LUDWIGS ANGINA
SUBMENTAL LN
SUBLINGUAL DERMOID
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THYROGLOSSAL CYSTSUBHYOID BURSITIS
RETEROSTERNAL GOITRE
THYMIC SWELLING
BONY SWELLING
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Sebaceouscyst,lipoma,fibroma etc mayarise anywhere.
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LATERAL SWELLINGSIn the submandibular triangle
LN.
SUBMANDIBULAR SALIVARY GLAND.
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PLUNGING RANULA.LATERAL SWELLINGS
IN THE CAROTID TRIANGLE
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ANEURYSM OF CAROTID ARTERY.CAROTID BODY TUMOR.
BRANCHIAL CYST.
BRANCHIOGENIC CA.
THYROID .
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LN.LATERAL SWELLINGS
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IN THE POSTERIOR TRIANGLECYSTIC HYGROMA.
PHARYNGEAL POUCH.
SUBCLAVIAN ANEURSYM.
CERVICAL RIB.
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COLD ABSCESS.BRANCHIAL CYST
Branchial cleft cysts are congenital epithelial cysts, which
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arise on the lateral part of the neck from a failure of
obliteration of the second branchial cleft in embryonic
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development.At the fourth week of embryonic life, the development of 4
branchial (or pharyngeal) clefts results in 5 ridges known as
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the branchial (or pharyngeal) arches.
The second arch grows caudal y and, ultimately, covers
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the third and fourth arches.The buried clefts become ectoderm-lined cavities, which
normal y involute around week 7 of development. If a
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portion of the cleft fails to involute completely, the
entrapped remnant forms an epithelium-lined cyst with or
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without a sinus tract to the overlying skin.S/S
A branchial cyst commonly presents as a solitary, painless
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mass in the neck of a child or a young adult. A history of
intermittent swel ing and tenderness of the lesion during
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upper respiratory tract infection may exist. Discharge maybe reported if the lesion is associated with a sinus tract.
In some instances, patients may present with local y
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compressive symptoms.
A family history may be present.
Branchial cysts are smooth, nontender, fluctuant masses,
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which occur along the lower one third of the anteromedial
border of the sternocleidomastoid muscle between the
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muscle and the overlying skin.The lesion may be tender if secondarily inflamed or
infected. When associated with a sinus tract, mucoid or
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purulent discharge onto the skin or into the pharynx may
be present.
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T\T
Medical Care
Antibiotics are required to treat infections or abscesses.
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Surgical CareSurgical excision is definitive treatment for this condition.
A series of horizontal incisions, known as a stairstep or
stepladder incision, is made to ful y dissect out the
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occasional y tortuous path of the cyst.
Surgery is best delayed until the patient is at least age 3
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months.Definitive surgery should not be attempted during an
episode of acute infection or if an abscess is present.
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Surgical incision and drainage of abscesses is indicated if
present, usual y along with concurrent antimicrobial
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therapy.BRANCHIAL FISTULA
Occurs when the cervical sinus of His
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persists.The fistula opens externally onto the lower
third of neck just anterior to the SCM.
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It may be asymptomatic or intermittent
mucoid discharge.
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Abscess may develop.If asymptomtic no tt reqd.
Excision.
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CYSTIC HYGROMA
Cystic hygroma (CH) is a cystic lymphatic lesion that
can affect any anatomic subsite in the human body.
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CH usually affects the head and neck (approximately
75%), with a left-sided predilection. Within the neck,
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the posterior triangle tends to be most frequentlyaffected.
Approximately 20% of CHs occur in the axilla; more
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infrequent subsites include the mediastinum, groin,
and retroperitoneum.
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CH is synonymous with cystic lymphangioma, which isalso known as a macrocystic lymphatic malformation
and was first described in 1828 by Redenbacker.
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Lymphangiomas are thought to arise from a
combination of the following: a failure of
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lymphatics to connect to the venoussystem, abnormal budding of lymphatic
tissue, and sequestered lymphatic rests that
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retain their embryonic growth potential.
In addition to congential development,
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lymphangiomas can be acquired. They canarise from trauma (including surgery),
inflammation, or obstruction of a lymphatic
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drainage pathway.
