benign head and neck neoplasms

7/24/2019 Benign Head and Neck Neoplasms

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References: So urce: Cor Chr ist i batch 2009 and 2011, past po werpoin t, recording , past-e

Guys, this is based on batch 2012 ppt. Ayaw kasi bigay ni doc ung new ppt nya.Items that came out in the past-es are Emphasized.I encourage everyone to read other references na rin, remember mahirap maging pula ulit ung Evalsresults nating lahat. Thats all I ask of you. God bless!

BENIGN TUMORS OF HEAD AND NECK

I. SURGICAL ANATOMY OF THE NECK

The neck is divided into specifictriangles: anterior triangle andpostero-lateral triangles.

The sternocleidomastoid will dividethe neck into anterior and posteriortriangle.

A. TRIANGLES OF THE NECK

Knowing the anatomy is important so that you will know what structures to look for whenpresented with masses in these particular areas. And based on what is under those triangles,more or less it will give us an idea of what structures are involved:

Location Triangle Boundaries ComponentsAnterior submandibular

triangledigastric muscles floor of the mouth,

submandibular glandand LN, facialvessels, carotids,IJV, vagus nerve

contains the cervicalparts of theaerodigestive tract:larynx and trachea,hypopharynx andesophagus, thyroidand parathyroidglands, carotidsheath and the large

neurovascularstructures containedtherein, andsuprahyoid andinfrahyoid strapmuscles, andassociatedneurovascular andlymphatic structures.

carotid digastric andomohyoid

carotid artery, IJV,hypoglossal andlaryngeal nerve

muscular omohyoid and hyoid midline structures;thyroid, strapmuscles, larynx,traches, esophagus

submental digastric and hyoid submental lymphnodes

Posterolateral Occipital SCM, traps, inferiorbelly of omohyoid

nerves such asspinal accessorynerve

bounded by theborders of thesternocleidomastoidand trapezius andthe middle third ofthe clavicle.Contains fibrofattylymphatics,, CN XI,cervical nerveplexus, and smallvascular bundles,hence known asbloody gulch

Supraclavicular SCM, inferior bellyof omohyoid,clavicle

low and middletrunk of brachialplexus,EJV,subclavian artery,nerve tosubclavius

Anterior Submandibular Carotid Muscular Submental

Lateral

Occipital Supraclavicular

1Benign Tumors ofHead and NeckDr. Billones

Erik

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B. CERVICAL LYMPHATICS

Cervical lymphatics are important in localization of the sites because this will give an idea on whatprimary sites to look for.

Superficial

lie near the surface of the neck along the external jugular vein

Superficial anterior and Superficial lateral

perforate the first layer of cervical fascia to empty into the deep cervical lymphatic chain

Although frequently involved by metastasis, especially during the late stages, the superficiallymph nodes are nevertheless of little significance from a practical standpoint of surgicaltreatment.

The reason is that if superficial lymphatics are involved with cancer they cannot be removedwithout resection of large areas of skin.

Deepmore important

since they receive lymph from the mucous membranes lining the mouth, pharynx larynx, andmajor salivary and thyroid glands, as well as the skin of the head and neck.

Accompany the internal jugular vein and their branches or lie within the major salivary glands

AnteriorSubmandibular (I)

preglandular

interglandular

prevascular and retrovascular

submental (IB)Anterior Compartment Group (VI)

Pre-tracheal

Para-tracheal

Pre-laryngeal

Jugular chain (II, III, IV)-> related to IJVsuperior jugular (Subdigastric) (II)

o junctional nodes of Finch

middle (III)

inferior (IV)o prescalene nodal masses

Lateral (Spinal accessory group) (V)

Upper

Middle

Inferioro supraclavicular group

Left

Thoracic duct

climbs upward and left lateral arch behind the carotid sheath, receives tributaries from the neck,enters the venous junction between the internal jugular and subclavian veins

Virchows nodes-enlarged, hard, left supraclavicular nodes that may indicate abdominalmalignancy

Multiple lymphatic ducts drain the right side which also drains to the venous system in the right.

