EDWARD WEISBERGER MD
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EDWARD WEISBERGER MD OTOLARYNGOLOGY/HEAD AND NECK SURGERY INDIANA UNIVERSITY MEDICAL CENTER PowerPoint PPT Presentation


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EDWARD WEISBERGER MD OTOLARYNGOLOGY/HEAD AND NECK SURGERY INDIANA UNIVERSITY MEDICAL CENTER. NECK MASS DIFFERENTIAL DIAGNOSIS. INFLAMMATORY (SUPPERATIVE BACTERIAL INFECTION, INFECTED BRANCHIAL CLEFT CYST, GRANULOMATOUS-MYCOBACTERIAL, CAT SCRATCH

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EDWARD WEISBERGER MD OTOLARYNGOLOGY/HEAD AND NECK SURGERY INDIANA UNIVERSITY MEDICAL CENTER

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EDWARD WEISBERGER MD

OTOLARYNGOLOGY/HEAD AND NECK SURGERY

INDIANA UNIVERSITY MEDICAL CENTER


NECK MASS DIFFERENTIAL DIAGNOSIS

  • INFLAMMATORY (SUPPERATIVE BACTERIAL INFECTION, INFECTED BRANCHIAL CLEFT CYST, GRANULOMATOUS-MYCOBACTERIAL, CAT SCRATCH

  • CONGENITAL-THYROGLOSSAL DUCT CYST, LYMPHANGIOMA, DERMOID CYST, BRANCHIAL CLEFT CYST, TERATOMA

  • NEOPLASM


AGE

  • PEDIATRIC-INFLAMMATORY, CONGENITAL

  • TEENAGE-INFLAMMATORY, LYMPHOMA, THYROID CA

  • ADULT-METASTATIC SCC, THYROID CANCER, LYMPHOMA


NEOPLASTIC (BENIGN)

  • NEUROGENIC (NEUROLEMMOMA)

  • VASCULAR (PARAGANGLIOMA OF CAROTID BODY OR VAGAL BODY)

  • VASCULAR (ANEURYSM)

  • PAROTID (BENIGN MIXED TUMOR, WARTHIN’S TUMOR)


  • AYSYMETRICAL ENLARGEMENT OF CERVICAL LYMPH NODES IN AN ADULT ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC)

    HAYES MARTIN 1952


NEOPLASTIC (MALIGNANT)

  • METASTATIC SQUAMOUS CELL CARCINOMA

  • LYMPHOMA

  • THYROID CANCER

  • METASTATIC MELANOMA

  • METASTIC TESTICULAR CANCER


CHARACTERISTICS OF A METASTAIC NECK MASS

  • PAINLESS

  • UNILATERAL

  • ADULT AGE GROUP


EVALUATION OF A NECK MASS

  • HX-HOARSNESS, DYSPHAGIA, PAIN ORAL CAVITY, TOBACCO USE

  • PE-EXAM OF ORAL CAVITY AND OROPHARYNX DISCLOSES PRIMARY 50% OF TIME

  • MIRROR OR FIBEROPTIC EXAM WILL FIND THE PRIMARY IN AN ADDITIONAL 35%


ORAL CAVITY ULCERATIVE LESION


FIBEROPTIC LARYNGOSCOPY


FIBEROPTIC LARYNGOSCOPY


FIBEROPTIC LARYNGOSCOPY


EVALUATION OF A NECK MASS

  • LOCATION-UPPER NECK ANT. TO SCM-MOST COMMON FOR H & N PRIMARIES (SENTINAL NODE)

  • POSTERIOR TRIANGLE-NASOPHARYNX

  • SUPRACLAVICULAR-THYROID OR SITE BELOW THE CLAVICLES


CAROTID BODY TUMOR

  • LOCATED CAROTID BIFURCATION

  • MORE DISCREET IN ANT/POSTERIOR DIRECTION THAN SUPERIOR/INFERIOR

  • SOMETIMES A BRUIT


EVALUATION OF A NECK MASS

  • OFFICE BX. IF IN ORAL

  • FNA-MIGHT DIRECT WORK-UP; IF LYMPHOMA OR THYROID CANCER

  • CT AND/OR PET SCAN

  • EXAMINATION UNDER ANESTHESIA-PALPATE TONGUE BASE, VISUALIZE APEX OF PYRIFORM SINUS AND POST-CRICOID AREA


EVALUATION OF A NECK MASS

  • IF PRIMARY NOT IDENTIFIED AND PATIENT HAS TONSILS-TONSILLECTOMY WILL DISCLOSE A PRIMARY IN 30% OF PATIENTS


TERATOMA


TERATOMA


LYMPHANGIOMA


LYMPHANGIOMA


VIRCHOW’S NODE

  • LEFT SUPRACLAVICULAR NODE REPRESENTING METASTASIS FROM BELOW THE CLAVICLE-OFTEN FROM BELOW THE DIAPHRAGM


VIRCHOW’S NODE


  • AVOID ANTIBIOTIC THERAPY FOR A PAINLESS NECK MASS IN AN ADULT

  • EXAMINE ORAL CAVITY

  • REFER FOR DEFINITIVE DIAGNOSIS


UNKNOWN PRIMARY

  • MOST COMMON SOURCE-HYPOPHARYNX, TONSIL, BASE OF TONGUE

  • IN PAST-NASOPHARYNX (MORE COMMON IN CHINESE, AMERICAN INDIAN, ALASKAN NATIVE)


UNKNOWN PRIMARY


HUMAN PAPILLOMA VIRUS

  • INCREASINGLY COMMON ETIOLOGY

  • EXPLAINS INCREASING INCIDENCE OF SCC OF THE HEAD AND NECK IN NON-SMOKERS

  • INCREASED RISK OF HPV WITH SEXUAL PROMUSCUITY

  • ? VACCINATE YOUNG MALES


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