ENT Board Prep High Yield Review for the Otolaryngology In-service and Board Exams

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1 ENT Board Prep

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3 ENT Board Prep High Yield Review for the Otolaryngology In-service and Board Exams Fred Y. Lin, M.D. Department of Otolaryngology/Head & Neck Surgery The Icahn School of Medicine at Mount Sinai Mount Sinai Sleep Surgery Center New York, NY, USA Zara M. Patel, M.D. Endoscopic Sinus and Skull Base Surgery Department of Otolaryngology/Head & Neck Surgery Emory University School of Medicine Atlanta, GA, USA

4 Editors Fred Y. Lin, M.D. Department of Otolaryngology/ Head & Neck Surgery The Icahn School of Medicine at Mount Sinai Mount Sinai Sleep Surgery Center New York, NY, USA Zara M. Patel, M.D. Endoscopic Sinus and Skull Base Surgery Department of Otolaryngology/Head & Neck Surgery Emory University School of Medicine Atlanta, GA, USA ISBN ISBN (ebook) DOI / Springer New York Heidelberg Dordrecht London Library of Congress Control Number: Springer Science+Business Media New York 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (

5 Dedication To my wife, Gigi, for all her love and support, to my mother, Karen, for her devotion to family and the sacrifices she made, and in loving memory of my father, Fusen. Fred Y. Lin To my husband and the love of my life, André, to my sister and best friend, Cheherazade, and to my parents and loving guides, Marzban and Shireen. Zara M. Patel

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7 Preface As the field of Otolaryngology grows, the depth and breadth of information that we are responsible for as otolaryngologists have also expanded. Along with the many recent advances in the subspecialties of Head and Neck, Plastics, Otology, Laryngology, Rhinology, and Pediatrics, we must also know Allergy, Sleep Medicine, Trauma, and the fundamentals of Fluid Balance, Nutrition, and those Systemic diseases that so frequently manifest in the head and neck region. The Board examination is designed to verify our grasp of this ever-increasing body of knowledge. When we studied for our Board exam, we spent hours poring over textbooks, searching the Internet for answers we could not find in those books and then going back to those sources over and over as the review books we were using would remind us, but not inform us, of something more in depth that we had forgotten by those last few weeks leading up to the exam. We found ourselves in need of a different kind of study guide. We wished for a directed review book to use as our source; brief enough to get through in the 1 2 weeks leading up to the exam, yet in depth enough so we would not need to go back to another source for more information. As a result, we have compiled this review guide. It covers all the topics noted above. We have asked experts in all subspecialties to serve as section editors, and we thank them for their excellent contributions. We hope it serves future residents and fellows in those crucial weeks leading up to the exam, and that it consolidates the years of training they have gone through to join our specialty. Fred Y. Lin Zara M. Patel New York, NY Atlanta, GA vii

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9 Contents Preface... Contributors... vii xvii I. PEDIATRICS 1 Embryology... 3 Pearls... 3 Branchial Arch Derivatives... 3 Branchial Arch Anomalies: Cysts, Sinus, Fistulae... 4 Otologic Development... 4 Midline Nasal Masses... 5 References General Pediatric Otolaryngology... 7 Pearls... 7 Pediatric Sinusitis... 7 Velopharyngeal Insufficiency... 8 Upper Airway Infections... 8 Adenotonsillar Disease... 9 Pediatric Head and Neck Masses Salivary Gland Masses Small Blue-Cell Malignancies in Children Differential Diagnosis for Midline Neck Mass Pediatric Base of Tongue Mass Lymphatic and Vascular Malformations References Congenital Syndromes Pearls Pierre Robin Sequence Achondroplasia VATER Syndrome Trisomy 21 (Down s Syndrome) Autosomal Dominant Syndromes Autosomal Recessive Syndromes X-Linked Recessive Syndromes Q Deletion Syndromes Other Craniofacial Syndromes Cleft Lip and Palate References Pediatric Airway Pearls Difference Between Pediatric and Adult Larynx Clinical Evaluation Radiographic Examination Clinical Scenarios ix

