A malignant tumour of the parotid gland:
Is likely to be a metastasis. Whilst there is undoubted geographical and demographic difference in tumour types, this is the best answer amongst the choices given, and is usually a metastatic SCC. In Australia, metastasis from squamous carcinoma or melanoma accounts for up to 75% of parotid malignancy. The commonest benign tumour is pleomorphic adenoma (the treatment for which has evolved from superficial parotidectomy to wide local excision). The commonest primary malignant tumour in most series is muco-epidermoid carcinoma, although some texts mistakenly suggest carcinoma ex-pleomorphic adenoma is the commonest malignancy. Gustatory sweating is Frey’s syndrome and is a complication of parotidectomy. Fine needle aspiration is a good diagnostic modality for parotid tumours.
References: 1. Gnepp DR. Diagnostic surgical pathology of the head and neck, 2nd ed. SaundersElsevier, 2009: 413-562.
What is the major artery in central and lower face transplantation (also referred to as partial facial transplantation)?
Facial artery.
Regarding head and neck tumours, which one of the following statements is false?
McFee described the classical ‘Y’ incision used for neck dissection. A is false. Neck incisions for neck dissection include: Lahey (1940), Martin (1951), Slaughter (1955), Schobinger (1957), Conley (1966), McFee (1960) and Ariyan (1980). The ‘Y’ incisions provide excellent exposure but necrosis of the tips may result and expose the vascular structures. McFee described two transverse incisions to approach neck nodes in 1960. The bipedicled McFee has a better blood supply but more tedious exposure. The hockey stick incision (Ariyan) is performed from mastoid to shoulder, behind the anterior border of the trapezius muscle and extending medially below the clavicle. The apron flap extends from mastoid to mastoid passing along the posterior border of the SCM to the midline, 2-3 fingerbreadths above the sternal notch.
The TNM system (Table below) is based on clinical evaluation of the patient. Staging is used to compare the results of different treatments and between institutions, to estimate prognosis in terms of tumour control and patient survival, to plan treatment and to influence the choice of therapy.
Classification for primary tumour of the larynx:
References:
Which of the following statements is false regarding face transplantation?
There have been no recorded mortalities so far following face transplantation. E is false. At least two of the initial face transplant recipients has died. One was linked to lack of patient compliance with immunotherapy, and the other was reportedly due to a cardiac event whilst undergoing revisional surgery.
The parotid gland:
Lies deep to the SMAS layer. The parotid gland contains almost exclusively serous cells although a few mucous acini are found in the tail of the parotid close to the submandibular gland. The parotid duct opens into the oral cavity opposite the second maxillary molar tooth.