Right

Multiple lymph vessels (right lymphatic duct)


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II. BENIGN TUMORS OF HEAD AND NECK

Frequency distribution by age, causative group and location

0-15 16-40 >40

CONGENITAL

Vascular lesions (AT)Branchial cyst (AT)Thyroglossal cyst (M)Dermoid (M)

CONGENITAL

Branchial cyst (AT)Thyroglossal cyst (M)Dermoid (M)

NEOPLASTIC

MetastaticCarcinomaThyroid

INFLAMMATORY ADENITISBacterial (AT/PT)Viral (AT/PT)Granulomatous (PT/AT)

INFLAMMATORY ADENITISViral (AT/PT)Bacterial (AT/PT)Granulomatous (PT/AT)

INFLAMMATORY ADENITISViral (AT/PT)Bacterial (AT/PT)Granulomatous (PT/AT)

NEOPLASTICLymphoma (AT/PT)Thyroid Ca (M)Sarcoma (AT/PT)

NEOPLASTICLymphoma (AT/PT)Thyroid Ca (M)Salivary (AT)Metastatic (AT/PT)Vascular (AT/PT)Neurogenic (AT)

CONGENITALBranchial cyst (AT)Thyroglossal cyst (M)

ATanterior trianglePTposterior triangleMmidline

youn ger group (0-15)-> Congenital(more common in this group) > inflammatory adenitis >neoplastic(least to think of)

***m iddle age gr oup (16-40) -> most present with congeni ta l

***older age g roup (>40) -> (think of) neoplastic> inflammatory adenitis > congenital (least tothink of)

A. BENIGN VASCULAR LESIONS

1. HEMANGIOMAS

a. Classification of Vascular Anomalies

Tumors (proliferative)- grow by cellular or endothelial hyperplasia, regress or persists

Juvenile hemangioma Rapidly involuting congenital hemangioma

Noninvoluting congenital hemangioma Kaposiform hemangioendothelioma Tufted angioma

Vascular malformations (structural anomalies)- quiescent endothelium, local defects of

morphogenesis, never regress

High-flowo Arteriovenous malformation

Low-flow Venous malformationo Lymphatic malformationo Lymphatic-venous malformationo Capillary (or venular) malformation

b. Description

overproliferation of vascular entities due to abnormal changes in angiogenesis

characterized histologically by high endothelial cell turnover

compared with vascular malformation which have normal endothelial cell turnover and

abnormal gross vascular anatomy

clinical "life cycle includes proliferative, plateau, and involution

30% are visible at birth, 70% become visible within one to four weeks after birth; majority arevisible a month after birth


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occur 5 times more often in females than in males, predominantly in Caucasians

low birth weight infants(less than 2.2 pounds) have a 26% chance of developing a lesion

usually involute in time (30% will resolve by 3 years of age, 50% by 5 years of age, and 80%-90%by 9 years of age) -> so do watchful waiting and manage conservatively

composed of proliferating, plump endothelial cells with limited basement membranes which

eventually form vascular spaces and channelstissue inhibitors of metalloproteinases(TIMPs), along with interferon and transforming growthfactor produced by the mast cells, terminate the endothelial cell proliferation and passivelyinduce involution by senescence of endothelial cells

cause nor the cell of origin of infantile hemangiomas has not been definitively elucidated

Theories on the cell of origin:

- placental tissue- cell markers (GLUT- 1, merosin, Lewis Y) - endothelial progenitor cells (EPCs) - mesenchymal stem cells

visible lesion on the face or neck may signify presence of another internal hemangiomaor may be part of a syndromic complex

PHACESo Posterior fossa structural brain abnormalitieso Hemangiomao Arterial Lesionso Cardiac abnormalities/Coarcatationo Eye abnormalities

over one-half of hemangiomas heal with an excellent cosmetic result without treatment

hemangiomas are proliferative lesions as compared to arteriovenous malformations which arevessel malformations

Superficial flat lesions which appear reddishin color

Deep deep beneath the skin and bluishin color

Compound both deep and superficial

c. Clinical Presentations:

Cavernous compressible globular, bright red or deep purple involving deep structures

Capillary plaque-like lesions, slightly elevated, more superficial

Port-wine stain flat, capillary type, mostly in dermis

Strawberry marks capillary type with cavernous component

Spider telangiectasia Senile hemangiomas/ruby spots

d. Indications for treatment: (PAST E)

***usually just do watchful waiting and inform the parents/px that it will involute in time because chances

are, it will.