The presenting signs and symptoms of the cystic
hygroma (CH) vary depending on the lesion's
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location.
The microcystic form of lymphangioma tends to
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predominate over CH in the oral cavity andoropharynx. Microcystic lymphangiomas commonly
appear as clusters of clear, black, or red vesicles on
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the buccal mucosa or tongue.
CHs tend to predominate below the mylohyoid
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muscle and can involve both the anterior andposterior triangles of the neck.
The cysts are typically large and thick walled and
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have little involvement of surrounding tissue. The
overlying skin can take on a bluish hue or may
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appear normal.CHs often present after a sudden increase in size
secondary to infection or intralesional bleeding.
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Spontaneous decompression or shrinkage is uncommon.Rarely, children with CH display symptoms of newly onset
obstructive sleep apnea syndrome (OSAS). This situation
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may involve children with CH or other space-occupying
lesions of the supraglottis or paraglottic region. Suprahyoid
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lymphangiomas tend to cause more breathing difficultiesthan infrahyoid lesions.
Potential y life-threatening airway compromise that
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manifests as noisy breathing (stridor) and cyanosis is a
possible symptom of lymphangiomas.
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Feeding difficulties, as wel as failure to thrive, may alert theclinician to a potential lymphangioma. This is especial y
true when the lesion affects structures of the upper
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aerodigestive tract.
CHs are typically soft, painless, compressible
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(doughy) masses.A CH typically transilluminates.
In children who present with CH of the neck,
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closely evaluate for tracheal deviation orother evidence of impending airway
obstruction.
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Closely inspect the tongue, oral cavity,
hypopharynx, and larynx because any
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involvement may lead to airway obstruction.MRI.
CT scanning.
Ultrasonography.
Plain radiography.
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Lymphoscintigraphy.Medical Care
The medical treatment of CH consists of the administration of sclerosing agents.
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Sclerosing agents include OK-432 (an inactive strain of group A Streptococcus
pyogenes), bleomycin, pure ethanol, bleomycin, sodium tetradecyl sulfate, and
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doxycycline.Bleomycin: Bleomycin is considered a poor choice because of its toxicity (pulmonary
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fibrosis) because CH is a benign disease and other treatment options are available.Alcohol: Absolute alcohol as a sclerosing agent has been used with some success in
some patients; alcohol works wel in vascular malformations.
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Interferon alfa-2a: This has been used in the treatment of hemangiomas, and its use has
been proposed in lymphangiomas. However, its efficacy has never been documented
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and it carries a serious side effect profile.Fibrin sealant: The use of a fibrin sealant after aspiration of CH has been reported in the
literature.
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An infected CH should be treated with intravenous antibiotics, and definitive surgery
should be performed once the infection has resolved. Incision and drainage or
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aspiration results in only temporary shrinkage, and subsequent fibrosis can furthercomplicate the resection. Radiotherapy has not been demonstrated to be effective.
The preferred treatment of all CH is surgical resection. Only resection can truly offer the
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potential for cure.
Surgical Care
The mainstay of treatment is surgical excision. If acute
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infection occurs prior to resection, surgery should bedelayed at least 3 months.
The surgical team should attempt to completely
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remove the lymphangioma or to remove as much as
possible, sparing all vital neurovascular structures.
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Complete excision has been estimated to be possiblein roughly 40% of cases.
Microcystic lesions are much more difficult to remove
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because of their intimate association with nearby
tissues. Laser therapy is a recent advancement in the
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treatment of microcystic lesions.Signs of airway obstruction require surgical
evaluation at the time of diagnosis. In
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emergency situations, aspiration with an 18-
gauge or 20-gauge needle may obviate the
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need for an emergency tracheostomy.Radiofrequency ablation has been advocated
for use with intraoral lymphatic malformations,
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especially microcystic lesions.
Magnetic resonance?control ed laser-induced
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interstitial thermotherapy is a novel therapythat has been proposed for treatment of
lymphangiomas.
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SUBLINGUAL DERMOID CYST
Congenital sequestration dermoid.
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Formd by inclusion of ectoderm at fusion line of firstarch.
Thin walled cyst lined by squamous epi.
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Lateral and median variety.Can be supra and inframylohyoid.
Usually seen b\w 10-25 years of age.
