Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 39 Neck Lump PPT-Powerpoint Presentations and lecture notes
NECK LUMP
MIDLINE
LUDWIGS ANGINA
SUBMENTAL LN
SUBLINGUAL DERMOID
THYROGLOSSAL CYST
SUBHYOID BURSITIS
RETEROSTERNAL GOITRE
THYMIC SWELLING
BONY SWELLING
Sebaceouscyst,lipoma,fibroma etc may
arise anywhere.
LATERAL SWELLINGS
In the submandibular triangle
LN.
SUBMANDIBULAR SALIVARY GLAND.
PLUNGING RANULA.
LATERAL SWELLINGS
IN THE CAROTID TRIANGLE
ANEURYSM OF CAROTID ARTERY.
CAROTID BODY TUMOR.
BRANCHIAL CYST.
BRANCHIOGENIC CA.
THYROID .
LN.
LATERAL SWELLINGS
IN THE POSTERIOR TRIANGLE
CYSTIC HYGROMA.
PHARYNGEAL POUCH.
SUBCLAVIAN ANEURSYM.
CERVICAL RIB.
COLD ABSCESS.
BRANCHIAL CYST
Branchial cleft cysts are congenital epithelial cysts, which
arise on the lateral part of the neck from a failure of
obliteration of the second branchial cleft in embryonic
development.
At the fourth week of embryonic life, the development of 4
branchial (or pharyngeal) clefts results in 5 ridges known as
the branchial (or pharyngeal) arches.
The second arch grows caudal y and, ultimately, covers
the third and fourth arches.
The buried clefts become ectoderm-lined cavities, which
normal y involute around week 7 of development. If a
portion of the cleft fails to involute completely, the
entrapped remnant forms an epithelium-lined cyst with or
without a sinus tract to the overlying skin.
S/S
A branchial cyst commonly presents as a solitary, painless
mass in the neck of a child or a young adult. A history of
intermittent swel ing and tenderness of the lesion during
upper respiratory tract infection may exist. Discharge may
be reported if the lesion is associated with a sinus tract.
In some instances, patients may present with local y
compressive symptoms.
A family history may be present.
Branchial cysts are smooth, nontender, fluctuant masses,
which occur along the lower one third of the anteromedial
border of the sternocleidomastoid muscle between the
muscle and the overlying skin.
The lesion may be tender if secondarily inflamed or
infected. When associated with a sinus tract, mucoid or
purulent discharge onto the skin or into the pharynx may
be present.
T\T
Medical Care
Antibiotics are required to treat infections or abscesses.
Surgical Care
Surgical 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
occasional y tortuous path of the cyst.
Surgery is best delayed until the patient is at least age 3
months.
Definitive surgery should not be attempted during an
episode of acute infection or if an abscess is present.
Surgical incision and drainage of abscesses is indicated if
present, usual y along with concurrent antimicrobial
therapy.
BRANCHIAL FISTULA
Occurs when the cervical sinus of His
persists.
The fistula opens externally onto the lower
third of neck just anterior to the SCM.
It may be asymptomatic or intermittent
mucoid discharge.
Abscess may develop.
If asymptomtic no tt reqd.
Excision.
CYSTIC HYGROMA
Cystic hygroma (CH) is a cystic lymphatic lesion that
can affect any anatomic subsite in the human body.
CH usually affects the head and neck (approximately
75%), with a left-sided predilection. Within the neck,
the posterior triangle tends to be most frequently
affected.
Approximately 20% of CHs occur in the axilla; more
infrequent subsites include the mediastinum, groin,
and retroperitoneum.
CH is synonymous with cystic lymphangioma, which is
also known as a macrocystic lymphatic malformation
and was first described in 1828 by Redenbacker.
Lymphangiomas are thought to arise from a
combination of the following: a failure of
lymphatics to connect to the venous
system, abnormal budding of lymphatic
tissue, and sequestered lymphatic rests that
retain their embryonic growth potential.
In addition to congential development,
lymphangiomas can be acquired. They can
arise from trauma (including surgery),
inflammation, or obstruction of a lymphatic
drainage pathway.
The presenting signs and symptoms of the cystic
hygroma (CH) vary depending on the lesion's
location.
The microcystic form of lymphangioma tends to
predominate over CH in the oral cavity and
oropharynx. Microcystic lymphangiomas commonly
appear as clusters of clear, black, or red vesicles on
the buccal mucosa or tongue.
