Download MBBS Surgery Presentations 40 Neck Swellings Midline And Lateral Lecture Notes

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a marble-sized mass beneath his left ear. The

mass is eventually excised, revealing which

of the following benign parotid gland lesions?

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(A) Glandular hypertrophy, secondary to

vitamin A deficiency

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(B) Cystic dilation

(C) Mikulicz's disease

(D) Pleomorphic adenoma

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A 43-year old man notes shortness of breath. He

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is a non smoker. His wife points out that his face

has become slightly swollen. On examination, his

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blood pressure is normal. His pupils are equal

and respond to light. Dilated veins are noted

around the shoulders, upper chest, and face. An

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x-ray of the chest reveals an opacity in the

superior mediastinum. What is the most likely

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diagnosis?

(A) Thymoma
(B) Neurogenic tumor
(C) Lymphoma

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(D) Teratodermoid tumor

This 19 year old girl had

a two-week history of a

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painless swelling in the

left jugulo digastric

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region. FNAC

demonstrated benign

squamous cells, cellular

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debris and cholesterol

crystals. CT scan

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demonstrated a well

circumscribed cystic

mass, anterior to the

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sternomastoid muscle.

This is a typical ?

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This young woman

had a one-week

history of a rapidly

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enlarging mass in

the upper right neck

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with localised

tenderness. The CT

scan again

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demonstrates a well

circumscribed

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unilocular cyst, with

a smooth wall

This young man has a

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prominent painless lymph

node in the jugulodigastric

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region. Fine needle

aspiration biopsy indicated

a diagnosis of Hodgkin's

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Disease. The 40 year old

man (inset) has a lump in

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an identical position, also

painless and present for

months. Fine needle

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aspiration biopsy

confirmed the diagnosis of

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metastatic squamous cell

carcinoma from a tonsil

cancer. He was a non

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smoker.

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The man is 60, a heavy

smoker and presents with

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a hoarse voice and large

mass in the right upper

neck. Fine needle

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aspiration biopsy showed

necrotic debris and the CT

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scan demonstrates a

unilocular cystic mass.

The cyst wall is irregular

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and this is metastatic

squamous carcinoma,

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which has undergone

cystic degeneration. The

primary cancer was in the

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hypopharynx

This man has

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nasopharyngeal

carcinoma with

multiple metastatic

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lymph nodes in the

posterior triangle,

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bounded by the

clavicle below,

sternomastoid

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muscle anteriorly

and the trapezius

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posteriorly..

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The young man had

a firm, but not hard

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submandibular

swelling which had

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been present for 5

years. The CT scan

on the right

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demonstrates a

midline dermoid

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cyst. This is a well

localised benign

congenital lesion.

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This young woman, aged

25, has a well localised

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swelling just below the

hyoid bone, which

elevates on protrusion

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of the tongue. The CT

scan on the right is from

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another patient but

demonstrates identical

pathology of a well

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circumscribed cystic

structure lying anterior

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to the thyroid cartilage

- thyroglossal cyst.

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This young woman

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has a prominent

right thyroid

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nodule. The

appropriate

investigations are

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FNAB and serum

TSH.

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This boy, aged 14,

presented with a cystic

mass in the left

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submandibular region.

Needle biopsy

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demonstrated the

presence of mucoid

material and the CT scan

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shows a cystic mass lying

anterior to the left

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submandibular salivary

gland. This is a typical

plunging ranula and is due

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to extravasation of mucoid

saliva from the sublingual

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gland

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This elderly man has

a large left

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submandibular mass.

An SCC of the cheek

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was removed a year

earlier. FNAB

showed metastatic

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SCC and the CT scan

demonstrates a

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large cystic mass

with a septum,

consistent with

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metastatic cancer.

This 45 year old

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Asian woman,

recently migrated to

Australia, presented

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with a supurating

mass in the right

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submandibular

region. A diagnosis

of tuberculosis was

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made following

culture of tissue

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from the mass

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The man is aged

58 has a two-year

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history of a

painless slowly

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growing mass at

the angle of the

jaw. Needle biopsy

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suggested a

diagnosis of

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Warthins tumour.

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The boundaries of the anterior triangle are:

--------------------------the midline of the neck.

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------------------------the body of the mandible.

------------------------the anterior border of the

sternocleidomastoid muscle.

