1
Q
Top 3 concerns when evaluating a neck mass
A
Reactive/Inflammatory
Neoplastic
Developmental
2
Q
Acute/Reactive neck masses
A
o Infection- EBV/HIV/CMV, viral URI, bartonella henselae (cat scratch), staph/strep, toxoplasmosis
o Sialadentis
3
Q
Subacute neck mass differential
A
o Cancer- think lymph nodes- painless, growing
o lymphoma
o HPV squamous cell
o Parotid/thyroid
o Metastasis
4
Q
Chronic neck mass differential
A
o Cancer
o Goiters
o Thyroid nodules
o Congenital cysts
o Laryngocele
5
Q
Most common congenital cyst
A
Thyroglossal Duct Cyst
6
Q
Thyroglossal Duct Cyst pathophysiology
A
- Cystic expansion of a remnant of the thyroglossal duct tract
- Often recent URI infection
7
Q
Thyroglossal Duct Cyst presentation
A
- Midline (or slightly off)
- Adjacent to the hyoid bone
- Mobile, soft, painless
- Rise with swallowing or tongue
protrusion - Kids: infection
- Adults: hoarse, dysphagia, pain, globus
sensation
8
Q
Thyroglossal Duct Cyst diagnosis
A
o US (kids), CT (adults), MRI
o Consider FNA biopsy
9
Q
Thyroglossal Duct Cyst Mgt
A
- Antibiotics if infected
- Refer**
- Surgery
- Sclerotherapy if confirmed noncancerous in
nonsurgical candidates
10
Q
20% of pediatric neck masses are ____
A
Branchial Cleft Cyst
11
Q
Pathophysiology of Branchial Cleft Cyst
A
Arise on the lateral part of the neck from a failure of pharyngobranchial ducts/branchial cleft structures to obliterate during fetal development
12
Q
Branchial Cleft Cyst presentation
A
- Inferior to the angle of the mandible and anterior to the
sternocleidomastoid muscle (SCM) - Painless, mobile, fluctuant mass
- Recurrent infection
- May have sinus/fistula tract
13
Q
What cyst is located Below jaw angle
Anterior to SCM?
A
Branchial Cleft Cyst
14
Q
Branchial Cleft Cyst management
A
- Antibiotics if infected
- Refer
- Surgical excision
15
Q
Laryngocele pathophysiology
A
- Chronic coughing, repetitive nose blowing, glass blowing,
musical instruments - herniation of the saccule of the larynx
- Increased airway pressure causes an intermittent air-filled
swelling of lateral neck
16
Q
Laryngocele presentation
A
- Hoarseness, cough, dyspnea, dysphagia, a foreign body sensation
- Neck bulge, changes in size
- Internal, external or combined
17
Q
Laryngocele management
A
- Laryngoscopic decompression
- Surgical excision
- Laser endoscopy
18
Q
Ranula pathophysiology
A
- trauma to the excretory duct of the major salivary glands or obstruction of the duct
- leaking mucus collects
- oral ranulas – secretions accumulate higher
- cervical/plunging ranulas- secretions accumulate along fascia of neck
19
Q
Ranula presentation
A
- large, cystic, translucent to blue, painless swelling in the floor of the mouth
- interfere with speech, swallowing, mastication
- may displace the tongue
20
Q
Teratoma pathophysiology
A
- germ cell tumors composed of multiple cell types derived from 3 germ layers
- tissue foreign to the site of origin- things growing in the wrong place
- differentiates toward somatic-type cell populations- may contain hair, teeth, bone
21
Q
Teratoma presentation
A
- Neck mass- Often at birth
- Disfigurement
- Compression of airway, neck structures
- Wheezing, SOB, dysphagia
- Palpable, firm mass
22
Q
Teratoma Management
A
- Surgical
- If dx’d prenatally: follow w/ serial US, c-section, secure airway, surgery
23
Q
Dermoid Cyst pathophysiology
A
- surface ectodermal elements along the lines of embryonic closure
(outside skin gets inside) - lined by stratified squamous epithelium
- filled with keratin and hair, sebaceous glands
- benign
24
Q
Dermoid Cyst presentation
A
- pale, flesh-colored, pearly, dome-
shaped, firm nodule - Asymptomatic, slow-growing
- may have a hair; usually solitary
- frontal, occipital, and supraorbital areas
- most common- near end of eyebrow
- neck- submental
25
Dermoid Cyst management
Excision
26
Hemangioma pathophysiology
* benign tumors of vascular endothelium
* blood vessels form incorrectly and multiply more than they should
* grow quickly for first 5 months, then start shrinking by age 1; mostly
shrunk by age 4
27
60% of hemangiomas are found on the ____
head and neck
28
Hemangioma presentation
* Absent at birth- appear 1-4 wks
* Superficial: raised, lobulated and bright red, “strawberry marks”
* Deep: blueish or skin color nodule/plaque
