Fiser Absite. Ch 19. Head And Neck.

Front 1

The anterior neck triangle contains the carotid sheath. What are the borders?

Back 1

SCM muscle, sternal notch and inferior border of the digastric muscle

Front 2

The posterior neck triangle contains the spinal accessory nerve and the brachial plexus. What are the borders?

Back 2

posterior border of SCM muscle, trapezius muscle and the clavicle

Front 3

In the neck, on what muscle does the phrenic nerve sit?

Back 3

anterior scalene muscle

Front 4

Three glands in the mouth can be identified by their secretions:

____ glands - secrete mostly serous fluid.
___ glands - secrete mostly mucin.
___ glands - 50/50

Back 4

parotid
sublingual
submandibular

Front 5

In the larynx, where are the false vocal cords located in relation to the true vocal cords?

Back 5

superior

Front 6

What are the three branches of the trigeminal nerve?

Back 6

ophthalmic, maxillary, mandibular

Front 7

What nerve provides motor function to face? and sensory?

Back 7

facial, trigeminal

Front 8

What nerve provides sensory to posterior tongue. Motor to stylpharngeus. Injury affects swallowing?

Back 8

Glossopharyngeal nerve

Front 9

Hypoglossal nerve provides motor to all of tongue except what muscle?

Back 9

palatoglossus

Front 10

Recurrent laryngeal nerve innervates all of larynx except which muscle? What is it innervated by?

Back 10

cricothyroid is innerved by superior thyroid nerve

Front 11

What syndrome occurs after parotidectomy; injury of auriculotemporal nerve that then cross-innervates with sympathetic fibers to sweat glands of skin • Symptom: gustatory sweating?

Back 11

Frey’s syndrome

Front 12

What are the 5 branches of the thyrocervical trunk with mnemonic?

Back 12

STAT, suprascapular artery, transverse cervical artery, ascending cervical artery, inferior thyroid artery

Front 13

What is the 1st branch of the external carotid artery?

Back 13

superior thyroid artery

Front 14

What artery is the trapezius flap based on?

Back 14

transerve cerivcal artery

Front 15

What aretery is pectoralis major based on?

Back 15

thoracoacromial artery

Front 16

___ – congenital bony mass on upper palate of mouth. Tx: nothing

___ – similar to above but on the anterior lingual surface of the mandible

Back 16

Torus palatini

Torus mandibular

Front 17

What procedure takes accessory nerve (CN XII), sternocleidomastoid, internal jugular, omohyoid, submandibular gland, sensory nerves C2–C5, cervical branch of facial nerve, and ipsilateral thyroid • Most morbidity occurs from accessory nerve resection.

Back 17

Radical neck dissection

Front 18

What procedure takes omohyoid, submandibular gland, sensory nerves C2–C5, cervical branch of facial nerve, ipsilateral thyroid?

Back 18

Modified radical neck dissection

Front 19

What is the most common cancer of the oral cavity, pharynx, and larynx?

Back 19

squamous cell CA

Front 20

What are the two biggest risk factors for squamous cell CA of the oral cavity, pharynx and larynx?

Back 20

tobacco and ETOH

Front 21

What is considered more pregmalignant, leukoplakia or erythroplakia?

Back 21

erythroplakia

Front 22

What is the most common site for oral cavity CA?

Back 22

lower lip

Front 23

What location for oral cavity cancer has the lowest survival rate because it is hard to resect?

Back 23

hard palate tumors

Front 24

Glossitis, cervical dysphagia from esophageal web, spoon fingers, iron deficiency anemia and increased oral cavity CA

Back 24

Plummer-Vinson Syndrome

Front 25

In the tx for oral cavity CA. Wide resection if tumor is < ___, need 1-2 cm margins.

If larger or if clinically positive nodes do what?

Back 25

2 cm

MRND

Front 26

What is the postop tx for oral cavity CA for advanced lesions (>2 cm, positive margins, nerve/vascular/lymphatic invasion)?

Back 26

XRT

Front 27

What location with lip CA is associated with more aggressive lesions?

Back 27

commissure

Front 28

Well-differentiated tumor of the cheek • Not aggressive • Tx: full cheek resection +/− flap; no MRND

Back 28

Verrucous ulcer

Front 29

What is the tx for cancer of the maxillary sinus?

Back 29

maxillectomy

Front 30

What is the primary tx for nasopharyngeal SCCA? and what for tumors > 2 cm or clinically positive nodes?

Back 30

XRT, MRND with postop chemo for advanced disease

Front 31

What is the #1 tumor of the nasopharynx in children and what is the tx?

Back 31

lymphoma, chemo

Front 32

What is the most common benign neoplasm of the nose/paranasal sinuses?

Back 32

papilloma

Front 33

What is the best way to bx tonsillary CA?

Back 33

tonsillectomy

Front 34

Benign tumor • Presents in males < 20 years (obstruction or epistaxis) • Extremely vascular • Tx: angiography and embolization (usually internal maxillary artery), followed by resection

Back 34

Nasopharyngeal angiofibroma

Front 35

What is the most common benign lesion of the larynx?

Back 35

papilloma

Front 36

What are the three locations for laryngeal cancer?