10 x CONTENTS Classification of Laryngeal Cleft Vocal Cord Paresis/Immobility Recurrent Respiratory Papillomatosis Subglottic Stenosis Posterior Glottic Stenosis Tracheal Obstruction Tracheoesophageal Fistula Caustic Ingestion Esophageal Foreign Bodies References Pediatric Otology and Cochlear Implants Pearls External Auditory Canal Pathology Otitis Media Congenital Sensorineural Hearing Loss Conductive Hearing Loss Congenital Inner Ear Malformations References II. RHINOLOGY/ALLERGY 6 Rhinology Pearls Anatomy Physiology Imaging Rhinitis Rhinosinusitis Epistaxis Benign Masses/Abnormalities Surgical Approaches Open Approaches Major Complications of Sinus Surgery References Allergy and Immunology Pearls Epidemiology Risk Factors Pathophysiology Classification of Hypersensitivity Reactions: Gell and Coombs Cellular Response of Allergic Reactions Neurogenic Response to Allergen Allergic Rhinitis Management of Allergy Symptoms Immunomodulation Severe Manifestations of Allergic Response References Systemic, Infectious, and Inflammatory Diseases Pearls Genetics Circulatory Autoimmune Infectious Osteodystrophies References... 77

11 CONTENTS xi III. GENERAL 9 Sleep-Disordered Breathing and Obstructive Sleep Apnea Pearls References Fluids, Hemostasis, Nutrition, and Pulmonary Physiology Pearls Fluids Hemostasis Nutrition Pulmonary Physiology Chest Diseases Pulmonary Function Test References Therapeutics: Pharmacology, Chemotherapy, Radiation Oncology Pearls Anesthesia Pharmacology Chemotherapy Radiation Oncology References Head and Neck Pathology Pearls Larynx Salivary Gland Sinonasal Malignant Sinonasal Neoplasms Infectious/Inflammatory Ear Endocrine References IV. OTOLOGY 13 Otologic and Neurotologic Disorders Pearls Otologic Embryology, Anatomy, and Physiology Audiology References Vestibular System Pearls Vestibular Physiology and Diagnostic Studies Vestibular Disorders References Ear Disorders Pearls Sensorineural Hearing Loss Conductive Hearing Loss References The Facial Nerve and Lateral Skull Base Disorders Pearls References

12 xii CONTENTS V. HEAD AND NECK 17 Thyroid and Parathyroid Surgery Pearls Thyroid Anatomy Vascular Nerves Histology Benign Thyroid Disease Malignant Thyroid Disease Classification Work-Up Staging Other Staging Systems Management Postsurgical Management Parathyroid Anatomy Epidemiology Pathophysiology Primary Hyperparathyroidism Diagnosis/Work-Up Treatment Parathyroid Carcinoma References Salivary Gland Diseases Pearls Anatomy Diagnostics Salivary Gland Diseases Benign Masses Salivary Gland Malignancies References Head and Neck Lymphoma and Sarcoma Pearls Lymphoma Head and Neck Sarcoma References Laryngeal Squamous Cell Carcinoma Pearls Anatomy Epidemiology Work-Up and Staging Management Other Laryngeal Malignancies References Oral Cavity and Oropharyngeal Squamous Cell Carcinoma Pearls Anatomy Epidemiology Presentation Work-Up and Staging Management Anatomy

13 CONTENTS xiii Epidemiology Work-Up and Staging Management References Nasal Cavity and Paranasal Sinus Carcinoma Pearls Anatomy Epidemiology Presentation Work-Up and Staging References Vascular Tumors Pearls Classification References Cutaneous and Temporal Bone Malignancies Pearls Anatomy Epidemiology Basal Cell Carcinoma Treatment Recommendations Cutaneous Squamous Cell Carcinoma of the Head and Neck Treatment Recommendations Malignant Melanoma Treatment Recommendations Temporal Bone Malignancies Treatment Recommendations References Odontogenic Cysts and Tumors Pearls Odontogenic Cysts Dentigerous Cyst Odontogenic Keratocyst (Keratocystic Odontogenic Tumor) Calcifying Odontogenic Cyst Glandular Odontogenic Cyst Odontogenic Tumors: Odontogenic Epithelium Odontogenic Tumors: Mixed Tumors Odontogenic Tumors Odontogenic Ectomesenchyme References VI. LARYNGOLOGY 26 Deep Neck Space Infections Pearls Anatomy Deep Neck Spaces Diagnostic Imaging Microbiology Surgical Management Complications of Neck Space Infections References Laryngology Pearls Anatomy