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Submental Submandib

Carotid

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Muscular

triangle

ular

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triangle

triangle

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triangle

Boundaries

Superiorly: the

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The bellies of the

Superiorly: the

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The superior belly

chin

diagastric muscles posterior belly of

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of the omohyoid

Laterally: the two

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and the mandible

the diagastric

muscle and the

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anterior bellies of

muscle

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sternohyoid

the diagastric

Laterally: the

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muscle

muscle

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anterior border of

Medially: the mid-

the

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line

sternocleidomastoi

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d muscle

Medially: the

superior belly of

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the omohyoid

muscle

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Contents

The submental

The submandibular

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The carotid artery,

The deep structures

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lymph nodes

salivary glands and

the internal jugular

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including the larnyx,

submandibular

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vein, the vagus

trachea, thyroid and

lymph nodes

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nerve and the

the oesophagus

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internal and

external laryngeal

nerves

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The boundaries of the posterior triangle are:

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-----------------------the posterior border of the

sternocleidomastoid muscle.

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--------------------the mid third of the clavicle.

-----------------------the anterior border of the

trapezius muscle.

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Occipital triangle

Supraclavicular

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triangle

Boundaries

Anteriorly:

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Anteriorly: the posterior border

the Sternocleidomastoid muscle

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of the Sternocleidomastoid

Posteriorly: the Trapezius muscle Superiorly: the inferior belly of

Inferiorly: the Omohyoid muscle

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the Omohyoid muscle

Inferiorly: the clavicle

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Contents

Most lumps arising from the posterior triangle are due to

enlarged occipital or supraclavicular lymph nodes.

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Other important structures include the subclavian artery,

the external jugular vein, the accessory nerve, the phrenic

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nerve and parts of the brachial plexus.

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1A-submental
1B-submandibular
II-Skull base to

carotid bifurcation

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III- carotid

bifurcation to

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cricothyroid notch

IV- cricothyroid

notch to clavicle

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V- post triangle
VI-hyoid to

suprasternal notch

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ETIOLOGY (Congenital or Acquired)

LOCATION (Midline or Lateral)

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CONSISTENCY (Solid or Cystic)

Ubiqutous

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Midline

Lateral Swellings

swellings

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Swellings

Anterior

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Posterior

Triangle

Triangle

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Sebaceous cyst Submental

Submandibular Lymphadenopat

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Lymph nodes

gland swelling

hy

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Lipoma

Thyroglossal

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Thyroid lobe

Cold abscess

cyst

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enlargement

Dermoid cyst

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Thyroid

Branchial cyst

Cystic Hygroma

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Swelling

Schwannoma

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Hyoid Bursa

Pharyngeal

Cervical Rib

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pouch

Haemangioma

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Pretracheal LNs Parotid gland

Subclavian

swelling

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artery

aneurysm

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Teratoma

Dermoid cyst

Laryngocele

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Laryngeal

Lymphadenopat

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swelling

hy

Chondroma of

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Cold abscess

thyroid

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cartilage
Ludwig's angina Carotid body

tumor

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Cold abscess

Brown tumor

Thymus tumors

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I. SOLID SWELLINGS:

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GLANDS: -

Lymph nodes (commonest).

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Thyroid gland nodule (2nd common).

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Submandibular gland.



Tail of parotid gland.

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VESSELS: -

Carotid body tumor.

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Glomus jugulare.

NERVES:
Schwannoma or Neurofibroma.
SUBCUTANEOUS: Lipoma.

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SCM MUSCLE: - Organized hematoma (infants).

Fibrosarcoma

o BONE- Cervical Rib

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II. CYSTIC SWELLINGS:
AIR: -

Laryngocele.

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Pneumatocele.
Pharyngeal diverticulum.

FLUID: -

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Thyroid gland cyst.
Branchial cyst.
Cystic hygroma (Lymphangioma).

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Sebaceous cyst.

ABSCESS: -

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Cold abscess (TB cervical lymphadenitis).
Parapharyngeal abscess.

Parotid abscess.

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BLOOD : -

Hemangioma.

Aneurysm (Carotid or Subclavian).

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I. SOLID SWELLINGS:

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GLANDS: -

Lymph nodes
Thyroid gland isthmus nodule.

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Median ectopic thyroid tissue.

SUBCUTANEOUS:

Lipoma of Burn's space (Suprasternal

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notch).

II. CYSTIC SWELLINGS:
FLUID: -

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Thyroid gland cyst in isthmus.

Thyroglossal cyst.

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Dermoid cyst (Sublingual or Suprasternal).

Subhyoid bursa.

Sebaceous cyst.

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ABSCESS: - Cold abscess.

Pyogenic abscess.

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BLOOD : -

Hemangioma.

Aneurysm (Innominate artery).