Involvement of a vital organ, like the eye or ear, or windpipe Bleeding (recurrent) Ulceration Crusting or infection Rapid growth and deformity (that will compromise function; e.g airway)of the surrounding tissues


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e. Diagnosis and Treatment:

CT scan, MRI for deep and large lesions Ultrasonography with color flow is cost effective but is operator dependent and does

notaccurately depict the relation of the lesion to other anatomic structures for fairly small areas and not on the face, intralesional injection with steroidswith or without

liquid nitrogen cryosurgery Pulsed dye laser can be used to reduce the superficial component along with the steroid

injection Largerhemangiomas require oral steroids usually given during the proliferative phase,

inhibits vascular endothelial growth factor(VEGF)

Alpha-interferon is recommended for lesions not responding to steroids and if the lesion isproblematic or life threatening (Spastic dysplegia has been associated in 10-12% of the childrentaking this drug)

Surgical excision-> could be very bloody (since it is a vascular lesion) so plan the surgery wellto prevent blood loss

Embolization

2. LYMPHANGIOMAS

a. Description

represents tumors, malformations or hamartomas of the lymphatic system

collections of lymph vessels filled with serous fluid

soft lesions with ill-defined borders

50% apparent at birth, 90% appear before age 2 years

reflects a failure of lymph ducts to connect with the venous system duringembryogenesis, abnormal sequestration of lymphatic structures, or both

found in patients with syndromic conditions (Turner, Klinefelter and Noonans syndromes)

b. Types

Lymphangioma circumscriptum

confined to superficial skin, forming small, vesicle-like lesions Cavernous

tongue, cheek, floor of mouth, lips, nose Cystic Hygroma

most common in the neck (posterior triangle behind the SCM) but may extend tothe head, face, axilla or mediastinum

Multicystic

tend to spread along vital structures and high incidence of recurrence

c. Diagnosis and Treatment

CT Scan, MRI for large and deep lesions

Wide surgical excision, staged excisions

in localized disease, a conservative period of watchful waiting is appropriate if thelesion causes no immediate compromise to life functions

fewer than 15% of lesions spontaneously regress

some surgeons believe that if the lesion has not spontaneously regressed by age 5years, surgical intervention is warranted

excision should be performed sooner to avoid complications (e.g. infection)

multistage operation for diffuse disease


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B. BENIGN SALIVARY GLAND TUMORS

most (70%) salivary gland tumors originate in the parotid gland (PAST E)

remaining tumors arise in the submandibular gland (8%) and minor salivary glands (22%)

75% of parotid gland tumors are benign, slightly more than 50% of tumors of the submandibulargland and 60-80% of minor SGTs are found to be malignant

classic presentation of a benign SGT is a painless, slow-growing mass on the face(parotid), angle

of the jaw (parotid tail, submandibular), or neck (submandibular) or a swelling at the floor of themouth (sublingual).

freely mobile, no facial nerve involvement- PAST E

sudden increase in size may be indicative of infection, cystic degeneration, hemorrhageinside the mass, or malignant degeneration

1. BENIGN EPITHELIAL TUMORS

Pleomorphic Adenoma (Benign Mixed Tumor)

most common tumor of the salivary gland

originate from intercalated duct cells and myoepithelial cells most often located in the tail of the parotid gland when in the minor salivary glands, the hard palate is the site most frequently involved,followed

by the upper lip

contains epithelial and connective tissue components Case Example:A 45 yr old female, right pre-auricular mass, firm, well-circumscribed, movable,

nontender w/ no facial nerve deficit.

Warthins Tumor (Cystadenolymphoma)

smooth, soft, parotid mass, well encapsulated and contains multiple cysts has a heavy lymphoid stroma tends to be bilateral (10% of cases)

Intraductal papilloma

small, tan, fairly smooth lesion, usually found in the submucosal layer rare

Oxyphil adenoma (oncocytoma)

manifest as small ( soft with straw-colored fluid upon aspiration surgical excision with preservation of the vital structures is the treatment of choice rarely cause symptoms of airway obstruction and excision is usually for cosmetic reasons

Lipoma

relatively uncommon in a major salivary gland derived from fat cells appear grossly as smooth, well-demarcated, bright-yellow masses consists of mature adipose cells with uniform nuclei.


