Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

HEENT > Diseases of the salivary glands and neck masses > Flashcards

Diseases of the salivary glands and neck masses Flashcards

1
Q

salivary gland stones aka sialolithiasis

A

-salivary gland stones usually occur in major salivary glands (parotid, submandibular, and sublingual)
-anatomy of glands and ducts affects where stones are likely to lodge and also affects the choice of therapies
-parotid glands and stensen’s duct
-submandibular glands and whartons duct
-sublingual glands- either empty into whartons duct or directly into the floor of the mouth
-minor salivary glands drain directly into mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

sialolithiasis

A

-pathogenesis of stone formation is not known, but relative stagnation of salivary flow and salivary calcium concentration are thought to be important
-compositions largely of calcium phosphate and hydroxyapatite with smaller amounts of magnesium, potassium, and ammonium
-inflammation of the salivary gland or duct and localized injury often contribute
-submandibular gland may be more prone to stone formation because the duct is long, the flow of saliva is slow and against gravity, and the saliva is more alkaline with high mucin and calcium constant
-80-90% of all stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

sialolithiasis risk factors

A

-dehydration
-diuretics
-anticholinergic medications
-trauma
-gout
-smoking
-hx of nephrolithiasis
-chronic periodontal disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

signs and symptoms sialolithiasis

A

-typically presents with pain and swelling in the involved gland
-aggravated by eating or by anticipation of eating
-can also present as painless swelling or may be noted incidentally on physical examination or on radiographs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

sialolithiasis diagnosis

A

-based on characteristic hx and physical exam
-sudden onset of swelling and pain in the affected gland associated with eating or anticipation of eating
-stone may be seen at the opening of the affected salivary gland duct or palpated along the course of the duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

sialolithiasis imaging

A

-provides location of stone, helpful to identify complications (abscess)
-solid lesions- concerning for malignancy
-cystic lesions- typically benign
-CT- w/o contrast is imaging modality of choice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

sialolithiasis treatment

A

-conservative management
-stay hydrated
-apply moist heat to area
-massage gland
-milk duct
-supportive care- discontinue medications with anticholinergic effects that reduce salivary flow (diphenhydramine and amitriptyline)
-NSAIDs PRN
-complications- acute bacterial sialadenitis and abscess formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

neck mass causes

A

-very common clinical finding
-1. congenital
-2. inflammatory/infectious
-3. neoplastic
-4. traumatic- anastamoses
-5. metabolic- thyroid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

acute bacterial sialadenitis

A

-AKA suppurative sialadenitis
-can occur in the absece of stone: older adults or post op pts
-parotid gland most commonly involved
-staph aureus- MC pathogen
-S&S-
-increased pain and swelling with meals
-tenderness and erythema of duct opening
-pus +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

indications for referral for acute bacterial sialadenitis

A

suspected salivary gland tumor
-failure to improve with conservative management
-recurrent symptoms
-specialist management- sialoendoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

viral sialadenitis

A

-aka viral parotitis
-MCC is mumps virus
-acute pain and swelling of one or both parotid glands
-frequently accompanied by nonspecific prodrome
-low grade fever, malaise, headache, myalgias, and anorexia
-these symptoms are generally followed within 48 hours by development of parotitis
-less common viral etiologies include coxsackie viruses A and B, echovirus, parainfluenza virus, influenza A, and epstein-barr virus
-self limiting supportive care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

HIV parotitis

A

-non painful swelling of gland occurs
-otherwise pt is asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

parotitis in tuberculosis

A

-chronic nontender swelling of one parotid gland occurs, or a lump is noted within the gland
-symptoms of tuberculosis are found in some cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Sjogren syndrome

