Head and neck

Squamous cell carcinoma of the head and neck (SCCHN) is the most common malignancy of the upper aerodigestive tract (UADT). The UADT is a complex area where functions of breathing and eating take place in a highly vascularized area. Patients can present to the emergency department (ED) with acute airway and bleeding issues. Patients with malignant tumors in the airway are unique and need a plan for alternative methods to control the airway from traditional endotracheal intubation. The surgically altered airway after tracheostomy and laryngectomy also presents unique airways, where the physician must be knowledgeable of the anatomy in order for proper acute airway control. Airway control is especially imperative in cases of emergent hemorrhage from tumors. These bleeds can be temporized with packing until definitive management by a head and neck surgeon or intervention neuroradiologist. Head and neck cancer patients can also develop emergent complications from treatment including fluid collections, dysphagia, and mucositis. In the ED setting, there are common pitfalls that should be avoided. Misdiagnosing and treating a cystic metastatic cervical lymph node for an abscess can delay treatment, induce complications, and ultimately have a significant negative effect on prognosis. Clinical signs of possible head and neck malignancy include unilateral otalgia or unilateral nasal obstruction both of which should be investigated.