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Surgery > Neck > Flashcards

Neck Flashcards

1
Q

Discuss clinical assessment of lumps

A
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2
Q

Discuss Mx of lumps

A

depends on location and suspected Dx

Investigations
- Imaging → USS, XR, CT, MRI
- Cytology/histology → FNA, core biopsy, excisional biopsy, aspiration
- Functional tests → thyroid function, radionucleotide scans

Treatment→ topical therapies, surgery (excisions, radical), anti-neoplastic medications

Referralif suspected malignancy +/- multiple lumps

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3
Q

Congenital neck masses

A

Branchial cleft cysts → arise through pharyngeal clefts, type II most common, occur at anterior border of SCM

Thyroglossal duct cysts → duct forms at base of tongue and goes to thyroid so cyst may occur anywhere along, midline mass, rise on swallow (joined to back of tongue; do USS/CT +/- FNA)

Dermoid cysts → occur in neck and scalp, midline, non-tender, mobile

Hemangiomas → vascular lesions occurring in trunk, head and neck, red or blue vascular mass, soft and compressible, tend to resolve in early life

Lymphangiomas → arises from lymphatic system, soft, compressible, transilluminates

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4
Q

Acquired neck masses

A

Inflammatory/Infectious → cervical lymphadenopathy

  • Viral → EBV, HIV
  • Bacterial → Staph aureus, Group A or B Strep
  • Granulomatous → TB, atypical mycobacteria, sarcoidosis
  • Fungal → Candida, histoplasma, aspergillus
  • Kawasaki disease, autoimmune processes

Neoplastic
- metastasing to LN in neck: oral cavity, tongue, nasopharynx, oropharynx, laryngophrynx, cutaneous (SCC, melanoma)
- thyroid nodules (adenoma or malignant), lymphoma, salivary neoplasms, lipomas, paragangliomas/glomus tumour (carotid body tumours)

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5
Q

Aetiology of acute cervical lymphadenopathy in children

A

Acute (< 2 weeks)

Reactive cervical LNs: small, uni/bilateral, non or mildly tender with URTI –> expectant Mx and resolution when viral Sx resolve

Acute bacterial lymphadenitis: large, tender, unilateral, firm, fluctuant, erythematous/overlying cellulitis, restricted ROM, febrile
- MC = staph aureus, GAS, GBS (neonates), anaerobes (dental source)
- Sources = scalp/anterolateral neck/dental/deep soft tissue infection e.g,, retropharyngeal abscess

Kawasaki disease

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6
Q

Aetiology of subacute/persistent cervical lymphadenopathy in children

A

Persistent/subacute (2-6 weeks)

EBV, CMV, rubella, HIV (hepatosplenomegaly, generalised)
Toxoplasmosis gondii (generalised)
Bartonella henselae (cat scratch disease; axillary)
Non-TB mycobacteria (violaceous) or mycoplasma TB
SLE/JIA (generalised)
Malignancy (leukaemia/lymphoma)

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7
Q

Hx taking for cervical lymphadenopathy in children

A
  • Site, onset, growth, changes, skin changes, pain/discharge, ROM
  • Viral URTI Sx, fever, systemic features (weight loss, night sweats, easy bruising, joint pain), trismus, muffled voice, other Sx of serious deep soft tissue infection
  • Lymphadenopathy elsewhere
  • OS travel, immunisations, animals/cats
  • Treatment, antibiotic response
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8
Q

Ex for cervical lymphadenopathy in children

A
  • General inspection and vitals
  • Site, size, skin changes, oedema, consistency, tenderness, discharge, firm/fluctuant/fixed/matted etc, temperature, mobility
  • ROM
  • Source of infection?
  • Lymphadenopathy elsewhere
  • Hepatosplenomegaly
  • Ex guided by Hx
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9
Q

Ix for acute cervical lymphadenopathy in children

A
  • Usually none
  • Consider if child is immunocompromised, systemically unwell, or there is suspicion of underlying infection
  • If systemically unwell  FBC, CRP, blood culture
  • If abscess suspected  USS before I&D and then MC&S on drained fluid
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10
Q

Ix for persistent cervical lymphadenopathy in children

A

FBC, blood film, LFTs, CRP, ESR, LDH
Tailor to suspicion
- HIV, EBV, CMV, Bartonella, toxoplasmosis, quanteferon gold
- CXR if malignancy suspected
- USS
- Excisional biopsy

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11
Q

Tx of cervical lymphadenopathy in children

A

Reactive usually do not need treatment

Acute bacterial lymphadenitis
- PO cephalexin 33mg/kg TDS 7 days and review after 48 hours
- If unwell or not responding to PO Abx: 50mg/kg IV flucloxacillin 6 hourly
- Fluctuant nodes not responding to Abx may need I&D (MC&S on drained fluid)

Mycobacterial infection requires excisional biopsy as sinus tract formation can occur

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12
Q

What are surgical airway options

A

EMERGENCY
Needle cricothyrotomy
Surgical cricothyrotomy
Emergency tracheostomy

PLANNED
Tracheostomy
Laryngectomy

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13
Q

What is a needle cricothyrotomy

A

Passage of a large bore cannula through the cricothyroid membrane which is then attached to jet ventilation

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14
Q

When is a needle cricothyrotomy indicated

A

CICV in young children in whom surgical cricothyrotomy is CI

CICV in adults if practitioner is not comfortable performing surgical cricothyrotomy

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15
Q

What is a surgical cricothyrotomy

A

An emergency procedure in which an incision is made through skin, cervical fascia, and cricothyroid membrane to obtain airway acess

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16
Q

When is surgical surgical cricothyrotomy indicated

A

CICV: Failure to maintain oxygenation or ventilation in bw intubation attempts or after 3 attempts at intubation

May be required in:
- severe oropharyngeal oedema
- foreign body aspiration causing complete occlusion of upper airway
- severe oropharyngeal/nasal haemorrhage
- acute epiglottitis
- severe maxillofacial trauma

17
Q

When is surgical cricothyrotomy CI

A

Young children and infants (risk of cricoid cartilage/surround structure damage)

Some airway injuries (tracheal transection, laryngeal #)

Obstruction distal to cricothyroid membrane

Inability to ID landmarks

Tumour/infection at incision site

18
Q

When is an emergency tracheostomy performed

A

CICV scenario with trained practitioner

More complex, takes more time, and is associated with more bleeding

19
Q

What is a tracheostomy

A

Permanent or temporary opening in cervical trachea created through a surgical incision below cricoid cartilage

20
Q

When is a planned tracheostomy indicated

A

Long term mechanical ventilation (>3 weeks)
- underlying cardiopulmonary and neurodegenerative diseases

Malignancy

21
Q

How is tracheostomy performed

A

Percutaneous: under bronchoscopy guidance MC at bedside for pts receiving longterm MV

Surgical: in OR

22
Q

What is a laryngectomy

A

Removal of all laryngeal structures including epiglottis and part of upper trachea with trachea brought to front of neck to create a stoma

23
Q

When is laryngectomy indicated

A

Laryngeal cancer

24
Q

What is an important consideration in oxygenating patients with a laryngectomy

A

Upper airway no longer connected to trachea
Cannot be oxygenated or intubated through upper airway

Surgery (17 decks)

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