Neck lumps pathology Flashcards

Question

How would you manage this patient with submandibular abscess?

Answer 1

-Assess floor of mouth for ludwig's angina -Perform fibreoptic nasoendoscopy to assess airway -OPG to check dentition -Start IV abx -Refer to maxfax Examine the oral cavity looking particularly for floor of mouth swelling as this means the airway is becoming compromised Perform a fibre optic nasendoscopy to assess the airway. Submandibular abscesses can very rapidly progress to Ludwig’s Angina If possible get an orthopantomogram (OPG) to assess the dentition Start IV antibiotics (based on local guidelines but most commonly amoxicillin and metronidazole) Refer urgently to Oral and Maxillofacial team on call

Answer 2

-Cellulitis of soft tissues of neck and floor of mouth -Spreads throughout both submandibular spaces causing elevation + posterior displacement of tongue -Leads to airway obstruction -Mostly requires intra and extra oral drainage with removal of causative tooth -Can cause airway oedema necessitating surgical airway It is a clinical diagnosis of cellulitis of the soft tissues of the neck and floor of the mouth. Cellulitis spreads throughout both submandibular spaces causing elevation and posterior displacement of the tongue. This leads to airway obstruction. Dental causes account for > 90% of cases The majority of cases require intra & extra oral incision and drainage with extraction of the causative tooth A small proportion of patients may require a surgical airway as intubation may not be possible due to airway oedema

Answer 3

-Congenital cystic malformation of lymphatic system -Most commonly in posterior triangle -Can rapidly enlarge if infected, can interfere with breathing/swalloign It is a congenital cystic malformation of the lymphatic system They can develop anywhere in the body but are most common found in the posterior triangle of the neck The majority are visible at birth and 90% are detected by 2 years of age Can rapidly enlarge when infected and this can interfere with breathing and swallowing

Answer 4

Aspiration and injection with a sclerosing agent or Surgical excision

Answer 5

-It is a diverticulum through Killian's dehiscence. -Killian’s dehiscence is found between the upper and lower portions of the inferior pharyngeal constrictor muscle

Answer 6

Most common in males over 70 years of age Often no lump in the neck, occasionally a lump that gurgles may be noticed Patients often present with: regurgitation, halitosis, weight loss and chronic cough

Answer 7

Barium swallow

Answer 8

If small and asymptomatic then no treatment is required However if treatment is required then either endoscopic stapling or external approach excision is performed

Answer 9

Full ENT exam including fibre optic nasendoscopy --> FNA or core biopsy (US guided if necessary) --> further imaging All patients require a full Ear, Nose and Throat examination including direct (fibre optic nasendoscopy) or indirect laryngoscopy (mirror) If it is safe and with appropriate experience then either an fine needle aspirate (FNA) or core biopsy should be taken in clinic to aid diagnosis If this is not possible then an FNA can be carried out under ultrasound guidance If there is a strong suspicion of malignancy many clinicians will also arrange appropriate imaging before a tissue diagnosis is made In summary: History --> Full ENT examination --> FNA --> Further imaging

Answer 10

Superficial: Sebaceous cyst Lipoma Abscess Anterior triangle: -Thyroglossal cyst -Thyroid swelling -Dermoid cyst -Submandibular gland pathology -Branchial cyst -Carotid body tumour -Lymphadenopathy Posterior triangle: -Pharyngeal pouch -Cystic hygroma -Lymphadenopathy Within SCM: Sternocleidomastoid tumor