ENT - Adult neck masses Flashcards
where do nasopharynx tumors metastasize?
upper jugular chain
where do nasopharynx / posterior scalp / ear / temporal bone / skull base tumors metastasize?
posterior triangle
where do thyroid / piriform sinus / upper esophagus tumors metastasize?
lower jugular chain
where do anterior 2/3 tongue / floor of mouth / gums / cheek mucosa tumors metastasize?
submandibular triangle
where do lip cancer tumors metastasize?
submental triangle
where do oral cavity (any location) / pharynx / larynx tumors metastasize?
midjugular chain
a tumor just behind the ear will be a metastasis from where?
nasopharynx
what should be the first step in addressing a neck mass / pain, especially with any inflammatory symptoms (redness, pain)?
2 week course of abx (prior to invasive treatment)
what is the standard diagnostic test for neck masses? what are the indications?
FNA
- neck mass that is not an obvious abscess
- persistence after 2 wk abx
- progressive growth / supraclavicular / over 3 cm
- B symptoms
what is radionucleotide scanning used for?
- salivary and thyroid masses
- location: glandular vs extra-glandular
- functional information
80% of asymmetric neck masses are of what origin?
SCC
if there is unilateral otalgia with normal otoscopy, where should you suspect a neoplasm?
nasopharynx - tonsil, tongue base, supraglottis, hypopharynx
if there is unilateral serous otitis, where should you look?
nasopharynx (direct examination) - obstructing auditory tube
what is the nodal mass workup in the adult?
- panendoscopy (FNA)
- directed biopsy
- synchronous primaries
- open excisional biopsy (only if neg workup)
what is the most common anterior neck mass?
thyroid mass
what are the signs and symptoms of lymphoma?
- lateral neck mass (discrete, rubbery, nontender)
- fever
- hepatosplenomegaly
- diffuse adenopathy
what diagnostic tests are done for lymphoma?
- FNA (first line)
- if suggestive for lymphoma: open biopsy
- full workup: CT chest, abdomen, head neck, bone marrow
does skin fixation indicate benign or malignant?
malignant
what are the diagnostic tests for salivary gland tumors?
- open excisional biopsy preferred
- FNA
- CT (deep lobe tumors, intra vs extra parotid)
for salivary gland tumor resection, what should you be prepared to do?
- total parotidectomy with possible facial nerve sacrifice
how is lipoma diagnosis confirmed?
excision
neurogenic tumors arise from what germ layer?
neural crest
what is the most common neurogenic head and neck tumor?
schwannoma
what are the neurogenic tumors?
- schwannoma
- neurofibroma
- malignant peripheral nerve sheath tumor
what are the s/sx of schwannoma?
- medial tonsillar displacement
- hoarseness
- horners syndrome
which branchial cleft has the highest incidence of cysts?
2nd
WHEN do branchial cleft cysts most commonly present? what is the presentation?
- post URI
- smooth fluctuant mass underyling SCM
what is the treatment for branchial cleft cysts?
- initial control of infection
- surgical excision, including tract
do thyroglossal duct cysts move with swallowing?
yes (elevates on swallowing / protrusion of tongue)
what is the treatment for lymphangiomas?
surgical excision if easily accessible
what is the treatment for hemangiomas?
surgical excision for rapid growth in vital structures or thrombocytopenia
what is required for equivocal or suspicious FNA in the pediatric nodal mass?
open excisional biopsy to rule out malignant or granulomatous disease
