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52 Cards in this Set

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most epithelial malignancies in the head and neck are what?
squamous cell carcinomas AKA epidermoid carcinoma
squamous cell carcinomas in this region usually metastasize to where?
lung
what are the premalignant lesions that may preceed a squamous cell carcinoma?
heaped up white mucosa - leukoplasia. red inflamed mucosa - erythroplasia.
describe characteristics of basal cell carcinoma.
most common cutaneous malignancy and most benign, only locally destructive, no metastasis, and affects facial structures typically exposed to sun (ears, cheek, scalp).
differentiated carcinomas of the thyroid include?
most commonly papillary followed by follicular thyroid cancers and then medullary thyroid cancers which affect the interfollicular C cells and may produce calcitonin (these are usually inherited)
compare the prevalence of malignant vs. benign salivary gland tumors.
benign ones are more common, but malignant ones are more likely to occur in smaller salivary glands.
cervical node metastasis of squamous cell carcinoma is present in what percent of patient's at time of diagnosis? what does this do to the prognosis?
40%, diminishes prognosis by half
compare the metastasis of midline tumors versus glottic tumors.
midlines tend to go bilaterally while glottics only spread in advanced stages due to anatomical barriers of spread.
what is the most common site of metastasis in head and neck cancers?
level II or the upper jugular area medial to the SCM above the level of the hyoid/bifurcation of the carotid.
obviously there are many presentations of head and neck cancers, but what are the common presentations and what do they mean?
dysphonia (hoarseness - indicates larynx, CN X or the RLN), dysphagia (swallowing difficulty), odynophagia (pain on swallowing), otalgia (CN IX, CN X), trismus (difficulty opening mouth - mastication muscles or CN V), hemoptysis (coughing blood), hearing loss (CN VIII or fluid in ear), otorrhea (drainage from ear), epistaxis (nosebleed), facial weakness (CN VII especially in parotic or ear malignancies), facial hypesthesia, diplopia
if otalgia exists and there is no ear pathology what does this mean?
TMJ, tonsil, larynx, and teeth may all refer pain to the ear bc of common innervation (V, VII, IX, and X)
blocking of the eustacian tube at the nasopharynx will indicate and cause what?
indicates nasopharynx cancer and will cause hearing loss by fluid buildup in the middle ear
what type of biopsies should be done with cancers in the head and neck?
fine needle aspiration, slicing it open might spread the cancer
what would a neck dissection remove?
the lymph nodes with or without removing other structures
what does the internal nasal valve seperate and what does it do in terms of air resistance?
it divides the nasal cavity into the nasal cavity proper and the nasal vestibule; it is the narrowest part of the nose and thus offers the greatest resistance to air flow.
what structure provides conveniant access to pituitary tumors?
sphenoid sinus
what is the source of most epixstasis (nosebleeds)?
kiesselbach's plexus which is from the internal and external carotid
taste buds can only distinguish what?
sweet, sour, salty, and bitter
anosmia and hyposmia may be due to what?
most commonly due to post viral infections but also due to head trauma, alzheimer's and environmental toxins
who is at risk for nasal polyps and how are they treated?
nasal allergies, chronic sinusitis, asthmatics... surgery
what mediates allergic rhinitis?
mast cell's release of IgE
diseases where may lead to vocal cord paralysis?
mediastinum, apex of the lung, thyroid and esophagus
in terms of the larynx, how can a CVA affect it and where would the lesion need to be?
lesion in the brainstem may lead to aspiration secondary to sensory and motor function
bilateral paralysis of the vocal cords can lead to what? What conditions may cause this?
airway obstruction. Can be due to bilateral injury of recurrent nerve, hydrocephalus, or chiari malformation
describe the four stages of swallowing.
the oral preparatory phase is bolus formation. the oral phase is the elevation and sweeping of the tongue. the pharyngeal phase uses motor activity of IX and X and is very fast, larynx moves up, neg pressure, glottis closes and the cricopharyngeus opens so the bolus can pass. The esophageal phase is done via CN X and is completely autonomic
how can dysphagia be treated?
thicker foods, maneuvering during swallowing, double swallow
what are the three zones in terms of penetrating neck trauma? what does an injury in each level indicate?
