Sesap Head And Neck

Front 1

Most common congential cystic lesion of the neck

Back 1

thyroglossal duct cyst
70% of all congenital neck abnormalities
Most commonly in 1st decade
Cystic anterior midline neck mass
Usually at or below the level of the hyoid bone

Front 2

Where does the thyroid gland develop from?

Back 2

midline endodermal invagination of the foregut (foramen cecum)

Front 3

Indications for operating on thyroglossal duct cyst

Back 3

increasing size
risk of cyst infection
suspicious for carcinoma

Front 4

Procedure for thyroglossal duct cyst

Back 4

Sistrunk procedure
complete excision of cyst
central portion of hyoid bone
tissue above hyoid bone extending to base of tongue

Front 5

What percentage of thyroglossal duct cysts harbor carcinoma?

Back 5

1%
MC papillary carcinoma (80%)
sistrunk is adequate if not advanced

Front 6

Workup of solitary neck mass

Back 6

1.) H&P
2.) U/S guided FNA
3.) panendoscopy
10% will require open biopsy

Front 7

history suggestive of metastatic neck mass

Back 7

older age, male, history of tobacco/etoh, painless, unilateral, rapid growth, fixed location, upper aerodigestive tract symptoms

Front 8

MC metastatic disease from carcinoma of unknown primary

Back 8

neck
upper neck mets usually from H&N CA
lower neck lesions usually from below clavicles

Front 9

Neck mass workup

Back 9

CT (20% identification)
Panendoscopy 65%

Front 10

MC H&N Ca from an unknown location

Back 10

tonsils

Front 11

Metastatic nodes in subdigastric, submandibular, and midjugular region are at high risk for?

Back 11

occult tonsillar malignancies

Front 12

Survival rates of H&N CA with neck mets

Back 12

<50%
4-10% synchronous tumors
27% metachronous tumors (lung/eso)

Front 13

Most commonly involved nodes in oral tongue cancer

Back 13

jugulodigastric and jugular nodes

Front 14

When is selective neck dissection indicated?

Back 14

N0 neck disease

Front 15

treatment of clinically positive neck involvement

Back 15

MRND or RND

Front 16

Role of XRT/Chemo in H&N cancers

Back 16

increases stage III survival
decreases risk of local regional recurrence
external beam (teletherapy) MC - 60-65Gy
initiated 6 weeks after operation
Cisplatin + 5-FU has not been shown to increase survival or decrease locoregional failure?

Front 17

Lateral aberrant thyroid is

Back 17

cervical LN mets from papillary thyroid CA

Front 18

How does papillary CA often present as?

Back 18

thyroid nodule

Front 19

Percentage of papillary cancers that is associated with LN mets

Back 19

80% (don't appear to influence long term survival)
35% palpable

Front 20

Treatment of papillary CA + lateral aberrant thyroid

Back 20

Thyroidectomy + prophylactic central neck dissection?

Front 21

Location of benign salivary glands

Back 21

proportional to gland size

Parotid (65-80%)
Submandibular (10%)

Front 22

Likelihood of malignancy

Back 22

inversely proportional to gland size
Sublingual 70-90%
Submandibular 40%
Parotid 15-30%

Front 23

MC benign salivary gland tumor

Back 23

Pleomorphic adenoma (mixed)
50% of all salivary gland tumors
>80% of benign lesions
Most in parotid

Front 24

2nd MC benign salivary tumor

Back 24

Warthin's
10-12%

Front 25

Benign tumor found almost exclusively in parotid

Back 25

Warthin's

Front 26

Warthin is also known as.....

Back 26

papillary cystadenoma lymphomatosum
always benign
2% recurrence rate
More common in males (5:1)
10% bilateral or multifocal
Smokers 8X risk

Front 27

Most common malignant salivary gland tumor

Back 27

Mucoepidermoid carcinoma
15% of all salivary tumors
usually in parotid
low grade invade locally and recur in 15%

Front 28

Metastatic potential, recurrence rate , and FYSR of low grade vs high grade mucoepidermoid carcinoma?

Back 28

rare (vs 30%)
>90% FYSR for low grade (vs ~50%)
15% recurrence (vs 30%)

Front 29

Presentation of parotid tumors

Back 29

painless swelling anterior to ear that's mobile to palpation
4-6cm @ time of dx
indolent growth

Front 30

Work up of parotid mass

Back 30

FNA

Front 31

treatment of all benign salivary neoplasms

Back 31

complete excision (Enucleation-> high recurrence)
superficial vs total parotidectomy

Front 32

Treatment of malignant salivary tumors

Back 32

en bloc surgical excision

Front 33

When is post op radiation therapy indicated?

Back 33

high grade
extraglandular dz
perineural invasion
regional mets

Front 34

When is temporal bone resection performed?

Back 34

gross facial nerve involvement

Front 35

Anterior triangle contains which groups of lymph nodes

Back 35

II, III, IV

Front 36

Posterior triangle contained with lymph node region?

Back 36

V

Front 37

Central lymph node groups are...

Back 37

I, VI, VII

Front 38

Submental triangle nodes

Back 38

regional I

Front 39

Centrally located nodes

Back 39

region VI (medial to lateral borders of strap muscles)

Front 40

Jugulodigastric nodes drain..

Back 40

Region II drain soft palate, tonsil, base of tongue, pyriform sinus, supraglottic larynx

Front 41

Middle jugular nodes drain....

Back 41

Region III
Drain supraglottic larynx, inferior piriform sinus, postcricoid region

Front 42

Most inferior jugular nodes...

Back 42

Region IV
drain thyroid, trachea, cervical esophagus

Front 43

Nasopharynx and oropharynx usually drain to

Back 43

posterior triangle (region V)

Front 44

Hypopharyngeal tumors drain to

Back 44

anterior cervical

Front 45

Efficacy of panendoscopy

Back 45

bronchoscopy
rigid cervical esophagoscopy
direct laryngoscopy
detects 65% of primary tumors

Front 46

Treatment for N1 or N2a

Back 46

Neck dissection or XRT alone

Front 47

Most important prognostic factor

Back 47

nodal status

Front 48

Percentage of parotid tumors that present with facial nerve paralysis

Back 48

1/8
poor prog (<3ysr)
usually high grade mucoepidermoid (25% occult nodal mets)
or adenoid cystic CA

Front 49

Work up and treatment of parotid tumors involving facial nerve

Back 49

MRI and FNA
radical parotidectomy
nerve sacrifice with sural nerve recon

Front 50

Stage I and 2 head and neck cancers

Back 50

surgery or xrt

Front 51

stage III or IV H&N cancers

Back 51

chemoxrt or surgery; neck dissection controversial