neck lump

Question 1

causes

Answer 1

isolated- dental abscess, tonsolitis, oropharyngeal tumour

systemic disease- HIV, lymphoma, sarcoidosis, amyloidosis, TB, RA, Glandular fever, SLE,

Question 2

differentials

Answer 2

salivary stones
malignancy 
cyst 
mass 
chondroma 
pharyngeal poch
pancoast tumour
subclavian artery aneurysm

Question 3

exam and investigations

Answer 3

ent and thyroid exam
FNA biopsy
Ultasound/CXR/CT
manoux test

Question 4

treatment

Answer 4

surgical excision

Question 5

what percentage of malignancies are due to partod tumours?

Answer 5

0.4%

rare

Question 6

what percentage occur in the paratoid gland

Answer 6

80%

Question 7

causes

Answer 7

pleomorphic adenomas -80% benign
M:F 1:1
30-50s years of age
no true capsule

warthrin tumour
also slow growing with potential to become malignant
50 years plus , men

malignant tumour
facial nerve involvement
slow growing with potential to mets

Question 8

how do they present

Answer 8

lump in infected gland

pain, trismus and facial palsy–> malignancy

Question 9

what is trismus

Answer 9

lock jaw

Question 10

investigations

Answer 10

ct-differentiate between stones, tumour inflamm

mri - sensitive to detecting surrounding tissue involvement

Question 11

treatment

Answer 11

excision

Question 12

where do most salivary gland swellings occur?

Answer 12

80% In submandibular gland

can be paratoid

Question 13

who ?

Answer 13

older adults-usually old and dehydrated

Question 14

what is it associated with?

Answer 14

inflam of salivary gland -siialadentitis

Question 15

what do the stones consist of?

Answer 15

calcium phosphate and carbonate

Question 16

presents?

Answer 16

with pain on eating and drinking
partial obstruction of duct can last mins to hours where complete can present with persistant pain
can be colicky if in duct

Question 17

diagnostics?

Answer 17

radiograph of subman and paratoid glands

Question 18

treatment

Answer 18

if in duct removal under general anaesthetic but if in gland usually gland is removed
if paratoid gland does not require removal but can be treated with sialagogues

Question 19

sialagogues what are they

example

Answer 19

stimulates/increase flow rate of saliva

example–Pilocarpine