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51 Cards in this Set
- Front
- Back
Most common congential cystic lesion of the neck
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thyroglossal duct cyst
70% of all congenital neck abnormalities Most commonly in 1st decade Cystic anterior midline neck mass Usually at or below the level of the hyoid bone |
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Where does the thyroid gland develop from?
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midline endodermal invagination of the foregut (foramen cecum)
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Indications for operating on thyroglossal duct cyst
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increasing size
risk of cyst infection suspicious for carcinoma |
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Procedure for thyroglossal duct cyst
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Sistrunk procedure
complete excision of cyst central portion of hyoid bone tissue above hyoid bone extending to base of tongue |
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What percentage of thyroglossal duct cysts harbor carcinoma?
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1%
MC papillary carcinoma (80%) sistrunk is adequate if not advanced |
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Workup of solitary neck mass
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1.) H&P
2.) U/S guided FNA 3.) panendoscopy 10% will require open biopsy |
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history suggestive of metastatic neck mass
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older age, male, history of tobacco/etoh, painless, unilateral, rapid growth, fixed location, upper aerodigestive tract symptoms
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MC metastatic disease from carcinoma of unknown primary
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neck
upper neck mets usually from H&N CA lower neck lesions usually from below clavicles |
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Neck mass workup
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CT (20% identification)
Panendoscopy 65% |
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MC H&N Ca from an unknown location
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tonsils
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Metastatic nodes in subdigastric, submandibular, and midjugular region are at high risk for?
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occult tonsillar malignancies
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Survival rates of H&N CA with neck mets
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<50%
4-10% synchronous tumors 27% metachronous tumors (lung/eso) |
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Most commonly involved nodes in oral tongue cancer
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jugulodigastric and jugular nodes
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When is selective neck dissection indicated?
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N0 neck disease
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treatment of clinically positive neck involvement
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MRND or RND
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Role of XRT/Chemo in H&N cancers
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increases stage III survival
decreases risk of local regional recurrence external beam (teletherapy) MC - 60-65Gy initiated 6 weeks after operation Cisplatin + 5-FU has not been shown to increase survival or decrease locoregional failure? |
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Lateral aberrant thyroid is
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cervical LN mets from papillary thyroid CA
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How does papillary CA often present as?
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thyroid nodule
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Percentage of papillary cancers that is associated with LN mets
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80% (don't appear to influence long term survival)
35% palpable |
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Treatment of papillary CA + lateral aberrant thyroid
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Thyroidectomy + prophylactic central neck dissection?
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Location of benign salivary glands
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proportional to gland size
Parotid (65-80%) Submandibular (10%) |
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Likelihood of malignancy
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inversely proportional to gland size
Sublingual 70-90% Submandibular 40% Parotid 15-30% |
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MC benign salivary gland tumor
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Pleomorphic adenoma (mixed)
50% of all salivary gland tumors >80% of benign lesions Most in parotid |
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2nd MC benign salivary tumor
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Warthin's
10-12% |
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Benign tumor found almost exclusively in parotid
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Warthin's
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Warthin is also known as.....
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papillary cystadenoma lymphomatosum
always benign 2% recurrence rate More common in males (5:1) 10% bilateral or multifocal Smokers 8X risk |
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Most common malignant salivary gland tumor
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Mucoepidermoid carcinoma
15% of all salivary tumors usually in parotid low grade invade locally and recur in 15% |
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Metastatic potential, recurrence rate , and FYSR of low grade vs high grade mucoepidermoid carcinoma?
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rare (vs 30%)
>90% FYSR for low grade (vs ~50%) 15% recurrence (vs 30%) |
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Presentation of parotid tumors
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painless swelling anterior to ear that's mobile to palpation
4-6cm @ time of dx indolent growth |
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Work up of parotid mass
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FNA
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treatment of all benign salivary neoplasms
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complete excision (Enucleation-> high recurrence)
superficial vs total parotidectomy |
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Treatment of malignant salivary tumors
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en bloc surgical excision
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When is post op radiation therapy indicated?
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high grade
extraglandular dz perineural invasion regional mets |
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When is temporal bone resection performed?
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gross facial nerve involvement
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Anterior triangle contains which groups of lymph nodes
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II, III, IV
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Posterior triangle contained with lymph node region?
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V
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Central lymph node groups are...
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I, VI, VII
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Submental triangle nodes
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regional I
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Centrally located nodes
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region VI (medial to lateral borders of strap muscles)
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Jugulodigastric nodes drain..
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Region II drain soft palate, tonsil, base of tongue, pyriform sinus, supraglottic larynx
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Middle jugular nodes drain....
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Region III
Drain supraglottic larynx, inferior piriform sinus, postcricoid region |
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Most inferior jugular nodes...
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Region IV
drain thyroid, trachea, cervical esophagus |
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Nasopharynx and oropharynx usually drain to
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posterior triangle (region V)
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Hypopharyngeal tumors drain to
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anterior cervical
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Efficacy of panendoscopy
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bronchoscopy
rigid cervical esophagoscopy direct laryngoscopy detects 65% of primary tumors |
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Treatment for N1 or N2a
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Neck dissection or XRT alone
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Most important prognostic factor
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nodal status
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Percentage of parotid tumors that present with facial nerve paralysis
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1/8
poor prog (<3ysr) usually high grade mucoepidermoid (25% occult nodal mets) or adenoid cystic CA |
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Work up and treatment of parotid tumors involving facial nerve
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MRI and FNA
radical parotidectomy nerve sacrifice with sural nerve recon |
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Stage I and 2 head and neck cancers
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surgery or xrt
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stage III or IV H&N cancers
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chemoxrt or surgery; neck dissection controversial
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