Isolated Neck Mass Flashcards
What imaging should be considered when presented with a neck mass ?
Ultrasound, CT, and MRI can all be used to determine size, extent, and physical characteristics of the mass.
How does head and neck squamous cell carcinoma typically present?
It used to typically present in smokers and drinkers, but now more and more commonly in nonsmokers >30 years old with no risk factors who presents itch a single firm neck mass at level II-III.
What if a patient presents with a unilateral cystic mass >30 years old over a short period of time?
Lymphoepithelial malignancy should be considered
What additional procedures could be performed following excision all biopsy in the neck?
If pathology suspects cancer, at least elective neck dissection should be considered with focus on lymph nodes. Comprehensive neck dissection may be needed as well.
What kind of biopsy should be performed?
FNA is preferred over open biopsy with sensitivity and specificity greater than 90% respectively. Incisional biopsy risks the spread of cancer cells in the wound bed and interferes with the eventual actual resection.
What if the diagnostic FNA is non diagnostic?
Given the complications associated with open biopsy, repeat FNA is recommended.
What kind of anesthesia should be used if an open biopsy needs to be performed?
General. Local anesthesia like lidocaine can abrogate nerve impulses, making precise localization of motor nerves difficult.
How should a patient with mass effect from their neck mass be incubated?
If there is tracheal deviation, fiber optic guidance may be necessary.
What are the nerves most likely to be injured during neck surgery?
VII and XI. The marginal mandibular branch of the facial nerve should also be avoided by going two fingerbreadths below the body of the mandible.
If epithelial malignancy is possible, what precautions should dissection take?
Dissection should aim for complete excision without violation of the pseudocapsule or spillage of the contents of the mass.
Why should you avoid incisional/excisional biopsies of the parotid gland?
Risk of damage to the facial nerve.
What cranial nerves should be carefully avoided with carotid body tumor resection?
X and XI