C\o of a painless swelling under the tongue or below
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the chin.Pain may be asso with infection.
Tranillumintion is ?ve.
Tt is excision.
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PLUNGING RANULA
A ranula is a type of mucocele found on the
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floor of the mouth.
Ranulas present as a swelling of connective
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tissue consisting of collected mucin from aruptured salivary gland duct, which is
usually caused by local trauma.
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The Latin rana means frog, and a ranula is
so named because its appearance is
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sometimes compared to a frog's underbelly.The gland that most likely causes a ranula is the
sublingual gland
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An oral ranula is a fluctuant swelling with a bluishtranslucent color that somewhat resembles the
underbelly of a frog .
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If it is deeper it does not have this bluish appearance.
If it is large ( 2 or more cm.), it may hide the salivary
gland and affect the location of the tongue.
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A ranula below the mylohyoid muscle is referred to
as a "plunging or cervical ranula", and produces
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swelling of the neck with or without swelling in thefloor of the mouth.
Ranulas are usual y asymptomatic,. The overlying skin is
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usual y intact.
The mass is not fixed and is also not tender.
The mass is not connected to the thyroid gland or lymph
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nodes. The mass may not be wel defined.
If it gets large enough it may interfere with swal owing, and
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cervical ranulas may even interfere with breathing.Some pain may be connected with very large ranulas.
Microscopical y, ranulas are cystic saliva fil ed distensions
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of salivary gland ducts on the floor of the mouth alongsidethe tongue, and are lined by epithelium. A salivary
mucocele, in contrast is not lined by epithelium.
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Treatment of ranulas could involve either
a procedure known as "marsupialization"
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or more often excision of both the gland
and lesion.
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Ranulas are likely to reoccur if thesublingual gland or other gland causing
them is not removed with the lesion.
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STERNOMASTOID TUMOR
The sternomastoid "tumor" of infancy is a firm, fibrous mass,
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appearing at two to three weeks of age, within the substance of
the Sternomastoid muscle and appears as a knot.
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It may or may not be associated with torticol is.Generally, the "tumor" initially grows, then stabilizes, and in about
half the cases recedes spontaneously after a few months. It may
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leave a residual torticol is or may be associated with a facial orcranial asymmetry of a delayed torticol is.
The etiology is unknown, a direct cause and effect relationship to
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birth trauma has been largely disproved although approximately
half these children are products of breech deliveries.
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The treatment is controversial.Approximately half of these "tumors" wil resolve spontaneously
without sequelae.
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Progressive torticol is or development of facial asymmetry areconsidered indications for surgery.
CAROTID BODY TUMOR
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Carotid body tumor may also be described as a chemodectoma, glomus tumor or aparaganglioma.
It is a slow growing, benign tumor that is usually non-functioning.
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Aggressive behavior and malignant transformation of the tumor with peri-neural and
vascular invasion is known to occur but is rare.
Carotid body tumors are neuro-endocrine tumors that arise from the neural crest
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paraganglionic cel s that are located at the level of the carotid bifurcation. These cel s
line the adventitia of the blood vessel. There may be a familial mode of inheritance.
Many patients are asymptomatic or may present with laterally placed, slow-growing,
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soft masses in the neck.
They may transmit the carotid pulsations and a bruit may be heard over the mass.
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Occasional y a patient may present with a hard and non-pulsatile mass.As the tumor enlarges, it may produce dysphagia/odynophagia or hoarseness.
If the tumor is functioning, symptoms due to excessive production of catecholamines occur.
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Neck ultrasound with color Doppler is a reliable
modality to image the entire extent of carotid
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body tumors.The treatment of choice is surgical excision.
A pre-operative biopsy is usually contraindicated
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[as these masses are typically very vascularand a biopsy may make adequate surgery
difficult], and hence the importance of
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ultrasound in arriving at a diagnosis by
demonstrating the classic location of the mass
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and its internal vascularCOLD ABSCESS
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Scrofula (scrophula or struma) is a form oftuberculosis, affecting the lymph nodes of
the neck.
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Historically known as the King's Evil, referring
to the method of treatment many sufferers
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used.In adults it is caused by Mycobacterium
tuberculosis and in children by
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nontuberculous mycobacteria.
