Anterior to posterior:

  • Subclavian vein

  • Phrenic nerve

  • Anterior scalene
  • Subclavian artery

Phrenic nerve anterior to Anterior scalene

Subclavian vein anterior to Anterior scalene

Subclavian artery between Middle scalene and Anterior scalene


  • Staph.
  • Seen in elderly, dehydrated
  • Tx: antibiotics; drainage if abscess/not improving

Painless mass on roof of mouth:

  • Torus (bony exostosis, midline of palate)

Erythroplakia: is worse (pre-malignant) than leukoplakia.

  • Retinoids can reverse leukoplakia and reduce chance of 2nd head and neck malignancy.

Head and Neck SCCa:

  • Stage I, II (up to 4cm, no nodes)
  • Tx with single modality (surgery or RT)
  • Stage III, IV get combined modality

Nasopharyngeal SCCa:

  • Present late (50% as neck mass)
  • Drain to posterior neck nodes, a/w EBV

Glottic CA:

  • If cords not fixed, then RT
  • If fixed, need surgery and RT

Lip CA:

  • 99% epidermoid 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 surgery and XRT.
  • Increase in Plummer Vinson
  • (Dysphagia, spoon fingers, anemia)

Salivary gland tumors:

  • Origen:
    • Most salivary gland tumors originate in the parotid (70%)
    • Minor salivary glands (22%)
    • Submandibular gland (8%)


  • Parotid tumors è benign (75%)
  • Minor SGTs è malignant (80%)
  • Submandibular gland è malignant (50%)

Malignant SGT:

Mucoepidermoid Carcinoma: #1 malignant salivary tumor overall

Adenoid Cystic Carcinoma: #1 malignant salivary tumor of the submandibular/minor glands.

Benign SGT:

Pleomorphic adenoma: mixed parotid tumor

  • #1 SGT (80%)
  • Do not enucleate, needs superficial parotidectomy (spare CN7)
  • If malignant, take whole parotid w/CN7
  • 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
  • Tx: superficial parotidectomy

Facial nerve 5 branches

  1. Temporal
  2. Zygomatic
  3. Buccal
  4. Marginal
  5. Cervical

Radical neck dissection:

  • Takes:
    • CN XII (accessory nerve)
    • Cervical branch of facial Nerve
    • Sensory nerves C2-C5
    • Sternocleidomastoid
    • Omohyoid
    • Submandibular gland
    • Ipsilateral thyroid
    • Internal Jugular
  • ​Most morbidity occur from= CN XII resection (accessory nerve)

Juvenile Nasopharyngeal Angiofirboma:

  • Benign
  • In teen males
  • Present w/obstruction, epistaxis.
  • Tx: embolize (internal maxillary a), then extirpate

Frey's syndrome: (crossed sweat/salivary fibers)

  • Injury of auriculotemporal nerve; gustatory sweating.

Massive bleeding from tracheostomy:

  • Is from innominate artery (tracheo-innominate fistula)
  • Present w/small heraldic bleed.
  • Avoid by making tracheostomy no lower than 3rd tracheal ring

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