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3. SALIVARY GLAND TUMORS DIAGNOSTIC PROCEDURES

the utility of FNAB has been well established with a reported accuracy rates of 74-90% procedure is somewhat operator dependent it is generally regarded as safe, simple to perform, and relatively inexpensive and results in

low morbidity controversy exists about whether FNAB is warranted for masses in the superficial lobe of the

parotid gland, as it is not likely to change the management because you end up still removingthe superficial lobe

CT scan or MRI for deeper lesions Management of benign SGTs includes complete removal with an adequate margin of tissue To avoid

recurrences

Surgical Complications- recurrence from inadequate excision or innoculation- bleeding- seroma formation- nerve injury (facial, lingual, hypoglossal nerves)- salivary fistula- Frey Syndromegustatory sweating caused by aberrant connection of parasympathetic fibers of

the salivary gland to sweat glands of the skin. (PAST E)

C. BENIGN ODONTOGENIC TUMORS

ODONTOGENIC CYSTS AND TUMORS derived from tissues of developing teeth

1. ODONTOGENIC CYSTS (Inflammatory)

Radicular Cyst

most common odontogenic cyst (65%)

thought to arise in response to inflammation originate in preexisting periapical granulomas painless when sterile but painful when infected xray shows pulpless, nonvital tooth with small well-defined periapical

radiolucency at its apex

Tx:extractionof the affected tooth and its periapical soft tissue

Paradental Cyst

Due to inflammation of the gingivaoverlying a partly erupted third molar.

2. ODONTOGENIC CYSTS (Developmental)

Dentigerous Cyst

developmental cyst, 2nd

most common (24%) originate via the accumulation of fluid between reduced enamel epithelium and a completed tooth

crown usually found in the mandibular third molars, maxillary canines, maxillary third molars most are asymptomatic, but large lesions can cause displacement or resorption of adjacent teeth and

pain xray shows a unilocular radiolucency with well defined sclerotic margins encircling the crown

of an unerupted tooth -> may clinically present the same as a radicular cyst but is different

radiographically (PAST-E) enucleation or decompression followed by enucleation if large.

Did you know?

For the taga-taas dati, DLSU-D is

now PAASCU Level 4, meaning it

now has the same quality of

education as DLSU-M and ADMU


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Odontogenic Keratocyst

3rd

most common- scalloping on x-rays- great mimic (e.g. ameloblastoma, dentigerous cyst)- diagnosis is a histologic one-

aggressive and can be difficult to remove- can grow quite rapidly, with frequent

recurrences- 40% of OKCs appear in a dentigerous

relationship, 9% of dentigerous cysts are OKCs when the histology is examined

Lateral Periodontal cyst

- well-circumscribed unilocular radiolucency along the lateral periodontal are- arises from cystic degeneration of clear cells of the dental lamina- most frequent location is at the level of the mandibular premolars but it has been reported

occurring in other areas- clinically silent and is usually discovered during routine radiologic examination

Residual Cyst

- an odontogenic cyst that remains within the jaw after the removal of the tooth with which it was

associated

Gingival Cyst of the Newborn- Bohn's nodules

- few or many, white to yellowish, round to oval, nodes in the maxillary and/or mandibular gingiva

and alveolar ridge of newborns(PAST-E)

- cystic degeneration of epithelial rests of the dental lamina (rests of Serres).

- majority of these cysts break by themselves, a few days after birth exuding the keratin.

- In some babies they may remain for a period of several months, in such cases surgical opening

is indicated.

3.ODONTOGENIC TUMORS

Ameloblastoma

most common odontogenic tumor (PAST-E) benign but locally invasive neoplasm

(acts like a malignant lesion) derived from

odontogenic epithelium

multicystic (86%), unicystic (13%) and peripheral (extraosseus1%) may arise from the lining of a dentigerous cyst but more often

arises independently of impacted teeth progressive growth rate and may reach enormous proportions symptoms may include a painless swelling, loose teeth, malocclusion, or nasal obstruction. maxillary tumors frequently perforate into the antrum and may grow freely, with extension into the

nasal cavity, ethmoid sinuses, and skull base they can exhibit cytologic features of malignancy with squamous differentiation (< 1%) -> malignant

degeneration unilocularoften confused with odontogenic cysts radiograph shows multilocular radiolucency with a predilection for the posterior mandible, well-

circumscribed, soap-bubble appearance(PAST E) Dx: biopsy

Tx: complete excision, including adequate zone of normal-appearing bone around the main tumormass; mandibular reconstruction

Calcifying Epithelial Odontogenic Tumor

Adenomatoid Odontogenic Tumor

Squamous Odontogenic Tumor

Calcifying Odontogenic Cyst

Break Bati:

Hi to my buchi mates! And

my SC cam whore mates,

seatmates and all other

mates. Hehe.

