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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 - 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

neck mass differential diagnosis
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
slide3
AGE
  • PEDIATRIC-INFLAMMATORY, CONGENITAL
  • TEENAGE-INFLAMMATORY, LYMPHOMA, THYROID CA
  • ADULT-METASTATIC SCC, THYROID CANCER, LYMPHOMA
neoplastic benign
NEOPLASTIC (BENIGN)
  • NEUROGENIC (NEUROLEMMOMA)
  • VASCULAR (PARAGANGLIOMA OF CAROTID BODY OR VAGAL BODY)
  • VASCULAR (ANEURYSM)
  • PAROTID (BENIGN MIXED TUMOR, WARTHIN’S TUMOR)
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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
NEOPLASTIC (MALIGNANT)
  • METASTATIC SQUAMOUS CELL CARCINOMA
  • LYMPHOMA
  • THYROID CANCER
  • METASTATIC MELANOMA
  • METASTIC TESTICULAR CANCER
characteristics of a metastaic neck mass
CHARACTERISTICS OF A METASTAIC NECK MASS
  • PAINLESS
  • UNILATERAL
  • ADULT AGE GROUP
evaluation of a neck mass
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%
evaluation of a neck mass1
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
CAROTID BODY TUMOR
  • LOCATED CAROTID BIFURCATION
  • MORE DISCREET IN ANT/POSTERIOR DIRECTION THAN SUPERIOR/INFERIOR
  • SOMETIMES A BRUIT
evaluation of a neck mass2
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 mass3
EVALUATION OF A NECK MASS
  • IF PRIMARY NOT IDENTIFIED AND PATIENT HAS TONSILS-TONSILLECTOMY WILL DISCLOSE A PRIMARY IN 30% OF PATIENTS
virchow s node
VIRCHOW’S NODE
  • LEFT SUPRACLAVICULAR NODE REPRESENTING METASTASIS FROM BELOW THE CLAVICLE-OFTEN FROM BELOW THE DIAPHRAGM
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AVOID ANTIBIOTIC THERAPY FOR A PAINLESS NECK MASS IN AN ADULT
  • EXAMINE ORAL CAVITY
  • REFER FOR DEFINITIVE DIAGNOSIS
unknown primary
UNKNOWN PRIMARY
  • MOST COMMON SOURCE-HYPOPHARYNX, TONSIL, BASE OF TONGUE
  • IN PAST-NASOPHARYNX (MORE COMMON IN CHINESE, AMERICAN INDIAN, ALASKAN NATIVE)
human papilloma virus
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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