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Patient age

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Pediatric (0 ? 15 years): 90% benign
Young adult (16 ? 40 years): similar to pediatric
Late adult (>40 years): "rule of 80s"

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Location

Congenital masses: consistent in location
Metastatic masses: key to primary lesion

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Congenital

epithelial cysts,

which arise from a

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failure of

obliteration of the

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second branchial

cleft.

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At the fourth week of embryonic

life, the development of 4

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branchial clefts results in 5 ridges

known as the branchial arches,

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which contribute to the formation

of various structures of the head,

the neck, and the thorax. The

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second arch grows caudally and,

ultimately, covers the third and

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fourth arches. The buried clefts

become ectoderm-lined cavities,

which normally involute around

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week 7 of development. If a

portion of the cleft fails to involute

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completely, the entrapped remnant

forms an epithelium-lined cyst with

or without a sinus tract to the

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overlying skin.

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A solitary, painless mass in the neck of a

child or a young adult.

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A history of intermittent swelling and

tenderness of the lesion during upper

respiratory tract infection.

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Spontaneous rupture of an infected branchial

cyst may result in a purulent draining sinus to

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the skin or the pharynx.

May present with locally compressive

symptoms.

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Smooth, nontender, fluctuant mass, along

the lower one third of the anteromedial

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border of the sternocleidomastoid muscle

between the muscle and the overlying skin.

May be tender if secondarily inflamed or

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infected.

When associated with a sinus tract, mucoid

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or purulent discharge onto the skin or into

the pharynx may be present.

Rarely, branchial cleft cysts have been

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reported as fluctuant nodules in the thorax

or the posterior mediastinum.

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Lymphadenopathy

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Vascular neoplasms and malformations

Capillary hemangioma

Carotid body tumor

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Lymphatic malformation (cystic hygroma)

Ectopic thyroid tissue

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Ectopic salivary tissue

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Ultrasonography.

Upper airway

endoscopy.

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FNAC

A contrast-

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enhanced CT scan

shows a cystic and

enhancing mass in

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the neck.

Surgical excision

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Stairstep or stepladder incision

Surgery done when the patient is at least age

3 months old.

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Surgery should not be attempted during an

episode of acute infection or if an abscess is

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present.

Sclerotherapy with OK-432 (picibanil) has

been reported to be an effective alternative.

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Present mostly in

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infancy as chronic

discharge along

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anterior border of

SCM in lower 1/3.

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CAROTID BODY

Small, reddish-brown, oval structure, located in

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the posteromedial aspect of the carotid artery

bifurcation.

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The gland is highly vascular and receives its

blood supply from feeder vessels from the

external carotid artery, typically the ascending

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pharyngeal artery.

It is innervated by the Hering nerve, originating

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from the glossopharyngeal nerve.

Helps in the body's acute adaptation to

fluctuating concentrations of oxygen, carbon

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dioxide, and pH.

How? By increasing the ventilatory rate.

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Rare neoplasms,

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Represent about

65% of head and

neck

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paragangliomas.

Develop within

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the adventitia of

the medial aspect

of the carotid

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bifurcation.

3 different types:
Familial

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Sporadic
Hyperplastic
The sporadic form is the most common type,

representing approximately 85% of carotid body

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tumors (CBTs).

The familial type (10-50%) is more common in

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younger patients.

The hyperplastic form is very common in

patients with chronic hypoxia, patients living at

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a high altitude, COPD or cyanotic heart disease.

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The mean age of onset is 45 years.

Age of onset in the familial group is younger,

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in the second to fourth decade.

About 5% of carotid body tumors (CBTs) are

bilateral and 5-10% are malignant.

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Risk factors are chronic hypoxic stimulation

and the genetic predisposition.

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Defective succinate dehydrogenase has been

postulated to cause an increase in the

intracellular concentration of molecular hypoxia

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mediators and the vascular endothelial growth

factor (VEGF) thus resulting in hyperplasia,

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angiogenesis, and neoplasia in Familial type.

Chronic hypoxic conditions overburden the

carotid bodies and subsequently lead to

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hypertrophy, hyperplasia, and neoplasia of the

chief cells. This condition is seen in the

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hyperplastic type of carotid body tumors (CBTs).

CBTs can be occasionally coupled with

syndromes, including MEN type II, von Hippel-

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Lindau syndrome, and neurofibromatosis type 1.

