ENT: Swellings in the Head and Neck

Question 1

Anatomical considerations

Answer 1

Prominent landmarks
Triangles of the neck
Carotid bulb
Lymphatic levels

Question 2

General factors

Answer 2

Age
Location
Metastasis location

Question 3

Diagnosis

Answer 3

History

• development time course
• associated symptoms
• personal habits
• previous irradiation/surgery

Exam

• complete H&H+N exam
• emphasis on location, mobility and consistency

Question 4

Diagnostic tests

Answer 4

FNAC - fine needle aspiration cytology 
Needle core biopsy 
Computed tomography 
MRI 
US
Radionucleotide scanning
PET scan

Question 5

Ultrasound

Answer 5

Solid v cystic

Congenital cysts from solid nodes/tumours

Question 6

CT

Answer 6

Distinguish cystic from solid

Useful for staging disease

Question 7

MRI - used for

Answer 7

Good for upper neck and skull base

Question 8

Primary tumours

Answer 8

Thyroid mass
Lymphoma 
Parotid/salivary gland
Carotid body and glomus tumours 
Neurogenic tumours
Lipoma

Question 9

Thyroid mass

Answer 9

No. 1 cause of ant. neck mass
Male predominance in kids
Female predominance in adults

Question 10

Lymphoma

Answer 10

Common in children and young adults

80% of children present with neck mass in HL

Question 11

Salivary gland tumours

Answer 11

Enlarged mass anterior/inferior to ear or at mandible angle
Benign
Malignant

Question 12

Carotid body tumour

Answer 12

Rare in children

Pulsatile/compressible mass

Question 13

Lipoma

Answer 13

Soft, ill defined mass

Question 14

Schwannoma

Answer 14

Acoustic

can occur in neck

Question 15

Thyroglossal duct cysts

Answer 15

Developmental abnormality

Can develop cancers inside them

Question 16

Vascular tumours - AKA

Answer 16

Lymphangioma

Large neck lumps which can be picked up pre natally

Question 17

Vascular tumours - AKA

Answer 17

Lymphangioma
Hemiangioma
Large neck lumps which can be picked up pre natally

Question 18

Inflammatory disorders

Answer 18

lymphadenitis - following colds and scalp infections, viral causes e.g EBV
can be granulomatous - following atypical TB, TB or actinomycosis

Question 19

Indications for FNAB in kids

Answer 19

Actively progressing infection