A

-recurrent or chronic swelling of one or both parotid glands with no apparent cause is noted
-it is frequently associated with autoimmune disease
-discomfort is modest in most cases and is related to dry mouth and eyes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

salivary gland tumors

A

-uncommon
-rare, accounting for 6-8% of head and neck tumors
-parotid gland is most frequent site of salivary gland tumors (80%-85% of SG tumors)
-75% benign and 25% malignant
-most common type of benign salivary gland tumor is pleomorphic adenoma
-most common malignant salivary gland tumors are mucoepidermoid carcinoma and adenoid cystic carcinoma
-salivary gland cancers vary in their aggressiveness and their propensity to recur and metastasize

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

facial nerve

A

-facial nerve goes through parotid gland
-parotid gland malignancy will weaken the facial nerve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

thyroglossoduct cyst

A

-use dye to identify
-thyroid can go through base of tongue as a developmental variation
-can be easily infected in this variation
-midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

salivary gland tumors

A

-radiation exposure
-smoking (Warthin tumor)
-viral infection?
-epstein barr virus (EBV)
-HIV
-HPV
-environmental factors and industrial exposure to factors such as rubber manufacturing, hair dressers, beauty shops, and nickel compounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

salivary gland tumors presentation

A

-typically a painless mass or swelling of parotid, submandibular, or sublingual gland
-parotid mass (+) signs or symptoms indicative of facial nerve involvement (facial nerve paralysis)
-malignant -> benign tumor
-diagnosis:
- CT vs MRI of salivary gland tumor for better assessment
-FNA bx or US core bx for tissue collection -> definitive dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

central neck

A

-hyoid bone
-thyroid and cricoid cartilages
-thyroid isthmus
-trachea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

lateral neck

A

-divided by the sternocleidomastoid muscle (SCM) into an anterior triangle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

anterior triangle of neck

A

-superiorly- inferior border of mandible (jawbone)
-laterally- anterior border of sternocleidomastoid
-medially- sagittal line down the midline of the neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

posterior triangle of the neck

A

-anterior- posterior border of the SCM
-posterior- anterior border of the trapezius muscle
-inferior- middle 1/3 of clavicle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

lymph nodes

A

-1. Preauricular—in front of the ear
-2. Posterior auricular—superficial to the mastoid process
-3. Occipital—at the base of the skull posteriorly
-4. Tonsillar—at the angle of the mandible
-5. Submandibular—midway between the angle and the tip of the mandible.
-6. Submental—in the midline a few centimeters behind the tip of the mandible
-7. Superficial cervical—superficial to the sternomastoid
-8. Posterior cervical—along the anterior edge of the trapezius
-9. Deep cervical chain—deep to the sternomastoid and often inaccessible to examination.
-10. Supraclavicular—deep in the angle formed by the clavicle and the sternomastoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

cervical lymph node evaluation

A

-size- normal < 1 cm; abnormal > 1.5 cm**
-mobility- normal movable; abnormal decreased/fixed
-consistency- normal soft, fleshy; abnormal firm/rubbery/matted
-PRESENCE OF MASS:
-parotid gland not normally present -> abnormally present
-thyroid gland not normally present -> abnormally present

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

normal neck structures that may be palpable

A

-transverse process of C1 vertebra
-hyoid bonne
-thyroid and cricoid cartilage
-atherosclerotic carotid bulb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

neck mass: very common clinical finding

A

-1. congenital
-2. inflammatory/infectious
-3. neoplastic
-4. traumatic
-5. metabolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

congenital anomaly neck mass

A

-CT (contrast medium optional)
-excisional bx
-ENT referral
-differentials- thyroglossal duct cyst, branchial cleft cyst, lymphangioma, hemangioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

inflammatory or infectious condition neck mass

A

-single course of broad spectrum antibiotic- close follow up for 2-4 weeks
-clinical improvement -> observation- reassessment in 2-4 weeks
-no clinical improvement -> chest radiograph and PPD tuberculin skin test -> positive PPD -> treatment or subspecialist consultation
-no clinical improvement -> chest radiograph and PPD tuberculin skin test -> negative PPD or findings suggestive of neoplasm -> contrast enhanced CT scan and fine needle aspiration bx -> subspecialist consultation
-abscess differentials- ludwigs, branchial cleft cyst, lymph node, deep neck infection
-infectious differentials- lymphadenitis, actinomycosis, tuberculosis, atypical mycobacteria, mononucleosis, sialoadenitis, fungus, cat scratch fever, HIV/AIDS, soft tissue neck abscess, lyme