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composed of 2 cell types that are arranged in

a pseudoalveolar pattern characteristic of

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paragangliomas known as "cell balls"

(zellballen):

Type I cells, which are the chief cells that

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predominate in carotid body tumors (CBTs)

and contain catecholamine-bound granules

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Type II cells, which are the sustentacular

cells located at the periphery, are devoid of

granules

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Asymptomatic palpable neck mass in the anterior

triangle of the neck. They are slow-growing tumors.

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Typically vertically fixed because of its attachment to

the bifurcation of the common carotid (Fontaine

sign).

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Bruit
Approximately 10% of the cases present with cranial

nerve palsy with paralysis of the hypoglossal,

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glossopharyngeal, recurrent laryngeal, or spinal

accessory nerve, or involvement of the sympathetic

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chain. May be associated with pain, hoarseness,

dysphagia, Horner syndrome, or shoulder drop.

Cause of fever of unknown origin.

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In cases of functional CBTs, symptoms similar to

those of pheochromocytoma, such as paroxysmal

hypertension, palpitations, and diaphoresis, are seen.

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Check urinary catecholamines in patients who have

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any symptoms of a functional carotid body tumor.

Color Doppler USG, which can assess the vascularity

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of the neck mass.

CT scanning typically reveals a hypervascular tumor

located between the external and internal carotid

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arteries.

MRI imaging is IOC and the tumor has a characteristic

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salt and pepper appearance on T1-weighted image.

MRA provides better insight into the vascularity of the

tumor and its feeder vessels.

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Angiography shows the typical lyre sign. also helpful

for better visualization of the feeder vessels.

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MIBG scans,in patients who have functional tumors

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Shamblin describes 3 different types or

stages of carotid body tumors.

Type I consists of a small tumor that is easily

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dissected from the adjacent vessels in a

periadventitial plane.

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Type II tumors are larger and more adherent

and partially surround the vessel.

Type III tumors are large and completely

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surround the carotid bifurcation.

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Surgery or radiotherapy.
Choice of treatment, depends on: presence

of other paragangliomas, bilateral carotid

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body tumors, the age and the health of the

patient, and the patient's preference.

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Preoperative embolization.
Surgery is the treatment of choice for

younger, healthier patients and radiotherapy

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is reserved for the elderly, patients who are

poor surgical candidates, individuals with

multiple paragangliomas in whom resection

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may be highly morbid.

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CH usually affects

the head and neck

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(approximately

75%), with a left-

sided predilection.

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The posterior

triangle tends to be

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most frequently

affected.

Other sites are the

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axilla; mediastinum,

groin, and

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retroperitoneum.

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Failure of lymphatics to connect to the

venous system, abnormal budding of

lymphatic tissue, and sequestered lymphatic

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rests that retain their growth potential.

They can arise from trauma (including

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surgery), inflammation, or obstruction of a

lymphatic.

More common with Turner syndrome, Down

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syndrome, Klinefelter syndrome and trisomy

18 and 13.

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Noonan syndrome, Fryns syndrome, multiple

pterygium syndrome, and achondroplasia

Intrauterine alcohol exposure has been

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associated with the development of

lymphangiomas.

--- Content provided by​ FirstRanker.com ---

Are evident at birth, with 80-90% of CHs presenting by age 2

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years.

CH can be visualized using abdominal ultrasonography by 10

weeks' gestation.

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Elevated alpha fetoprotein levels in amniocentesis fluid
Can involve both the anterior and posterior triangles of the neck.
The cysts are typically large and thick walled. The overlying skin

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can take on a bluish hue or may appear normal.

Often present with a sudden increase in size secondary to

infection or intralesional bleeding.

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Rarely, children with CH display symptoms of newly

onset obstructive sleep apnea syndrome (OSAS).

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Potentially life-threatening airway compromise that manifests as

noisy breathing (stridor) and cyanosis.

Feeding difficulties, as well as failure to thrive___when the lesion

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affects structures of the upper 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 or

other evidence of impending airway

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obstruction.

Closely inspect the tongue, oral cavity,

hypopharynx, and larynx because any

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involvement may lead to airway obstruction.

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Branchial cleft cyst

Thyroglossal duct cyst

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Ranula

Goiter

Soft tissue tumors

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Neck abscess

MRI is the study of choice. Contrast can be

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used to differentiate hemangiomas from

lymphangiomas.

CT scanning not very good.

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Ultrasonography: It is very useful in

demonstrating the relationship of CH to the

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surrounding structures.

