Otolaryngology Board & Inservice Review Flashcards

Flashcards covering clinical high-yield concepts, board review notes, and diagnostic figures in otolaryngology, head and neck surgery, pathology, and facial plastic surgery.

Melkersson-Rosenthal syndrome

A syndrome characterized by the triad of recurrent facial swelling (especially of the lips), recurrent facial nerve palsy, and a fissured tongue, with lip biopsy demonstrating non-caseating granulomas with histiocytes.

Kiesselbach's plexus

A vascular network on the anterior nasal septum formed by anastomoses of four arteries: sphenopalatine, superior labial, greater palatine, and anterior ethmoid.

Baker-Gordon peel

A deep chemical peel composed of phenol and croton oil; phenol carries risks of systemic cardiotoxicity and cardiac arrhythmias.

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Warthin Tumor

A benign parotid gland tumor characterized by double-layered oncocytic columnar surface cells with abundant pink granular cytoplasm, discontinuous underlying basal cells, lymphoid stroma with germinal centers, and cystic spaces with papillary projections.

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Warthin

A benign salivary gland neoplasm presenting with papillary cystic structures lined by a bilayer of oncocytic epithelium surrounding dense lymphoid tissue.

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Pleomorphic Adenoma

The most common benign salivary gland neoplasm, characterized by a heterogeneous mixture of epithelial cells, myoepithelial cells, and chondromyxoid stroma.

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Mucoepidermoid Carcinoma Histology

The most common malignant salivary gland tumor, composed of a mixture of mucin-producing cells, epidermoid (squamous) cells, and intermediate cells.

Post-Operative Radiation Therapy (PORT) Indications

Indicated when loco-regional recurrence risk is $>20\%$. Specific indications include close or positive resection margins, perineural invasion, lymphovascular invasion, extracapsular spread, or $>2$ histologically positive lymph nodes. Must be initiated within $6\,\text{weeks}$ of surgery unless there is an exposed or partially-covered carotid artery.

Immunotherapy Mechanism (Allergy)

Promotes an immune shift from Th2 to Th1 predominance, increases IL-10, causes an initial increase followed by a decline in allergen-specific IgE, and increases IgG4.

Paraganglioma Malignancy Rates

Orbital and laryngeal paragangliomas have the highest rate of malignant transformation ($\sim 25\%$). Vagal paragangliomas have a $10\%$ rate, jugulotympanic paragangliomas have a $5\%$ rate, and carotid body tumors have a $3\text{--}6\%$ risk.

Indications for Neck Dissection in Parotid Tumors

Indicated for clinically apparent cervical lymphadenopathy (present in $\sim 14\%$), parotid tumors $>4\,\text{cm}$ (occult lymph node risk $>20\%$), or high-grade histology (occult lymph node risk $>40\%$).

Cleft-Side Lower Lateral Cartilage Deformity

The cleft-side lower lateral cartilage is equal in size and length to the non-cleft side, but features a shortened medial crus, an elongated lateral crus, a blunted dome, and a posteriorly, laterally, and inferiorly displaced alar base.

Sunderland Classification of Nerve Injury

A 5-grade system: Wallerian degeneration occurs in Grades 2--5; Grade 3 has a high risk for synkinesis; Grade 4 features synkinesis; Grade 5 carries a risk for neuroma formation.

Auricular Hillocks of His

Six embryological hillocks forming the pinna: Hillocks 1--3 stem from the 1st pharyngeal arch (tragus, helical crus, helix), and Hillocks 4--6 stem from the 2nd pharyngeal arch (antihelix, antitragus, lobule).

Pharyngeal Arch Derivatives

Anatomical structures organized by arch: 1st arch (CN V) forms malleus/incus; 2nd arch (CN VII) forms stapes and facial expression muscles; 3rd arch (CN IX) forms stylopharyngeus; 4th arch (CN X) forms laryngeal structures.

