Flashcards in HEAD AND NECK Deck (9)
Differential diagnoses for neck mass
(laryngitis or thrush),
work up for neck mass
with biopsies under general anesthesia for treatment planning
confirm absence of a second primary tumor (up to 10% of patients).
patient presents with regional metastasis in the neck without evidence of primary tumor location
thorough head and neck exam, including
fiberoptic nasopharyngoscopy and laryngoscopy,
A fine needle aspiration biopsy of the neck mass should be performed, either directly or with ultrasound guidance,
A contrast-enhanced CT of the neck and chest including the skull base
If no primary tumor is identified with anatomic (CT) imaging, PET scanning may aid in diagnosis.
tonsillectomy (if tonsils are present),
biopsies directed by the previous workup.
The most common sites for an unknown primary with neck node
Tx options for early stage (I, II) disease.
Treatment According to the AJCC guidelines,
tumors are limited in their extent,
no evidence of regional or distant metastasis.
Tx options for advanced disease
Multimodality treatment is necessary
stage (III, IV) disease,
adjuvant radiation OR chemoradiation.
followed every 1 to 3 months for the first year,
every 2 to 4 months for the second year,
every 4 to 6 months until the fifth year.
At this point, the patient is considered to be cured of disease and can follow up yearly or on an as-needed basis.
A key factor in oncologic surveillance is to encourage patients to be seen early if they develop new pain (or worsening pain) at the primary site, new otalgia, dysphagia, odynophagia, hoarseness, significant weight loss, hemoptysis, or hematemesis.
Case Conclusion The patient was staged as a T3N1M0 (stage 3) squamous cell cancer of the supraglottic larynx.
Options for chemoradiation versus primary surgery with postoperative radiation were discussed.
The patient successfully underwent surgical excision of his tumor with total laryngectomy, bilateral selective neck dissections of levels II to IV, cricopharyngeal myotomy, tracheoesophageal puncture for later speech rehabilitation, and placement of a temporary Dobhoff feeding tube.
Branches of the facial nerve
Potential complications of parotidectomy
Increase amylase and drainage for example 15,000
parotid duct tail prob the source
NPO five days
Inappropriate connection of (para?!) sympathetic aprocrine nerves with the facial nerve causes gustatory sweating
Botox is now standard
used to try interposition