CHs tend to predominate below the mylohyoid
muscle and can involve both the anterior and
posterior triangles of the neck.
The cysts are typically large and thick walled and
have little involvement of surrounding tissue. The
overlying skin can take on a bluish hue or may
appear normal.
CHs often present after a sudden increase in size
secondary to infection or intralesional bleeding.
Spontaneous decompression or shrinkage is uncommon.
Rarely, children with CH display symptoms of newly onset
obstructive sleep apnea syndrome (OSAS). This situation
may involve children with CH or other space-occupying
lesions of the supraglottis or paraglottic region. Suprahyoid
lymphangiomas tend to cause more breathing difficulties
than infrahyoid lesions.
Potential y life-threatening airway compromise that
manifests as noisy breathing (stridor) and cyanosis is a
possible symptom of lymphangiomas.
Feeding difficulties, as wel as failure to thrive, may alert the
clinician to a potential lymphangioma. This is especial y
true when the lesion affects structures of the upper
aerodigestive tract.
CHs are typically soft, painless, compressible
(doughy) masses.
A CH typically transilluminates.
In children who present with CH of the neck,
closely evaluate for tracheal deviation or
other evidence of impending airway
obstruction.
Closely inspect the tongue, oral cavity,
hypopharynx, and larynx because any
involvement may lead to airway obstruction.
MRI.
CT scanning.
Ultrasonography.
Plain radiography.
Lymphoscintigraphy.
Medical Care
The medical treatment of CH consists of the administration of sclerosing agents.
Sclerosing agents include OK-432 (an inactive strain of group A Streptococcus
pyogenes), bleomycin, pure ethanol, bleomycin, sodium tetradecyl sulfate, and
doxycycline.
Bleomycin: Bleomycin is considered a poor choice because of its toxicity (pulmonary
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.
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
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.
An infected CH should be treated with intravenous antibiotics, and definitive surgery
should be performed once the infection has resolved. Incision and drainage or
aspiration results in only temporary shrinkage, and subsequent fibrosis can further
complicate 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
potential for cure.
Surgical Care
The mainstay of treatment is surgical excision. If acute
infection occurs prior to resection, surgery should be
delayed at least 3 months.
The surgical team should attempt to completely
remove the lymphangioma or to remove as much as
possible, sparing all vital neurovascular structures.
Complete excision has been estimated to be possible
in roughly 40% of cases.
Microcystic lesions are much more difficult to remove
because of their intimate association with nearby
tissues. Laser therapy is a recent advancement in the
treatment of microcystic lesions.
Signs of airway obstruction require surgical
evaluation at the time of diagnosis. In
emergency situations, aspiration with an 18-
gauge or 20-gauge needle may obviate the
need for an emergency tracheostomy.
Radiofrequency ablation has been advocated
for use with intraoral lymphatic malformations,
especially microcystic lesions.
Magnetic resonance?control ed laser-induced
interstitial thermotherapy is a novel therapy
that has been proposed for treatment of
lymphangiomas.
SUBLINGUAL DERMOID CYST
Congenital sequestration dermoid.
Formd by inclusion of ectoderm at fusion line of first
arch.
Thin walled cyst lined by squamous epi.
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
the chin.
Pain may be asso with infection.
Tranillumintion is ?ve.
Tt is excision.
PLUNGING RANULA
A ranula is a type of mucocele found on the
floor of the mouth.
Ranulas present as a swelling of connective
tissue consisting of collected mucin from a
ruptured salivary gland duct, which is
usually caused by local trauma.
The Latin rana means frog, and a ranula is
so named because its appearance is
sometimes compared to a frog's underbelly.
The gland that most likely causes a ranula is the
sublingual gland
An oral ranula is a fluctuant swelling with a bluish
translucent color that somewhat resembles the
underbelly of a frog .
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.
A ranula below the mylohyoid muscle is referred to
as a "plunging or cervical ranula", and produces
swelling of the neck with or without swelling in the
floor of the mouth.
Ranulas are usual y asymptomatic,. The overlying skin is
usual y intact.
The mass is not fixed and is also not tender.
The mass is not connected to the thyroid gland or lymph
nodes. The mass may not be wel defined.
If it gets large enough it may interfere with swal owing, and
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
of salivary gland ducts on the floor of the mouth alongside
the tongue, and are lined by epithelium. A salivary
mucocele, in contrast is not lined by epithelium.