Parotid Parasympathetic Pathway

Preganglionic parasympathetic pathway originating in the inferior salivatory nucleus (medulla), running via CN IX, Jacobson's nerve, and the tympanic plexus to become the lesser petrosal nerve, synapsing at the otic ganglion, and traveling via the auriculotemporal nerve ($\text{V}_3$) to the parotid gland.

Hitselberger sign

Numbness of the posterior external auditory canal and conchal bowl resulting from facial nerve compression by an acoustic neuroma.

Physaliferous cells

Large cells with prominent vacuolated, bubbly cytoplasm that are pathognomonic histological features of chordomas.

Zellballen

The classic histological nests of chief cells surrounded by sustentacular cells characteristic of paragangliomas.

Adenoid Cystic Carcinoma (ACC)

A salivary gland carcinoma noted for late distant metastases to lungs; histological patterns with $>30\%$ solid growth carry the worst prognosis compared to cribriform or tubular types.

Zenker's Diverticulum

A pharyngoesophageal outpouching occurring in Killian's triangle, located between the cricopharyngeus and thyropharyngeus components of the inferior constrictor muscle.

Killian-Jamieson Diverticulum

An esophageal diverticulum located in the Killian-Jamieson space between the oblique and transverse fibers of the cricopharyngeus muscle.

Laimer's Diverticulum

An esophageal diverticulum arising in the area between the cricopharyngeus muscle and the superior circular muscle fibers of the esophagus.

Pendred syndrome

An autosomal recessive condition caused by SLC26A4 gene mutations affecting chloride/iodine transport, characterized by euthyroid goiter, sensorineural hearing loss, Mondini dysplasia, and an enlarged vestibular aqueduct.

Lateral crural steal

A rhinoplasty technique involving shortening the lateral crura to effectively lengthen the medial crura, resulting in nasal tip rotation.

Granular cell tumor

A benign neoplasm associated with pseudoepitheliomatous hyperplasia on biopsy, most frequently found in the head and neck on the tongue, followed by the larynx.

OSHA Hearing Conservation Guidelines

Maximum allowable noise exposure durations per day: $8\,\text{hrs}$ at $90\,\text{dB}$, $4\,\text{hrs}$ at $95\,\text{dB}$, $2\,\text{hrs}$ at $100\,\text{dB}$, $1\,\text{hr}$ at $105\,\text{dB}$, and $30\,\text{mins}$ at $110\,\text{dB}$.

Plummer-Vinson syndrome

A condition defined by iron deficiency anemia and pharyngoesophageal webs, predisposing patients to an increased risk of esophageal and post-cricoid squamous cell carcinoma.

Inverted V deformity

A structural nasal deformity resulting from excessive dorsal hump removal causing width discrepancy between the middle and upper vaults.

Gorlin's syndrome

An autosomal dominant disorder characterized by multiple odontogenic keratocysts and cutaneous basal cell carcinomas.

Gradenigo syndrome

A clinical triad of deep facial pain (CN V), abducens nerve palsy (CN VI), and otitis media / petrous apicitis.

Vernet syndrome

Paralysis of cranial nerves IX, X, and XI associated with lesions involving the jugular foramen.

Godtfredsen syndrome

Combined paralysis of cranial nerves VI and XII resulting from clival metastases or nasopharyngeal lesions.

Tobey-Ayer / Queckenstedt's test

A physical finding where manual compression of the contralateral internal jugular vein produces a rise in CSF pressure, indicative of lateral sinus thrombophlebitis.

House-Brackmann Facial Nerve Dysfunction Grades (3/6, 4/6, 5/6)

HB 3/6 can close eye with effort; HB 4/6 cannot close eye completely but maintains rest symmetry; HB 5/6 exhibits facial asymmetry at rest.

HPV Oncoproteins E6 and E7

Viral oncoproteins in HPV pathogenesis: E6 binds and degrades the p53 tumor suppressor, whereas E7 binds and inactivates the retinoblastoma (RB) protein.