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EENT Neck Masses
KYCOM Block 10
99
Medical
Graduate
09/18/2013

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Term
what are the common neck masses from age 0-15 in order of prevelence
Definition
inflammatory
congenital
neoplasia: malignant > benign
Term
what are the common neck masses from age 16-40 in order of prevelence
Definition
inflammatory
congenital
neoplasia: benign > malignant
Term
what40+ in order of prevelence
Definition
neoplasia: malignant > benign (cancer until proven otherwise)
inflammatory
congenital
Term
what are the 7 common primary origins of neck masses in order of their prevelence
Definition
tonsil 25%
base of tongue and nasopharynx 20%
hpoppharynx 15%
floor of mouth 10%
pharynx and thyroid 5%
Term
what parts are looked at on the physical exam for a neck mass(10)
Definition
oral cavity, nasopharynx, hypopharynx, larynx, thyroid, salivary glands
skin of scalp, face, ears, neck
Term
what types of radiographic studies can be done for a neck mass (10)
Definition
chest x-ray, sinus x-ray, ultrasound, MTI, CT, mrA, arteriography, saliography, radionucleotid, endoscopy
Term
what is neck level 6, what is its significance
Definition
paratracheal
dissected in thyroid ectomy for cancer
Term
what is level 2 of the neck
Definition
upper jugular
Term
what is level 3 of the neck
Definition
mid jugular
Term
what is level 4 of the neck
Definition
lower jugular
Term
what is level 5 of the neck
Definition
behind SCM
Term
what is level 1 of the neck
Definition
submandibular
Term
why are the levels of the neck important for neck masses
Definition
they tell you where the primary is at
Term
what biopsies are done for neck masses
Definition
open or needle aspiration
Term
what areas drain into the posterior triangle
Definition
aurical and back, scalp, nasopharynx
Term
what areas drain into the submandibular triangle
Definition
facial, sinuses
Term
what areas drain into the preauricular triangle
Definition
antrior scalp
Term
where are thyroid masses located in the neck, what can the mass be composed of, what should you do when you see one
Definition
midline neck
can be benign, malignant, inflammatory, or infectious