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giguere et al have proposed categorization of

lymphangiomas based on the size of the cystic component,

as follows:

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Macrocystic - Cystic spaces at least 2 cm
Microcystic - Spaces less than 2 cm
Mixed lesions
de serres et al have proposed the following system

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for staging of CH of the head and neck:

Stage I - Unilateral infrahyoid (17% complication rate)
Stage II - Unilateral suprahyoid (41% complication rate)

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Stage III - Unilateral and both infrahyoid and suprahyoid

(67% complication rate)

Stage IV - Bilateral suprahyoid (80% complication rate)

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Stage V - Bilateral infrahyoid and suprahyoid (100%

complication rate)

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Watchful waiting should be considered only

in patients who are asymptomatic.

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Administration of sclerosing agents like OK-

432 (an inactive strain of group

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A Streptococcus pyogenes), bleomycin, pure

ethanol, sodium tetradecyl sulfate, and

doxycycline.

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An infected CH should be treated with

intravenous antibiotics, and definitive

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surgery should be performed once the

infection has resolved

The mainstay of treatment is surgical

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excision.

Radiofrequency ablation for intraoral

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lymphatic malformations, especially

microcystic lesions.

Magnetic resonance?controlled laser-induced

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interstitial thermotherapy.

The ex utero intrapartum treatment (EXIT)

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procedure.

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PHARYNGEAL

POUCH

Zenker diverticula occur in a muscular

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dehiscence that is present most commonly

between the oblique muscle fibers of the

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inferior constrictor muscle and the transverse

fibers of the CP muscle. This area is known as

the Killian triangle.

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Herniation of the esophageal mucosa posteriorly between

the cricopharyngeus (CP) muscle and the thyropharyngus

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part of inferior pharyngeal constrictor muscles.

Hypothetical abnormalities include the following:
Abnormal timing of deglutition resulting in closure of the

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CP muscle when ideally it should be opening

Incomplete CP muscle relaxation
Elevated resting tone of the entire upper esophageal

--- Content provided by⁠ FirstRanker.com ---

sphincter (UES)

Loss of CP muscle elasticity
CP muscle myopathy or denervation atrophy

--- Content provided by​ FirstRanker.com ---

Central nervous system (CNS) injury with a focal spastic CP

muscle

CP muscle spasm in response to gastroesophageal reflux

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disease (GERD)

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Lahey system

Criteria of the Lahey staging system are as

--- Content provided by‍ FirstRanker.com ---

follows:

Stage I - A small mucosal protrusion is

present

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Stage II - A definite sac is present, but the

hypopharynx and esophagus are in line

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Stage III - The hypopharynx is in line with

diverticulum, and the esophagus is indented

and pushed anteriorly.

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Morton system

Criteria of the Morton staging system are as

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follows:

Small sacs are less than 2 cm in length

Intermediate sacs are 2-4 cm in length

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Large sacs are greater than 4 cm in length

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Van Overbeek system

Criteria of the van Overbeek system are as

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follows:

Small sacs are less than 1 vertebral body in

length

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Intermediate sacs are 1-3 vertebral bodies in

length

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Large sacs are greater than 3 vertebral

bodies in length

Dysphagia - Most patients (98%) present with

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some degree of dysphagia

Regurgitation of undigested food hours after

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eating

Sensation of food sticking in the throat
Special maneuvers to dislodge food
Coughing after eating

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Aspiration of organic material
Unexplained weight loss
Fetor ex ore (halitosis)
Borborygmi in the neck

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The most common life-threatening complication

--- Content provided by⁠ FirstRanker.com ---

in patients with a Zenker diverticulum is

aspiration.

Other complications include massive bleeding

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from the mucosa or from fistulization into a

major vessel, esophageal obstruction, and

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fistulization into the trachea. Coexistent hiatal

hernia, esophageal spasm, achalasia, and

esophagogastroduodenal ulceration are common.

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Squamous cell carcinoma (SCC) within a Zenker

diverticulum is extremely rare, occurring in 0.3%

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of Zenker diverticula worldwide.

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Barium swallow with videofluoroscopy. This

study provides information about the size,

location, and character of the mucosal lining

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of the Zenker diverticulum.

Esophageal manometry

--- Content provided by​ FirstRanker.com ---

Rigid or flexible esophagoscopy is essential

before surgical management to assess the

nature of the mucosa of the Zenker

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diverticulum and to exclude the presence of

SCC or carcinoma in situ.

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Patients with diverticula of under 1 cm or in

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patients with medical comorbidities

precluding surgery.

Botulinum toxin may be used to provide

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temporary relief of dysphagia symptoms.

Zenker diverticula require intervention only if

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they produce symptoms.