The word comes from the Latin scrofula,
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meaning brood sow.The most usual signs and symptoms are the
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appearance of a chronic, painless mass in the neck,which is persistent and usually grows with time.
The mass is referred to as a "cold abscess", because
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there is no accompanying local color or warmth and
the overlying skin acquires a violaceous (bluish-
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purple) color.NTM infections do not show other notable
constitutional symptoms, but scrofula caused by
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tuberculosis is usually accompanied by other
symptoms of the disease, such as fever, chills, malaise
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and weight loss in about 43% of the patients.As the lesion progresses, skin becomes adhered to
the mass and may rupture, forming a sinus and an
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open wound.
Diagnosis is usually performed by needle
aspiration biopsy or excisional biopsy of
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the mass and the histological
demonstration of stainable acid-fast
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bacteria in the case of infection by M.tuberculosis (Ziehl-Neelsen stain), or the
culture of NTM using specific growth and
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staining techniques.
Treatment approaches are highly dependent on the
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kind of infection.Surgical excision of the scrofula does not work well
for M. tuberculosis infections, and has a high rate of
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recurrence and formation of fistulae. Furthermore,
surgery may spread the disease to other organs. The
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best approach then is to use conventional treatmentof tuberculosis with antibiotics.
Scrofula caused by NTM, on the other hand, responds
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well to surgery, but is usually resistant to antibiotics.
The affected nodes can be removed either by
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repeated aspiration, curettage or total excision (withthe risk in the latter procedure, however, of causing
cosmetically negative effects or damage to the
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facial nerve, or both).
Zenker diverticulum
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Zenker diverticula occur in a muscular
dehiscence that is present most commonly
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between the oblique muscle fibers of theinferior constrictor muscle and the transverse
fibers of the cricopharyngeus (CP) muscle. This
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area is known as the Kil ian triangle.
Other areas of muscular dehiscence occur
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between the oblique and transverse fibers ofthe CP muscle (ie, Kil ian-Jamieson area) and
between the CP muscle and the esophageal
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muscles (ie, Laimer triangle).
More inferiorly positioned Zenker diverticula
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may occur in one of these latter sitesZenker diverticula extend into the left
neck 90% of the time.
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This is likely due to the slight convexity ofthe cervical esophagus to the left side
and to the more laterally positioned
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carotid artery on the left side, creating a
potential space for the sac.
Zenker proposed a pulsion mechanism affecting the
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pharyngeal mucosa above the CP muscle.
Hypothetical abnormalities include the following:
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Abnormal timing of deglutition resulting in closure ofthe CP muscle when ideally it should be opening
Incomplete CP muscle relaxation
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Elevated resting tone of the entire upper esophagealsphincter (UES)
Loss of CP muscle elasticity
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CP muscle myopathy or denervation atrophyCNS injury with a focal spastic CP muscle
CP muscle spasm in response to gastroesophageal
reflux disease (GERD)
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The combination of the fol owing symptoms is nearly pathognomonic for Zenker
diverticulum:
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DysphagiaRegurgitation of undigested food hours after eating
Sensation of food sticking in the throat
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Special maneuvers to dislodge food
Coughing after eating
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Aspiration of organic materialUnexplained weight loss
Fetor ex ore
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Borborygmi in the neck
Symptoms may last from months to years.
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The most common life-threatening complication is aspiration. Other complicationsinclude massive bleeding from the mucosa or from fistulization into a major vessel,
esophageal obstruction, and fistulization into the trachea. Squamous cel carcinoma
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(SCC) within Zenker diverticulum is extremely rare, occurring in 0.3% of Zenker diverticula
worldwide. A Mayo Clinic review suggests an incidence of 0.48% in the United States.
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Approximately 50 cases of invasive SCC and carcinoma in situ are reported in theliterature. This possibility should be considered when evaluating patients with cervical
metastatic SCC with an unknown primary cancer.
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Zenker diverticula require intervention only if theyproduce symptoms. In general, small (ie, <2 cm)
lesions found incidentally require no intervention.
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Small lesions are satisfactorily treated with a CP
myotomy with or without an invagination procedure.
