Head & Neck

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Head & Neck
2013-12-29 05:24:51

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  1. Duct of the sublingual glands =
    Ducts of Rivinus
  2. Duct of the submandibular glands=
    Wharton ducts
  3. Duct of the parotid gland =
    Stensen duct
  4. Componants of the oral cavity:
    • lips
    • oral tongue (ant 2/3)
    • buccal mucosa
    • floor of the mouth
    • upper & lower alveolar ridge
    • retromolar trigone
    • hard palate

    • Anterior boundary: skin-vermillion junction
    • Posterior boundary: circumvallate papillae, anterior tonsillar pillars, junction of hard/soft palate, pharyngoepiglottic fold
  5. Componants of the hypopharynx:
    • piriform sinuses
    • postcricoid region
    • posterior pharyngeal wall between pharyngoepiglottic fold to the upper esophageal sphincter
  6. Componants of the larynx:
    supraglottis = epiglottis, aryepiglottic folds, arytenoids, ventricle, false vocal cords

    glottis = true vocal cords, anterior & posterior commissures

    subglottis = inferior to glottis extending to the inferior border of the cricoid cartilage
  7. Course of the retromandibular vein =
    Between the superficial and deep lobes of the parotid
  8. 3 major nerves at risk during surgery on the submandibular gland =
    • hypoglossal
    • marginal mandibular
    • lingual
  9. Reference landmarks for identification of the facial nerve:
    • Tympanomastoid suture line - just deep & medial
    • Tragal pointer - 1cm deep & inferior
    • Posterior belly of the digastric - same plane
    • Trace back from peripheral branches
    • Mastoidectomy
    • Stylomastoid foramen ???
  10. Where is the marginal mandibular branch of the facial nerve located?
    Just deep to the superficial layer of the deep cervical fascia, which lies below the platysma
  11. Innervation of the submandibular gland:
    Lingual nerve
  12. Pharynx is composed of what type of epithelium?
    • nonkeratinizing stratified squamous
    • ciliated respiratory
  13. Name the componants of the Waldeyer ring:
    • palatine tonsils
    • adenoids
    • lingual tonsils
  14. What are the crypts of the palatine tonsils lined with?
    stratified squamous epithelium
  15. What type of epithelium covers the adenoids?
    pseudostratified ciliated columnar epithelium with surface folds but no crypts
  16. What type of epithelium lines the nasal cavity?
    • respiratory epithelium primarily
    • specialized sensory olfactory epithelium
  17. What nodal basins do tumors of the larynx most commonly metastasize to?
    II, III, IV
  18. Contents of Level IA:
    • fibroadipose/lymphatic tissue
    • no major neurovascular structures
  19. Contents of Level IB:
    submandibular gland
  20. Boundaries of Level II
    • Superior - skull base
    • Inferior - hyoid bone
  21. Boundaries of Level III
    Posterior - posterior edge of SCM
  22. Boundaries of Level IV
    Superior - cricoid cartilage
  23. Describe the course of the left recurrent laryngeal nerve:
    Separates from the vagus in the mediastinum, wraps around the aortic arch at the ductus arteriosis, ascends along the tracheoesophageal groove
  24. Describe the course of the right recurrent laryngeal nerve
    Divides off the vagus and passes around the right subclavian artery, travels along the tracheoesophageal groove & enters larynx just superior to the cricoid cartilage
  25. How often to nonrecurrent nerves occur and what are they associated with?

    retroesophageal right subclavian vein
  26. Synchronous versus metachronus lesions =
    synchronous - found within 6mo

    metachronous - diagnosed after 6mo
  27. Most commonly altered tumor suppressor gene in human cancers =

    Most commonly altered gene locus =
    p53 (poorly degraded & so overly expressed in H&N cancers)

  28. Oral cavity carcinoma staging:
    • T1 = < 2cm
    • T2 = 2-4cm
    • T3 = >4cm
    • T4 = invasion of adjacent structures
  29. What cancers drain to the level II region?
    Oropharyngeal cancers
  30. Most common locations for a primary site of an unknown SCC of the head & neck:
    • Tonsils
    • Base of tongue
    • Piriform sinuses
    • Nasopharynx
  31. Risk factors for development of head & neck cancer:
    • Tobacco - SCC
    • Alcohol abuse - SCC
    • Heavy metal/wood dust inhalation exposure - sinonasal cancers
    • UV light - cutaneous malignancies
    • Salted fish - nasopharyngeal cancers
    • Epstein-Barr virus - nasopharyngeal cancers
    • Plummer-Vinson syndrome - oral cavity & hypopharyngeal carcinoma
    • Human Papilloma Virus - oral, oropharyngeal, & laryngeal cancer
  32. Most common cancerous pathology of the lower lip:
    squamous cell carcinoma

    (basal cell is most common on upper lip)
  33. Lower lip SCC initial workup:
    • evaluate for mental nerve involvement, mandibular invasion
    • examine cervical lymphatics
    • consider CT
  34. Lower lip SCC treatment:
    Early stage - primary external beam radiation or surgical resection

    Elective LN disection for clinically negative neck - advanced T stage, deep tumor invasion

    Positive nodal disease - therapeutic neck dissection indicated
  35. Indications for postoperative irradiation in lower lip SCC:
    • advanced T stage
    • positive margins
    • perineural/perivascular invasion
    • mulitple/bulky nodal disease
    • invasion of bone
  36. lower lip SCC prognosis:
    Stage I & II - 90% 5yr survival

    cervical lymph node involvement - 50% 5yr survival
  37. Lower lip excisional defect reconstructive options:
    Lesions involving less than 1/3 to 1/2 of the lip - primary closure with local tissue advancement

    Lesions 1/2 to 2/3 of lip - Pedicled two-stage cross-lip transfer flap (Abbe flap for central defects, Estlander flap for lateral defects)

    Larger than 2/3 of lip - local advancement techniques, local rotational flaps, distal free flaps
  38. Rate of occult cervical metastases in oral tongue cancer:

    Factors that increase risk:

    limited supraomohyoid dissection (levels I, II, III) recommended in almost all pts.

    • Risk Factors:
    • depth of invasion > 4-5mm