mouth oral & face maxillofacial...management of neck lumps mr ceri hughes bds, fdsrcs, mbchb,...
TRANSCRIPT
![Page 1: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/1.jpg)
mouth oral &
face maxillofacial
jaws head & neck
neck surgery
![Page 2: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/2.jpg)
Management of Neck Lumps
Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS)
Consultant Oral & Maxillofacial / Head and Neck Surgeon Head & Neck MDT Lead
University Hospitals Bristol
![Page 3: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/3.jpg)
Learning objectives
• Classification of neck lumps
• Relevant anatomy and descriptive terms
• Relevant investigations (primary care + 2nd)
• Surgical sieve, provisional diagnosis
• Clinical examples
• Quiz
![Page 4: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/4.jpg)
Broad classification
Neck lump
Benign Malignant
![Page 5: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/5.jpg)
NECK
LUMP
Benign
Lymphoid Thyroid Salivary Infection Congenital
![Page 6: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/6.jpg)
NECK
LUMP
Malignant
Lymphoma Salivary Thyroid Metastatic
![Page 7: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/7.jpg)
Diagnostic pathway
• History
• LOCAL examination
• REGIONAL (NECK) examination
• GENERAL examination
• Provisional diagnosis
• Special tests
• Tipping point, to refer or not
![Page 8: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/8.jpg)
REGIONAL
Useful to think in terms of
MIDLINE & LATERAL LUMPS
![Page 9: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/9.jpg)
LATERAL
![Page 10: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/10.jpg)
MIDLINE
![Page 11: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/11.jpg)
THINK, what structures are there?
• Skin
• Fat
• Muscle
• Blood vessels
• Lymph nodes
• Salivary (parotid, submandibular)
• Thyroid
![Page 12: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/12.jpg)
LATERAL
![Page 13: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/13.jpg)
MIDLINE
![Page 14: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/14.jpg)
Clinical examination
• Position patient
![Page 15: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/15.jpg)
Clinical examination
• Ring
– Sub mental
– Sub mandibular
– Parotid
– Posterior auricular
– Occipital
![Page 16: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/16.jpg)
Clinical examination
• Rod
– Deep jugular
– Level II/III/IV/V
– Anterior triangle
– Post triangle
![Page 17: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/17.jpg)
Clinical examination
• Rod
– Deep jugular
– Level II/III/IV/V
– Anterior triangle
– Posterior triangle
![Page 18: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/18.jpg)
Description of neck disease
Anterior/posterior Level I-VI
![Page 19: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/19.jpg)
![Page 20: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/20.jpg)
TNM STAGING
![Page 21: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/21.jpg)
INVESTIGATIONS
• BLOOD
• RADIOLOGICAL
• MICROBIOLOGY
• SEROLOGY
• CYTOLOGY
• HISTOLOGY
![Page 22: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/22.jpg)
BLOOD
• FULL BLOOD COUNT & DIFF
• U&E, LFT
• SPECIFIC ANTIBODIES
• THYROID FUNCTION
![Page 23: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/23.jpg)
RADIOLOGY • PLAIN
• ULTRASOUND (USS)
• SIALOGRAPHY
• CT (computerised tomography)
• MRI (magnetic resonance imaging)
• ISOTOPE
• PET (positron emission tomography)
![Page 24: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/24.jpg)
RADIOLOGY • PLAIN
![Page 25: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/25.jpg)
• USS
RADIOLOGY
![Page 26: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/26.jpg)
cystic
Micro calcification
![Page 27: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/27.jpg)
RADIOLOGY
• SIALOGRAPHY
![Page 28: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/28.jpg)
RADIOLOGY • CT
![Page 29: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/29.jpg)
RADIOLOGY • MRI
![Page 30: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/30.jpg)
RADIOLOGY • ISOTOPE
![Page 31: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/31.jpg)
RADIOLOGY • PET
![Page 32: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/32.jpg)
MICROBIOLOGY
• Swab
• Pus
• Tissue
• For MC&S (microscopy, culture and sensitivity) TB, Actinomycosis
• Quantiferon
![Page 33: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/33.jpg)
CYTOLOGY & HISTOLOGY
• FINE NEEDLE ASPIRATION (cytology/culture)
• FLOW CYTOMETRY
• TRUCUT (increasing especially in lymphoma)
• CELL BLOCKS (centrifuged needle washings)
• IMPRINT CYTOLOGY (from biopsy)
• OPEN BIOPSY
• RESECTION
![Page 34: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/34.jpg)
FNA
![Page 35: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/35.jpg)
USS + FNA
![Page 36: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/36.jpg)
![Page 37: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/37.jpg)
![Page 38: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/38.jpg)
![Page 39: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/39.jpg)
Thyroid cytology
• Th1 (inadequate)
• Th2 (benign)
• Th3 (follicular lesion 3a or 3f)
• Th4 (suspicious for malignancy)
• Th5 (malignant)
![Page 40: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/40.jpg)
RADIOLOGY • ELASOTOGRAPHY
![Page 41: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/41.jpg)
Thyroid Decision making
• Clinical
• Ultrasound (U)
• Cytology (Th)
• Elastography
• Patient preference
![Page 42: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/42.jpg)
HISTOLOGY
![Page 43: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/43.jpg)
![Page 44: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/44.jpg)
CLASSIFICATION (neck pathology)
![Page 45: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/45.jpg)
Surgical sieve
Congenital Aquired
![Page 46: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/46.jpg)
CONGENITAL
– LYMPHANGIOMA
– DERMOID CYSTS
– THYROGLOSSAL CYSTS
– BRANCHIAL CYSTS
– PHARYNGEAL POUCH
![Page 47: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/47.jpg)
![Page 48: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/48.jpg)
AQUIRED
• TRAUMATIC
• INFECTIVE
• INFLAMMATORY
• IATROGENIC
• NEOPLASTIC
• METABOLIC
• AUTOIMMUNE
• NO IDEA
![Page 49: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/49.jpg)
TRAUMATIC
• HAEMATOMA
• DISSECTION
