neck lumps

Question 1

Who gets salivary calculi

Answer 1

adults

old and dehydrated

Question 2

what causes salivary calculi

Answer 2

composed of calcium phosphate and carbonate and may be related to sialadenitis (inflammation of the salivary gland)

Question 3

where do most salivary calculi occur?

Answer 3

submandibular glands and some in parotid

Question 4

presentation of salivary calculi?

Answer 4

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

Question 5

investigations of salivary calculi

Answer 5

radiographs of submandibular gland and duct and parotid gland are helpful

many calculi not radio opaque tho

Question 6

treatment of salivary calculi

Answer 6

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

Question 7

causes of parotid tumours

Answer 7

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

Question 8

presentation of parotid tumours

Answer 8

slow growing lump in infected gland
pain
anaesthesia or trismus and facial palsy imply malignancy

Question 9

investigations for parotid tumour

Answer 9

CT - differentiate between stones, inflammation and tumour

MRI scanning offers sensitive investigation for assessment of local invasion and involvement of surrounding structures

Question 10

treatment of parotid tumours

Answer 10

excision

Question 11

what is cervical lymphadenopathy

Answer 11

swelling of lymph nodes in the neck

Question 12

causes of cervical lymphadenopathy

Answer 12

local or systemic

inflammatory or malignant or autoimmune

Question 13

inflammatory cuases of cervical lymphadenopathy

Answer 13

bacterial
viral
parasitic
non-infective: sarcoid and connective tissue disorders, benign reactive lymph nodes in children

Question 14

autoimmune cuases of lymphadenopathy

Answer 14

systemic lupus erythematosus
Rheumatoid arthritis
sarcoidosis

Question 15

presentation of inflammatory lymphadenopathy

Answer 15

acute, painful swelling of lymph nodes
associated with symptoms of tonsilitis, pharyngitis or glandular fever
abscess formation can sometimes occur and become necrotic

Question 16

presentation of malignant lymphadenopathy

Answer 16

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

Question 17

signs on examination of lymphoma

Answer 17

any age
painless rubbery in posterior triangle and sometimes in inguinal and axilla

systemic symptoms - fevr, night sweats, fatigue and weight loss

Question 18

investigations of lymphadenopathy

Answer 18

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

Question 19

treatment of lymphadenopathy

Answer 19

treat by cause
considerantibiotics for viral and if not gone in 2 weeks, refer to ENT

If suspected lymphoma refer urgently