Head and Neck

CHAPTER 10
Head and Neck

Jonathan M. Lee and Margaret M. Moore

Test Taking Tips

• Know that the treatment for benign parotid tumors is superficial parotidectomy and that the treatment for malignant parotid tumors is total parotidectomy.

• Know the staging for squamous cell cancer of the head and neck. There is often a question about squamous cell cancer of the head and neck and the appropriate adjuvant treatment (in regards to the size of the primary tumor).

ANATOMY

Name the 3 auditory ossicle bones:

Malleus (hammer), incus (anvil), stapes (stirrup)

Name the nerve that crosses the internal carotid artery 1 to 2 cm above the carotid bifurcation:

Hypoglossal nerve

The hypoglossal nerve supplies motor innervation to all of the muscles of the tongue except:

Palatoglossus

The phrenic nerve lies on top of what muscle?

Anterior scalene

Name the branches of the facial nerve:

Temporal, zygomatic, buccal, marginal mandibular, cervical branches

Which branch of the facial nerve is most often injured in carotid surgery?

Marginal mandibular nerve

Name the branches of the trigeminal nerve:

Opthalmic (V1), maxillary (V2), mandibular (V3)

What nerve is found within the carotid sheath?

Vagus

The recurrent laryngeal nerve innervates all of the muscles of the larynx except:

Cricothyroid muscle

Which nerve is responsible for sensory innervation of the larynx above the level of the vocal folds?

Internal branch of the superior laryngeal nerve

Which nerve is responsible for sensory innervation of the larynx below the level of the vocal folds?

Recurrent laryngeal nerve

Name the branches of the thyrocervical trunk:

STAT

Suprascapular artery

Transverse cervical artery

Ascending cervical artery

Inferior thyroid artery

What is the first branch of the external carotid artery?

Superior thyroid artery

Name the blood supply to the nose:

Anterior/posterior ethmoidal arteries off the ophthalmic artery

Superior labial artery from the facial artery

Sphenopalatine artery off the internal maxillary artery

What nerve innervates the strap muscles?

Ansa cervicalis

FIGURE 10-1. Lymph node compartments in the neck. The central compartment (level VI) is defined laterally by the carotid sheaths, superiorly by the hyoid bone, and inferiorly by the suprasternal notch. The lateral compartment contains superior jugular (level II), middle jugular (level III), and inferior jugular (level IV) lymph nodes, as well as the posterior triangle nodal tissue bound by the posterior border of the sternocleidomastoid, the anterior border of the trapezius, and the clavicle (level V). The division between levels II and III is a horizontal plane defined by the inferior body of the hyoid bone. The division between levels III and IV is a horizontal plane defined by the inferior border of the cricoid cartilage. Level I contains the submental and submandibular lymph nodes. a., artery; m., muscle; n., nerve; v., vein. (Reproduced with permission from The University of Texas MD Anderson Cancer Center. Visual Art © 2008 The University of MD Anderson Cancer Center. All rights reserved.)

Define the regions of the cervical lymph nodes:

Level I: submental and submandibular nodes

Level II: upper jugular nodes

Level III: middle jugular nodes

Level IV: lower jugular nodes

Level V: posterior triangle

Level VI: anterior compartment

Level VII: upper mediastinal nodes

FIGURE 10-2. Diagrammatic representation of the relations of the parotid gland to the facial nerve and its branches. a., artery; m., muscle; n., nerve; v., vein. (Modified from Skandalakis’ Surgical Anatomy: The Embryologic Basis of Modern Surgery. Paschalidis Medical Publications; 2004, with permission.)

What structure divides the parotid gland into superficial and deep lobes?

Facial nerve

What is the name of the duct in the parotid gland?

Stenson duct

What is the name of the duct in the submandibular gland?

Wharton duct

What is the most common nerve injured in parotid surgery?

Greater auricular nerve