Rusty, pag nasa Thailand ka

na pakikamuzta kay PJune

ha. Check mo na lng sa Fbko. Hehe.


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4. RELATED JAW LESIONS

FIBROOSSEUS LESIONS

Fibrous dysplasia replacement of medullary bone with fibrous tissues, leading to expansion and weakness of

the involved bone likely due to gene mutation found in the proximal femur, tibia, humerus, ribs, and craniofacial bones (aside from the head

& neck) monostotic, polyostotic (different bone involvement), McCune-Albright syndrome (polyostotic

fibrous dysplasia occurs with pigmented skin lesions or "cafe au lait" spots and hormonalabnormalities

radiography shows a ground glass appearance- PAST E bone scan (particularly for polyostotic lesions) to evaluate entire skeleton CT scan conservative management, tend to mature -> when they mature, they harden contouring or resection with reconstruction -> for cosmetic purposes

D. SOFT TISSUE TUMORS

1. FIBROMATOSES

non metastasizing, locally invasive fibroblastic or myofibroblastic lesions

Desmoid fibromatosis deep-seated, benign, slowly growing Greek word "desmos- band or tendon-like intraabdominal or extraabdominal usually at the supraclavicular fossa at head and neck may develop along surgical scars locally aggressive, but do metastasize

tumor-related destruction of vital structures and/or organs can be fatal, particularly when theyarise in patients with familial adenomatous polyposis (FAP, Gardner's syndrome)

CT Scan, MRI, biopsy high rate of recurrence with surgery alone Systemic therapy include antiinflammatory agents, hormonal agents (eg, tamoxifen), and

cytotoxic chemotherapy Radiotherapy

Fibromatosis Colli (Sternocleidomastoid Tumor) produces torticollis (wry neck) usually develops several weeks after birth, slowly increase in size over 2-3 months, then

regresses and disappears in 4-6 months olive-shaped or oval tumor mass in the lower third of the SCM

high incidence of difficult labor and breech presentation CT Scan, MRI, biopsy conservative managament, stretching exercises surgery for progressive torticollis at an older age

2. NEUROGENIC TUMORS

Neurilemoma (Schwannoma) encapsulated neoplasms from Schwann cells slow-growing tumor, present for several years pain and neurologic symptoms are uncommon unless the tumor is

large or, by virtue of a deep-seated location, is impinging on neighboring structures.

waxing and waning of the tumor size may be noted due to fluctuations in the amount of cysticchange and high vascularity

common along lateral neck region exact nerve of origin may be impossible to determine CT Scan, MRI, biopsy Surgical excision


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Neurofibroma affects all neural crest cells (schwann cells, melanocytes, endoneural fibroblasts genetically

inherited, autosomal dominant usually arise from subcutaneous tissues(ill-defined and unencapsulated) but

may also occur deeper in head areas (circumscribed and encapsulated)

tend to be multiple (associated with caf-au-lait spots, von Recklinghausensdisease)

significant risk of developing malignant neurogenic tumors if with multipleneurofibromatosis frequently found in the head rather than neck

CT Scan, MRI, biopsy Surgical excision

3. PARAGANGLIOMAS

arise from the glomus cells (chemoreceptors located along blood vessels that have a role inregulating blood pressure and blood flow)

found in the abdomen (85%), thorax (12%), and head and neck (3%)

unlike paragangliomas of the abdomen, head andneck paragangliomas rarely secretecatecholamines

most occur as single tumor when occuring at multiple sites they are usually found as a part of a heritable syndrome such as

multiple endocrine neoplasia types II-A and II-B

MEN Type IIA MEN Type IIB

Medullary Ca Pheochromocytoma

Pheochromocytoma Medullary Ca

ParathyroidMucosal Neuromas

Marfanoid habitus

Typical locations for paragangliomas of the head and neck

1) Carotid body tumor - from the carotid body, a baroreceptor and chemoreceptor, at the

bifurcation of the common carotid,(PAST-E)may extend to the skull base, pharynx, or along

cranial nerves

2) Glomus vagale - from the paraganglia of the vagus nerve, may compress the internal jugular,

displace the carotid vessels anteromedially, or pushe the pharyngeal wall medially

