Head and Neck Overview - Scholting Flashcards
Identify this condition:
pt has a midline mass just below her chin
exam: mass does not move when pt swallows or sticks out her tongue
Dermoid Cyst
located in the submental area
endoderm and mesoderm remnants
does NOT move with swallowing or tongue protrusion
Identify and describe the management of this condition:
pt: has enlarged parotid and submandibular glands that are tender to palpation, ducts have a purulent discharge
Sialoadenitis
tx: antibiotics, hydration, massage of gland, warm compress
Benign Neoplastic Salivary Gland Enlargement - Differential Diagnosis
- Pleomorphic adenoma
- Warthin’s tumor
- Oncocytoma
- Hemangioma
Benign Neck Masses: Schwannoma
solid, slow growing, neurogenic tumor, painless
most common in 25-50 year olds
Identify this condition and describe the managment:
pt: reports pain on the left side of her mouth/cheek right before sitting down to eat dinner
exam: observed swelling of salivary gland, palpation of a stone in Wharton’s duct
Sialolithiasis
tx: removal of stone by massage or milking the gland
refer: ENT if stone does not pass within 5-7 days
Benign Neck Masses: Sebacous Cyst
cyst sac, slow growing, painless, moveable
possibly infammed and tender
tx: incision and drainage, excision
Benign Neoplasia Neck Mass Differential Diagnosis
- Lipomas
- Fibromas
- Sebaceous Cyst
- Epidermoid Inclusion Cysts
- Paragangliomas
- Schwannomas
- Neurofibromas
Identify this condition and describe the management:
pt has a 3 cm (midline) mass on his anterior neck, the mass moves when the patient swallows or sticks out his tongue
Thyroglossal Duct Cyst
remnant of descending tract of thyroid
may intermittenly become infected
Management: surgical excision of cyst, tract
Malignant Neoplasia Differential Diagnosis
- Metastatic squamous cell carcinoma
- Lymphoma
- Rhabdmyosarcoma
- Neurofibrosarcomas
- Thyroid Carcinoma
- Salivary Carcinoma
Malignant Neck Masses - Lymphoma
occurs in pediatrics and adults
enlarged lymph nodes, non-tender
addtional sxs: weight loss, night sweats
Identify this condition and describe the management:
pt complains of mass on her neck
reports s/s of cough, fever, nasal drainage, tonsillar enlargment with exudates
exam shows: enlarged, tender/painful submandibular and anterior cervical lymph nodes
Inflammatory Neck Mass: **Reactive lymphadenitis **
secondary to viral or bacterial illness
- most common bacterial casue: strep and staph infection
- most common viral: Mononucleosis (EBV)
- less common causes: Mycobacterium, Tuberculosis, Cat Scratch Disease, Toxoplasmosis, HIV
diagnosis can utilize labs - rapid strep test, CBC, PPD, HIV test, Bartonella, EBV titer, etc.
tx: 10-14 days of antibiotic unless viral (self-limited) - follow up in 2-3 weeks
managment: further work-up if doesn’t resolve in 2-3 weeks
Benign Neck Masses: Lipoma
soft mass, ill-defined borders, painless
tx: excision if needed
Malignant Neck Mass: Rhabdomyosarcoma
pediatrics - peak incidence age 5
painless, enlarging mass
Congenital Lateral Neck Masses - Differential Diagnosis
- Branchial cleft cysts
- Lymphangiomas (cystic hygromas)
- Hemangiomas
Identify this condition and describe the management:
pt has a cyst on the anterior border of the his left SCM, it has increased in size over the past year
pt had a cold last week and now the mass is infected
exam: palpation reveals the mass is soft, and does not elicit pain
Branchial Cleft Cyst
can be a cyst, sinus or fistula anywhere on the SCM
2nd cleft most common, 1st cleft less common
- First Branchial Cleft - associated with EAC, Parotid Gland
- Second Branchial Cleft - associated with Superior pole of tonsil, located on the anterior border of the SCM, between the internal and external carotid arteries, opens into tonsilar fossa
- Third Branchial Cleft - associated with Pyriform Sinus, located on the anterior border of the SCM, posterior to common carotic, opens into Pyiriform sinus
management: surgical excision of cyst and sinus tract
Malignant Neoplastic Salivary Gland Enlargment
- Muccoepidermoid carcinoma
- Adenoid cystic carcinoma
- Adenocarcinoma
- Squamous cell carcinoma
- Lymphoma
- Metastasis
Inflammatory Salivary Gland Differential Diagnosis
- Acute or chronic sialoadenitis
- Mumps
- Sialolithiasis
- HIV
- Tuberculosis
- Cat Scratch Disease
- Cytomegalovirus
- First branchial arch cysts/sinus
Benign Thyroid Neoplasm Differential Diagnosis
Follicular Adenoma
Malignant Neck Masses: Metastatic Squamous Cell Carcinoma
most common cause of malignant neck mass in adults
primary tumor most likely in aerodigestive tract
Benign Neck Masses: Fibroma
fibrous or connective tissue, painless
tx: excision if needed
Thyroiditis - Thyroid Masses Differential Diagnosis
- Acute thyoiditis
- Subacute thyroiditis (granulomatous, lymphocytic)
- Chronic lymphocyte thyroitis (Hashimoto’s)
- Fibrous thyroiditis (Riedel’s)
Metabolic Salivary Gland Enlargment Differential Diagnosis
- Sjogren’s Syndrome
- Medications
- Sarcoidosis
Identify this condition:
pt presents with a cystic lesion on the floor of his mouth, it plunges through muscle planes into the upper neck
Ranula
occurs from mucus extravasation from blocked salivary duct
Degenerative Thyroid Masses - Differential Diagnosis
- nontoxic multinodular goiter
- Graves’ disease
Congenital Midline Neck Masses - Differential Diagnosis
- thyroglossal duct cyst
- dermoid cysts
- Ranulas (plunging)
Inflammatory Neck Mass - Differential Diagnosis
- Cervical adenitis (viral or bacterial)
- Infectious mononucleosis
- Atypical mycobacteria
- Cat scratch disease
- Tuberculosis
- Histoplasmosis
- Toxoplasmosis
- Accquired immunodeficiency syndrome
- Granulomatous (sarcoidosis)
Malignant Thyroid Neoplasms
- Papillary Carcinoma
- Follicular Carcinoma
- Medullary Carcinoma
- Anaplastic Carcinoma
- Lymphoma