Treatment of ranulas could involve either
a procedure known as "marsupialization"
or more often excision of both the gland
and lesion.
Ranulas are likely to reoccur if the
sublingual gland or other gland causing
them is not removed with the lesion.
STERNOMASTOID TUMOR
The sternomastoid "tumor" of infancy is a firm, fibrous mass,
appearing at two to three weeks of age, within the substance of
the Sternomastoid muscle and appears as a knot.
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
leave a residual torticol is or may be associated with a facial or
cranial asymmetry of a delayed torticol is.
The etiology is unknown, a direct cause and effect relationship to
birth trauma has been largely disproved although approximately
half these children are products of breech deliveries.
The treatment is controversial.
Approximately half of these "tumors" wil resolve spontaneously
without sequelae.
Progressive torticol is or development of facial asymmetry are
considered indications for surgery.
CAROTID BODY TUMOR
Carotid body tumor may also be described as a chemodectoma, glomus tumor or a
paraganglioma.
It is a slow growing, benign tumor that is usually non-functioning.
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
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,
soft masses in the neck.
They may transmit the carotid pulsations and a bruit may be heard over the mass.
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.
Neck ultrasound with color Doppler is a reliable
modality to image the entire extent of carotid
body tumors.
The treatment of choice is surgical excision.
A pre-operative biopsy is usually contraindicated
[as these masses are typically very vascular
and a biopsy may make adequate surgery
difficult], and hence the importance of
ultrasound in arriving at a diagnosis by
demonstrating the classic location of the mass
and its internal vascular
COLD ABSCESS
Scrofula (scrophula or struma) is a form of
tuberculosis, affecting the lymph nodes of
the neck.
Historically known as the King's Evil, referring
to the method of treatment many sufferers
used.
In adults it is caused by Mycobacterium
tuberculosis and in children by
nontuberculous mycobacteria.
The word comes from the Latin scrofula,
meaning brood sow.
The most usual signs and symptoms are the
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
there is no accompanying local color or warmth and
the overlying skin acquires a violaceous (bluish-
purple) color.
NTM infections do not show other notable
constitutional symptoms, but scrofula caused by
tuberculosis is usually accompanied by other
symptoms of the disease, such as fever, chills, malaise
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
open wound.
Diagnosis is usually performed by needle
aspiration biopsy or excisional biopsy of
the mass and the histological
demonstration of stainable acid-fast
bacteria in the case of infection by M.
tuberculosis (Ziehl-Neelsen stain), or the
culture of NTM using specific growth and
staining techniques.
Treatment approaches are highly dependent on the
kind of infection.
Surgical excision of the scrofula does not work well
for M. tuberculosis infections, and has a high rate of
recurrence and formation of fistulae. Furthermore,
surgery may spread the disease to other organs. The
best approach then is to use conventional treatment
of tuberculosis with antibiotics.
Scrofula caused by NTM, on the other hand, responds
well to surgery, but is usually resistant to antibiotics.
The affected nodes can be removed either by
repeated aspiration, curettage or total excision (with
the risk in the latter procedure, however, of causing
cosmetically negative effects or damage to the
facial nerve, or both).
Zenker diverticulum
Zenker diverticula occur in a muscular
dehiscence that is present most commonly
between the oblique muscle fibers of the
inferior constrictor muscle and the transverse
fibers of the cricopharyngeus (CP) muscle. This
area is known as the Kil ian triangle.
Other areas of muscular dehiscence occur
between the oblique and transverse fibers of
the CP muscle (ie, Kil ian-Jamieson area) and
between the CP muscle and the esophageal
muscles (ie, Laimer triangle).
More inferiorly positioned Zenker diverticula
may occur in one of these latter sites
Zenker diverticula extend into the left
neck 90% of the time.
This is likely due to the slight convexity of
the cervical esophagus to the left side
and to the more laterally positioned
carotid artery on the left side, creating a
potential space for the sac.
Zenker proposed a pulsion mechanism affecting the
pharyngeal mucosa above the CP muscle.