30
Q

neoplasm (also based on consideration of risk factors, including age > 46 years) neck mass

A

-contrast enhanced CT scan and fine needle aspiration bx
-subspecialist consultation for endoscopy
-management based on histology and stage
-ENT referral
-differentials- squamous cell cancer, salivary gland cancer, lymphoma, thyroid cancer, metastatic cancer

31
Q

trauma neck mass

A

-ENT referral
-differentials- aneurysm, esophageal diverticulum, laryngocele, hematoma

32
Q

metabolic neck mass

A

-differential dx- thyroid, parathyroid

33
Q

inflammatory neck mass hx process

A

-fluctuance -> FNA -> gram stain C&S aerobes anaerobes admit IV Abx (1) -> ENT referral
-no fluctuance -> fever pt sick WBC -> chronic -> Tv skin test monospot medical workup -> dx and treatment/ENT workup -> observe
-no fluctuance -> fever pt sick WBC -> acute bacterial antibiotics -> resolution -> observe

34
Q

neck mass history

A

-duration of symptoms
-enlargement- acute or progressive
-associated symptoms
-previous treatments

35
Q

patient history age

A

-<16 typically inflammatory vs congenital
-16-40- inflammatory vs congenital, however frequently of malignancy begins to increase
->40 r/o malignancy

36
Q

patient history mass growth pattern

A

-present for years with little change- likely benign
-rapidly expanding - concern for infectious etiology
-masses that fluctuate overtime, increase with viral or URI- likely congenitla
-tobacco or alcohol use?

37
Q

symptoms of neck mass

A

-pain often related to rate of growth and expansion but can be related to direct neural invasion in setting of certain malignancies
-voice changes, hoarseness, dysphagia, otalgia -> may indicate cervical lymph node metastasis from underlying upper aerodigestive tract malignancy (or infection)
-fever, night sweats, or weight loss -> suspicious for lymphoma or TB, spiking fevers alone -> suggestive of acute infection
-recent trauma- hematomas, AV fistulas, pseudo-aneurysms

38
Q

symptoms and signs of neck mass

A

recent associated URTI
-stridor- SOB
-problems with swallowing
-globus sensation- cant swallow
-hemoptysis
-oral lesions
-dental problems
-difficulty handling secretion

39
Q

neck mass physical exam

A

-scalp and face for skin lesions and scars
-squamous cell carcinoma of skin, malignant melanoma
-recent bite marks or scratches may indicate cat scratch disease
-look for source: (infection/inflammation/growth)
-external auditory canal and tympanic membrane
-cutaneous lesions and serous otitis media
-facial nerve weakness- can be caused by parotid gland tumor
-combination of a neck mass and facial nerve weakness -> points to an aggressive malignant process
-3 branches of trigemial nerve should be tested on forehead, cheek, and chin

40
Q

characteristics of lymph nodes

A

-reactive lymph nodes are usually discrete, mobile, firm or rubbery but not rock hard, and slightly tender
-rock hard fixed masses raise concern for malignant, may be matted to the underlying structures and are usually nontender
-infected lymph nodes are usually isolated, asymmetric, tender, warm, and erythematous -> may be fluctuant

41
Q

characteristics of cystic masses

A

-congenital cyst- soft, ballotable, mobile masses are often congenital cysts
-however in adults cystic neck masses may represent nodal metastases from HPV related oropharyngeal squamous cell carcinoma (OPSCC)
-age is an important factor in determining the differential dx of a cystic neck mass

