ENT swelling in head and neck Flashcards
common neck masses can be catagorised into
neoplastic
congenital/developmental
inflammatory
anatomical considerations
look at triangles of neck, prominent landmarks e.g. thyroid cartilage
lymph nodes
what can tonsilittues progress to and then following that
peritonisillar abcess symptoms - trismus building of peritonsillar area deviated uvula severe pain
can then lead to deep neck space abcess if not treated
spaces in the neck
peritonsillar area parapharyngeal space reteropharYngeal space danger space prevertebral space
Ludwig’s angina
usually from odontogenic infection
spreads from supra hyoid spaces in floor of mouth
symptoms
- pain trismus drooling
tongue protrusion, fever
acute viral parotitis
caused by paramyxovirus (mumps)
mostly bilateral swelling
managed by rehydration and analgesia
acute bacterial parottitis
pain swelling pyre dehydration
by staph aureus
ranula
painless masses that do not change in size in response to chewing eating or swallowing
mucous filled cyst from sublingual salivary glands
infective lymphadenopathy
increase in size of the cervial lymph nodes in response to infection
neoplasia lymahtdenoptjy
haematological malignancy that commonly causes lymphadenopthy
diagnostic step history
- developmental time course (how long have they had the lymphadenopathy)
- associated symptoms (dysphagia, otalgia, voice)
- personal habits (tobacco, alcohol)
- previous irradiation or surgery
diagnostic tests
- fine needle aspiration cytology (FNAC) – usually for thyroid
- needle core biopsy – for any other masses
- Computed tomography (CT)
- magnetic resonance imagine (MRI)
- ultrasonography
- radionucleotide scanning
- PET scan (usually for metastatic lympathdeopathy)
primary tumours can be
1) thyroid mass
2) lymphoma
3) salivary tumours
4) lipoma
- benign
5) carotid body and glomus tumours
6) neurogenic tumours
lymphoma signs and symptosm
- lateral neck mass only (discrete, rubbery)
- fever
- Hepatosplenomegaly
- diffuse adenopathy
salivary gland tumours
parotid
sub mandibular
sublingual
malignant salivar gland timours
Benign
- asymptomatic except for mass
Malignant
- rapid growth, skin fixation, cranial nerve palsies
- CT/MRI deep lobe tumours, intra vs extra parotid
prefer core biopsy than FNAC (more specimen, more accurate)
carotid body tumour
Pulsatile compressive mass
- mobile medial/lateral not superior/inferior
- generally at level of carotid bulb
Clinical diagnosis confirmed by
- angiogram or CT
Treatment
- irradiation or close observation in elderly
- surgical resection for small tumours in young patients
- try and treat conservatively due to complications
lipoma
small ill defined mass
confrmed by full excision
neurogenic tumours
arise from neural crest derivatives
schwannoma
Signs and symptoms
- medial tonsillar displacement
- hoarsness (vagus nerve)
- horners syndrome (sympathetic chain)
congenital and developmental masses
- epidermal and sebaceous cysts
- branchial cleft cysts
- thyroglossal duct cysts
- vascular tumours
Epidermal and sebaceous cysts - older age groups
clinical diagnosis - elevation and movement of overlying skin
- skin dimple or pore
thyroglossal duct cyst
midline or near midline
usually inferior to hyoid bone
elevated on swallowing or protrusion of tongue
vascular tumours
Lymphangiomas and hermangiomas most common
- haemangiomas often resolve spontaneously, lymphangiomas remain unchanged
CT/MRI can help determine extent of disease
Treatment
1) lymphangiomas
- surgical excision for easily accessible or lesions affecting vital functions
2) haemangiomas
- surgical excision for those with rapid growth involving vital structures or associated thrombocytopenia that fails medical therapy (steroids/interferon)
granola lymphadenitis
firm relatively fixed node with injection of skin
typical m tuberculossi
posterior triangle nodes
usually response to anti TB meds
atypical tyeberculosis
kids
anterior triangel nodes
pain and brawny skin
usually response to surgical excision
cat scratch fever (bartonella
paediatric group
pre auricular and SM nodes