Hypothetical abnormalities include the following:
Abnormal timing of deglutition resulting in closure of
the CP muscle when ideally it should be opening
Incomplete CP muscle relaxation
Elevated resting tone of the entire upper esophageal
sphincter (UES)
Loss of CP muscle elasticity
CP muscle myopathy or denervation atrophy
CNS injury with a focal spastic CP muscle
CP muscle spasm in response to gastroesophageal
reflux disease (GERD)
The combination of the fol owing symptoms is nearly pathognomonic for Zenker
diverticulum:
Dysphagia
Regurgitation of undigested food hours after eating
Sensation of food sticking in the throat
Special maneuvers to dislodge food
Coughing after eating
Aspiration of organic material
Unexplained weight loss
Fetor ex ore
Borborygmi in the neck
Symptoms may last from months to years.
The most common life-threatening complication is aspiration. Other complications
include massive bleeding from the mucosa or from fistulization into a major vessel,
esophageal obstruction, and fistulization into the trachea. Squamous cel carcinoma
(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.
Approximately 50 cases of invasive SCC and carcinoma in situ are reported in the
literature. This possibility should be considered when evaluating patients with cervical
metastatic SCC with an unknown primary cancer.
Zenker diverticula require intervention only if they
produce symptoms. In general, small (ie, <2 cm)
lesions found incidentally require no intervention.
Small lesions are satisfactorily treated with a CP
myotomy with or without an invagination procedure.
Intermediate and large diverticula (ie, 2-6 cm) are
best managed by open diverticulectomy with CP
myotomy or by endoscopic diverticulotomy.
Very large diverticula (ie, >6 cm) are best managed
with excision with CP myotomy or a diverticulopexy
with CP myotomy, depending on the health of the
patient
Flexible endoscopic evaluation of
swallowing (FEES).
Rigid or flexible esophagoscopy is
essential before surgical management to
assess the nature of the mucosa of the
Zenker diverticulum and to exclude the
presence of SCC or carcinoma in situ..
Cricopharyngeal (CP) myotomy alone.
Diverticulum invagination or imbrication
with CP myotomy.
Diverticulopexy with CP myotomy.
Diverticulectomy with CP myotomy.
Endoscopic diverticulotomy with cautery,
laser, or stapler .
Flexible endoscopic diverticulotomy with
laser or needle-knife techniques are in the
development stage.
Laryngoceles
Laryngoceles present as lateral neck masses.
Most frequently males in the fifth and sixth decade of
life.
The causative factor of laryngoceles is felt to be
either a congenital enlargement of the saccule or
acquired by increased, sustained intralaryngeal
pressure (i.e. trumpet player).
There are three types of laryngoceles: internal,
external, and combined.
The internal laryngocele is found entirely within the
larynx and typically extends posterior and superior to
the false vocal cord and aryepiglottic fold.
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
thyrohyoid membrane from where the superior laryngeal
nerve and vessels pass.
The combined laryngocele has features of both internal
and external.
Symptoms includes lateral neck mass, dysphagia, cough,
dyspnea, and occasional y a gurgling sensation as the
dilatation releases the contained air.
On physical examination, the external and combined
laryngoceles may appear as intralaryngeal pressures are
elevated and is an easily compressible mass.
Additional y, these may present as an acute cervical
inflammation if the sac becomes secondarily infected,
fil ed with a purulent fluid, forming a laryngopyocele.
The management of symptomatic
internal and external laryngoceles is
surgical, usually through an external
approach.
Prior to excision of the laryngocele, it is
important that a thorough endoscopic
examination is performed to rule-out an
underlying carcinoma
Cervical lymph nodes
Relevant Anatomy
The lymphatic drainage of the head and
neck is directed to the lymph nodes
located within the fibroadipose tissue that
lies between the investing (superficial) layer
of the deep fascia superficially and the
visceral and prevertebral layers underneath.
In this space, these lymph nodes tend to be
aggregated around certain neural and
vascular structures such as the internal
jugular vein, spinal accessory nerve, and
transverse cervical artery.
Lymph nodes in the neck are grouped
into levels I-V, corresponding with the
submandibular and submental nodes
(level I); upper, middle, and lower jugular
nodes (levels I , I I, IV); and posterior
triangle nodes (level V).
Level I
This level is bound by the body of the mandible superiorly,
stylohyoid muscle posteriorly, and the anterior bel y of the
digastric muscle on the contralateral side anteriorly.
This level may be divided into level Ia, which refers to the nodes
in the submental triangle (bound by the anterior bel ies of the
digastric muscles and the hyoid bone), and Ib, which refers to
the submandibular triangle nodes.
