Neck Lumps

Question 1

How common is cervical lymphadenopathy?

Answer 1

Annual incidence of 0.6-0.7% for generalised lymphadenopathy

Question 2

Who does cervical lymphadenopathy affect?

Answer 2

Everyone

Particularly young children and >40 years

Question 3

What causes cervical lymphadenopathy?

Answer 3

Acute:
Staphylococcus Aureus or group A streptococcus (strep pyogenes)

Persistent: atopic eczema, infections (EBV, cat scratch disease, TB, HIV), malignancy (primary lymphoma or metastatic), rheumatological conditions

Question 4

What are the risk factors for cervical lymphadenopathy?

Answer 4

Exposure to virus

age for metastatic malignancy

Question 5

What are the symptoms of cervical lymphadenopathy?

Answer 5

Enlargement of the cervical lymph nodes

Different type of lump depending on cause

Question 6

What are the differential diagnoses of cervical lymphadenopathy?

Answer 6

Sebaceous cyst
Lipoma
Abscess
Dermoid cyst
Carcinoma
Carotid aneurysm
Carotid body tumour
Cervical rib
Subclavian artery aneurysm

Question 7

What investigations are necessary to diagnose cervical lymphadenopathy?

Answer 7

FBE/film
Serology- EBV, CMV, HIV 
Mantoux test
CXR
CT preoperatively
Excision biopsy/FNA

Question 8

Where do parotid neoplasms most commonly occur?

Answer 8

In the tail of the gland as a discrete mass in an otherwise normal gland
About 80% of parotid neoplasms are benign

Question 9

How common are parotid tumours?

Answer 9

They are fewer than 1% of all cancers and 3-6% of all tumours of he head and neck

Question 10

What are the causes and risk factors for Parotid tumours?

Answer 10

Radiation to neck increases risk of malignancyof salivary glands
Smoking
High use of mobile phones
HPV

Question 11

What are the symptoms of a parotid tumour?

Answer 11

Most common is lump or swelling on or near jaw, in mouth or neck
75% of tumours are benign

Other symptoms include:

• numbness in part of face
• facial palsy
• pain in the area
• problems swallowing
• difficulty opening mouth fully
• swelling on one side of face

Question 12

What clinical features of a salivary gland mass are suggestive of malignancy?

Answer 12

Hardness
Fixation
Tenderness
Infiltration of surrounding structures
Overlying skin ulceration
Cranial nerve palsy

Question 13

What investigations are necessary to diagnose a parotid tumour?

Answer 13

X-Ray to define location
FNA to detect malignant features
Ultrasound assess local extension and invasion
MRI defect Mets and systemic involvement
Incisional biopsy

Question 14

What are the treatments for parotid tumour?

Answer 14

Local ablation
Surgery
Radiotherapy

Question 15

What causes salivary gland swellings?

Answer 15

Salivary stones (sialoliths)- most common, build up of crystallised saliva desposits

Salivary gland infection (sialadenitis) - bacterial infection of salivary gland, can occur when duct blocked

Infections - mumps, flu

Cysts

Tumours

Question 16

What are the symptoms of a salivary gland swelling?

Answer 16

Swelling 
Dry mouth
Abnormal/foul tastes
Mouth and facial pain associated especially with eating 
Decreased mouth opening
Difficulty talking
Systemically unwell

Question 17

What is cervical lymphadenopathy?

Answer 17

Enlargement of the cervical lymph nodes usually due to infections or involvement by malignant neoplasms.