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