29
Hemangioma management
* Most resolve- can have residual scar, saggy skin, telangiectasia
* Depends on location, associated structures, size
* If complicated
- oral or injected steroids
- oral or topical propranolol
- excision
Refer- derm, plastic surgery
30
Reactive Lymphadenopathy epidemiology
* Benign LAD common in kids
* Kids- #1 viruses- resolve in 1-2 weeks
* Infections: staph/strep, cat scratch dz, tuberculosis, EBV/HIV/CMV,
toxoplasmosis,
* Eczema
31
Reactive Lymphadenopathy pathophysiology
* lymph glands respond to infection by becoming swollen
* Supraclavicular------rule out malignancy
32
Reactive Lymphadenopathy presentation
* Normal node- < 1 cm, mobile, soft
* Reactive- firm, enlarged, tender, red
* Malignancies- rubbery/hard, enlarged, matted, nontender, fixed
33
Reactive Lymphadenopathy Management
* Observe
* Course of abx- 10-14 days augmentin, Keflex, clindamycin; azithryomycin
if cat scratch dz
* Refer for bx: B symptoms; hard, firm, or rubbery consistency; fixed;
supraclavicular; > 2 cm in diameter; persistent enlargement for more than 2
weeks; > 1 cm and doesn’t resolve 4-6 weeks; failure to respond to abx
34
Sialadenitis acute vs chronic presentation
* Acute- sudden swelling, pain, fever, chills, pus drainage, foul taste in mouth
* Chronic- not typically painful, firm gland,
intermittent acute episodes; progressive loss of gland function
34
Sialadenitis pathophysiology
* inflammation of a salivary gland
* retrograde bacterial contamination and stasis of flow- slow saliva
* obstructive, infectious, or inflammatory etiology
* staph/strep/h. flu
* most common in parotid gland
35
Sialadenitis Management
* Treat infection- abx– Augmentin, clindamycin
* Treat underlying risk factors- hydrate, warm compress, stimulate salivary flow- lozenges, salivary gland massage, NSAIDs
36
Sialolithiasis epidemiology
* 30-60 yo, M>F
* 80-90% Wharton’s duct (submandibular gland)
37
Sialolithiasis risk factors
* Hypovolemia
* Diuretics
* Anticholinergic medications
* Trauma
* Gout
* Smoking
* History of nephrolithiasis
* Chronic periodontal disease
38
Sialolithiasis pathophysiology
* Stones within the salivary glands or
the salivary gland ducts
* Secondary to reduced salivary flow
39
Sialolithiasis presentation
* Postprandial and pre-prandial pain
* Swelling
* Recent sialadenitis
* Can have painless swelling
* Episodic or persistent
40
Sialolithiasis management
1. Conservative- hydrate, apply moist heat to the involved area, massage the gland, "milk" the duct
* Increase saliva- candies
* Stop anticholinergic med if possible
2. Antibiotics
* dicloxacillin 500 mg QID x 7-10 days
cephalexin 500 mg QID x 7-10 days
* If no improvement in pain/fever- augmentin,
clindamycin
3. Refer- if refractory to treatment (after 2-3 days) or
recurrent; sialoendoscopy, lithotripsy
41
Parotitis Epidemiology
* MUMPS
* Children, college age; late winter to spring
* vaccine
42
Parotitis pathophysiology
* MUMPS- highly infectious
* Other viral causes: flu, coxsackievirus, Epstein-Barr virus, CMV, parainfluenza viruses,
herpes simplex virus (HSV), HIV
* Complications: orchitis, meningitis, encephalitis, and deafness
* MUMPS
43
Parotitis diagnosis
* IgM antibody, PCR oral swab, serum PCR for mumps
* If vaccinated- not helpful (IgM is negative half the time)
* Meningitis- lumbar puncture
44
Temporomandibular Joint Disorder Pathophysiology
* interplay of biological, behavioral,
environmental, and cognitive
1. Joint trauma
2. Poor posture
3. Low pain threshold
4. Mental illness- depression/anxiety, PTSD,
abuse
45
Temporomandibular Joint Disorder presentation
* Facial pain (96 percent), chewing pain
* Ear discomfort or dysfunction (82 percent)
* Headache (80 percent)- jaw, temple, or forehead
* TMJ discomfort or dysfunction (75 percent)- small ROM, pop & lock
46
Temporomandibular Joint Disorder Management
Improve posture, strengthen neck muscles, physical therapy an option
* Nighttime bite splints
* Good sleep hygiene
* Warm compresses 3-5 times daily w/ gentle massage
* Avoid gum, chewing hard food
* Manage psychological factors- stress, mood disorders
* Meds- NSAIDs 10-14 days, muscle relaxant, TCAs (nortriptyline)
EENT Exam 3
flashcards
Decks in class (4)
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