Surgical Complications and Flaps Quiz

Chylous Fistula

• Higher incidence on the left side of the neck.
• Trendelenburg position (head down) exaggerates the leak.
• Pressure dressing is crucial in management to prevent fluid accumulation.
• Neck exploration is indicated if high output, non-decreasing, or causing biochemical imbalances.
• Surgical repair is considered for high output (>500 ml/day).

Radial Free Forearm Flap

• Fasciocutaneous flap (may be osseocutaneous).
• Primarily used in head and neck reconstruction, especially for structures like oral cavity, lip, tongue, buccal mucosa.
• Donor site closure requires skin grafting or a hatchet flap.
• Long pedicle to reach recipient vessels.
• Allen's test does not assess radial artery patency. A test for ulnar artery patency is the Allen test.

Facial Nerve Injury

• Temporary weakness can stem from trauma, traction, heat, or prolonged surgery (neurapraxia).
• Permanent facial nerve injury is rare (0.5%). Permanent injury occurs from nerve transection or cautery.
• Parotidectomy often results in initial facial nerve dysfunction (42.7%), improving to 30.7% at one month and resolution at 6 months.
• Marginal mandibular branch is most affected during parotidectomy.
• Total parotidectomy causes significantly higher dysfunction than superficial parotidectomy.
• Facial nerve identification methods include anterograde (preferred) and retrograde dissection.
• Stylomastoid foramen (palpatory landmark) is difficult to locate in a live surgical setting.
• Tympanomastoid suture and tragal pointer are also landmarks.

Nasopharyngeal Cancer

• Two types of nasopharyngeal cancer are keratinizing squamous cell carcinoma (associated with Epstein-Barr virus) and a differentiated non-keratinizing carcinoma (most common type and most responsive to treatment).
• Bimodal treatment (concurrent chemotherapy and radiation) recommended for stage II, III, IVA, and IVB.
• Recurring tumor after treatment warrants resection.
• Distant metastasis (stage IVC) treatment utilizes platinum-based combination chemotherapy.

Neck Lesions

• Ultrasound is not more reliable than radionuclide scanning in detecting parathyroid adenomas.
• Ultrasound-guided fine-needle aspiration can be used to diagnose neck lesions smaller than 1 cm.

Radical Neck Dissection and Horner's Syndrome

• Inadvertent dissection deep to the internal jugular vein can cause ipsilateral upper eyelid ptosis (drooping).
• Common carotid artery dissection can also cause this.
• Brachial plexus and phrenic nerve dissection can cause this.

Free Tissue Transfer Contraindications

• Age is not a contraindication.
• Raynaud's phenomenon is a contraindication.
• Donor site irradiation is a contraindication.
• Obesity is not a contraindication

Parapharyngeal Tumors

• Parapharyngeal tumors are less common (0.5% of head and neck tumors).
• Most are benign (80%), salivary gland origin (50%, deep lobe of parotid).
• Pleomorphic adenoma is the most common benign tumor.
• Mucoepidermoid carcinoma is the most common malignant tumor.
• Neurogenic tumors (30%) are prevalent, particularly vagal schwannomas.
• Vagal schwannomas are linked to vocal cord palsy (hoarseness). Diagnosis by imaging, biopsy contraindicated.

Acute Tonsillitis

• Preceding upper respiratory infection is a predisposing factor.
• Infectious mononucleosis is associated with increased lymphocytes (not decreased).
• Carbimazole (antithyroid medication) can cause agranulocytosis, leading to tonsillitis among other complications.
• Streptococcus pyogenes is the common bacterial cause.
• Mitral valve stenosis can develop as a result of rheumatic fever following strep throat.

Stomal Recurrence

• Stomal recurrence rate is roughly 5–15% following total laryngectomy.
• Residual disease in paratracheal nodes is a cause
• High tracheostomy does not increase risk.
• Treatment is not external beam radiotherapy.

Papillary Thyroid Carcinoma

• Papillary thyroid carcinoma is often multicentric.
• Demonstrates "Orphan Annie" nuclei on histology.
• Does not have uniform biological behavior; the prognosis varies by type.
• More aggressive in children.
• 60% 10-year survival rate with extrathyroidal lesions.

Malignant Salivary Gland Tumors

• Low-grade mucoepidermoid carcinoma rarely metastasizes.
• Complete resection is not adequate for high-grade mucoepidermoid carcinoma.
• Adenoid cystic carcinoma is the most common malignancy in minor salivary glands.

This quiz covers key surgical concepts including the management of chylous fistula and the use of radial free forearm flaps in reconstruction. It also addresses facial nerve injuries and their implications. Test your knowledge on these important topics in surgical practice.