ENT - Adult neck masses

Question 1

where do nasopharynx tumors metastasize?

Answer 1

upper jugular chain

Question 2

where do nasopharynx / posterior scalp / ear / temporal bone / skull base tumors metastasize?

Answer 2

posterior triangle

Question 3

where do thyroid / piriform sinus / upper esophagus tumors metastasize?

Answer 3

lower jugular chain

Question 4

where do anterior 2/3 tongue / floor of mouth / gums / cheek mucosa tumors metastasize?

Answer 4

submandibular triangle

Question 5

where do lip cancer tumors metastasize?

Answer 5

submental triangle

Question 6

where do oral cavity (any location) / pharynx / larynx tumors metastasize?

Answer 6

midjugular chain

Question 7

a tumor just behind the ear will be a metastasis from where?

Answer 7

nasopharynx

Question 8

what should be the first step in addressing a neck mass / pain, especially with any inflammatory symptoms (redness, pain)?

Answer 8

2 week course of abx (prior to invasive treatment)

Question 9

what is the standard diagnostic test for neck masses? what are the indications?

Answer 9

FNA

• neck mass that is not an obvious abscess
• persistence after 2 wk abx
• progressive growth / supraclavicular / over 3 cm
• B symptoms

Question 10

what is radionucleotide scanning used for?

Answer 10

• salivary and thyroid masses
• location: glandular vs extra-glandular
• functional information

Question 11

80% of asymmetric neck masses are of what origin?

Answer 11

SCC

Question 12

if there is unilateral otalgia with normal otoscopy, where should you suspect a neoplasm?

Answer 12

nasopharynx - tonsil, tongue base, supraglottis, hypopharynx

Question 13

if there is unilateral serous otitis, where should you look?

Answer 13

nasopharynx (direct examination) - obstructing auditory tube

Question 14

what is the nodal mass workup in the adult?

Answer 14

• panendoscopy (FNA)
• directed biopsy
• synchronous primaries
• open excisional biopsy (only if neg workup)

Question 15

what is the most common anterior neck mass?

Answer 15

thyroid mass

Question 16

what are the signs and symptoms of lymphoma?

Answer 16

• lateral neck mass (discrete, rubbery, nontender)
• fever
• hepatosplenomegaly
• diffuse adenopathy

Question 17

what diagnostic tests are done for lymphoma?

Answer 17

• FNA (first line)
• if suggestive for lymphoma: open biopsy
• full workup: CT chest, abdomen, head neck, bone marrow

Question 18

does skin fixation indicate benign or malignant?

Answer 18

malignant

Question 19

what are the diagnostic tests for salivary gland tumors?

Answer 19

• open excisional biopsy preferred
• FNA
• CT (deep lobe tumors, intra vs extra parotid)

Question 20

for salivary gland tumor resection, what should you be prepared to do?

Answer 20

• total parotidectomy with possible facial nerve sacrifice

Question 21

how is lipoma diagnosis confirmed?

Answer 21

excision

Question 22

neurogenic tumors arise from what germ layer?

Answer 22

neural crest

Question 23

what is the most common neurogenic head and neck tumor?

Answer 23

schwannoma

Question 24

what are the neurogenic tumors?

Answer 24

• schwannoma
• neurofibroma
• malignant peripheral nerve sheath tumor

Question 25

what are the s/sx of schwannoma?

Answer 25

- medial tonsillar displacement - hoarseness - horners syndrome

Question 26

which branchial cleft has the highest incidence of cysts?

Answer 26

2nd

Question 27

WHEN do branchial cleft cysts most commonly present? what is the presentation?

Answer 27

- post URI | - smooth fluctuant mass underyling SCM

Question 28

what is the treatment for branchial cleft cysts?

Answer 28

- initial control of infection | - surgical excision, including tract

Question 29

do thyroglossal duct cysts move with swallowing?

Answer 29

yes (elevates on swallowing / protrusion of tongue)

Question 30

what is the treatment for lymphangiomas?

Answer 30

surgical excision if easily accessible

Question 31

what is the treatment for hemangiomas?

Answer 31

surgical excision for rapid growth in vital structures or thrombocytopenia

Question 32

what is required for equivocal or suspicious FNA in the pediatric nodal mass?

Answer 32

open excisional biopsy to rule out malignant or granulomatous disease