Chapter 19 Head & Neck

Anterior neck triangle

Posterior neck triangle

What nerve runs on the anterior scalene muscle?

What gland secrete mostly serous fluid?

What gland secrete secrete mostly mucin?

What nerve runs between IJ and carotid arteries?

What gland secretes 50% serous fluid and 50% mucin?

Name the nerve that gives sensation to most of the face and its branches.

What nerve gives Motor function to face? Name the branches.

Injury to Glassophaqrngeal nerve would result in?

Name the nerve:
taste to anterior 2/3 of tongue, sensation to the floor of mouth, and gingiva

Name the Nerve:
motor to all of tongue except palatoglossus
• Tongue deviates to side of injury

Name the nerve:
innervates all of the larynx except cricothyroid muscle

Name the nerve:
innervates the cricothyroid muscle

occurs after parotidectomy;
gustatory sweating

injury of auriculotemporal nerve that then cross-innervates with sympathetic fibers to sweat glands of skin

List the branches of the Thyrocervical trunk

1st branch of the External carotid artery

Blood supply to a Trapezius flap is based on?

Pectoralis major blood supply

Describe a Radical neck dissection.

What structures are taken in a modified radical neck dissection?

Most common cancer of the oral cavity, pharynx, and larynx

Considered more premalignant than leukoplakia

Name the syndrome.
glossitis, cervical dysphagia from esophageal web, spoon fingers, iron - deficiency anemia

What is the tx for Oral cavity CA?

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

#1 tumor of nasopharynx in children?

most common benign neoplasm of nose/ paranasal sinuses

tx for Nasopharyngeal SCCA

What lymph noded does Nasopharyngeal SCCA drain to?

neck mass, sore throat
• Goes to posterior (deep) cervical neck nodes
• Tx: XRT or surgery; MRND for tumors > 2 cm or if clinically positive nodes

ETOH, tobacco, males; SCCA most common; asymptomatic until large; 80% have lymph node metastases at time of diagnosis
• Tx: tonsillectomy best way to biopsy; XRT mainstay

hoarseness; early metastases
• Goes to anterior cervical nodes
• Tx: usually surgery (laryngectomy), MRND, postop XRT

benign tumor
• Presents in males < 2 0 years (obstruction or epistaxis)
• Extremely vascular
• Tx: angiography and embolization (usually internal maxillary artery), followed by
resection

What are the sx and tx for LARYNGEAL CANCER?

Most common benign lesion of the larynx

early nodal spread to submental/submandibular areas
• Small - Tx: XRT or conservative surgery
• Large - Tx: laryngectomy, MRND, postop XRT

nodal spread to anterior cervical chain
• Small - Tx: XRT or laser, chordectomy with recurrence
• Large - Tx: laryngectomy, MRND, postop XRT
• Fixed cords require laryngectomy

early nodal to anterior cervical chain and metastatic spread
• Small - Tx: XRT or conservative surgery ·
• Large - Tx: laryngectomy, MRND, postop XRT

Most frequent SALIVARY GLAND site for malignant tumor?

#1 malignant tumor of the salivary glands

#1 malignant salivary tumor of the minor salivary glands

Tx for SALIVARY GLAND CANCERS

#1 benign tumor of the salivary glands

#2 benign tumor of the salivary glands
Males, bilateral in 10 %

Most common injured nerve with parotid surgery

Most common salivary gland tumor in children

For submandibular gland resection, What nerves should be identified?

Undrained hematomas of the ear that organize and calcify; need to be drained to avoid this

Vascular tumor of middle ear Tx: surgery + / - XRT

CN VIII, tinnitus, hearing loss, unsteadiness; can grow into
cerebellar/ pontine angle
Tx: craniotomy and resection XRT is a l tern ative to
s u rgery

Most common childhood aural malignancy

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

20% metastasize to parotid gland
Tx: parotidectomy, MRND for
positive node or large tumors, XRT

sx of a cribriform plate fracture

Tx for persistent posterior nose bleeding despite packing/ balloon

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

Inferior alveolar nerve damage results in?

Acute inflammation of the salivary gland related to a stone in the duct; most calculi near orifice

Symptoms: trismus, odynophagia; usually does not obstruct airway
• Tx: needle aspiration 1 st, then drainage through tonsillar bed if no relief in 24 hours
• May need to intubate to drain; will self-drain with swallowing once opened

Symptoms: fever, odynophagia, drool; is an airway emergency
• Can occur in elderly with Pott's disease
• Tx: intubate the patient in a calm setting; drainage through posterior pharyngeal
wall; will self- drain with swallowing once opened

all age groups; occurs with dental infections, tonsillitis,
pharyngitis
• Morbidity comes from vascular invasion and mediastinal spread via prevertebral and retropharyngeal spaces
• Tx: drain through lateral neck to avoid damaging internal carotid and internal jugular need to leave drain in

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

Most common distant metastases for head and neck tumors

Neck mass workup

Epidermoid CA found in cervical node without known primary

Esophageal foreign body most likely found?

Prolonged intubation can lead to?

Consider inpatients who will require intubation for > 7-1 4 days
• Decreases secretions, provides easier ventilation, decreases pneumonia risk

Occurs after tracheostomy, can have rapid exsanguination
• Tx: place finger in trach hole and hold pressure
median sternotomy
• This complication is avoided by keeping tracheostomy above the 3rd tracheal ring

failure of tongue fusion

(primary palate) - involves lip, alveolus, or both
• Repair at 10 weeks, 10 lb, Hgb 10 Repair nasal deformities at same time
• May be associated with poor feeding

(secondary palate) - involves hard and soft palates; may affect speech and swallowing if not closed soon enough may affect maxillofacial growth if closed too early
repair at 12 months

most common benign head and neck tumor in adults

Rare; results as a complication of untreated acute supportive otitis media

Most common neoplasm in patients with AIDS