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Intermediate and large diverticula (ie, 2-6 cm) arebest managed by open diverticulectomy with CP
myotomy or by endoscopic diverticulotomy.
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Very large diverticula (ie, >6 cm) are best managed
with excision with CP myotomy or a diverticulopexy
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with CP myotomy, depending on the health of thepatient
Flexible endoscopic evaluation of
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swallowing (FEES).Rigid or flexible esophagoscopy is
essential before surgical management to
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assess the nature of the mucosa of the
Zenker diverticulum and to exclude the
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presence of SCC or carcinoma in situ..Cricopharyngeal (CP) myotomy alone.
Diverticulum invagination or imbrication
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with CP myotomy.Diverticulopexy with CP myotomy.
Diverticulectomy with CP myotomy.
Endoscopic diverticulotomy with cautery,
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laser, or stapler .
Flexible endoscopic diverticulotomy with
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laser or needle-knife techniques are in thedevelopment stage.
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LaryngocelesLaryngoceles present as lateral neck masses.
Most frequently males in the fifth and sixth decade of
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life.The causative factor of laryngoceles is felt to be
either a congenital enlargement of the saccule or
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acquired by increased, sustained intralaryngeal
pressure (i.e. trumpet player).
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There are three types of laryngoceles: internal,external, and combined.
The internal laryngocele is found entirely within the
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larynx and typically extends posterior and superior to
the false vocal cord and aryepiglottic fold.
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As it is intraluminal, it does not present as a neck mass.The external laryngocele is seen as a lateral swel ing in the
neck and passes superiorly through the opening of the
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thyrohyoid membrane from where the superior laryngealnerve and vessels pass.
The combined laryngocele has features of both internal
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and external.
Symptoms includes lateral neck mass, dysphagia, cough,
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dyspnea, and occasional y a gurgling sensation as thedilatation releases the contained air.
On physical examination, the external and combined
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laryngoceles may appear as intralaryngeal pressures are
elevated and is an easily compressible mass.
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Additional y, these may present as an acute cervicalinflammation if the sac becomes secondarily infected,
fil ed with a purulent fluid, forming a laryngopyocele.
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The management of symptomatic
internal and external laryngoceles is
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surgical, usually through an externalapproach.
Prior to excision of the laryngocele, it is
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important that a thorough endoscopic
examination is performed to rule-out an
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underlying carcinomaCervical lymph nodes
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Relevant AnatomyThe lymphatic drainage of the head and
neck is directed to the lymph nodes
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located within the fibroadipose tissue that
lies between the investing (superficial) layer
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of the deep fascia superficially and thevisceral and prevertebral layers underneath.
In this space, these lymph nodes tend to be
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aggregated around certain neural and
vascular structures such as the internal
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jugular vein, spinal accessory nerve, andtransverse cervical artery.
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Lymph nodes in the neck are groupedinto levels I-V, corresponding with the
submandibular and submental nodes
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(level I); upper, middle, and lower jugular
nodes (levels I , I I, IV); and posterior
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triangle nodes (level V).Level I
This level is bound by the body of the mandible superiorly,
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stylohyoid muscle posteriorly, and the anterior bel y of the
digastric muscle on the contralateral side anteriorly.
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This level may be divided into level Ia, which refers to the nodesin the submental triangle (bound by the anterior bel ies of the
digastric muscles and the hyoid bone), and Ib, which refers to
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the submandibular triangle nodes.
The nodes of level Ia are at greatest risk of harboring metastasis
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from cancers that arise from the floor of mouth, anterior tongue,anterior mandibular alveolar ridge, and lower lip, while the
nodes of level Ib often receive metastasis from cancers of the
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oral cavity, anterior nasal cavity, soft tissue structures of the mid
face, and submandibular gland.
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Closely related, although not strictly a part of the level I group ofnodes, are the perifacial nodes, related to the facial vessels
above the mandibular margin, and the buccinator nodes, which
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may become involved with metastasis from tumors in the buccal
mucosa, nose, and soft tissues of the cheek and lips.
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Level I
Level I lymph nodes are related to the upper third of
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the jugular vein, extending from the skull base to theinferior border of the hyoid bone.
The anterior border of level I is the stylohyoid muscle,
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and the posterior border is the posterior border of the
sternocleidomastoid muscle.
