Head and Neck Surgery and Oncology
Core concepts
Anchor on TNM staging logic and the neck levels (I–VI). Level I submental/submandibular; II–IV jugular chain; V posterior triangle; VI central compartment. Know the patterns of nodal spread by primary site (oral cavity → levels I–III; oropharynx → II–IV; nasopharynx → retropharyngeal and V; thyroid → VI). Understand red flags for malignancy: unilateral otalgia with normal ear exam (referred pain), persistent hoarseness >3 weeks, non-healing ulcer, neck mass in an adult (until proven otherwise), and unilateral nasal obstruction with bleeding. Know the work-up: history, panendoscopy, biopsy, CT/MRI, and PET-CT for unknown primary or advanced disease.
Traps
A young patient with a neck mass is not automatically benign - lymphoma and sarcoma occur. "Branchial cyst" in a patient >40 is a metastasis until excluded. Differentiate referred otalgia (via CN IX/X) from primary ear disease. Do not over-stage clinically; imaging and histology refine. Know that HPV-positive oropharyngeal SCC has a distinct, better prognosis and separate staging.
Rule of thumb
Any adult with a persistent neck mass >2 weeks, or any non-healing oral ulcer >3 weeks, requires urgent specialist assessment and tissue diagnosis. Stage the neck and primary together; treatment planning is multidisciplinary.