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Sinonasal Tumors

Key Points 1. Sinonasal tumors are rare and account for 3% of upper aerodigestive tract cancers. 2. Squamous cell carcinoma is the most common sinonasal malignancy. 3. Occupational exposures are the main risk factors for sinonasal malignancies. Risk factors for adenocarcinoma are wood dust exposure and leather working. 4. Sinonasal malignancies typically present at a late stage because diagnosis is delayed due to nonspecific clinical presentation,…

Vascular Tumors of the Head and Neck

Key Points 1. Most head and neck paragangliomas are nonfunctional, although suspected sympathetic symptoms (flushing, palpitations, sweating) should be evaluated thoroughly. 2. Treatment of head and neck paragangliomas involves observation, surgery, or radiotherapy depending on patient-specific factors, tumor growth rate, and suspicion for malignancy. 3. The natural history of a hemangioma is rapid growth followed by involution; therefore a conservative approach is recommended for most lesions…

Neck Dissection

Key Points 1. The presence of cervical lymphadenopathy is a significant negative prognostic indicator in head and neck squamous cell carcinoma. 2. Knowledge and identification of first echelon nodes for various primary head and neck tumor sites allows for selective neck dissection of nodes at greatest risk for metastatic disease. 3. A thorough knowledge of key anatomic relationships allows the surgeon to preserve important anatomic structures…

Thyroid and Parathyroid Disease

Key Points 1. Thyroid cancer occurs in 5% to 10% of palpable nodules. 2. Most thyroid cancers are papillary thyroid cancer (70%–80%) and follicular thyroid cancer (15%–20%). 3. In medullary thyroid cancer, the age of surgery is determined by specific gene mutations. For the highest risk mutations, surgery is recommended before 6 months of age (MEN IIB). Surgery for moderate risk mutations is usually recommended before age…

Diseases of the Salivary Glands

Key Points 1. It is important to know multiple ways to identify the facial nerve during parotidectomy. 2. Differentiate between infectious, inflammatory, granulomatous, autoimmune, and neoplastic processes based on history, physical examination, laboratory tests, and radiographic imaging. 3. Know the prevalence and malignancy rates of neoplasms in each major salivary gland. Pearls 1. Mumps and Staphylococcus aureus are the most common causes of viral and acute…

Cancer of the Hypopharynx, Larynx, and Esophagus

Key Points 1. The most affected subsite for laryngeal cancer is the glottis. 2. Smokers are approximately 20 times more likely than nonsmokers to develop laryngeal cancer. Smoking and alcohol intake are synergistic risk factors for the development of laryngeal cancer. 3. Conservation surgery or radiation are treatment options for voice preservation in early laryngeal cancer. 4. The supraglottis has bilateral lymphatic drainage. 5. Hypopharyngeal cancers…

Oral Cavity and Oropharynx Malignancy

Key Points 1. Despite their proximity, oral cavity and oropharyngeal cancers can behave differently and thus are treated differently. 2. Premalignant lesions of the oral cavity warrant evaluation and follow-up. Biopsies of clinically different lesions show nonspecific dysplasia. 3. Pathologic depth of invasion is the main determinant in treatment decisions and staging for oral cavity cancer. 4. Recent discoveries about human papillomavirus (HPV) have changed the…

Skin Cancer

Key Points 1. Skin cancer incidence Normal population: basal cell carcinoma > squamous cell carcinoma > melanoma > Merkel cell carcinoma Transplant population: squamous cell carcinoma > basal cell carcinoma > melanoma > Merkel cell carcinoma 2. Patients at higher risk for nonmelanoma skin cancer Fair-skinned with light eyes Previous history of significant sun exposure and blistering sunburns Personal or family history of skin cancer History of chemical exposure Genetic syndromes Immunosuppression Male sex Older age 3. Important…

Tumor Biology

Key Points 1. Cancer development requires an accumulation of genetic and cellular alterations. 2. The most common risk factors associated with head and neck squamous cell cancer in the United States are tobacco use, alcohol use, and the HPV virus (type 16). 3. HPV-positive and HPV-negative HNSCC have different drivers of carcinogenesis. 4. There are recurring DNA translocations and receptor overexpression patterns in different salivary gland…

Head and Neck Anatomy and Embryology with Radiology Correlates

Key Points 1. The six branchial arches form the skeletal and muscular derivatives of the head and neck and the six pharyngeal pouches form the endothelium and glands. Each arch is associated with a nerve and artery. 2. Aberrant embryologic development can cause first, second, third, and fourth branchial cleft anomalies. Branchial cleft anomalies have associated sinus tracts, which pass deep to their associated aortic arch…

