ENT Flashcards
Diagnostic Approach
Location lateral vs midline
Type of lesion
- Congenital
- Inflammatory (infection vs non-infectious-inflammatory)
- Neoplastic (benign vs malignant)
Combination of the two
Neoplastic
Not painful, not tender No fever Associated weight loss Older Hard usually fixed
Adult head and neck cancer
- Squamous cell carcinoma 90%
- basal cell carcinoma (MC skin cancer)
- salivary cancer
- sarcoma
malignant lesions in children
5%
>50% lymphoma or soft tissue
- under 6: neuroblastoma, non-hodgkins lymphoma, rhabdomyosarcoma
- 7-13 years old: hodgkins, non-hodgkins, thyroid carcinoma, rhabdomyosarcoma - from skeletal muscle progenitors
- adolescent: hodgkins lymphoma
Second branchial clef
Most common (> 90%)
Location:
Along the anterior border of the middle to lower third of the sternocleidomastoid
Course:
Tracts along carotid sheath and then between branches of carotid, terminating in tonsillar fossa
10% are bilateral
Congenital midline
Thyroglossal duct anomaly (between tongue + thyroid) *rise with swallow
dermoid cyst
teratoma
abberant thyroid tissue
Thyroglossal duct cysts are often located over the hyoid bone and elevate with tongue protrusion or swallowing, whereas dermoid cysts typically move with the overlying skin
Lateral neck masses congential
- branchial clef cyst (#2 MC)
2. Venous malformation
Infectious/Inflammatory midline
- submental - lymphadenopathy
- thyroiditis
sebaceous cyst
Infectious/inflammatory lateral
- kawasaki, cat scatch, castleman
- HIV
- salivary gland calculi
What is the current first line treatment for infantile hemangiomas?
Propranolol
MOA?
- Effect on growth factors
- Anti-angiogenesis
- Vasoconstrictive effects
Is it effective?
YES – has replaced traditional treatment for most cases (even airway)
Kawasaki disease treatment?
Salicylates
- IV IG
Long term sequellae?
- Coronary artery lesions/aneurysm
Most common cause of acquired heart disease in children
Kawasaki disease is a generalized vasculitis that affects medium-size arteries. Treatment should be initiated as soon as the diagnosis is made and should involve the administration of intravenous immunoglobulin (IVIG) and high-dose aspirin.
Thyroglossal duct cyst
Diagnosis
Usually noted in children 2-10 years old
Most commonly in the midline at the level of the hyoid bone
Soft, smooth and non-tender
What is a pathopneumonic clinical sign?
Elevation with tongue protrusion/swallow!
Ultrasound is test of choice*
Identify thyroid gland
- Risk of cyst being the only active thyroid tissue
Cystic vs Solid
- If solid – think of aberrant thyroid gland
Thyroglossal duct cyst treatment
Treatment
Infected cyst should be treated first with antibiotics
Complete excision of the cyst and sinus tract including *portion of hyoid bone – Sistrunk procedure
Recurrence should be less then 10% with Sistrunk, more common in the face of previous infection
Dermoid cyst
Develop along embryonic lines of fusion
They contain ectoderm and mesodermal tissue
Most commonly located along lateral supraorbital ridge
Midline lesions may penetrate the calvarium and CT or MRI may be useful pre-operatively
Occasionally they may occur in midline of neck at the level of the hyoid and be confused with thyroglossal duct cyst
Treatment is complete surgical excision
Stridor
abnormal, high pitched sound by turbulent airflow through a partially obstructed airway
- inspiratory: laryngeal (supraglottic) obstruction –laryngomalacia
- expiratory: tracheal/bronchial obstruction –tracheomalacia
- biphasic = supraglottic (upper trachea) or glottic – sublglottic stenosis **emergency