The nodes of level Ia are at greatest risk of harboring metastasis
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
oral cavity, anterior nasal cavity, soft tissue structures of the mid
face, and submandibular gland.
Closely related, although not strictly a part of the level I group of
nodes, are the perifacial nodes, related to the facial vessels
above the mandibular margin, and the buccinator nodes, which
may become involved with metastasis from tumors in the buccal
mucosa, nose, and soft tissues of the cheek and lips.
Level I
Level I lymph nodes are related to the upper third of
the jugular vein, extending from the skull base to the
inferior border of the hyoid bone.
The anterior border of level I is the stylohyoid muscle,
and the posterior border is the posterior border of the
sternocleidomastoid muscle.
The spinal accessory nerve, which travels obliquely
across this area, is used as a landmark to subdivide
this group into I b, the portion above and behind the
nerve, and I a, the part that lies anteroinferiorly and
closer to the internal jugular vein.
The nodes in level I are at greatest risk of harboring
metastasis from cancers that arise from the oral
cavity, nasal cavity, nasopharynx, oropharynx,
hypopharynx, larynx, and parotid gland.
Level I I
Level III nodes are located between the
hyoid superiorly and a horizontal plane
defined by the inferior border of the cricoid
cartilage.
The sternohyoid muscle marks the anterior
limit of level III, and the posterior border of
the sternocleidomastoid muscle is the
posterior border.
Level III most commonly receives metastasis
from cancers that originate in the oral
cavity, nasopharynx, oropharynx,
hypopharynx, and larynx.
Level IV
Group of nodes related to the lower third of
the jugular vein.
These nodes are located between the
inferior border of the cricoid cartilage and
the clavicle, and, like level III, the anterior
boundary is the sternohyoid muscle, and
the posterior border is the posterior border
of the sternocleidomastoid muscle.
The nodes of level IV commonly harbor
metastasis from cancer that originates in
the larynx, hypopharynx, thyroid, and
cervical esophagus.
Level V
This refers to the lymph nodes located in the posterior triangle of the
neck. These include the spinal accessory, transverse cervical, and
supraclavicular group of nodes.
Level V is bound anteriorly by the posterior border of the
sternocleidomastoid muscle and posteriorly by the anterior border of the
trapezius muscle.
Level V extends from the apex of the convergence of the
sternocleidomastoid and trapezius muscle superiorly to the clavicle
inferiorly. This level is subdivided by a plane defined by the inferior border
of the cricoid cartilage into level Va superiorly and level Vb inferiorly.
LevelVa contains the nodes associated with the spinal accessory nerve,
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
posterior scalp and neck
Level VI
This refers to lymph nodes of the anterior, or central,
compartment of the neck.
Defined by the carotid arteries laterally, the hyoid
bone superiorly, and the suprasternal notch inferiorly,
it is rich in lymphatics that drain the thyroid gland,
subglottic larynx, cervical trachea, hypopharynx, and
cervical esophagus.
Lymph nodes in this compartment are located in the
tracheoesophageal groove (paratracheal nodes), in
front of the trachea (pretracheal nodes), around the
thyroid gland (parathyroidal nodes), and on the
cricothyroid membrane (precricoid or Delphian
node).