always fine needle aspirate masses and send out specimine
Term
what are 5 studies that can be done on the thyroid, what is a percaution
Definition
thyroid function studies
thyroid scan (99-Tc)
U/S
FNA
CT scan- do thyroid scan first, contrast will mess it up for 6 weeks
Term
what two types of neck masses can be due to carcinomas
Definition
nasopharyngeal
paranasal and sinus
Term
what 4 neck masses are congenital
Definition
branchial cleft cyst
thyroglossal duct cyst
laryngocele
lymphangomia
Term
what neck masses are adenoma / adentitis (6)
Definition
warthin's tmor
pyelomorphic ademona of the salivary glands
Tb adentitis
cat scratch disease
actinomycosis
sialedentitis
Term
what areas metastazise into the upper jugular (1-3)
Definition
oral pharynx and oral cavity
Term
what areas metastasize into the lower jugular
Definition
hypopharynx and larynx
Term
what areas metastasize into the submantibular triangle
Definition
oral cavity, nasal, sinus, facial
Term
what 5 neck masses are due to infection
Definition
ludwigs angina
odontogenic abscess
submandibular abscess
midline neck abscess
adentitis
Term
what neck masses can be malignant 4
Definition
parotid
lymphoma
virchow;s node
glomus tumor
Term
what neck mass is autoimmune
Definition
shorgern's syndrome
Term
what neck mass is a benign tumor
Definition
hemangioma
Term
what neck mass is a sarcoma
Definition
karposki's (AIDS)
Term
what neck mass is induced by trauma
Definition
laryngocele - acquired
Term
nasopharyngeal carcioma: CC, Dx, complications
Definition
cc: i can't hear
dx: unilateral serious otitis media without history
complications: can invade skull base
Term
who commonly gets nasopharyngeal carcinoma (2), what causes it
Definition
cantonese chinese between 44-55 yo
EBV associated
Term
what are the 3 types of nasopharyngeal carcinoma, which is the most common
Definition
squamous cell
non-keratainizing
undifferentiated - most common
Term
who most commonly gets a paranasal or sinus carcinoma (4)
Definition
males > females
50-79 yo
hardwood and niclel workers
Term
around when is a paranasal or sinus carcinoma diagnosed, why
Definition
8 mo delay from symptoms becaise the symptoms are non-specific
Term
what types of carcinoma do hardwood workers get (3)
Definition
adenocarcinoma, squamous cell, anaplastic paranasal and sinuc carcinomas
Term
what types of carcinomas do nickel workers get (2)
Definition
squamous cell and anaplastic paranasal and sinus carcinoma
Term
when and how are paranasal and sinus carcinoma treated
Definition
one sinus = send to surgery (espically if bony erosion)
especially if it is a bony erosion
Term
branchial cleft cyst: where is it located, when is it diagnosed
Definition
anterior triangle
usually diagnosed as child or early adult
Term
describe the mass of a branchial cleft cyst (3)
Definition
non-tender, fluctuant, has abscess that is tender inflammed and painful
Term
what are 5 symptoms of branchial cleft cyst
Definition
mass, abscess, dysphagia, dyspenia, stridor
Term
first branchial cleft cyst: location
Definition
behind ear lobule, connects to external canal
Term
what do you do if a branchial cleft cyst develops an abscess
Definition
stick a knife in it
Term
second branchial cleft cyst: location
Definition
cyst in neck that connects to external canal, most common
Term
fourth branchial cleft cyst: location, sign
Definition
open to skin
between internal and external carotid, over cn12, under aortic arch, up into piriform sinus
Term
what is the difference between a second and third branchial cleft cyst
Definition
second goes over CN 9 and 12
third goes between CN 9 and 12
cant tell the difference until surgery
Term
what branchial cleft cyst is the most common
Definition
second
Term
what is the treatment of a branchial cleft cyst (2)
Definition
surgical excision
use 18 gauge needle to get the thick green goo out
Term
thyroglossal duct cyst: location, complications (2)
Definition
anterior midline neck
may become infected
may have more than one thyroid
Term
thyroglossal duct cyst: how to identify
Definition
moves with swallowing and potrusion of the tongue
Term
thyroglossal duct cyst: treatment (2)
Definition
operation
thyroid scan before operation
Term
laryngocele: location, cause, who gets it (2)
Definition
most common in 50-60s
more in males
midline neck
dilation of laryngeal ventricle and saccule
Term
laryngocele types and how to identify them
Definition
internal: inside larynx, no neck mass, can cause airway stress

external; outside larynx, neck mass
Term
laryngocele symptoms (4)
Definition
aiways compormise (internal)
laterla neck mass (external)
increase in size with increased pressure
gurgling sensation
Term
lymphangomia: aka, location, cause
Definition
cystic hygroma
posterior triangle
congenital malformation of the lymphatic system
Term
lymphangomia: where is it most commonly located, who is it seen in
Definition
head and nack
usually found <2yo
Term
lymphangomia: symptoms(5)
Definition
painless, soft, ill defined, doughy mass

