Head & Neck

Question 1

Branchial cleft anomalies

Answer 1

1st
External opening - pre-auricular area
Internal opening: middle ear
2nd
EO: lateral neck at SCM
IO: tonsillar fossa
3rd 
EO: lateral neck at SCM
IO: pyriform sinus

Question 2

Treatment of branchial cleft anomalies

Answer 2

Comoplete excision once inflmmation subsides

Question 3

Where do we do blind biopsies in unknown primaries of the head and neck

Answer 3

Base of tongue
Tonsillar fossa
Pyriform sinus
Nasopharynx

Question 4

Ranula

Answer 4

Mucous retention cyst involving the sublingual gland

Tx: excision or marsupialization

Question 5

Epulis

Answer 5

Granulomatous lesions on the gingival or alveolar mucosa

literally means growth on the gingiva

Question 6

Describe granular cell myoblastoma

Answer 6

“SAS”

• firm, submucosal swellings in the mid 1/3 of the tongue
• aka Abrikossoff tumor
• derived from Schwann cells
• tx: wedge excision

Question 7

Describe juvenile nasopharyngeal angiofibroma

Answer 7

“FAME”

• highly expansile and destructive Fibrovascular neoplasms
• typically occurs in Adolescent males
• presents with Massive Epistaxis
• tx: angioembolization

Question 8

Lateral rhinotomy eponym

Answer 8

Weber-Ferguson procedure

Question 9

Anterior epistaxis is from

Answer 9

Kisselbach’s plexus in the little’s area

• ICA branches (anterior and post ethmoidal br’s)
• ECA (sphenopalatine and greater palatine arteries, septal branch of the superior labial artery)

Question 10

Posterior epistaxis is from

Answer 10

Woodruff’s plexus
Formed by branches of internal maxillary artery
-posterior nasal sphenopalatine
-ascending pharyngeal arteries

Question 11

Describe laryngocele

Answer 11

• herniation of the laryngeal ventricles d/t chronic increaes in intralaryngeal presure
• tx: lligation of stalk and repair of ventriccles

Question 12

Describe ameloblatoma

Answer 12

• aka adamantinoma
• assoc’d with impacted tooth
• painless benign but localy aggressive mandibula mass THAT MAY ERODE THE BONE CORTEX
• (+) soap-bubble appearance on radiographs
• tx: excision with 1-2cm margin of normal mandible

Question 13

Marginal vs segmental mandibulectomy

Answer 13

Marginal - inf alveolar nerve is NOT invloved

Question 14

Describe HNSCC

Answer 14

• HPV-negative is more commone (80%) but it’s the one that carries a poor porgnosis
• TP53 mutation occurs early (vs colon CA’s late TP53 mutation)

Question 15

Cervical lymph node (CLN) 1a

Answer 15

Submental nodes (medial to anterior belly of digastric)

Question 16

CLN 1b

Answer 16

Submandibular node (posterior to anterior belly of diagstric)

Question 17

CLN 2a

Answer 17

Upper jugular chain

Inferior to SAN

Question 18

CLN 2b

Answer 18

Submuscular recess

Superior to SAN

Question 19

CLN 3

Answer 19

Midjugular ln

Hyoid to cricoid

Question 20

CLN 4

Answer 20

Lower jugulrn ln

Cricoid to clvicle

Question 21

Cln 5

Answer 21

Posterior triangle / suboccipital ln

SAN is the divider

Question 22

Cln6

Answer 22

Anterior / central lymph nodes
Inferior to hyoid, superior to superasternal notch, medial to strap muscles
- removed in total thyroidectomy in cases of MTC

Question 23

Cln 7

Answer 23

Superior mediastinal / paratracheal / suprasternal ln

-inferior to suprasternal notch

Question 24

Cancer cells in thyroid malignancy will metastasize first to this group of cln

Answer 24

Cln V

Question 25

SUPRAOMOHYOID DISSECTION

Answer 25

- for oral cavity and lip malignancies | - I, II, III

Question 26

Lateral neck dissection

Answer 26

- for laryngeal, oropharyngeal, hypopharngeal malignancies | - II, III, and IV

Question 27

Central neck dissection

Answer 27

- for thyroid malignancy (MTC?) | - VI

Question 28

Posterolateral neck dissection

Answer 28

- for thyroid and posterior malignancies - nasopharynx (?) - II, III, IV, and V

Question 29

Boundaries of the hypopharnyx

Answer 29

Suprior: hyoid bone, glossoepiglottic and pharyngoepiglottic folds Inferior: cricoid cartilage, cricopharyngeus Anterior: posteriro cricoarytenoid muscle Posterior: mucosal wal, middle and inferior constrictor muscles

Question 30

Subsites of hypopharynx

Answer 30

Pyriform sinus Postcricoid region Posterior wall (3 subsites of the hypopharynx are pertinent to localize where SCC arises)