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13 ENT > Pedia Neck Masses > Flashcards

Pedia Neck Masses Flashcards

1
Q

treatment algorithm for pedia neck masses

A

read

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2
Q

what is a branchial cleft cyst

A
  • congenital epithelial cyst
  • benign, nontender fluctuant mass
  • can become inflamed and form an abscess during an urti
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3
Q

types of branchial cleft cysts

A

1st: near angle of mandible
2d: high in neck, deep to anterior border of scm (most common)
3rd: upper pole of thyroid gland

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4
Q

management of branchial cleft cysts

A

radio: uts, ct, mri

surgical excision

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5
Q

what are thyroglossal duct cysts

A
  • form in persistent thyroid descent tract
  • elongation of thyroid diverticulum at foramen cecum of tongue -> thyroid gland
  • remnant cysts not associated with cutaneous sinus or fistula tract unless surgically drained and inadequately excised
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6
Q

manifestation and treatment of thyroglossal duct cyst

A
  • asymptomatic midline neck mass that elevates with swallowing or tongue protrusion
  • treatment: sistrunk procedure
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7
Q

what are lymphangiomas

A
  • lymphatic malformation from failure of lymph spaces to connect to lymph system
  • soft, smooth, nontender, can be compressed and transilluminated
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8
Q

complications of lymphangiomas

A

can cause significant cosmetic deformity

can impair respiration and alimentation

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9
Q

types of lymphatic mallformations

A
  • combined venolymphatic malformation (lymphatic and venous)

- macrocystic lymphatic malformation (cystic hygroma)

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10
Q

management for lymphangiomas

A

sclerotherapy if macrocystic (>2 cm)

surgical excision

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11
Q

what are hemangiomas

A
  • proliferative endothelial lesion (red or blue soft mass)
  • present at birth, involutes at 18-24 mos
  • may have bruit over lesions
  • ct/mri
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12
Q

management of hemangiomas

A
  • observation: involutes after several years
  • surgical excision or laser therapy for incomplete involution
  • propanolol to reduce angiogenesis and vasoconstriction
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13
Q

what are dermoid cysts

A
  • similar to teratomas which are pathologically related
  • epithelium lined cavities filled with skin appendages
  • from entrapped epithelium during embryogenesis
  • common in midline/submental region
  • painless
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14
Q

management of dermoid cysts

A

complete surgical excision

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15
Q

what are laryngocoeles

A
  • abnormal dilation or hernation of the saccule of the larynx
  • hoarseness, cough, dysphagia
  • ct scan
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16
Q

types of laryngoceles

A

internal: within thyroid cartilage
external: extends cephalad, protrudes through thyrohyoid membrane

17
Q

management for laryngocoele

A

surgical excision from external approach

18
Q

what is congenital torticollis

A
  • dense fibrous tissue and absence of normal striated muscle in scm
  • firm, painless, discrete, fusiform mass
  • appears at 1-8 wks, increased for 2-3 mos, regress for 4-8 mos
19
Q

management of congenital torticollis

A

conservative mgt with physiotherapy (passive and active motion) preventes teh development of restrictive torticollis

resistant: surgical section of scm

20
Q

more common type of acquired neck mass

A

viral

21
Q

what is reactive lymphadenopathy

A
  • bilateral
  • reactive from benign self-limiting viral urti (adeno, rhino, entero, ebv)
  • nodes are small, rubbery, modile, discrete, and minimally tender WITHOUT erythema
22
Q

management of reactive lymphadenopathy

A

supportive

23
Q

what is suppurative lymphadenopathy

A
  • unilateral
  • tender, warm, erythematous, non-discrete, and poorly mobile
  • w/ associated symptoms but non toxic
  • usually at submandibular and anterior or posterior cervical triangles
24
Q

most common organisms in suppurative lymphadenopathy

A

s aureus

group a beta hemolytic strep

25
Q

management of suppurative lymphadenopathy

A
  • single course broad spectrum antibiotic, reassessment in 1-2 wks
  • s aureus/gas: 10 day cefalexin, coamoxiclav, clindamycin
26
Q

what is non-tuberculous mycobacterial lymphadenopathy

A
  • firm and nontender
  • grows overr several weeks
  • skin becomes violaceous and thin
27
Q

what are lipomas

A
  • benign encapsulated fatty tumors in the subcutaneous tissue (rare in h&n)
  • mgt: surgery
28
Q

what are neurofibromas

A
  • circumscribed tumors of schwann cells, nerve fibers, and fibroblasts
  • small cutaneous nerves or cranial nerves
  • rarely occur as multiple fibromas (may be nf1)
    • mgt: excision
29
Q

what are pleomorphic adenomas

A
  • uncommon
  • usually salivary gland tumors
  • mgt: excision
30
Q

most common neck malignancy in pedia

A

lymphoma

31
Q

types of hodgkin and non hodgkin lymphomas

A

h: nodular sclerosing, mixed cellularity, lymphocyte predominant, lymphocyte depleted
nh: lymphoblastic, large cell, undifferentiated

32
Q

___ lymphoma is more common in the neck

A

hodgkin

33
Q

mgt for lymphoma

A

h: chemo or radio
nh: chemo

34
Q

clues for diagnosing nasopharyngeal carcinoma

A
  • unilateral otitis media
  • rhinorrhea
  • nasal obstruction
  • 1-2 cn palsies
  • blacks and asian adolescents
  • elevated ebv type 2 and 3 titers
35
Q

diagnostics for nasopharyngeal carcinoma

A
  • biopsy
  • ct/mri for tumor extent
  • bone scan/abdominal ct for bone or liver metasases
36
Q

mgt for nasopharyngeal carcinoma

A

combined chemo-radiotherapy

37
Q

what is neuroblastoma

A
  • originate from neuroblasts and neural crest cells
  • associated with ipsi horner syndrome
  • sx: lump in abdomen/chest, bone pain, bruising around eyes
38
Q

diagnostics for neuroblastoma

A

ct/mri of the neck, chest, and abdomen

elevated vanillylmendelic acid in 24 hr collection

mgt: surgery, radio, chemo

13 ENT (18 decks)

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