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ENT > neck swellings > Flashcards

neck swellings Flashcards

1
Q

what are the lateral neck swellings generally divided into ?

A

lymph nodes
branchial cysts
carotid body tumor
cervical rib
sternomastoid muscle tumor
cystic hygroma
Laryngocele

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2
Q

what are the two different forms that lymph nodes as lateral swellings take ?

A

eitheer neoplastic or inflammatory

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3
Q

what are the different types of inflammatory lymph node ?

A

acute non specific - diphtheria
acute specific - tonsillitis or pharyngitis
chronic non specific - chronic tonsillitis
chronic specific - granuloma e.g TB
or as part of generalized lymphadenopathy

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4
Q

what types of neoplastic lymph nodes are there ?

A

primary - lymphoma
secondary- metastasis
occult primary - metastatic cancer with unknown primary site

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5
Q

what is the origin of a branchial cyst ?

A

embryonic pharyngeal arches

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6
Q

what is the clinical picture of branchial cysts ?

A

lateral cystic swellings that are on the upper third of the anterior border of the sternomastoid muscle that may be accompanied by a branchial cyst fistula

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7
Q

what are the complications associated with a branchial cyst ?

A

acquired branchial fistula
abscess formation

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8
Q

what are the investigations that should be done to confirm a case of branchial cyst ?

A

CT Scan of the neck
fistulography

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9
Q

what s the treatment for branchial cysts ?

A

surgical excision

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10
Q

what is the difference between a congenital and an acquired branchial fisttula ?

A

1- congenital branchial fistulas are not preceded by any swelling , seen at birth and are located on the upper third of the sternomastoid muscle

2- an acquired branchial cyst is preceded by swelling, not seen at birth and usually exists on the lower third of the sternomastoid muscle

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11
Q

what is the other name for carotid body tumors ?

A

chemodectoma
paraganglioma

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12
Q

where do carotid body tumors originate from ?

A

benign tumor that arises from paraganglionic cells

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13
Q

where are carotoid body tumors located ?

A

at the bifurcation of the common carotid artery

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14
Q

what neuroendocrine tumor is associatted with carotid body tumors ?

A

phaechromocytoma

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15
Q

what iis the presentation of carotid body tumors ?

A

bilateral lateral solid neckline swelling
more commonly in females
audible bruit
pulsations present
thrill present
upon compression may induce syncope

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16
Q

what investigations can be done for carotid body tumors ?

A

CT scan of the neck
Carotid angiography

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17
Q

what sign appears with carotid angiography of a carotid body tumor ?

A

Lyre sign

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18
Q

what is thee treatment for carotid body tumors ?

A

surgical excision

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19
Q

what is thee etiology of a cervical rib ?

A

congenital

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20
Q

what is the clinical picture of cervical ribs ?

A

may be asymptomatic and discovered accidentally
may cause sensory issues due to compression on the brachial plexus
may cause upper limb ischemia due to subclavian artery compression
( thoracic outlet syndrome )

21
Q

what are the investigations for diagnosis of a cervical rib ?

A

plain X-ray

22
Q

what is the treatment for cervical rib ?

A

surgical excision only if symptomatic

23
Q

what iis the etiology of sternomastoid muscle tumor ?

A

misnomer , not actually a tumor
hematoma of the sternomastoid muscle due to birth trauma

24
Q

what is thee presentation of sternomastoid tumor ?

A

lateral neck swelling
torticollis on the same side

25
Q

what investigation should be done for a sternomastoid tumor ?

A

neck ultrasound

26
Q

what is the treatment for a sternomastoid tumor ?

A

surgical evacuation
postoperative physiotherapy

27
Q

what is the etiology of a cystic hygroma ?

A

persistence of a primitive lymph sac

28
Q

what is thee treatment for a cystic hygroma ?

A

Preoperative injection of sclerosing material,
Surgical excision.

29
Q

investigation for cystic hygroma ?

A

neck ultrasound

30
Q

what is a laryngocele ?

A

dilatation of the laryngeal sacuule and is usually unilateral

31
Q

what are the types of laryngocele ?

A

internal - confined by thyrohyoid membrane
external - no longer confined by thyrohyoid membrane
mixed - elements of both

32
Q

what is the etiology of laryngocele ?

A

raised intra laryngeal pressure secondary to :
1- excessive coughing
2- playing brass instruments
3- glass blowing

33
Q

what is the clinical picture of laryngocele ?

A

usually asymptomatic
may present with hoarsness if large

34
Q

treatment for laryngocele ?

A

surgical excision

35
Q

investigation for laryngocele ?

A

CT Scan

36
Q

what aree the midline swellings ?

A

Subhyoid bursa
Ranula
Thyroglossal cyst
Ludwig’s angina

37
Q

what is the etiology of a thyroglossal cyst ?

A

originally a duct that connects the back of the tongue with the thyroid isthmus that should disappear after development - in some cases it persists and fills up and forms a cyst

38
Q

site of thyroglossal cyst ?

A

infrahyoid

39
Q

what is the clinical picture of a thyroglossal cyst ?

A

Cystic swelling in midline,
Moves up and down with deglutition and protrusion of
tongue

40
Q

what are thee complications of a thyroglossal cyst ?

A

acquired thyroglossal fistula due to rupture of an infected cyst

41
Q

what is the treatment for a thyroglossal cyst ?

A

surgical excision of the central core of thee tongue base , the whole thyroglossal duct and the middl part of thee hyoid bone

42
Q

what is the surgery for the treat of a thyroglossal duct called ?

A

Sistrunk operation

43
Q

what is the etiology of a ranula ?

A

sublingual salivary gland retention cyst

44
Q

what is the clinical picture of a ranula ?

A

unilateral swelling under the tongue , rapidly reforms after rupture and may present in submandibular region ( plunging ranula )

45
Q

treatment of ranula ?

A

marsupilization

46
Q

subhyoid bursa

A

also called boyer’s bursa
attached to hyoid bone

47
Q

what is Ludwig’s angina ?

A

cellulitis and suppuration of the submandibular space
which arises from a 2nd or 3rd submandibular molar tooth
more common in diabetics

48
Q

clinical picture of Ludwig’s angina

A

Fever
Severe pain with dysphagia
Indurated severely tender submandibular swelling o Swollen floor of mouth
Tongue may be pushed upwards
Fluctuation indicates suppuration
May lead to difficult respiration

49
Q

treatment of Ludwig’s angina

A

o Hospitalization
o Airway management: Tracheostomy may be needed in some cases o Parenteral antibiotics
o Antipyretics, analgesics
o Control diabetes
o Incision and drainage: if suppuration occurs

ENT (30 decks)

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