Neck lumps + acute airway disorders Flashcards
History features of an atypical mycobacteria lump on a neck
painless
cold abscess
children/adults
transmitted oral route from soil
abscess may fistulate and discharge
typically submandibular area
child will look well
Treatment of atypical mycobacteria neck lump
oral clarithromycin 6/52
surgery with nodal excision
surgery with curettage
What is TB neck called?
scrofula
Treatment of TB neck
triple therapy: rifampicin, ethambutol, isoniazid
What is a left sided supraclavicular lymph node called and why would this be concerning?
Virchow’s node
highly likely another malignancy eg. bowel cancer
What type of biopsy do you do if you suspect lymphoma?
core biopsy - can’t diagnose from FNA
What type of biopsy is done on a lump if you do not suspect lymphoma?
fine needle aspiration (FNA)
Oral cavity cancer treatment
must have surgery
Why can’t you treat oral cavity cancers with radiotherapy?
risk of osteoradionecrosis of the mandible
How many times can you have curative radiotherapy for a head/neck cancer?
one 6 week block
if it recurs you can only have radiation as part of palliation not curative treatment
Deep neck space infections presentation
external erythema and significant neck swelling are late signs
torticollis +/- sepsis in a child
Treatment principles of deep neck space infections
airway stabilise/monitor
incision + drainage of abscesses
IV abx with mixed polymicrobial cover
close monitoring post-op
low threshold for rescan/return to theatre
may need to secure airway before CT scan
What is Ludwig’s angina?
sub mental infection
What is the most common cause of Ludwig’s angina?
dental disease
How can Ludwig’s angina cause airway compromise?
submental infection can push tongue up and backwards