42
Q

concerning signs of neck mass

A

-rapidly expanding mass (over days to weeks) raises concern for infection or rapidly growing lymphoma
-firm, lateral neck mass that moves from side to side but not up and down indicates involvement with the carotid sheath (carotid body tumor or vagal schwannoma- overgrowth of myelin on vagus nerve)
-pulsatile quality or bruit suggests a vascular lesion
-immobile midline neck mass that elevates with swallowing indicates a thyroid source, such as a thyroglossal duct cyst or thyroid tumor

43
Q

lateral neck

A

-brachial anomalies are most common congenital masses
-cyst, sinuses, fistulae
-may be present anywhere along the sternocleidomastoid muscle
-typically soft, slow growing and painless
-hx of infection, spontaneous discharge and previous I&D

44
Q

central neck

A

thyroglossal duct cyst- most common
-hyoid bone
-cysts and thyroid carcinoma
-thymic rests and dermoids

45
Q

infectious neck masses

A

-bacterial/viral (mumps)
-parasitic (toxoplasmosis)
-fungal (coccidiodomycosis)

46
Q

inflammatory neck mass

A

-sialadenitis (including parotid, submandibular, sublingual glands)
-obstructive (stone)
-thyroiditis (acute, subacute, chronic)
-other inflammatory conditions- neck abscess

47
Q

lyme disease: Inflammatory and infectious conditions

A

-borrelia burgdorferi
-transmitted by ticks of Ixodes genus
-facial paralysis, dysesthesias, dysgeusia, or other cranial neuropathies are most common
-headache, pain, cervical lymphadenopathy may occur

48
Q

cat scratch disease: Inflammatory and infectious conditions

A

-most common in young pts
-age under 21 years in 80% of cases
-rochalimaea henselae (gram neg rod)
-signs- cat scratch or bite
-painful
-local papule, pustule or vesicle overlying scratch
-persistent painful regional lymphadenopathy

49
Q

cat scratch labs

A

-skin test with antigen (Hanger-Rose skin test)*
-anti-bartonella henselae IgM titers
-excisional bx:
-pleomorphic intracellular rods
-warthin-starry silver impregnation stain (dont need to know)

50
Q

cat scratch disease management

A

-may require 28 days of antibiotics
-ampicillin
-second generation cephalosporin
-third generation cephalosporin
-spontaneous resolution common
-Complications:
-neurologic involvement
-liver or spleen involvement
-bone involvement
-further skin involvement

51
Q

congenital disorders

A

-1. thyroglossal duct cyst
-2. branchial cleft cyst or fistula
-3. dermoid cyst
-4. lymphangioma
-5. congenital torticollis (rare)
-6. teratoma (rare)
-7. thymic mass (rare)

52
Q

thyroglossal duct cyst: congenital disorders

A

-most common form of congenital cyst in neck
-epithelial remnants of thyroglossal tract
-midline neck mass at level of thyrohyoid membrane, closely associated with hyoid bone
-most pts with TGDCs are children or adolescents - up to 1/3 are aged 20 years or older
-males and females are equally affected
-dx- CT/MRI/US- visualization
-FNA- definitive DX
-treatment- surgical excision with sistrunk procedure

53
Q

fistrulography

A

-radio-opaque is injected into opening of the thyroglossal duct
-course of the thyroglossal duct from lower neck to region of hyoid

54
Q

sinus neck mass

A

-occasionally a sinus tract is present in midline without visible cyst
-fluid can come out of skin
-midline sinus tract represents the remnant of thyroglossal duct
-it may open into the region of hyoid or lower above the sternal notch

55
Q

brachial cleft cyst or fistula

A

-congenital epithelial cysts
-large*
-lateral part of neck- failure of obliteration of second brachial cleft in embryonic development
-swelling in upper part of neck anterior to sternocleidomastoid- can have opening to skin surface (fistula)
-treatment- conservative vs surgical excision
-recurrence common with surgical excision

56
Q

dermoid cyst

A

-due to entrapment of epithelium in deeper tissue, occurring either developmentally or post trauma
-usually midline nontender, mobile, submental neck masses
-treatment- surgical excision