3) Glomus tympanicum - from paraganglia along the tympanic branch of the glossopharyngeal

nerve, also known as Jacobsen's nerve, or the auricular branch of the vagus nerve, also known

as Arnold's nerve. It is often seen at the dome of the jugular bulb or submucosally at the cochlearpromontory. By definition it remains confined to the middle ear and mastoid air cells.

4) Glomus jugulare - within the jugular foramen from the jugular bulb, Jacobsen's nerve, or

Arnold's nerve. It may extend through bone into the mastoid air cells and middle ear with an

aggressive pattern of bone destruction.

Carotid Body Tumor/ Paragangl ioma most common head and neck paraganglioma slow-growing, painless neck mass along the anterior edge of the SCM lateral to the tip of the

hyoid bone may expand and cause bulging of the pharynx may compress adjacent nerves to cause hoarseness, dysphagia, cord paralysis Angiography, CT Scan Surgical excision


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4. LIPOMAS

most common soft tissue tumor composed of mature adipose cells tend to occur in obese patients or those with recent weight gain smooth, soft, encapsulated, freely movable masses that almost always arise in the subcutaneous

tissue presence of capsule differentiates the tumor from simple aggregation of fat deeper lipomas may occur between muscle groups or within muscles that become obvious with

muscular contraction Surgical excision with biopsy

From the net: Benign Symmetric Lipomatosis or Madelung'sDiseaseand Lanois-Bensaude Syndrome is a metabolic conditioncharacterized by the growth of fatty masses around the face,back of the head, neck, upper arms, abdomen, back and upperleg in a very speci f ic pattern or distr ibut ion. Unlike the usuallipoma, these benign,fatty masses are not enclosed within amembranous capsule with very distinct boundaries. (PAST-E)

5. RHABDOMYOMA

rare, benign tumor of striated muscles important to differentiate from malignant rhabdomyosarcoma

Adult Rhabdomyoma

most common subtype, occuring at a mean age of approximately 50 years predilection for head and neck region (larynx, pharynx, and the floor of the mouth) circumscribed mass (usually less than 10 cm), coarse, with a brick-red colour may be multinodular

Fetal Rhabdomyoma

slow growing mass, usually less than 5cm in size. occurs primarily in the subcutaneous tissues of the head and neck region (common behind ear) usually among infants usually less than 3 years of age CT scan, MRI, section biopsy Surgical excision

E. DEVELOPMENTAL NECK MASSES

1. DERMOID CYSTS (PAST E)

solitary, or occasionally multiple, hamartomatous tumorcontaining structures derived

from ectoderm

covered by a thick dermis-like wall that contains multiplesebaceous glands and almostall skin adnexa

may contain substances such as nails and dental, cartilagelike, and bonelike structures occur mostly on the face, neck, or scalp but can be intracranial, intraspinal, perispinal or within the

ovary or omentum

2. CERVICAL TERATOMAS

midline mass in an infant with airway obstruction Ex. A dyspneic newborn w/ large midline neck mass (PAST E)

tumors containing tissue elements derived from all three germinal layers usually discovered at birth, rarely presents after age of 1 year encapsulated, partially cystic sometimes referred to as thyroid teratoma since it is in the midline symptoms develops over time due to progressive pressure, resulting in upper

airway obstruction

maternal hydramnios has been incriminated as a predisposing factor Ultrasonography, CT scan Surgical excision


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3. BRANCHIAL CLEFT REMNANTS

lateral cervical lesions arising from congenital developmental defectsof the primitive branchial arches,clefts and pouches

may take the form of cysts, fistulas, sinuses rarely diagnosed at birth, becomes apparent in childhood or adulthood

may become infected, develop abscess, form draining sinuses fistulas and sinuses usually present as a small opening along

anterior border of SCM

orifice may discharge milky, serous, mucoid or purulent material

First Branchial Cleft Remnants

Second Branchial Cleft Remnants

most common (PAST E) external opening along anterior border of SCM at the junction of its

middle and lower thirds tract follows the carotid sheath crossing over the hypoglossal nerve

and coursing between the internal and external carotid arteries,ending at the tonsillar fossa (where it rarely opens into the posteriortonsillar pillar)