Back 36

Supraglottic SCCA
Glottic SCCA
Subglottic SCCA

Front 37

What is the tx for small laryngeal cancer?

Back 37

XRT or conservative surgery (glottic is laser or chordectomy with recurrence)

Front 38

What are the three treatments for large laryngeal cancer?

Back 38

laryngectomy, MRND, post op XRT

Front 39

With glottic laryngeal cancer, what treatment is required for fixed cords?

Back 39

laryngectomy

Front 40

What is the most frequent salivary gland for malignant tumor?

Back 40

parotid

Front 41

Is a mass in a large salivary gland more likely benign or malignant? and a small salivary gland?

Back 41

mass in large gland is more likely benign
mass in small glands is more likely malignant

Front 42

What is the #1 type of malignant tumor of the salivary gland?

Back 42

Mucoepidermoid CA

Front 43

What is the #2 type of malignant tumor of the salivary glands and the #1 malignant salivary tumor of the minor salivary glands?

Back 43

Adenoid cystic CA

Front 44

Tx for malignant tumor of the salivary gland is resection of the gland and if high grade or SCCA what are 2 other additional treatments?

Back 44

prophylactic MRND and postop XRT

Front 45

With parotidectomy when should the facial nerve be sacrificed?

Back 45

facial nerve should be sacrificed only for direct tumor invasion or for preexisting facial paralyses

Front 46

What is the #1 benign tumor of the salivary glands? what

Back 46

pleomorphic adenoma

Front 47

What percentage of pleomorphic adenoma have malignant degeneration?

Back 47

5%

Front 48

What is the difference in tx for pleomorphic adenoma and one with malignant degeneration?

Back 48

superficial parotidectomy for pleomorphic adenoma and total parotidectomy with malignant degeneration with MRND if high grade

Front 49

What is the #2 benign tumor of the salivary glands?

Back 49

Warthin's tumor

Front 50

What sex preference for Warthin's tumor? what percent are bilateral?

Back 50

males, 10%

Front 51

What is the tx for Warthin's tumor?

Back 51

superficial parotidectomy

Front 52

What is the most common injured nerve with parotid surgery and what is the sx?

Back 52

greater auricular nerve, numbness over lower portion of auricle

Front 53

For submandibular gland resection what three nerves need to be found?

Back 53

mandibular branch of the facial nerve, lingual nerve and hypoglossal nerve

Front 54

What is the most common salivary gland tumor in children?

Back 54

hemangiomas

Front 55

The facial nerve runs between what two lobes of the parotid gland?

Back 55

superficial and deep

Front 56

What is the physiology of cauliflower ear? and tx?

Back 56

undrained hematomas that organize and calcify; need to be drained to avoid this

Front 57

What is the name of a vascular tumor of the middle ear (paraganglionoma), tx: surgery and +/- XRT

Back 57

chemodectomas

Front 58

CN VIII, tinnitus, hearing loss, unsteadiness; can grow into cerebellar/pontine angle. Tx: craniotomy and resection; XRT is alternative to surgery

Back 58

Acoustic neuroma

Front 59

Epidermal inclusion cyst of ear; slow growing but erode as they grow; present with conductive hearing loss and clear drainage from ear. Tx: surgical excision.

Back 59

Cholesteatoma

Front 60

20% of Ear SCCA metastasize to where?

Back 60

parotid gland

Front 61

What is the most common childhood aural malignancy (although rare) of the middle or external ear?

Back 61

rhabdomyosarcoma

Front 62

What is the tx for septal hematoma?

Back 62

need to drain to avoid infection and necrosis of septum

Front 63

What is the tx for nasal fractures?

Back 63

set after swelling decreases

Front 64

CSF rhinorrhea usually indicates what fracture?

Back 64

cribiform plate

Front 65

CSF rhinorrhea tx is conservative for how long? then try epidural catheter, may need transethmoid repiar.

Back 65

2-3 weeks

Front 66

What percentage of epistaxis is anterior and can be controlled with packing?

Back 66

90%

Front 67

Persistant posterior epistaxis, consider ligation (direct or angiographically) of what two arteries?

Back 67

internal maxillary artery or ethmoid artery

Front 68

Slow-growing odontogenic malignancy; soap bubble appearance on xray; can have metastases. Tx: wide-local excision.

Back 68

Ameloblastoma

Front 69

Treatment for TMJ dislocation?

Back 69

closed reduction

Front 70

What nerve damage can cause lip numbness?

Back 70

inferior alveolar nerve

Front 71

What is the tx for Stensen's duct laceration? why not ligation?

Back 71

repair over catheter stent. Ligation can cause painful parotid atrophy and facial asymmetry

Front 72

What is the most common organism is suppurative parotitis?

Back 72

staph

Front 73

Tx for suppurative parotitis includes fluids, salivation, antibiotics; and ___ if abscess develops or pt not improving.

Back 73

drainage

Front 74

Acute inflammation of the salivary gland related to a stone in the duct; most calculi near orifice. Recurrent is thought to be due to ascending infection from the oral cavity. 80% of the time affects the submandibular or sublingual glands.