Small lesions(<2cm) are satisfactorily treated

with a cricopharyngeus (CP) myotomy with or

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without an invagination procedure.

Intermediate and large diverticula (ie, 2-6 cm)

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are best managed with 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

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diverticulopexy with CP myotomy, depending on

the health of the patient.

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Recurrent laryngeal nerve (RLN) paralysis

Esophageal stenosis

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Mediastinitis

Pharyngocutaneous fistula

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Hematoma

Esophageal perforation

LARYNGOCELE

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Anomalies of the supraglottic larynx.

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Result of air or fluid filled dilation of the laryngeal ventricle,

which communicate with the laryngeal lumen.

Classified as "internal" or "external".

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Internal laryngoceles, are comprised of a collection of air

or serous fluid and mucous in the anterior portion of the

laryngeal ventricle. Their sac remains within the confines of the

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thyroid cartilage.

In contrast, as external laryngoceles enlarge, their sac may

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protrude through the thyrohyoid membrane and present as a

anterior neck mass.

Laryngoceles may be congenital and may also be acquired. They

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are often seen in glassblowers due to continual forced expiration

producing increased pressures in the larynx which leads to

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dilatation of the laryngeal ventricle. It is also seen in people with

chronic obstructive airway disease.

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Lateral Compressible Neck Mass that

increases in size with increase in

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intralaryngeal pressure, Cough, Hoarseness

and possible airway compromise.

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Laryngoceles may also become infected, in

which case they are called Laryngopyoceles.

If infected present with fever, pain,

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leukocytosis etc.

Indirect mirror exam.

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Flexible fiberoptic laryngoscopy.

CT of the neck with IV contrast.

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Internal laryngoceles are managed

endoscopically.

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External laryngoceles and combined internal

and external laryngoceles are managed

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through an open approach.

All procedures, both open and endoscopic,

typically begin with upper airway endoscopy

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to evaluate the lesion completely.

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The term ranula is derived

from the Latin

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word rana, meaning frog,

and describes a blue

translucent swelling in the

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floor of the mouth

reminiscent of the

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underbelly of a frog.

Hippocrates described

ranulas and thought that

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they were secondary to

inflammation. Par?

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thought that ranulas may

represent descent of brain

or pituitary matter.

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Congenital ranulas can arise secondary to an

imperforate salivary duct or ostial adhesion.

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Posttraumatic ranulas arise from trauma to the

sublingual gland, leading to mucus extravasation

and formation of a pseudocyst.

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Plunging ranulas
Also called deep, diving, cervical, or deep

plunging ranula and oral ranula with cervical

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extension.

Plunging ranulas generally appear in conjunction

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with an oral ranula. Patients present first with an

oral swelling in up to 45% of cases, with

associated oral swelling in 34%, and without any

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oral involvement in 21% of cases.

--- Content provided by‌ FirstRanker.com ---

Experimentally, partial severance or ligation of

the sublingual duct leads to ranula formation,

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whereas ligation of the submandibular duct does

not. The ligation of the parotid duct ultimately

leads to atrophy.

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The difference lies in the fact that the sublingual

gland secretes continuously in the interdigestive

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period, whereas the other two major salivary

glands only secrete in response to stimuli, such

as eating. Therefore, with trauma, if a duct is

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obstructed, secretory backpressure builds and

acini rupture, leading to mucus extravasation.

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Plunging ranulas arise in the neck by 3

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mechanisms:

The sublingual gland may project through the

mylohyoid, or an ectopic sublingual gland

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may exist on the cervical side of the

mylohyoid..

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The cyst may penetrate through the

mylohyoid

A duct from the sublingual gland may join

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the submandibular gland, allowing ranulas to

form in continuity with the submandibular

--- Content provided by​ FirstRanker.com ---

gland.

Bluish cyst located below the tongue

May fill the mouth and raise the tongue.

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These are painless masses that do not change in size

in response to chewing, eating, or swallowing.

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Plunging ranulas
Plunging ranulas can manifest as neck swelling in

conjunction with or withuot a floor-of-mouth cyst.

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Usually found in the submandibular space.

They have been reported to extend into the

submental region, the contralateral neck, the

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nasopharynx up to the skull base, the retropharynx,

and even into the upper mediastinum

--- Content provided by FirstRanker.com ---

CT scanning

--- Content provided by‌ FirstRanker.com ---

MRI

Ultrasonography

Lymphadenopathy

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Cystic hygroma
Pleomorphic adenoma
Abscess
Thyroglossal duct cyst
Dermoid or epidermoid cyst

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Laryngocele
Lipoma
Hemangioma
Cervical thymic cyst
Cysts of the parathyroid or thyroid gland

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Marsupialization

--- Content provided by⁠ FirstRanker.com ---

Placement of suture or Seton

Sclerosing agents

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Carbon dioxide laser

Radiation therapy

Sublingual gland excision

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paraesthesia of the lingual nerve

injury to the Wharton duct

--- Content provided by​ FirstRanker.com ---

obstructive sialadenitis

salivary leakage

recurrence of the ranula

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Congenital sequestration dermoid.