Pharyngitis and Laryngitis

Key Points 1. Infections are the most common cause of pharyngitis. Viral infections are more common than bacterial, with 50% to 60% of cases caused by common viruses. 2. The AAO-HNS Clinical Practice Guideline for Tonsillectomy in Children from 2018 strongly recommends watchful waiting for recurrent throat infections if there have been <7 episodes in the past year, <5 episodes per year in the past 2 years,…

Taste and Smell

Key Points 1. Chemosensation (the perception of chemicals) relies on three sensory systems: taste, olfaction, and somatosensory. 2. Chemosensory dysfunction can severely influence quality of life, ranging from safety issues such as detection of a gas leak to higher functions such as emotion and memory. 3. Flavor results from the combination of taste, smell, and somatosensory-mediated sensations of temperature, texture, and pungency. Pearls 1. There are…

Facial Pain and Headache

Key Points 1. Headaches can be classified as primary, secondary, or both. Primary headaches occur in the absence of another disorder known to cause headaches (e.g., tension-type or migraine headache). Secondary headaches occur in the presence of another disorder that is known to cause headaches (e.g., headache attributed to rhinosinusitis). 2. The majority of patients with “sinus headaches” will meet International Classification of Headache Disorders (ICHD)…

Head and Neck Manifestations of Systemic Disease

Key Points 1. Granulomatosis with polyangiitis is the most common vasculitis disease affecting the head and neck. 2. In patients with recurrent inflammation of the cartilages of the nose, ears, or larynx, you must consider a diagnosis of relapsing polychondritis. 3. Sjögren’s syndrome (SS) is a systemic autoimmune disorder that is associated with inflammation of the epithelial tissues, including the salivary and lacrimal glands. Pearls 1.…

Adult Snoring and Obstructive Sleep Apnea

Key Points 1. Obstructive sleep apnea (OSA) is a major problem in the United States and is associated with serious health complications. Noninvasive treatment with continuous positive airway pressure (CPAP) therapy remains the gold standard therapy, and it is typically recommended that patients try CPAP before considering alternative treatment options. For patients who are intolerant to CPAP therapy, surgical alternatives may be appropriate. 2. History and…

Antimicrobials and Pharmacotherapy

Key Points 1. Knowledge of the most common bacteria causing infection, antibiotic methods of action, and microbial resistance mechanisms and patterns can facilitate appropriate drug selection. 2. The most directed antimicrobial therapy is preferred and may require a sample to be obtained for culture and sensitivity testing. 3. Factors to consider when choosing an antibiotic: The antibiotic must have activity against the organism(s) Consider the local…

Deep Neck Infections

Key Points 1. Initial evaluation of deep neck space infections (DNSI) should be directed toward identifying the acuity and medical stability of the patient; hemodynamic and airway instability may require emergent intervention. 2. Trismus, dysphonia, “hot potato” voice, stridor, and stertor are signs of airway compromise and may require urgent evaluation using flexible fiber-optic laryngoscopy. Tachypnea and oxygen desaturations are late manifestations of airway obstruction and…

ENT Emergencies

Key Points 1. Airway management is the otolaryngologist’s main role in emergencies. 2. Epiglottitis is an emergency because of the high potential for airway obstruction. 3. Angioedema involves the reticular dermis as well as the subcutaneous and submucosal layers of nondependent areas. 4. Malignant otitis externa most commonly affects immunocompromised or elderly patients. 5. The mylohyoid muscle boundary is crossed in Ludwig’s angina. Pearls 1. In…

General Anatomy and Embryology with Radiology Correlates

Key Points 1. Eight branches of the external carotid artery: Superior thyroid Ascending pharyngeal Lingual Facial Occipital Posterior auricular Maxillary Superficial temporal 2. Layers of fascia in the neck: Superficial cervical fascia Superficial layer of deep cervical fascia Middle layer of deep cervical fascia Deep layer of deep cervical fascia 3. Characteristics of malignant lymph nodes on neck CT with contrast: Size >1.5 centimeters Round shape…

Surgical Pathology of the Parathyroid Glands

Development and Anatomy The parathyroid glands develop from the endoderm of pharyngeal pouches III and IV. These are first identifiable at 5 to 6 weeks of fetal development as thickenings of the anterodorsal branchial pouch epithelium (see Chapter 2 , Applied Embryology of the Thyroid and Parathyroid Glands). Each pharyngeal pouch III gives rise to the inferior parathyroid gland (parathyroid III) and the corresponding half of…