• AIR EMPHYSEMA
![Page 50: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/50.jpg)
INFECTIVE
• DENTAL INFECTION
• NECK SPACE INFECTIONS
• EBV
• CAT SCRATCH DISEASE
• TOXOPLASMA
• TB
• CMV
• HIV (PGL)
![Page 51: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/51.jpg)
INFECTIVE
• DENTAL INFECTION
• NECK SPACE INFECTIONS
![Page 52: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/52.jpg)
INFECTIVE
• REACTIVE NODES
• TOXOPLASMOSIS
• CAT SCRATCH
• CMV
• EBV
![Page 53: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/53.jpg)
![Page 54: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/54.jpg)
INFLAMMATORY
• SIALADENITIS (GUSTATORY)
• SARCOIDOSIS
• RHEUMATOID (FELTYS )
![Page 55: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/55.jpg)
METABOLIC
![Page 56: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/56.jpg)
![Page 57: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/57.jpg)
AUTOIMMUNE
![Page 58: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/58.jpg)
NEOPLASTIC
• BENIGN
• MALIGNANT
–PRIMARY
–METASTATIC
![Page 59: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/59.jpg)
NEOPLASTIC
• BENIGN
![Page 60: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/60.jpg)
NEOPLASTIC
• MALIGNANT
–PRIMARY
–METASTATIC
![Page 61: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/61.jpg)
NEOPLASTIC
• MALIGNANT
–PRIMARY
–METASTATIC
![Page 62: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/62.jpg)
QUIZ
• RED FLAGS
– Rapid growth
– Effect on adjacent structures
• Nerves (facial, recurrent laryngeal), skin, airway
– Risk factors
Age, smoking, radiation, FH, previous
– Systemic symptoms such as wt loss, B sypmtoms
![Page 63: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/63.jpg)
![Page 64: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/64.jpg)
![Page 65: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/65.jpg)
![Page 66: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/66.jpg)
![Page 67: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/67.jpg)
![Page 68: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/68.jpg)
![Page 69: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/69.jpg)
![Page 70: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/70.jpg)
![Page 71: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/71.jpg)
![Page 72: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/72.jpg)
![Page 73: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/73.jpg)
![Page 74: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/74.jpg)
![Page 75: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/75.jpg)
![Page 76: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/76.jpg)
![Page 77: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/77.jpg)
![Page 78: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/78.jpg)
![Page 79: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/79.jpg)
![Page 80: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/80.jpg)
![Page 81: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/81.jpg)
Questions
![Page 82: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/82.jpg)
Oral cavity malignancy
Mr Ceri Hughes FDSRCS, FRCS(OMFS)
Consultant Oral & Maxillofacial / Head and Neck Surgeon University Hospitals Bristol
![Page 83: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/83.jpg)
Aims
• Understand classification of tumour sites
• Become familiar with clinical examples
• Be aware of referral triggers
![Page 84: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/84.jpg)
Oral cavity
• Vermillion skin junction of lip to junction of hard and soft palate above and to circumvallate papillae below
• Mucosal lip
• Buccal mucosa
• Lower alveolar ridge
• Upper alveolar ridge
• Retromolar trigone
• Floor mouth
• Hard palate
• Anterior 2/3 tongue
![Page 85: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/85.jpg)
Presentation of oral cancer
• ulcer
• white or red patches
• mass
• pain
• bleeding
• tooth mobility
• neck lump
![Page 86: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/86.jpg)
![Page 87: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/87.jpg)
![Page 88: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/88.jpg)
![Page 89: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/89.jpg)
![Page 90: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/90.jpg)
![Page 91: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/91.jpg)
![Page 92: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/92.jpg)
![Page 93: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/93.jpg)
![Page 94: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/94.jpg)
![Page 95: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/95.jpg)
![Page 96: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/96.jpg)
![Page 97: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/97.jpg)
![Page 98: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/98.jpg)
![Page 99: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/99.jpg)
Red flags
• White/red patches (that have changed)
• Induration
• Bleeding
• Rapid increase in size
• Earache
• Necrosis especially with odour
![Page 100: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/100.jpg)
Case discussions
![Page 101: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/101.jpg)
![Page 102: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/102.jpg)
![Page 103: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/103.jpg)
![Page 104: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/104.jpg)
![Page 105: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/105.jpg)
![Page 106: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/106.jpg)
![Page 107: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/107.jpg)
![Page 108: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/108.jpg)
![Page 109: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/109.jpg)
![Page 110: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/110.jpg)
![Page 111: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/111.jpg)
![Page 112: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/112.jpg)
![Page 113: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/113.jpg)
![Page 114: mouth oral & face maxillofacial...Management of Neck Lumps Mr Ceri Hughes BDS, FDSRCS, MBChB, FRCS(OMFS), FRACDS (OMS) Consultant Oral & Maxillofacial / Head and Neck Surgeon Head](https://reader030.vdocuments.net/reader030/viewer/2022040406/5ea4f8770a957e4797580b02/html5/thumbnails/114.jpg)