neck lumps Flashcards
Who gets salivary calculi
adults
old and dehydrated
what causes salivary calculi
composed of calcium phosphate and carbonate and may be related to sialadenitis (inflammation of the salivary gland)
where do most salivary calculi occur?
submandibular glands and some in parotid
presentation of salivary calculi?
pain and swelling of affected gland on eating and drinking
partial obstruction of duct = swelling lasts minutes - hours
complete obstruction of duct leads to persistent swelling and infection
may experience colicky pain in the duct when eating
investigations of salivary calculi
radiographs of submandibular gland and duct and parotid gland are helpful
many calculi not radio opaque tho
treatment of salivary calculi
stones on the intra-oral part of the duct can be removed under general anaesthesia
stones in the submandibular gland are an indication for removal of the submandibular gland
dont usually operate on the parotid - treated conservatively with sialagogues and intermittent massage of the gland towards the duct
causes of parotid tumours
pleiomorphic adenoma - most parotid tumours - malignant change develops in 10-30yrs
warthins tumour (adenolymphoma) - benign, presents as slow growing soft swelling - treat by wide local excision
malignant tumours - mucoepidermoid, cylindroma, , acinic
presentation of parotid tumours
slow growing lump in infected gland
pain
anaesthesia or trismus and facial palsy imply malignancy
investigations for parotid tumour
CT - differentiate between stones, inflammation and tumour
MRI scanning offers sensitive investigation for assessment of local invasion and involvement of surrounding structures
treatment of parotid tumours
excision
what is cervical lymphadenopathy
swelling of lymph nodes in the neck
causes of cervical lymphadenopathy
local or systemic
inflammatory or malignant or autoimmune
inflammatory cuases of cervical lymphadenopathy
bacterial
viral
parasitic
non-infective: sarcoid and connective tissue disorders, benign reactive lymph nodes in children
autoimmune cuases of lymphadenopathy
systemic lupus erythematosus
Rheumatoid arthritis
sarcoidosis
presentation of inflammatory lymphadenopathy
acute, painful swelling of lymph nodes
associated with symptoms of tonsilitis, pharyngitis or glandular fever
abscess formation can sometimes occur and become necrotic
presentation of malignant lymphadenopathy
mass in supraventricular fossa (vichows node)
indicates metastatic malignancy from tumour below the clavicle (lung or upper GI)
leukaemia can present with generalised lymphadenopathy
pallor, fatigue, persistent infection, bruising, bleeding
weight loss, fatigue, fever, night sweats
signs on examination of lymphoma
any age
painless rubbery in posterior triangle and sometimes in inguinal and axilla
systemic symptoms - fevr, night sweats, fatigue and weight loss
investigations of lymphadenopathy
lymph node examination
no further evaluation unless red flags - think malignancy or serious infection
if unexplained very urgent FBC
> 40 with supraclavical lymphadenopathy or persistent cervical lymphadenopathy = urgent CXR
treatment of lymphadenopathy
treat by cause
considerantibiotics for viral and if not gone in 2 weeks, refer to ENT
If suspected lymphoma refer urgently
