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Duct of the sublingual glands =
Ducts of Rivinus
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Duct of the submandibular glands=
Wharton ducts
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Duct of the parotid gland =
Stensen duct
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Componants of the oral cavity:
- lips
- oral tongue (ant 2/3)
- buccal mucosa
- floor of the mouth
- upper & lower alveolar ridge
- retromolar trigone
- hard palate
- Anterior boundary: skin-vermillion junction
- Posterior boundary: circumvallate papillae, anterior tonsillar pillars, junction of hard/soft palate, pharyngoepiglottic fold
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Componants of the hypopharynx:
- piriform sinuses
- postcricoid region
- posterior pharyngeal wall between pharyngoepiglottic fold to the upper esophageal sphincter
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Componants of the larynx:
supraglottis = epiglottis, aryepiglottic folds, arytenoids, ventricle, false vocal cords
glottis = true vocal cords, anterior & posterior commissures
subglottis = inferior to glottis extending to the inferior border of the cricoid cartilage
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Course of the retromandibular vein =
Between the superficial and deep lobes of the parotid
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3 major nerves at risk during surgery on the submandibular gland =
- hypoglossal
- marginal mandibular
- lingual
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Reference landmarks for identification of the facial nerve:
- Tympanomastoid suture line - just deep & medial
- Tragal pointer - 1cm deep & inferior
- Posterior belly of the digastric - same plane
- Trace back from peripheral branches
- Mastoidectomy
- Stylomastoid foramen ???
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Where is the marginal mandibular branch of the facial nerve located?
Just deep to the superficial layer of the deep cervical fascia, which lies below the platysma
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Innervation of the submandibular gland:
Lingual nerve
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Pharynx is composed of what type of epithelium?
- nonkeratinizing stratified squamous
- ciliated respiratory
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Name the componants of the Waldeyer ring:
- palatine tonsils
- adenoids
- lingual tonsils
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What are the crypts of the palatine tonsils lined with?
stratified squamous epithelium
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What type of epithelium covers the adenoids?
pseudostratified ciliated columnar epithelium with surface folds but no crypts
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What type of epithelium lines the nasal cavity?
- respiratory epithelium primarily
- specialized sensory olfactory epithelium
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What nodal basins do tumors of the larynx most commonly metastasize to?
II, III, IV
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Contents of Level IA:
- fibroadipose/lymphatic tissue
- no major neurovascular structures
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Contents of Level IB:
submandibular gland
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Boundaries of Level II
- Superior - skull base
- Inferior - hyoid bone
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Boundaries of Level III
Posterior - posterior edge of SCM
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Boundaries of Level IV
Superior - cricoid cartilage
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Describe the course of the left recurrent laryngeal nerve:
Separates from the vagus in the mediastinum, wraps around the aortic arch at the ductus arteriosis, ascends along the tracheoesophageal groove
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Describe the course of the right recurrent laryngeal nerve
Divides off the vagus and passes around the right subclavian artery, travels along the tracheoesophageal groove & enters larynx just superior to the cricoid cartilage
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How often to nonrecurrent nerves occur and what are they associated with?
1-2%
retroesophageal right subclavian vein
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Synchronous versus metachronus lesions =
synchronous - found within 6mo
metachronous - diagnosed after 6mo
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Most commonly altered tumor suppressor gene in human cancers =
Most commonly altered gene locus =
p53 (poorly degraded & so overly expressed in H&N cancers)
p16-ARF
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Oral cavity carcinoma staging:
- T1 = < 2cm
- T2 = 2-4cm
- T3 = >4cm
- T4 = invasion of adjacent structures
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What cancers drain to the level II region?
Oropharyngeal cancers
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Most common locations for a primary site of an unknown SCC of the head & neck:
- Tonsils
- Base of tongue
- Piriform sinuses
- Nasopharynx
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Risk factors for development of head & neck cancer:
- Tobacco - SCC
- Alcohol abuse - SCC
- Heavy metal/wood dust inhalation exposure - sinonasal cancers
- UV light - cutaneous malignancies
- Salted fish - nasopharyngeal cancers
- Epstein-Barr virus - nasopharyngeal cancers
- Plummer-Vinson syndrome - oral cavity & hypopharyngeal carcinoma
- Human Papilloma Virus - oral, oropharyngeal, & laryngeal cancer
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Most common cancerous pathology of the lower lip:
squamous cell carcinoma
(basal cell is most common on upper lip)
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Lower lip SCC initial workup:
- evaluate for mental nerve involvement, mandibular invasion
- examine cervical lymphatics
- consider CT
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Lower lip SCC treatment:
Early stage - primary external beam radiation or surgical resection
Elective LN disection for clinically negative neck - advanced T stage, deep tumor invasion
Positive nodal disease - therapeutic neck dissection indicated
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Indications for postoperative irradiation in lower lip SCC:
- advanced T stage
- positive margins
- perineural/perivascular invasion
- mulitple/bulky nodal disease
- invasion of bone
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lower lip SCC prognosis:
Stage I & II - 90% 5yr survival
cervical lymph node involvement - 50% 5yr survival
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Lower lip excisional defect reconstructive options:
Lesions involving less than 1/3 to 1/2 of the lip - primary closure with local tissue advancement
Lesions 1/2 to 2/3 of lip - Pedicled two-stage cross-lip transfer flap (Abbe flap for central defects, Estlander flap for lateral defects)
Larger than 2/3 of lip - local advancement techniques, local rotational flaps, distal free flaps
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Rate of occult cervical metastases in oral tongue cancer:
Factors that increase risk:
20%
limited supraomohyoid dissection (levels I, II, III) recommended in almost all pts.
- Risk Factors:
- depth of invasion > 4-5mm
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