Head and neck part 2

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Head and neck part 2
2015-06-29 11:21:25
Head neck

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  1. Causes of glottic insufficiency
  2. Management of glottic insufficiency
  3. Direct swallow manouvres
  4. Indirect swallow exercises
  5. Oral blister causes
    • A Anginga bullosa haemoragica
    • I Infections
    • M Mucocutaneous and mucocoels
  6. Ix for mucocutaneous diseases
    • Biopsy – immunofluorescence
    • Serology IgG,IgA,C3
    • FBC
  7. Water requirements
  8. Cricopharyngeal dysphunction
    surgery more effective if good laryngeal elevation and no pharyngeal weakness
  9. Cutaneous SCC H&N
    • incidence of metastases  2% to 5%
    • parotid lymph nodes = most common site for metastatic spread from anterior H&N cutaneous SCC

    • elective management in clinically and radiographically negative parotid and lymph nodes is not routinely performed of the parotid basin in management of cutaneous SCC.
    • The rate of microscopic metastasis in the neck with an N?+ parotid ranges from
    • 14.7% to 35%, and cervical lymphadenectomy at the time
    • of parotidectomy is generally recommended

    temporal and forehead regions mainly metastasize to the parotid and level II. The anterior neck skin drains mostly to level II, including external jugular nodes.

    Anteroinferior aspects of the face drain mainly to the lymph nodes in levels I, II, and III

    • Routine parotidectomy with the N
    • neck depends on the location of the primary. For example,
    • parotidectomy should be strongly considered in an SCC of the temple and a positive level II lymph node, but much less
    • so in an SCC of the left anterior neck skin with a positive level III lymph node.

    • Adjuvant radiation therapy after neck
    • dissection is recommended for N disease, similar to the data supporting its use in mucosal SCC metastatic to the neck. There are few data to support adjuvant chemotherapy for cutaneous SCC, and the justification to give adjuvant chemotherapy in the adjuvant setting for extracapsular extension is extrapolated from the mucosal SCC data.

    Merkel cell carcinoma

    • Lymph node involvement is
    • common, and is seen in up to 27% of all patients. Given this high rate of regional metastases, elective management of the regional lymphatics is recommended

    lesions anterior to a coronal line drawn through the external auditory canal drain into the parotid and neck levels I-IV.

    external jugular lymph nodes should be incorporated into the lymphadenectomy, preferably in continuity.
  10. Hypopharyngeal cancer resection
    Margins 3cm inf, 2cm lateral, 1.5cm sup, extended to 2cm sup, 4cm inf, 3cm laterally. with proior radiotherapy

    • Partial pharyngectomy for T1 or T2 lesions confined to lateral or posterior pharyngeal wall and dont involve apex of pyriform fossa.
    • 3cm pharyngeal mucosa to allow primary closure
  11. Oral blister causes
    A Anginga bullosa haemoragica

    I Infections

    M Mucocutaneous and mucocoels
  12. Anginga bullosa haemoragica
    • Blood
    • blisters with no defined cause or minimal trauma
  13. Investigations for mucocutaneous diseases
    • Biopsy – immunofluorescence
    • Serology IgG,IgA,C3
    • FBC
  14. Resection margins
    • R0 resection indicates complete removal of all tumor with microscopic examination of margins showing no tumor cells.
    • R1 resection indicates that the margins of the resected parts show tumor cells when viewed microscopically
    • R2 resection indicates that portions of tumor visible to the naked eye were not removed.
  15. Adenocystic carcinoma
    Lung mets 3yr median survival
  16. Intubating ventilating catheters
    • Aintree - 19Fr, place over endoscope, then size 7 + tube
    • Cook airway exchange catheter - 8-19fr, then 43+ et tube
  17. Pharyngocutaneous fistula
    • Fistula types
    • Type 1: fistula size less than 0.5 cm.
    • Type 2: fistula size greater than 0.5 cm but less than 2 cm.
    • Type 3: fistula size greater than 2 cmRepair methods

    • Fistula repair - corresponds to fistula type
    • Type I: two layers are repaired locally
    • Type II: one locally, one distantly
    • Type III: both layers repaired distantly

    • Conservative management
    • Saliva diversion
    • Local dressing
    • Nutrition
    • Infection control

    • Surgical
    • Freshen edges / excise fistula
    • repair
  18. New radiotherapy treatments
    Carbon ions - sharper dose fall off, good for areas close to important structures

    Oroton ion
  19. Prognostic feature
    • Nodal involvement reduces survival by 50%
    • ECS reduces survival by further 50%