neck swellings Flashcards
what are the lateral neck swellings generally divided into ?
lymph nodes
branchial cysts
carotid body tumor
cervical rib
sternomastoid muscle tumor
cystic hygroma
Laryngocele
what are the two different forms that lymph nodes as lateral swellings take ?
eitheer neoplastic or inflammatory
what are the different types of inflammatory lymph node ?
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
what types of neoplastic lymph nodes are there ?
primary - lymphoma
secondary- metastasis
occult primary - metastatic cancer with unknown primary site
what is the origin of a branchial cyst ?
embryonic pharyngeal arches
what is the clinical picture of branchial cysts ?
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
what are the complications associated with a branchial cyst ?
acquired branchial fistula
abscess formation
what are the investigations that should be done to confirm a case of branchial cyst ?
CT Scan of the neck
fistulography
what s the treatment for branchial cysts ?
surgical excision
what is the difference between a congenital and an acquired branchial fisttula ?
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
what is the other name for carotid body tumors ?
chemodectoma
paraganglioma
where do carotid body tumors originate from ?
benign tumor that arises from paraganglionic cells
where are carotoid body tumors located ?
at the bifurcation of the common carotid artery
what neuroendocrine tumor is associatted with carotid body tumors ?
phaechromocytoma
what iis the presentation of carotid body tumors ?
bilateral lateral solid neckline swelling
more commonly in females
audible bruit
pulsations present
thrill present
upon compression may induce syncope
what investigations can be done for carotid body tumors ?
CT scan of the neck
Carotid angiography
what sign appears with carotid angiography of a carotid body tumor ?
Lyre sign
what is thee treatment for carotid body tumors ?
surgical excision
what is thee etiology of a cervical rib ?
congenital
what is the clinical picture of cervical ribs ?
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 )
what are the investigations for diagnosis of a cervical rib ?
plain X-ray
what is the treatment for cervical rib ?
surgical excision only if symptomatic
what iis the etiology of sternomastoid muscle tumor ?
misnomer , not actually a tumor
hematoma of the sternomastoid muscle due to birth trauma
what is thee presentation of sternomastoid tumor ?
lateral neck swelling
torticollis on the same side
what investigation should be done for a sternomastoid tumor ?
neck ultrasound
what is the treatment for a sternomastoid tumor ?
surgical evacuation
postoperative physiotherapy
what is the etiology of a cystic hygroma ?
persistence of a primitive lymph sac
what is thee treatment for a cystic hygroma ?
Preoperative injection of sclerosing material,
Surgical excision.
investigation for cystic hygroma ?
neck ultrasound
what is a laryngocele ?
dilatation of the laryngeal sacuule and is usually unilateral
what are the types of laryngocele ?
internal - confined by thyrohyoid membrane
external - no longer confined by thyrohyoid membrane
mixed - elements of both
what is the etiology of laryngocele ?
raised intra laryngeal pressure secondary to :
1- excessive coughing
2- playing brass instruments
3- glass blowing
what is the clinical picture of laryngocele ?
usually asymptomatic
may present with hoarsness if large
treatment for laryngocele ?
surgical excision
investigation for laryngocele ?
CT Scan
what aree the midline swellings ?
Subhyoid bursa
Ranula
Thyroglossal cyst
Ludwig’s angina
what is the etiology of a thyroglossal cyst ?
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
site of thyroglossal cyst ?
infrahyoid
what is the clinical picture of a thyroglossal cyst ?
Cystic swelling in midline,
Moves up and down with deglutition and protrusion of
tongue
what are thee complications of a thyroglossal cyst ?
acquired thyroglossal fistula due to rupture of an infected cyst
what is the treatment for a thyroglossal cyst ?
surgical excision of the central core of thee tongue base , the whole thyroglossal duct and the middl part of thee hyoid bone
what is the surgery for the treat of a thyroglossal duct called ?
Sistrunk operation
what is the etiology of a ranula ?
sublingual salivary gland retention cyst
what is the clinical picture of a ranula ?
unilateral swelling under the tongue , rapidly reforms after rupture and may present in submandibular region ( plunging ranula )
treatment of ranula ?
marsupilization
subhyoid bursa
also called boyer’s bursa
attached to hyoid bone
what is Ludwig’s angina ?
cellulitis and suppuration of the submandibular space
which arises from a 2nd or 3rd submandibular molar tooth
more common in diabetics
clinical picture of Ludwig’s angina
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
treatment of Ludwig’s angina
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
