Head and Neck

• Anterior to posterior: subclavian vein, phrenic nerve, anterior scalene, subclavian artery
• Parotitis: staph. Seen in elderly, dehydrated. Rx abx, drainage if abscess / not improving
• Painless mass on roof of mouth: Torus (bony exotosis, midline of palate)
• Erythroplakia is worse (pre malignant) than leukoplakia. Retinoids can reverse leukoplakia and reduce chance of a second head and neck malignancy
• Head and Neck SCCA: State I, II (upto 4 cm, no nodes) Rx with single modality (surgery or RT). III, IV get combined modality
• Nasopharyngeal SCCA present late (50% as a neck mass), drain to posterior neck nodes, associated with EBV
• Glottic Ca: if cords not fixed, then RT; if fixed, need surgery and RT
• Lip Ca (99% spidermoid carcinoma): lower > upper due to sun exposure; resect, primary closure if < 1/2 of lip, otherwise flaps. Radical neck dissection if node +
• Tongue CA: usually need surg and RT. Increase in plummer vinson (dysphagia, spoon fingers, anemia)
• Larger salivary glands (parotid) = more likely for tumor to be benign
• Mucoepidermoid Carcinoma: #1 malignant salivary tumor overall
• Adenoid Cystic Carcinoma: #1 malignant salivary tumor of the submandibular/minor glands
• Pleomorphic adenoma = mixed parotid tumor = #1 benign tumor, do not enucleate, needs superficial parotidectomy (spare CN 7). If malignant, take whole parotid with CN 7. If high grade (anaplastic), need radical neck dissection
• Warthin's tumor (adenolymphoma) #2 benign salivary tumor. 10% bilateral. 70% of bilateral parotid tumors are Warthin's tumor. Rx: superficial parotidectomy.
• Radical neck dissection takes CN XI, SCM, IJ, submandibular gland. Most morbid = CN XI
• Juvenile Nasopharyngeal Angifibroma: benign, in teen males, present w/obstruction, epistaxis. Rx embolize (internal maxillary a.), then extirpate
• Frey's syndrome: injury of auriculotemporal nerve; gustatory sweating (crossed sweat/salivary fibers)
• Massive bleeding from trach is from innominate artery (tracheo-innominate fistula). Present with small 'heraldic' bleed. Avoid by making tracheostomy no lower than 3rd tracheal ring

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