evaluation and treatment of the patint with a neck mass a slide lecture series of the american...
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EVALUATION AND EVALUATION AND TREATMENT OF THE PATINT TREATMENT OF THE PATINT
WITH A NECK MASSWITH A NECK MASS
A slide lecture series of the A slide lecture series of the American academy of the American academy of the otolaryngology – head and otolaryngology – head and
neck surgery .neck surgery .
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ETIOLOGIES - INFLAMMTORYETIOLOGIES - INFLAMMTORY
• Pyogenic lymphadenitis & R.L.HPyogenic lymphadenitis & R.L.H
• Scrofula .Scrofula .
• Cat scratchCat scratch ..
• Toxoplasmosis .Toxoplasmosis .
• Sialadenitis .Sialadenitis .
• Thyroiditis .Thyroiditis .
• I.M.NI.M.N
• AIDSAIDS
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ETIOLOGIES- NEOPLASTIC ETIOLOGIES- NEOPLASTIC PRIMARY TUMORSPRIMARY TUMORS
• Lymphoma .Lymphoma .
• Thyroid .Thyroid .
• Salivary Gland .Salivary Gland .
• Vascular .Vascular .
• Neurogenic .Neurogenic .
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ETIOLOGIES – NEOPLASTICETIOLOGIES – NEOPLASTICMETASTATIC TUMORSMETASTATIC TUMORS
• SUPRACLAVICULAR . SUPRACLAVICULAR .
• INFRACLAVICULAR .INFRACLAVICULAR .
• ANKNOWN ORIGIN.ANKNOWN ORIGIN.
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HISTORY HISTORY • Age .Age .• Gender .Gender .• Ethnic Background .Ethnic Background .• Smoking History .Smoking History .• Onset and Course .Onset and Course .• Trauma . Trauma . • Infectious Exposure .Infectious Exposure .
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HISTORYHISTORY• Change in Voice .Change in Voice .
• Pain . Pain .
• Dysphagia .Dysphagia .
• Hearing Loss .Hearing Loss .
• Skin Lesions .Skin Lesions .
• Infraclavicular Symptoma .Infraclavicular Symptoma .
• Family History .Family History .
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PHYSICAL EXAMINATION PHYSICAL EXAMINATION
LYMPH NODE LYMPH NODE CHARACTERISTICSCHARACTERISTICS
• Hard , Fixed .Hard , Fixed .
• Rubbery , Matted .Rubbery , Matted .
• Fluctuant .Fluctuant .
• Tender .Tender .
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PHYSICAL EXAMINATION PHYSICAL EXAMINATION COMPLETE HEAD AND NECK COMPLETE HEAD AND NECK
EXAMINATIONEXAMINATION• Ear .Ear .
• Nose .Nose .
• Oral Cavity .Oral Cavity .
• Larynx and Hypopharynx .Larynx and Hypopharynx .
• Nasopharynx .Nasopharynx .
• Neck .Neck .
• Skin and Scalp .Skin and Scalp .
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PHYSICAL EXAMINATIONPHYSICAL EXAMINATIONGeneral examinationGeneral examination
• Breast .Breast .
• Lymph Nodes .Lymph Nodes .
• Prostate . Prostate .
• Rectum . Rectum .
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FNAFNAتشخیص گام تشخیص اولین گام اولین
پاراکلینیکپاراکلینیک
است گردنی توده است در گردنی توده .. در
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LABORATORY TESTLABORATORY TEST• Complete Blood Count .Complete Blood Count .
• Urinalysis . Urinalysis .
• Liver Function Test .Liver Function Test .
• TB Skin Test .TB Skin Test .
• Syphilis Test . Syphilis Test .
• Mononucleosis Test .Mononucleosis Test .
• Thyroid Function Test . Thyroid Function Test .
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ROUTINE RADIOGRAPHICROUTINE RADIOGRAPHICSTUDIESSTUDIES
• Chest x – ray .Chest x – ray .
• Computerized Tomographr .Computerized Tomographr .
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ANCILLARY ANCILLARY IMAGING STUDIESIMAGING STUDIES
• Bone Scan .Bone Scan .
• GL Tract studies .GL Tract studies .
• Thyroid Scan .Thyroid Scan .
• IVPIVP
• Liver / Spleen Scan.Liver / Spleen Scan.
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PANENDOSCOPYPANENDOSCOPY
• Nasopharyngoscopy .Nasopharyngoscopy .
• Laryngoscopy .Laryngoscopy .
• Bronchoscopy .Bronchoscopy .
• Esophagoscopy .Esophagoscopy .
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THERAPEUTIC OPTIONS BASED ON THERAPEUTIC OPTIONS BASED ON FROZEN SECTION ANALYSIS OF FROZEN SECTION ANALYSIS OF
NECK MASS BIOPSYNECK MASS BIOPSY
NECK MASS BIOPSY NECK MASS BIOPSY
UNDIFFERENTIATED ORUNDIFFERENTIATED ORSQUAMOUS CARCINOMASQUAMOUS CARCINOMA
ADENO ADENO CARCINOMACARCINOMA
THYROID THYROID CARCINOMACARCINOMA
BENIGN NON- BENIGN NON- DIAGNOSTIC DIAGNOSTIC LYMPHOMALYMPHOMA
INFRACLAVICULARINFRACLAVICULARPRIMARYPRIMARY
NECK NECK DISSECTIONDISSECTION
LOOK FOR LOOK FOR PRIMARYPRIMARY
LOW NECK NODELOW NECK NODEHIGH NECK NODE HIGH NECK NODE
NECK DISSECTIONNECK DISSECTION
THYROIDECTOMYTHYROIDECTOMY
LOOK FOR PRIMARYLOOK FOR PRIMARYEXCISE SALIVARY EXCISE SALIVARY TUMORTUMOR
NO FURTHER NO FURTHER SURGERYSURGERY
NO FURTHER NO FURTHER SURGERYSURGERY
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DIAGNOSTIC AND DIAGNOSTIC AND THERAPEUTIC APPROACH TO THERAPEUTIC APPROACH TO
CERVICAL MASSESCERVICAL MASSESHISTORY PHYSICAL ANDHISTORY PHYSICAL ANDFINE NEEDLE ASPIRATEFINE NEEDLE ASPIRATE
LAB AND X-RAYLAB AND X-RAYFINDINGSFINDINGS
PRIMARY PRIMARY UNKNOWNUNKNOWN
PRIMARY PRIMARY KNOWNKNOWN
BIOPSY OFBIOPSY OFLESIONLESION
RANDOMRANDOMBIOPSIESBIOPSIES
POSITIVEPOSITIVE NEGATIVENEGATIVE
BIOPSYBIOPSYLYMPH NODELYMPH NODE
TREATTREAT
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