dysphagia, paiin, stidor, dyspenia
Term
lymphangomia: treatment
Definition
surgical excision (difficult due to finger like projections)
Term
what 4 things do you do when an inflammatory adenopathy is suspected
Definition
observe, put on antibiotics for two weeks, repeat exam
if not better aspirate and send for tests
Term
warthin's tumor: aka, what is it, who gets it, where is it
Definition
papillary cystadenoma lymphomatosum
benign cystic mass
more in men than women
usually in parotid, rarley bilateral
Term
warthin;s tumor: 3 signs
Definition
slow growing
non tendor
cystic
Term
warthin's tumor: treating
Definition
none, dont risk life to take it out
Term
pyelomorphic adenoma of the salivary glands: prognosis, treatment
Definition
benign, high reoccurrance
operation: it can convert to cancer and damage to facial or marginal nerve
Term
what is the claim to fame of pyelomorphic adenoma of the alivary glands
Definition
most common benign salivary tumor
Term
who gets pyelomorphic adenoma of the salivary glands (2)
Definition
mostly women
in their 50s
Term
where is pyelomorphic adenoma of the salivary glands usually
Definition
parotid
Term
tuberculosis adentitis: what disease category, what location, cause
Definition
granulomatous adenopathy
posterior triangle
atypical mycobacterium (not usually TB)causes node to outgrow blood supply and abscess
Term
tuberculosis adentitis: who gets it (2) where is it located (2)
Definition
kids (more common) - anterior triangle adults - posterior triangle (may be TB)
Term
tuberculosis adentitis 4 signs
Definition
progressive enlargement
fever, local pain, alaise
Term
cat scratch disease: disease family, location, cause
Definition
granulomatous adenopathy
posterior triangle
regional lymphadentitis due to rochalimaea henselae infection from cat interaction 3 weeks prior
Term
cat scratch disease: who gets it and where
Definition
kids in periauricular and submandibular areas (posterior triangle says notes in other spot)
Term
cat scratch disease signs (6)
Definition
lymphadenopathy
low grade fever
myalgia
malaise
headache
anorexia
Term
cat scratch disease pathology
Definition
multiple granulomas with micro abscesses
Term
cat scratch disease: treatment (4)
Definition
resolves in 3 mo
analgesics
warm compress
antibiotics (erythromycin, clythromycin)
Term
actinomycosis: disease family, lcation (3), who gets it
Definition
granulomatous adenopathy
seen in adults
in submandibular and upper jugular (other spot says posterior triangle)
Term
sialdentitis: what is it, what subtype is there
Definition
infection of the slaivary glands
sialyosis: enlarged infected parotid
Term
sialdentitis causes (8)
Definition
infection, dehydration, chemo, saliolithiasis,
saliosis: DM, alcoholic, vitamin deficiency, sjogerns
Term
sialdentitis treatment (3)
Definition
hydration, antibiotics, warm compress
Term
what is ludwigs angina
Definition
infection of the floor of the mouth usually due to dental procedure or treatment
Term
what are the signs of ludwigs angina (4)
Definition
woody induration (not abscess)
submental and submandibular enlargement (fluid in all triangles)
high temperature
tongue displacement
Term
odontogenic abscess: cause, signs (2)
Definition
infection due to dentition
painful swelling trismus
floow or mout elevated pushing tongue posterior
Term
odontogenic abscess treatment (2)
Definition
extraction
I&D
Term
what is the cause of a submandibular abscess, when and how is it treated
Definition
impacted stone in submandibular duct
if swollen for >2 d then start antibiotics
Term
parotid malignancy: ddx, 3 signs, complications
Definition
ddx: bells palsy

parotid mass, CN VII paralysis, pain in 5-7%

20% metastizises to lung and bone
Term
signs a neck mass is lymphoma (6)
Definition
may or may not be symptomatic
soft, smooth, elastic, mobile node
slow growing
Term
how is a neck lymphoma diagnosed (2)
Definition
biopsy, flow cytometry
Term
how is a neck lymphoma treated
Definition
chemotherapy and or radiation
Term
what are the types of virchow;s nodes, where did they come from
Definition
left supraclavicular: comes from anywhere in the body but the right chest
right supraclavicular: comes from the right chest

GI, GI, lung, pancreas
Term
glomus tumor: aka, prognosis, treatment
Definition
chemdectoma
rarley malignant
surgical excision
Term
glomus tumor signs: (4)
Definition
firm round slow growing
on lateral neck
Term
glomus tumor diagnosis (4)
Definition
angiography, CT, mri, MRA
Term
sjogern's syndrome: aka, 3 signs
Definition
dry eyes and mouth, arthritis
SICCA syndrom
Term
4 ways to diagnose sjogern's syndrome
Definition
sjogern;s antibody test
biopsy of lower lip
scarred down minor salivary glands
parotid enlargement
Term
hemangioma: location, when does it show up, when does it involution
Definition
anterior triangle
usually evident by 6 mo
spontaneous involution by 7 mo
Term
hemangomia signs (2)
Definition
diffuse skin lesions
soft cystic masses
Term
hemangomia treatment (3)
Definition
conservative therapy - dont operate early it will get smaller
surgery for cosmetic or functional impairment
steroids to slow or stop groath
Term
karposki's sarcoma: aka, who gets it, where is it
Definition
diffuse adenopathy
seen in HIV positive
bilateral parotid masses
Term
acquired laryngocele : how does it happen give examples (4)
Definition
prolonged increased intralaryngeal pressure

cough, straining, glass blowing, wind insturments
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