14 xiv CONTENTS Physiology of Voice (Voice Production) Clinical Voice Assessment Infectious and Inflammatory Diseases of the Larynx Vocal Fold Paralysis Neurolaryngology Miscellaneous Laryngology Subglottic and Tracheal Stenosis Tracheal Neoplasms References Benign Lesions of the Larynx Pearls Benign Lesion of the Vocal Folds Phonomicrosurgery Other Benign Lesion of the Larynx References Dysphagia Pearls Anatomy Physiology of Swallowing Phases of Swallowing Causes of Dysphagia Evaluation of Dysphagia Chronic Aspiration Benign Disorders of the Esophagus References Lasers Pearls Laser Physics Types of Lasers Laser Tissue Interaction Laser Safety References VII. FACIAL PLASTICS AND RECONSTRUCTION 31 Facial Plastics Pearls Aesthetic Facial Analysis Rhinoplasty Facial Aging Facial Implants and Surgical Augmentation Surgical Treatment of the Aging Face Characteristics of the Aging Face Facelift Brow-lift Blepharoplasty References Head and Neck Reconstruction: Local, Pedicled and Free Flaps; Facial Nerve Reanimation Pearls Approach to Facial Reconstruction Classification of Flaps Local Flaps Regional Flaps

15 CONTENTS xv Free Flaps Facial Nerve Re-animation References Head and Neck Trauma Pearls Initial Assessment of the Head and Neck Trauma Patient Upper Facial Trauma Midface Trauma Lower Face Trauma Temporal Bone Trauma Laryngeal Trauma (Also Find in Laryngology) References Index

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17 Contributors Abib A. Agbetoba, M.D. Mount Sinai, New York, NY, USA Jennifer Alyono, M.D. Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA Melynda Barnes, M.D. Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, CA, USA Eric Berg, M.D. Department of Otolaryngology Head and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA Paula Borges, M.D. Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA Matthew Luke Carlson, M.D. Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA Jeffrey Cheng, M.D. Department of Otolaryngology Head and Neck Surgery, North Shore-Long Island Jewish Health System, New Hyde Park, NY, USA Anthony G. Del Signore, M.D. Mount Sinai, New York, NY, USA Joelle Glick, M.D. Mount Sinai, New York, NY, USA Katherine Hayes, M.D. Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA Alfred M. Iloreta, M.D. Mount Sinai, New York, NY, USA xvii

18 xviii CONTRIBUTORS Fred Y. Lin, M.D. Mount Sinai, Mount Sinai Sleep Surgery Center, New York, NY, USA Margee Louisias, M.D. Division of Rheumatology, Immunology and Allergy, Brigham and Women s Hospital, Boston, MA, USA Kelly R. Magliocca, M.D. Department of Pathology, Emory University School of Medicine, Atlanta, GA, USA Brett A. Miles, D.D.S., M.D. Mount Sinai, New York, NY, USA Lucia Olarte, M.D. Mount Sinai, New York, NY, USA Zara M. Patel, M.D. Rhinology, Department of Otolaryngology/Head & Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA Stanley Pelosi, M.D. Department of Otolaryngology Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA Anthony Prince, M.D. Mount Sinai, New York, NY, USA Eitan Prisman, M.D. Mount Sinai, New York, NY, USA Anaïs Rameau, M.D. Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA Ansley M. Roche, M.D. Department of Otolaryngology Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA Joshua D. Rosenberg, M.D. Mount Sinai, New York, NY, USA Victor J. Schorn, M.D. Mount Sinai, New York, NY, USA

19 CONTRIBUTORS xix Arash Shahangian, M.D. Department of Otolaryngology Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA Robert N. Sharobiem, D.D.S. Department of Oral and Maxillofacial Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA Chaz L. Stucken, M.D. Mount Sinai, New York, NY, USA C. Kwang Sung, M.D., M.S. Division of Laryngology, Department of Otolaryngology Head and Neck Center, Stanford University School of Medicine, Stanford, CA, USA Hailun Wang, M.D. Department of Otolaryngology Head and Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY, USA