--- Content provided by⁠ FirstRanker.com ---

Formd by inclusion of ectoderm at fusion line of

first arch.

Thin walled cyst lined by squamous epi.

--- Content provided by‌ FirstRanker.com ---

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

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below the chin.

Pain may be asso with infection.
Tranillumintion is ?ve.
Tt is excision.

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STERNOMASTOID

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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.

It may or may not be associated with torticollis.

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Generally, the "tumor" initially grows, then stabilizes, and in

about half the cases recedes spontaneously after a few months. It

may leave a residual torticollis or may be associated with a facial

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or cranial asymmetry of a delayed torticollis.

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.

The treatment is controversial.

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Approximately half of these "tumors" will resolve spontaneously

without sequelae.

Progressive torticollis or development of facial asymmetry are

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considered indications for surgery.

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CAUSES OF LYMPHADENOPATHY

Infection

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Acute

Pyogenic infections

Infectious mononucleosis

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Toxoplasmosis

Infected eczema

--- Content provided by FirstRanker.com ---

CMV

Chronic

TB

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Sarcoidosis

Syphilis

--- Content provided by‍ FirstRanker.com ---

HIV

CAUSES OF LYMPHADENOPATHY

Malignancy

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Primary

Hodgkins lymphoma

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Non-Hodgkins lymphoma

CLL

ALL

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Secondary

Nasopharngeal

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Thyroid

Lung

Breast

--- Content provided by‍ FirstRanker.com ---

Stomach ("Troisier's sign")

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TUBERCULAR

LYMPHADENOPATHY

--- Content provided by FirstRanker.com ---

? Enlargementoflymphnodes,typicallytogreaterthan

1.5cmwithchangeintsconsistency,isknownas

? Lymphadenopathy.

--- Content provided by​ FirstRanker.com ---

Tuberculosisachronicgranulomatousinfection

causedbyMycobacteriumtuberculosi,whichisan

--- Content provided by‍ FirstRanker.com ---

? acid-fastbacil us.

? It com onlypres ntsaspulmonarytuberculosi .

Acom onextrapulmonarymanifestationof

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tuberculosislymphadenopathy.

--- Content provided by‍ FirstRanker.com ---

CervicalLN(mostcom on)

--- Content provided by​ FirstRanker.com ---

InguinalLN,

Axil aryLN,

Mes ntericLN,

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Mediastinal& HilarLN,and

Intramam aryLN.

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1. Inhalationof rganisminfreshcoughdropletorin

2. dIrniegdes

st put

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ion um

.

--- Content provided by FirstRanker.com ---

ofrganisms(duetoselfswallowingof

infectedsputumoringestionofbovinetubercule

3. bIancinlo fr

--- Content provided by‌ FirstRanker.com ---

culoamti

io nf

--- Content provided by⁠ FirstRanker.com ---

n ectedmilk.

4. Trans-placental route (rare)

--- Content provided by​ FirstRanker.com ---

B
? yJones& Campbel

--- Content provided by FirstRanker.com ---

Stage1-Reactivelymphadenitis:Enlarged,Firm

mobilediscretnodeshowingnonspecifcreactive

? hyperplasia.

--- Content provided by‌ FirstRanker.com ---

Stage2-Periadenitis:Largerubberynodesfixedto

? surroundingtis ue(matingtakesplace)

--- Content provided by‍ FirstRanker.com ---

Stage3-Coldabsces:Centralsofteningduetoabsces

formation.

Caseatingnecrosinlymphnodestakesplace.

--- Content provided by​ FirstRanker.com ---

Stage4-Colarstudabsces :Absces is nde pfascia,it

ruptures&comesinsuperficalfasciabutremainsinside

--- Content provided by⁠ FirstRanker.com ---

theskin.

Stage5-Sinus:Blindtractlinedbygranulationtisue.

--- Content provided by​ FirstRanker.com ---

Stage 4- Collar stud abscess : Bilocular abscess with

one locule deep to the deep fascia and another

--- Content provided by FirstRanker.com ---

locule in superficial fascia.

