Head and Neck onco

Facial nerve pointers

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Q: What is the most consistent anatomical landmark of the facial nerve?

A) Anterior border of the posterior belly of the digastric muscle.
B) Posterior border of the posterior belly of the digastric muscle.
C) Superior border of the posterior belly of the digastric muscle.
D) Inferior border of the posterior belly of the digastric muscle.

Inoperability criteria of ca oral cavity

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Q) Inoperability criteria in ca oral cavity is  ( MCH Onco 2020) 

a) Pterygoid plate involvement

b) Tooth socket involvement

c) Cheek involvement

d)

Ans a) Pterygoid

T4b in oral cancer is Very advanced local disease.

Tumor invades masticator space, pterygoid plates, or skull base and/or encases internal carotid artery, skull base and/or encases the internal carotid artery.

Note: Superficial erosion alone of bone/tooth socket by gingival primary is not sufficient to classify as T4

Tumour involvement of the following structures are considered technically unresectable

Erosion of pterygoid plates, sphenoid bone, widening of foramen ovale

Extension to superior nasopharynx or deep extension into Eustachian tube or lateral nasopharyngeal wall

Encasement of internal carotid artery, defined radiologically as tumor surrounding the carotids> 270 degrees.

Involvement of mediastinal structures

Involvement of prevertebral fascia or cervical vertebrae

Ref is here 

 

Adenoid Cystic Tumors

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MCQ on Adenoid Cystic Tumor of the Hard Palate
Q) All are true for adenoid cystic tumor of the hard palate except:
✅ Answer: C. Lymph node metastasis

🔍 Explanation:
**Adenoid cystic carcinoma** is a rare tumor arising from the minor salivary glands, with the **palate** being the most common site.
- **Perineural invasion** is common and leads to the spread of the tumor along nerves.
- **Lung metastasis** is also frequent, with distant metastasis occurring via the bloodstream, often affecting the lungs and bones.
- The tumor is **uncapsulated** and infiltrative, which often leads to **local recurrence**.
- **Lymph node metastasis** is **uncommon**, with an incidence that is low.
- Direct extension of the tumor to the base of the skull may lead to severe complications and death.

🧠 Key Point: The most important distinguishing feature of adenoid cystic carcinoma is its tendency for **perineural invasion** and **lung metastasis**, but it rarely metastasizes to the lymph nodes.

📘 Reference: [NCBI Article](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633292/)

2nd primary tumors

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Q) In buccal mucosa cancer after surgery and CRT, after 2 year patient developed cancer at base of tongue with N3 nodes positive. Best line of management

A Palliative RT
B. CTRT
c. Rehabilitation
D.  Surgery followed CTRT

There are two parts to this questions 

a) Second Primary tumor (SPM)

b) Management of Base of tongue tumors with N3

Both are discussed here ---

 

Lymphoma Head and NECk

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Q) Lymphoma of the head and neck - False statement is 
A. Hodgkin’s disease is common in the oropharynx.
B. Most are of the B-cell type .
C. FNAC of neck lymph nodes is now mandatory.
D. For disseminated non-Hodgkin’s lymphoma, systemic chemotherapy is preferred.

 

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