57
Q

lymphangioma

A

-uncommon
-lymph tracts and glands fuse together
-congenital malformations of the lymphatic system
-involve the skin and subcutaneous tissues
-surgery
-sclerotherapy
-laser therapy or radiofrequency ablation

58
Q

congenital torticollis

A

-rare
-postural deformity of the neck
-lateral neck flexion (head tiled to one side)
-neck rotation (chin pointed to the opposites side)
-asymmetry
-goals of treatment:
-midline head position
-Symmetric posture and gross motor skills
-Prevention/improvementof craniofacial asymmetry
-Resolution of restricted cervical range of motion.
-Early Initiation is more effective

59
Q

teratoma

A

-rare
-arises from pluripotential cells and contain all 3 germ layers
-classically large, encapsulated, and contain a cystic component

60
Q

thymic mass

A

-rare
-result from implantation of thymic tissue during its embryologic descent
-typically midline position but can present anywhere between the angle of the mandible and midline of the neck
-surgical excision if pressing on esophagus or cosmetic

61
Q

metabolic, autoimmune causes

A

-metabolic disorders- rare causes of neck masses
-gout
-sarcoidosis- lymph nodes enlarge
-kimura’s disease- uncommon chronic inflammatory condition involving subcutaneous tissue
-castleman’s disease- benign lymphoproliferative disorder that most frequently involves the mediastinal lymph nodes

62
Q

substernal goiter

A

-trachea displaced
-can extend below manubrium

63
Q

lymphoma

A

-cancer of lymphatic system
-consider in younger pts
-2 major types: Hodgkins vs non Hodgkins
-S&S of lymphoma may include:
-painless swelling of lymph nodes in your neck, armpits, or groin
-persistent fatigue
-B-symptoms: fever, night sweats, unexplained weight loss***
-b symptoms can be associated with either type of lymphoma
-presence or absence of b symptoms has prognostic significance and is reflected in staging of these lymphomas
-shortness of breath
-treatment depends on type of dz, aggressiveness, dz location, pt age and general health

64
Q

Hodgkins Lymphoma

A

-occurs most often in ages 15-24 year old and > 60 year old
-more likely to arise in neck, axilla, chest
-progresses in orderly fashion
-reed sternberg cell- identical cells on both sides large, abnormal lymphocytes
-one of most treatable cancers- 5 year survival 90%

65
Q

non-hodgkins lymphoma

A

-median age 60 year old
-can arise in LN throughout body
-most pt are dx at a more advanced stage

66
Q

overview of neck masses

A

-only easy way to dx a neck mass is to know exactly what the pt has before you begin
-then your only challenge it to prove it!!
-next most challenging is to have some idea of what the pt has -> perform a few tests, narrow differential, then prove final dx
-most challenging is to have absolutely no idea whether this is a benign lymph node, malignant tumor or absolutely bizarre infectious disease
-probably only thing worse is to think one knows what the disease is only to discover one is 180 degrees off course
-thorough hx and physical -> postulating correct first impression
-number of imaging techniques which are useful but are intended for defining illness not for dx
-CT scan, CT scan with contrast, MR, MR with contrast, U/S and nuclear scanning all play some role but when over used are unnecessarily expensive
-fine needle aspiration* finding increasing role in dx of cervical masses

67
Q

increase likelihood of malignant disease

A

-age > 40 yr
-previous head and neck squamous cell carcinoma
-heavy tobacco use
-heavy alcohol consumption
-drug use (marijuana)
-family hx of cancer
-previous radiation therapy (thymic disease, acne) -> causes abnormal cells
-mass present > 2-3 weeks

68
Q

malignant mass

A

look tethered to the skin

69
Q

lingual thyroid mass

A

-can be visible behind the tongue on exam

70
Q

ranula cyst

A

-collection of fluid
-floor of the mouth
-I&D

HEENT (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions