Parotid

Question 1

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Answer 1

Inspection:
I examined a patient presenting with a swelling in the neck region.
On inspection, the swelling was located in the (mention region — e.g., parotid/thyroid/submandibular) region, (mention relation to landmarks like mandible, SCM, midline, etc.).
It was (shape), approximately (size), with (smooth/irregular) surface.
The overlying skin showed no redness, scars, sinus, or dilated veins.
No similar swelling was seen on the contralateral side.
(If relevant) The swelling moved/ did not move with swallowing or tongue protrusion.
No visible pulsation.

⸻

Palpation:
There was no local rise in temperature or tenderness.
The swelling was (soft/firm/hard), (smooth/irregular), (mobile/fixed) with well-defined/ill-defined margins.
It was (non-pulsatile) and (non-compressible/non-fluctuant).
The overlying skin was free/adherent to the swelling.
It was mobile side-to-side / vertically fixed (as appropriate).
Cervical lymph nodes were palpable/not palpable.

(If parotid):
Facial nerve function was intact/affected.
Bimanual palpation revealed deep lobe palpable/not palpable.
Stenson’s duct showed no inflammation or stone.

(If thyroid):
The swelling moved with deglutition and not with tongue protrusion.
There was no retrosternal extension on palpation.
No bruit or thrill felt.

⸻

Percussion and Auscultation:
(If relevant) — No dullness, no bruit heard.

Question 2

Differential diagnosis of parotid lump?
Investigations
Treatment
Rule of 80
Differ benign vs malignant

Answer 2

• Benign neoplasm:
Pleomorphic adenoma
• Warthin’s tumor

• Malignant neoplasm:
• Mucoepidermoid carcinoma
• Adenoid cystic carcinoma
• Adenocarcinoma
• Lymphoma

• Inflammatory:
• Sjögren syndrome
• Mikulici’s syndrome
• Infective:
• Parotitis

Investigations?
• CT, MRI to assess the extent of local, bony, or perineural invasion
• U/S
• FNAC

Treatment?
Superficial parotidectomty

Q:rule of 80?
-80% of salivary gland
neoplasm
in parotid
-80% of parotid neoplasm is benign
-80% of benign neoplasm in parotid is pleomorphic adenoma

I:signs differentiate malignancy from benign in parotid?
-Rapid growth
-facial nerve affection
-pain
-attached to underlying structure