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The spinal accessory nerve, which travels obliquelyacross this area, is used as a landmark to subdivide
this group into I b, the portion above and behind the
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nerve, and I a, the part that lies anteroinferiorly and
closer to the internal jugular vein.
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The nodes in level I are at greatest risk of harboringmetastasis from cancers that arise from the oral
cavity, nasal cavity, nasopharynx, oropharynx,
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hypopharynx, larynx, and parotid gland.
Level I I
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Level III nodes are located between thehyoid superiorly and a horizontal plane
defined by the inferior border of the cricoid
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cartilage.
The sternohyoid muscle marks the anterior
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limit of level III, and the posterior border ofthe sternocleidomastoid muscle is the
posterior border.
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Level III most commonly receives metastasis
from cancers that originate in the oral
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cavity, nasopharynx, oropharynx,hypopharynx, and larynx.
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Level IVGroup of nodes related to the lower third of
the jugular vein.
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These nodes are located between the
inferior border of the cricoid cartilage and
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the clavicle, and, like level III, the anteriorboundary is the sternohyoid muscle, and
the posterior border is the posterior border
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of the sternocleidomastoid muscle.
The nodes of level IV commonly harbor
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metastasis from cancer that originates inthe larynx, hypopharynx, thyroid, and
cervical esophagus.
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Level V
This refers to the lymph nodes located in the posterior triangle of the
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neck. These include the spinal accessory, transverse cervical, andsupraclavicular group of nodes.
Level V is bound anteriorly by the posterior border of the
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sternocleidomastoid muscle and posteriorly by the anterior border of the
trapezius muscle.
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Level V extends from the apex of the convergence of thesternocleidomastoid and trapezius muscle superiorly to the clavicle
inferiorly. This level is subdivided by a plane defined by the inferior border
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of the cricoid cartilage into level Va superiorly and level Vb inferiorly.
LevelVa contains the nodes associated with the spinal accessory nerve,
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and level Vb contains the transverse cervical and supraclavicular nodes.The posterior triangle nodes are at greatest risk for harboring metastasis
from cancers that arise in the nasopharynx, oropharynx, and skin of the
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posterior scalp and neck
Level VI
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This refers to lymph nodes of the anterior, or central,
compartment of the neck.
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Defined by the carotid arteries laterally, the hyoidbone superiorly, and the suprasternal notch inferiorly,
it is rich in lymphatics that drain the thyroid gland,
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subglottic larynx, cervical trachea, hypopharynx, and
cervical esophagus.
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Lymph nodes in this compartment are located in thetracheoesophageal groove (paratracheal nodes), in
front of the trachea (pretracheal nodes), around the
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thyroid gland (parathyroidal nodes), and on the
cricothyroid membrane (precricoid or Delphian
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node).Dif erential Diagnosis for Cervical
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adenopathy--- Content provided by FirstRanker.com ---
Infectious Disorders (SpecificAgent)
> Influenza
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> Coxacki virus> Cytomegalic virus
> Streptococcal pharyngitis, beta type A
> Klebsiella
> Immune deficiency , acquired (AIDS/HIV)
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> Lyme disease> Salmonella infection
> Staphylococcus aureus infection
Infectious Disorders (Specific
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Agent)
> Bacteroides oralis
> Cat-scratch disease
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> CFS/Fibromyalgia/Chronic fatigue syndrome> Herpanginia
> Herpes simplex
> Infectious mononucleosis
> Primary HIV/infection syndrome
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> Tuberculosis> Typhoid fever
> Vincent's infection/trench mouth
> Atypical mycobacteria
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Infectious Disorders (Specific
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Agent)> Atypical mycobacteria
> Diphtheria
> Pulmonary anthrax
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> Tuberculosis, disseminated> Anthrax
> Atypical mycobacteria, disseminated
> Kawasaki disease
> Measles (rubeola)
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> Yersinia enterocolitica infection> Actinomycosis, cervicofacial
> Cytomegalic mononucleosis syndrome
> Lymphogranuloma venereum
> Mycobacteria, atypical pulmonary
