septal necrosis

Answer 272

Otitis externa is characterized by severe | pain upon manipulation of the auricle

Answer 273

Most cases are caused by pneumococci | and H. influenzae

Answer 274

Pseudomonas aeruginosa

Answer 275

Nasopharyngeal carcinoma

Answer 276

Bell’s palsy, which has an unidentified | etiology

Answer 277

Whether the affected muscles are completely paralyzed (if not, prognosis is >95% complete recovery)

Answer 278

Sarcoidosis with parotid enlargement, | facial nerve paralysis, and uveitis

Answer 279

Submandibular gland

Answer 280

Any cause of bilateral enlargement of the | parotid, lacrimal, and submandibular glands

Answer 281

1. Airway protection 2. Airway/respiration 3. Phonation

Answer 282

Emergent surgical airway by incising the | cricothyroid membrane

Answer 283

``` 1. Prolonged mechanical ventilation (usually 2 weeks) 2. Upper airway obstruction 3. Poor life-threatening pulmonary toilet 4. Severe obstructive sleep apnea ```

Answer 284

Sublingual retention cyst arising from | sublingual salivary glands

Answer 285

Flushing, pain, and diaphoresis in the auriculotemporal nerve distribution initiated by chewing

Answer 286

``` Cutting the auriculotemporal nerve causes abnormal regeneration of the sympathetic/parasympathetic nerves, which, once destined for the parotid gland, find new targets in skin sweat glands; thus, people sweat when eating ```

Answer 287

Hearing loss, tinnitus, vertigo (HTV)

Answer 288

Acoustic neuroma, usually occurring at | the cerebellopontine angle

Answer 289

Maxillary sinus

Answer 290

Esthesioneuroblastoma

Answer 291

Squamous cell

Answer 292

Excessive alcohol use and tobacco abuse | of any form

Answer 293

Parotid gland

Answer 294

Pleomorphic adenoma

Answer 295

Mucoepidermoid carcinoma

Answer 296

Barking, seal-like cough

Answer 297

“Hot-potato” voice, sitting up, drooling, toxic appearance, high fever, leaning forward

Answer 298

Do not biopsy; obtain tissue via FNA | and complete head and neck examination

Answer 299

Painful facial nerve paralysis from herpes | zoster of the ear

Answer 300

Rhabdomyosarcoma

Answer 301

Frey’s syndrome!

Answer 302

Tympanic membrane pulsations that cease with positive pressure (from a “pneumatic” otoscope); seen with middle ear tumor mass

Answer 303

Parainfluenza virus

Answer 304

Pseudomonas

Answer 305

H. influenzae

Answer 306

Pseudomonas

Answer 307

Staphylococcus

Answer 308

S. pneumoniae (33%)

Otolaryngology: Head and Neck Surgery, C70 P586-620 Flashcards

(344 cards)