Head and neck oncologic emergencies

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. These patients can develop emergent complications from treatment including fluid collections, dysphagia, and mucositis. In the ED setting, there are common pitfalls that should be avoided at all cost. Misdiagnosing and treating a cystic metastatic cervical lymph node for an abscess can leave the patent at a significant disadvantage with cancer prognosis. There are other signs of possible head and neck malignancy including unilateral otalgia or sinus opacification that should have further investigation before acommon otolaryngologic diagnosis is given.