Third Branchial Cleft Anomalies

rare opening may also be located in the same place

as the second branchial cleft tract extend along the carotid sheath behind

the internal carotid artery over the hypoglossal nerve and followsthe superior laryngeal nerve

internal opening would be at the region of the pyriform sinus

Fourth Branchial Cleft Anomalies

more of a theoretical possibility than reality opening would have to be along the anterior border of SCM in

the lower third tract would extend along the carotid sheath into the chest,

passing under either the arch of the aorta on the left or thesubclavian on the right

internal opening would be along the esophagus

Diagnostics: cystogram with contrast

Treatment: management of infection with antibiotics and drainage; complete surgical excision

Type Iduplications of membranous EAC ending at acul-de-sac

Type II

extend near angle of mandible through parotid

substance to the vicinity of EAC


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4. THYROGLOSSAL DUCT CYST

results from the persistence of the thyroglossal tract midline- NALABAS LAGI SA PAST-E!or paramedian masses tract is intimately related to the hyoid bone and the mass is usually seen below the hyoid may retract on swallowing or tongue protrusion ->just like thyroid gland fistulas may occur spontaneously or secondary to trauma or infection

Diagnosis and Treatment:

Ultrasonography Thyroid scintiscans Complete surgical excision with removal of the central portion of the hyoid (Sistrunk)

F. BENIGN SKIN TUMORS

1. EPIDERMAL TUMORS

Seborrheic keratosis

sharply demarcated, keratotic, usually pigmented lesions, elevatedabove the level of the adjacent epidermis

may be confused with malignant melanoma

Keratoacanthoma

develops over several months, assuming an elevated dome-shape configuration with a central keratin plug diagnosis is clinicopathologic

2. ADNEXAL TUMORS

Hair Follicle Tumors-> excise and send for histopathology

Pilar Cyst (Trichilemmal Cyst) Trichoepithelioma Trichofolliculoma Pilomatrixom

Sebaceous Gland Tumors

Senile Sebaceous Hyperplasia Nevus Sebaceus Sebaceous Adenoma

Apocrine Gland Tumors

Eccrine Sweat Gland Tumors


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3. MELANOCYTIC TUMORS

Epheliscommon freckle due to localized increase in melanin pigment Lentigononspecific term for flat, macular hyperpigmented skin lesion, related to sun exposure Melanocytic Nevuscircumscribed new growth of skin of congenital origin

junct io nalat epidermal-dermal junction intradermalconfined at dermis compoundboth junctional and intradermal are present

Premalignant Melanocytic Lesions irregular Lentigo malignaflat, slow-growing, pigmented lesion Atypical intraepidermal melanocytic proliferationmore rapid growth

4. SEBACEOUS CYST

(EPIDERMAL CYST; KERATIN CYST; EPIDERMOID CYST)

closed sac found just under the skin, most often arising from swollen hair follicles contains cheesy-looking skin secretions. skin trauma can also induce a cyst to form

a sac of cells is created into which a protein called keratin is secreted usually slow- growing, painless, freely movable lumps beneath the skin occur in almost any part of head and neck asymptomatic unless infected management of infection with local heat, antibiotics and drainage surgical excision with meticulous removal of all cyst remnants to prevent recurrence

III. THE SANDS OF TIME (PAST-E

Which does not belong to the group?TIP: Marami pa yan. Most of the questions are based on under what heading they are. Some memorize!

1. muscular, carotid, occipital, submandibular, submental triangle

2. MRI, Plain X-ray, UTZ, CT, biopsy3. digastric, lateral triangle, supraclavicular triangle, trapezius, omohyoid4. carotid body tumor, glomus vagale, neurofibroma, glomus tympanicum, paraganglioma5. E. Inclusion cyst, radicular cyst, dentigerous cyst, paradental, residual

For the Past-e, Doc seems to recycle his questions. Different Questions but same points of emphasis.Know the must knows and ESPECIALLY the group of diseases they are under.

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Hello Christine

benign head and neck neoplasms

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