Stage 5-Sinus tract formation : A blind tract lined

--- Content provided by​ FirstRanker.com ---

by granulation tissue.

Sinus formation

--- Content provided by‍ FirstRanker.com ---

Reactive lymphadenitis

a)

--- Content provided by FirstRanker.com ---

?LNbecomes

b) Inflam ed

--- Content provided by FirstRanker.com ---

c) Enlarge

d) Palpable

Te

--- Content provided by‌ FirstRanker.com ---

P nd

e er

riadenitis ?

--- Content provided by​ FirstRanker.com ---

a)
b) MatedLNmas

Slightender

--- Content provided by⁠ FirstRanker.com ---

Cold abscess

a)
b)Noriseintemperature

--- Content provided by‍ FirstRanker.com ---

c)Nopain

d)Notendernes

--- Content provided by‍ FirstRanker.com ---

No

Coredne

llar s stud abscess

--- Content provided by FirstRanker.com ---

a)
b)Signsofinflam ationonskin

c)Fluctuation

--- Content provided by FirstRanker.com ---

Sweling

--- Content provided by FirstRanker.com ---

Sinus

a)
b)Openingintheneckorulcer(underminededge)

--- Content provided by​ FirstRanker.com ---

c)Bluishdiscol urationofskin

Pusdischarge;Caseatingmaterialcomesout.

--- Content provided by⁠ FirstRanker.com ---

PYOGENIC ABSCESS

COLD ABSCESS

?

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?

?Notsocom on.

--- Content provided by⁠ FirstRanker.com ---

?Com onestvarietyof

absces.

Cardinalsignsof

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in
? flam ationare

?Allcardinalsigns of

--- Content provided by‍ FirstRanker.com ---

inflam ationpresnt. absent.

?Doesnotproducehot

--- Content provided by‌ FirstRanker.com ---

?Producehot& painful

absces.

Brawnyoedmawith

--- Content provided by⁠ FirstRanker.com ---

in

&painfulabsces.

--- Content provided by​ FirstRanker.com ---

Brawnyinduration,

o
? ed ma& tendernes

--- Content provided by‌ FirstRanker.com ---

? durationpres nt

whenpusisdepseated.

Aresultofprimary

--- Content provided by​ FirstRanker.com ---

disease.

areabsent.

--- Content provided by‍ FirstRanker.com ---

Almostalwaysasequel

oftubercularinfection.

--- Content provided by FirstRanker.com ---

TREATMENT:

1.Suitableantibotic

--- Content provided by​ FirstRanker.com ---

started.

TREATMENT:

--- Content provided by‍ FirstRanker.com ---

1.Fullantiubercular

2.Pusisdrainedby

regimestarted.

--- Content provided by FirstRanker.com ---

givngincisonon 2.Pusisdrainedby

mostprominetpart. givnganoblique

--- Content provided by​ FirstRanker.com ---

incison

A 43-year-old man presents to his GP with a 6-

month history of a painless pulsatile mass at the

--- Content provided by‍ FirstRanker.com ---

angle of the jaw.

A 23-year-old girl complains of intermittent

--- Content provided by‌ FirstRanker.com ---

numbness and paraesthesiae in her right hand

for the past 2 months. On examination there is a

fixed, hard, 1cm2 cm swelling in the right

--- Content provided by​ FirstRanker.com ---

supraclavicular fossa.

A 3-year-old boy is seen by his GP with a

--- Content provided by‌ FirstRanker.com ---

enlarging midline swelling that has been

present for the past year. It is smooth and

rounded, located just below the hyoid bone,

--- Content provided by‍ FirstRanker.com ---

measuring 2 cm2 cm, and rises on protrusion of

the tongue.

--- Content provided by FirstRanker.com ---

A 32-year-old woman presents to her GP with a

neck lump enlarging for the last 3 years. It

--- Content provided by‌ FirstRanker.com ---

measures 1 cm1.5 cm and is located behind the

junction of the upper and middle thirds of the

left sternocleidomastoid muscle. In the past this

--- Content provided by⁠ FirstRanker.com ---

lump has become infected, resolving with oral

antibiotics.

--- Content provided by​ FirstRanker.com ---

A 23-year-old man presents to his GP with a 2

cm3 cm painless lump at the angle of the jaw;

it has been there for 2 months. He also

--- Content provided by‌ FirstRanker.com ---

complains of weight loss, night sweats and fever,

over the same period. Hepatosplenomegaly is

--- Content provided by‍ FirstRanker.com ---

detected on examination of the abdomen.