Head and Neck Surgery and Oncology
Core concepts
Understand the anatomy of the neck triangles and the levels of cervical lymph nodes, since staging and surgical planning depend on them. Know the principles of head and neck cancer staging (TNM), the role of the sentinel node in oral cavity cancer, and the indications for neck dissection. Be familiar with the common histologies: squamous cell carcinoma (most common), salivary gland tumors (pleomorphic adenoma, mucoepidermoid carcinoma), and thyroid carcinoma subtypes. Understand the approach to a neck mass in an adult: assume malignancy until proven otherwise.
Traps
A frequent trap is attributing a neck mass in an adult to infection without further workup; a persistent mass requires fine-needle aspiration and imaging. Another trap is confusing the levels: level I is submental/submandibular, level II upper jugular, level III mid jugular, level IV lower jugular, level V posterior triangle. Questions on thyroid cancer often test that papillary carcinoma spreads via lymphatics and is generally indolent, whereas anaplastic is aggressive. Do not forget that a cystic neck mass in an adult may represent HPV-related squamous cell carcinoma.
Worked rule
For any adult with a unilateral neck mass, the first step is a thorough head and neck exam including the oral cavity, pharynx, and larynx, followed by fine-needle aspiration; do not observe without a diagnosis.