Dif erential Diagnosis for Cervical
adenopathy
Infectious Disorders (Specific
Agent)
> Influenza
> Coxacki virus
> Cytomegalic virus
> Streptococcal pharyngitis, beta type A
> Klebsiella
> Immune deficiency , acquired (AIDS/HIV)
> Lyme disease
> Salmonella infection
> Staphylococcus aureus infection
Infectious Disorders (Specific
Agent)
> Bacteroides oralis
> Cat-scratch disease
> CFS/Fibromyalgia/Chronic fatigue syndrome
> Herpanginia
> Herpes simplex
> Infectious mononucleosis
> Primary HIV/infection syndrome
> Tuberculosis
> Typhoid fever
> Vincent's infection/trench mouth
> Atypical mycobacteria
Infectious Disorders (Specific
Agent)
> Atypical mycobacteria
> Diphtheria
> Pulmonary anthrax
> Tuberculosis, disseminated
> Anthrax
> Atypical mycobacteria, disseminated
> Kawasaki disease
> Measles (rubeola)
> Yersinia enterocolitica infection
> Actinomycosis, cervicofacial
> Cytomegalic mononucleosis syndrome
> Lymphogranuloma venereum
> Mycobacteria, atypical pulmonary
> Mycobacterium Kansasii
Infectious Disorders (Specific
Agent)
> Paracoccidiodomycosis (S.A. Blastomyco)
> Scrofula/cervical nodes tuberculosis
> Toxoplasmosis
> Toxoplasmosis, lymphadenitis, acute
> Tuberculosis, cavitary pulmonary
> Tuberculosis, lymph node
> Tularemia
> Plague, bubonic
> Dengue fever
> Monkeypox epizoonosis
> Staphylococcus aureus/CA-MRSA virulent PVL gene
Epstein-Barr
Infected organ, Abscesses
> Abscess, dentoalveolar
> Adenitis/lymph node
> Abscess, cervical gland
> Tonsillitis/exudative, acute
> Cervical adenitis/abscess
Tonsillitis, chronic
Granulomatous, Inflammatory
Disorders
> Sarcoidosis
> Sarcoidosis, pulmonary
> Uveoparotid fever/sarcoidosis
> Kikuchi's disease
Neoplastic Disorders
> Myelogenous/Blastic Leukemia, Acute
> Leukemia, acute
> Hodgkin's disease
> Metastasis, lymph node
> Monocytic leukemia, acute
> Acute Lymphoblastic/lymphocytic leukemia,
> Leukemia
> Myelomonocytic, acute leukemia
> Adenocarcinoma, parathyroid
> tumor, malignant
Neoplastic Disorders
> Adenocarcinoma, parathyroid
> Adenocarcinoma, thyroid follicular
> Burkitt's lymphoma
> Carcinoma throat/vallecular
> Carcinoma, head and neck
> Carcinoma, laryngeal
> Carcinoma, medullary, thyroid
Neoplastic Disorders
> Carcinoma, nasopharynx
> Carcinoma, oral
> Carcinoma, papillary, thyroid
> Carcinoma, pharynx
> Carcinoma, thyroid, anaplastic
> Carcinoma, tongue
> Hamartoma, angiomatous lymphoid
Neoplastic Disorders
> Neuroblastoma, peripheral
> Oral carcinoma, floor
> Rhabdomyosarcoma
> Thyroid lymphoma
Salivary gland tumor, malignant
Hereditary, Familial, Genetic
Disorders
> Hyper IGD syndrome/HIDS (12q24)
> TRAPS/Tumor necrosis factor Receptor
Periodic Syndrome
> PFAPA/Periodic fever (Marshals benign)
> Hereditary inflammatory periodic fevers
group
Hyperimmunoglobulinemia D-Periodic
fever
Neck Dissections
Radical Neck Dissection
Original y described by Crile in 1906, this procedure is an
en bloc clearance of al fibrofatty tissue from one side of
the neck, including the lymph nodes from levels I-V and
lymph nodes that surround the tail of the parotid gland,
the spinal accessory nerve, the internal jugular vein, and
the sternocleidomastoid muscle.
Radical neck dissection does not include the removal of
the postauricular, suboccipital, perifacial, buccinator,
retropharyngeal, or central compartment nodes.
Previously used for neck disease of any stage, from
microscopic to bulky nodal disease, this procedure is now
limited to patients with advanced neck disease, recurrent
disease after chemoradiation, or gross extracapsular
spread to the spinal accessory nerve, sternomastoid
muscle, and the internal jugular vein.
Modified Radical Neck
Dissection
This operation involves the removal of the same
lymph node groups as those involved in the radical
neck dissection (levels I-V) but requires preservation
of 1 or more of the following 3 nonlymphatic
structures: the spinal accessory nerve, the internal
jugular vein, and the sternomastoid muscle.
Modified neck dissection is indicated for clinically
palpable metastatic neck disease.
Conversion to the radical neck dissection becomes
necessary upon gross involvement of the nerve, vein,
and muscle, although the involvement of all 3 is
unusual, except in very advanced (N3) disease.
Selective Neck Dissection
This term refers to a type of neck dissection
in which one or more lymph node groups
normally removed in a radical neck
dissection are preserved.
The 1991 classification schema classified
selective neck dissections into the following
categories: supraomohyoid neck dissection
(levels I, II, III), lateral neck dissection (levels
II, III, IV), anterior compartment neck
dissection (VI), and posterolateral neck
dissection (levels II, III, IV, V).).
This post was last modified on 08 April 2022