1. sternal notch to cricoid. 2. cricoid to angle of mandible
3. angle of mandible to skull

areas 1 and 3 are more likely to have damaged major vascular structures and will need angiography. Level 2 injuries may be managed by endoscopy and angiography or surgical exploration
how are mandibular fractures described?
anatomic location, condition of the surrounding teeth, favorability (masticator muscles pulling it open or closed?), and type (simple or comminuted).
what are the types of midface fractures and their classifications?
lefort 1 seperates teeth and palate from the rest of the face. lefort II seperates the middle of the face and palate from the orbits and skull. lefort III seperates the face and orbits from the skull. A blowout fracture is caused by blunt direct trauma to the eye causing the orbital floor bone to go into the maxillary sinus
what is a rhytidectomy?
face lift
what is a blepharoplasty?
improves the appearance of the eyelids
what is the most common branchial cleft anomaly and how is it treated?
branchial cleft cyst which is treated surgically. Note is usually from the second arch and becomes enlarged esp in URI.
what is a branchial cleft anomally that presents in the posterior triangle of the neck, is an abnormality in the development of the lymphatic channels, and can obstruct the mouth and airway?
cystic hygroma AKA cavernous lymphangioma
this branchial cleft anomaliy is due to the migration of the thyroid and is treated by surgery as well as removal of part of the hyoid and the migrational tract.
thyroglossal duct cyst
when are tympanostomy tubes used?
with recurrent acute otitis media that antibiotics will not eliminate
what is a cholesteatoma and how is it treated?
the tympanic bursts near the edge and thus ingrowth of the TM may occur forming these bad boys. They may become infected and must be removed via a mastoidectomy
what is a tympanocentesis?
aspiration of the middle ear contents
what is a tympanoplasty?
repair of the eardrum with or without the repair of the ossicles (ossiculoplasty)
describe the two divisions of hearing loss.
conductive involves lesions of the external ear canal, TM, and middle ear. Sensorineural involves the cochlea, VIII, or the CNS
what is the pathology of otosclerosis?
the stapes has extra bone and becomes fixed, thus it cannot vibrate and soundwaves are not transported to the cochlea. Note it can be treated with a prosthetic stapes
What are the genetic reasons for sensorineural hearing loss?
sporadic via cochlear malformations, chromosomal via tri 18, or dominant inherited via pendrids syndrome or wardenbergs
what are the prenatally aquired ways to develop sensorineural hearing loss?
infections, toxins, hypoxia, prematurity, or kernicterus (elevated bilirubin)
what are postnatal ways to develop sensorineural hearing loss?
meningitis, mumps, measles, and otitis media
what are the two ways to test an infant's hearing abilities?
auditory brainstem response (reflex) or by detecting otoacoustic emissions from the movement of hair cells thus indicating a functioning cochlea
if the cochlea is damaged by say meningitis, how can hearing be restored?
by cochlear implant
What is a vestibular schwanoma?
benign tumor located on the vestibular nerve which grows slowly causing hearing loss with out vertigo
bell's palsy is usually caused by what?
herpes simplex virus
this paralysis is caused by herpes zoster, is associated with pain, and a rash near the ear canal
ramsay hunt syndrome
a rinne negative test result means what?
bone conduction is greater than air conduction thus conductive hearing loss
describe benign paroxysmal positional vertigo.
the posterior semicircular canal develops canoliths in its fluid and thus vertigo occurs when the head is rotated and extended toward the affected ear.
the cause of this disease is unknown, but the pathology is periodic distension of the endolymphatic space in the cochlea and semicircular canals
menieres disease
this is caused by a viral infection in the inner ear.
vestibular neuronitis