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H&N > Session 11: Anatomy of the Thyroid Gland & Head and Neck Cancers > Flashcards

Session 11: Anatomy of the Thyroid Gland & Head and Neck Cancers Flashcards

1
Q

Vertebral location of the thyroid gland.

A

C5 to T1

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2
Q

Explain the anatomical position of the thyroid in relation to other structures.

A

Lies posterior to the sternohyoid and sternohyoid muscles.

It wraps around the cricoid cartilage and superior tracheal rings.

Found inferior to the thyroid cartilage and the gland is in the visceral compartment of the neck along with the trache, oesophagus and the pharynx.

The compartment is bound by pretracheal fascia.

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3
Q

During development where does the thyroid gland initially form?

A

Near the base of the tongue in the primitive pharynx.

It then descends down the neck to lie in its adult anatomical position.

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4
Q

As the thyroid gland descends during development, what does it move through?

A

The thyroglossal duct.

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5
Q

What happens to the thyroglossal duct?

A

It will normally fuse and regress.

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6
Q

What happens in case the duct doesn’t fuse correctly?

A

It may happen in around 50% individuals that the distal portion of the duct contines as a pyramidal lobe.

This becomes an extra piece of thyroid tissue but has no clinical consequence.

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7
Q

What are thyroglossal cysts?

A

If other portions of the duct persist that is not the distal portion.

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8
Q

How do thyroglossal cysts present?

A

As a mass in the midline of the neck.

Can be excised surgically.

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9
Q

Anterolateral structures to the thyroid gland.

A

Sternothyroid

Superior belly of omohyoid

Sternohyoid

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10
Q

Posterolateral structures to the thyroid gland.

A

Carotid sheath with common carotid, internal jugular vein and the vagus nerve.

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11
Q

Posteromedial structures to the thyroid gland.

A

Larynx

Trachea

Pharynx

Oesophagus

External laryngeal nerve

Recurrent laryngeal nerve

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12
Q

Blood supply of the thyroid gland.

A

Superior and inferior thyroid arteries.

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13
Q

From what and where does the superior thyroid artery arise?

A

First branch of the external carotid artery.

After it arises it descends toward the thyroid gland.

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14
Q

What does the superior thyroid artery supply?

A

Superior and anterior portions of the thyroid gland.

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15
Q

What does the inferior thyroid artery arise from?

A

The thyrocervical trunk which is a branch of the subclavian artery.

Then travels superomedially to reach the inferior pole of the thyroid.

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16
Q

What does the inferior thyroid artery supply?

A

The posteroinferior aspect of the gland.

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17
Q

What is the thyroid ima artery?

A

In 10% of people there is an extra artery called the thyroid ima artery.

Comes from the brachiocephalic trunk of the arch of the aorta.

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18
Q

Venous drainage of the thyroid.

A

Superior, middle and inferior thyroid veins which form a venous plexus.

19
Q

What does the inferior, middle and superior thyroid veins draini into?

A

Superior and middle -> internal jugular veins

Inferior -> brachiocephalic vein

20
Q
A
21
Q

Innervation of the thyroid gland.

A

Branches derived from the sympathetic trunk.

These nerves do not control the endocrine secretion as they are controlled by the pituitary gland.

22
Q

Common sites for cancer in head and neck.

A

Lip/oral cavity

Pharynx

Larynx

Thyroid

23
Q

What is most common type of cancer in head and neck?

A

Squamous cell carcinoma (90%)

24
Q

Risk factors of head and neck cancers.

A

Alcohol

Tobacco (including chewing tobacco)

Age (older patients)

Male

Betel nut chewing

Dental hygiene

Long term exposeure to sunglight or sunbeds

25
Q

What is an additional risk factor especially for oropharyngeal cancers?

A

HPV

26
Q

What is an additional risk factor especially for nasopharyngeal cancers?

A

Epstein-Barr virus

27
Q

Additional risk factors for thyroid cancer.

A

Irradiation exposure (radioactive iodine e.g.)

Family history like FAP

28
Q

Staging of head and neck cancers.

A

TNM

29
Q

Clinical diagnosis of head and neck cancers.

A

History

Through clinical examination and biopsy.

Imaging

Endoscopic investigations if nasal cavity, pharynx and larynx.

30
Q

Why is staging important in head and neck cancers?

A

To determine appropriate treatment.

31
Q

Early stage H&N cancer treatment.

A

Usually done by surgical removal or radiotherapy

32
Q

More advanced H&N cancers treatment.

A

Surgery and adjuvant chemoradiation.

33
Q

How might surgery be done in H&N cancers?

A

Microsurgical techniques like lasers.

Radical neck dissections where all ipsilateral lymph nodes, CN XI, IJV and SCM are removed.

34
Q

Implications of radical neck dissection.

A

Difficulty eating, drinking, speaking and breathing.

35
Q

General clinical presentation of head and neck cancers.

A

Unexplained painful and/or mucosal ulceration or lesion (leukoplakia, erythroplakia or a lump) within the oral cavity.

Unexplained hoarseness of voice

Dysphagia

Odynophagia

Otalgia

Cervical lymphadenopathy

36
Q

Clinical presentation of lip/oral cavity cancer.

A

Lump

Pain included referred pain to the ear.

Fixation of tongue

Dysphagia

Odynophagia

37
Q

Clinical presentation of pharynx cancer.

A

Lump

Pain + otalgia

Dysphagia

Odynophagia

Weight loss

38
Q

Clinical presentation of larynx cancer.

A

Dysphonia

Dysphagia

Otalgia

Globus sensation (feel like something is stuck in the throat)

Neck lump

Weight loss

Cachexia

39
Q

Types of thyroid cancers.

A

Papillary adenocarcinoma

Follicular adenocarcinoma

Medullary carcinoma

Anaplastic carcinoma

40
Q

Most common type of thyroid cancer.

A

Papillary adenocarcinoma

41
Q

Treatment of thyroid cancer.

A

Thyroidectomy

Radioactive iodine

Chemoradiotherapy

42
Q

What type of imaging is used in laryngeal and pharyngeal cancers?

A

Usually CT first

43
Q

Investigation of thyroid cancer.

A

Ultrasound

Biopsy

H&N (37 decks)

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