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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