Stell and Maran’s Textbook of Head and Neck Surgery and Oncology 5th Edition [PDF]
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Stell and Maran’s Textbook of Head and Neck Surgery and Oncology 5th Edition
Let’s talk about most common questions
When do the sinuses develop?
The maxillary sinus is the first to develop in utero. After birth, this sinus enlarges in two stages, once at age three and then again between ages 7 and 12. Neonates have three to four ethmoid cells at birth, which multiply to become ten to fifteen cells by the age of 12. The sphenoid sinus begins pneumatization at 3 years of age, while the frontal sinus is the last to develop at about age 5. The sphenoid and frontal sinuses do not reach adult size until the teenage years.
2. What is the difference between agger nasi, Onodi, and Haller ethmoid cells?
The agger nasi cell is the most anterior of the ethmoid cells. It is found anterior and superior to the attachment of the middle turbinate to the lateral wall. The Onodi cell is an ethmoid cell that pneumatizes lateral or posterior to the anterior wall of the sphenoid. This cell can be adjacent to the optic nerve or carotid artery, so it is important to recognize this variation during sinus surgery. A Haller cell forms when the ethmoid pneumatizes into the medial and inferior orbital walls. If this cell is large, it can cause obstruction of the maxillary ostium.
3. Name the branches of the internal carotid artery in the neck.Trick question! The internal carotid artery does not branch in the neck.
4. Name the eight branches of the external carotid artery in the neck.
From proximal to distal, the branches are: the superior thyroid, ascending pharyngeal, lingual, facial,
occipital, posterior auricular, maxillary, and superficial temporal arteries.
5. Name the four types of tongue papillae. Where are they located?
The four types are circumvallate, fungiform, foliate, and filiform papillae. The circumvallate are located at the junction of the anterior two thirds and posterior one third of the tongue in a V shape.
Fungiform papillae are found at the tip and lateral edges of the anterior two thirds of the tongue.
Foliate papillae are found at the posterolateral base of tongue. Filiform papillae are found all over the tongue, and do not participate in taste sensation .
[highlight color=”green”]6. Describe the landmarks used to find the facial nerve during parotid surgery.[/highlight]
The typical landmarks used to find the facial nerve during parotid surgery are the tragal pointer, the tympanomastoid suture line, and the posterior digastric muscle. The tragal pointer refers to the tragus cartilage, which “points” to the location of the nerve one centimeter anterior, inferior, and deep to the cartilage.
Another method of identification is to follow the tympanomastoid suture line inferiorly to its drop-off point. Six to eight millimeters medial to this point, the facial nerve can be found passing through the stylomastoid foramen. Finally, the nerve can be located just medial to the insertion of the posterior belly of the digastric on the mastoid.