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What can a lump in the neck be?
- LYMPH NODES
- GRANULOMATOUS DISEASE
- OTHER DISCRETE LUMPS IN NECK
What �other� lumps could it be, if not lymph node or salivary?
- Branchial Cyst
- Skin cyst
- Soft Tissue Neoplasms
What is a Branchial cyst?
- At angle of mandible,
- Histo - lymphoepithelial cyst,
- developmental remnant
- Surgical removal
- complication Branchial fistula?
How can a dermoid cyst present?
- can be I/O or E/O
- Doughy/fluctuant swelling
- FOM / midline of neck
- Double chin
- displaces tongue (interferes with speech/swallow)
- Surgical removal
Why is the deep cervical chain of nodes important?
all head and neck lymphatic eventually drain into deep cervical nodes.
What lymph nodes make up the cervical chain, along which vein do they run?
- Internal jugular vein
- most superior - jugulodigastric (tonsils)
- Jugulomyohyoid node - drainage from tongue
What does Submandibular lymph node receive drainage from?
- structures along path of facial artery
What does the submental lymph node receive drainage from?
- lower lip,
- tip of tongue
- lower incisor teeth
What consistency is a node assoc with inflammatory process (most likely due to infection)?
Suggest general INFECTIVE causes of lymphad:
- Oral or local infection (dental, ENT)
- Upper respiratory tract infection (viruses)
- systemic infection (e.g HIV, CMV, EBV)
Suggest 6 viral causes of lymphadenopathy:
- HIV (PGL)
- Herpes simplex
- Varicella zoster
Suggest Bacterial causes of lymphadenopathy:
- Local infections of head and neck
- Cat scratch fever
Suggest a Protozoal cause of lymphadenopathy:
Suggest a Fungal cause of lymphadenopathy:
Tx for cat scratch and toxoplasmosis?
- Both self limiting.
- Long term tetracycline
What are possible NEOPLASTIC causes of neck lumps?
- Oro-pharyngeal Squamous Cell Carcinoma
Granulomatous cause of cervical lymphadenopathy?
- Pulmonary lesions most common
- cough / dyspnoea
- Bilateral hilar lymphadenopathy
Oral symptoms of sarcoidosis?
- Lip swelling,
- cobblestone mucosa
- Ulcers or focal swellings
- Hyperplastic gingivitis
- Salivary swellings/ dry eyes / dry mouth (SS-like)
In combo with uveitis, facial palsy, pyrexia and parotitis, sarcoidosis?
General principles of managing neck lumps?
- Special investigations
- ----Haematology and serology
- ----Ultrasound +/- fine needle aspiration biopsy +/- core
- Open biopsy � EUA
- Neck dissection