Back 74

Sialoadenitis

Front 75

What is the tx for sialoadenitis? and for recurrent disease?

Back 75

incise duct and remove stone, gland excision may eventually be necessary for recurrent diesease

Front 76

What age group is peritonsillar abscess more common? and retropharyngeal abscess?

Back 76

older kids (>10 years), younger kids (<10 years)

Front 77

Which is an airway emergency peritonsillar abscess or retropharyngeal abscess?

Back 77

retropharyngeal abscess

Front 78

Retropharyngeal abscess is usually seen in younger kids but can be seen in the elderly with what disease?

Back 78

Pott's disease

Front 79

What is the 1st tx for peritonsillar abscess? and if no relief in 24 hrs?

Back 79

Needle aspiration 1st, then drainage through tonsillar bed if no relief in 24 hours May need to intubate to drain; will self-drain with swallowing once opened

Front 80

Retropharyngeal abscess is an airway emergency. What is the tx?

Back 80

Intubate the patient in a calm setting; drainage through posterior pharyngeal wall; will self-drain with swallowing once opened.

Front 81

What age group does parapharyngeal abscess occur in?

Back 81

all age groups

Front 82

Morbitity in parapharyngeal abscess comes from ___ and mediastinal spread via prevertebral and retopharyngeal spaces.

Back 82

vascular invasion

Front 83

Tx for parapharyngeal abscess includes drainage through lateral neck to avoid damaging what 2 structures? will need to leave drain in.

Back 83

internal carotid and internal jugular veins

Front 84

Acute infection of the floor of the mouth, involves mylohyoid muscle • Most common cause is dental infection of the mandibular teeth • May rapidly spread to deeper structures and cause airway obstruction • Tx: airway control, surgical drainage, antibiotics

Back 84

Ludwig's angina

Front 85

All lumps near ear are what until proven otherwise?

Back 85

parotid tumors

Front 86

What is the most common distant metastases location for head and neck tumors?

Back 86

lung

Front 87

With posterior neck masses, if no obvious malignant epithelial tumor, considered to have what until proven otherwise? and how to dx?

Back 87

Hodgkin's lymphoma, FNA or open bx

Front 88

Neck mass workup:
• 1st – history and exam, laryngoscopy, antibiotics if thought to be inflammatory, ___ if hard
• 2nd – panendoscopy with multiple random biopsies, neck and chest CT
• 3rd – still cannot figure it out → perform ____; need to be prepared for MRND

Back 88

FNA, excisional biopsy

Front 89

Adenocarcinoma found in neck mass workup suggests what 3 possible primaries?

Back 89

breast, GI or lung

Front 90

Epidermoid CA found in cervical node without known primary
• 1st – ___ with random biopsies
• 2nd – CT scan
• 3rd – still cannot find primary → ipsilateral MRND, ipsilateral tonsillectomy, bilateral ___

Back 90

panendoscopy,

XRT

Front 91

What is the most common location for esophageal foreign body (95%)?

Back 91

just below the cricopharyngeus

Front 92

Perforation risk with esophageal foreign body increases with what?

Back 92

length of time in the esophagus

Front 93

Fever and pain after rigid EGD for esophageal foreign body. What next?

Back 93

CXR and gastrografin followed by barium swallow to rule out perforation

Front 94

Laryngeal foreign body, what might be needed as a last resort to secure airway?

Back 94

cricothyroidotomy

Front 95

Lip lacerations – apposition of the ___ is key. ___ closure is preferred

Back 95

vermillion border, Layered

Front 96

Prolonged intubation – can lead to ___, which is treated with laser, dilatation, possible excision

Back 96

subglottic stenosis

Front 97

Tracheostomy should be considered in any pt who will require intubation for more than how many days?

Back 97

7-14

Front 98

Tracheostomy decreases secretions, provides easier ventilation, and decreases what other risk?

Back 98

pneumonia risk

Front 99

Rapid exsanguination after tracheostomy, think what? and do what?

Back 99

tracheo-innominate fistula, median sternotomy

Front 100

Tracheo-innominate fistula can be avoided by keeping tracheostomy above what?

Back 100

3rd tracheal ring

Front 101

Median rhomboid glossitis is failure of tongue fusion. What is the tx?

Back 101

none necessary

Front 102

Cleft lip should be repaired at how many weeks, how many pounds and with a Hgb of what? Repair nasal deformities at the same time.

Cleft palate should be repaired at what age?

Back 102

10 weeks, 10 lb, Hgb 10.

12 months

Front 103

What is the most common benign head and neck tumor in adults?

Back 103

hemangioma

Front 104

Thumbprint sign on lateral neck film indicates what?

Back 104

Epiglottitis

Front 105

Why is epiglottits rare?

Back 105

H. influenzae type B vaccine

Front 106

What is the tx for epiglottitis?

Back 106

early control of airway and abx

Front 107

What are the most common sites for Kaposi's sarcoma?

Back 107

oral and pharyngeal mucosa

Front 108

What is the most common neoplasm in pts with AIDS?

Back 108

Kaposi's sarcoma

Front 109

What are the 2 treatments for Kaposi's sarcoma?

Back 109

XRT and intratumor vinblastine