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> Mycobacterium KansasiiInfectious Disorders (Specific
Agent)
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> Paracoccidiodomycosis (S.A. Blastomyco)
> Scrofula/cervical nodes tuberculosis
> Toxoplasmosis
> Toxoplasmosis, lymphadenitis, acute
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> Tuberculosis, cavitary pulmonary> Tuberculosis, lymph node
> Tularemia
> Plague, bubonic
> Dengue fever
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> Monkeypox epizoonosis> Staphylococcus aureus/CA-MRSA virulent PVL gene
Epstein-Barr
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Infected organ, Abscesses
> Abscess, dentoalveolar
> Adenitis/lymph node
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> Abscess, cervical gland> Tonsillitis/exudative, acute
> Cervical adenitis/abscess
Tonsillitis, chronic
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Granulomatous, Inflammatory
Disorders
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> Sarcoidosis> Sarcoidosis, pulmonary
> Uveoparotid fever/sarcoidosis
> Kikuchi's disease
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Neoplastic Disorders
> Myelogenous/Blastic Leukemia, Acute
> Leukemia, acute
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> Hodgkin's disease> Metastasis, lymph node
> Monocytic leukemia, acute
> Acute Lymphoblastic/lymphocytic leukemia,
> Leukemia
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> Myelomonocytic, acute leukemia> Adenocarcinoma, parathyroid
> tumor, malignant
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Neoplastic Disorders> Adenocarcinoma, parathyroid
> Adenocarcinoma, thyroid follicular
> Burkitt's lymphoma
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> Carcinoma throat/vallecular> Carcinoma, head and neck
> Carcinoma, laryngeal
> Carcinoma, medullary, thyroid
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Neoplastic Disorders
> Carcinoma, nasopharynx
> Carcinoma, oral
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> Carcinoma, papillary, thyroid> Carcinoma, pharynx
> Carcinoma, thyroid, anaplastic
> Carcinoma, tongue
> Hamartoma, angiomatous lymphoid
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Neoplastic Disorders
> Neuroblastoma, peripheral
> Oral carcinoma, floor
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> Rhabdomyosarcoma> Thyroid lymphoma
Salivary gland tumor, malignant
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Hereditary, Familial, Genetic
Disorders
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> Hyper IGD syndrome/HIDS (12q24)> TRAPS/Tumor necrosis factor Receptor
Periodic Syndrome
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> PFAPA/Periodic fever (Marshals benign)> Hereditary inflammatory periodic fevers
group
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Hyperimmunoglobulinemia D-Periodicfever
Neck Dissections
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Radical Neck Dissection
Original y described by Crile in 1906, this procedure is an
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en bloc clearance of al fibrofatty tissue from one side of
the neck, including the lymph nodes from levels I-V and
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lymph nodes that surround the tail of the parotid gland,the spinal accessory nerve, the internal jugular vein, and
the sternocleidomastoid muscle.
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Radical neck dissection does not include the removal of
the postauricular, suboccipital, perifacial, buccinator,
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retropharyngeal, or central compartment nodes.Previously used for neck disease of any stage, from
microscopic to bulky nodal disease, this procedure is now
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limited to patients with advanced neck disease, recurrent
disease after chemoradiation, or gross extracapsular
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spread to the spinal accessory nerve, sternomastoidmuscle, and the internal jugular vein.
Modified Radical Neck
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Dissection
This operation involves the removal of the same
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lymph node groups as those involved in the radicalneck dissection (levels I-V) but requires preservation
of 1 or more of the following 3 nonlymphatic
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structures: the spinal accessory nerve, the internal
jugular vein, and the sternomastoid muscle.
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Modified neck dissection is indicated for clinicallypalpable metastatic neck disease.
Conversion to the radical neck dissection becomes
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necessary upon gross involvement of the nerve, vein,
and muscle, although the involvement of all 3 is
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unusual, except in very advanced (N3) disease.Selective Neck Dissection
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This term refers to a type of neck dissectionin which one or more lymph node groups
normally removed in a radical neck
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dissection are preserved.
The 1991 classification schema classified
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selective neck dissections into the followingcategories: supraomohyoid neck dissection
(levels I, II, III), lateral neck dissection (levels
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II, III, IV), anterior compartment neck
dissection (VI), and posterolateral neck
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dissection (levels II, III, IV, V).).