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EDWARD WEISBERGER MD OTOLARYNGOLOGY/HEAD AND NECK SURGERY INDIANA UNIVERSITY MEDICAL CENTER

EDWARD WEISBERGER MD OTOLARYNGOLOGY/HEAD AND NECK SURGERY INDIANA UNIVERSITY MEDICAL CENTER. NECK MASS DIFFERENTIAL DIAGNOSIS. INFLAMMATORY (SUPPERATIVE BACTERIAL INFECTION, INFECTED BRANCHIAL CLEFT CYST, GRANULOMATOUS-MYCOBACTERIAL, CAT SCRATCH

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EDWARD WEISBERGER MD OTOLARYNGOLOGY/HEAD AND NECK SURGERY INDIANA UNIVERSITY MEDICAL CENTER

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  1. EDWARD WEISBERGER MD OTOLARYNGOLOGY/HEAD AND NECK SURGERY INDIANA UNIVERSITY MEDICAL CENTER

  2. NECK MASS DIFFERENTIAL DIAGNOSIS • INFLAMMATORY (SUPPERATIVE BACTERIAL INFECTION, INFECTED BRANCHIAL CLEFT CYST, GRANULOMATOUS-MYCOBACTERIAL, CAT SCRATCH • CONGENITAL-THYROGLOSSAL DUCT CYST, LYMPHANGIOMA, DERMOID CYST, BRANCHIAL CLEFT CYST, TERATOMA • NEOPLASM

  3. AGE • PEDIATRIC-INFLAMMATORY, CONGENITAL • TEENAGE-INFLAMMATORY, LYMPHOMA, THYROID CA • ADULT-METASTATIC SCC, THYROID CANCER, LYMPHOMA

  4. NEOPLASTIC (BENIGN) • NEUROGENIC (NEUROLEMMOMA) • VASCULAR (PARAGANGLIOMA OF CAROTID BODY OR VAGAL BODY) • VASCULAR (ANEURYSM) • PAROTID (BENIGN MIXED TUMOR, WARTHIN’S TUMOR)

  5. AYSYMETRICAL ENLARGEMENT OF CERVICAL LYMPH NODES IN AN ADULT ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC) HAYES MARTIN 1952

  6. NEOPLASTIC (MALIGNANT) • METASTATIC SQUAMOUS CELL CARCINOMA • LYMPHOMA • THYROID CANCER • METASTATIC MELANOMA • METASTIC TESTICULAR CANCER

  7. CHARACTERISTICS OF A METASTAIC NECK MASS • PAINLESS • UNILATERAL • ADULT AGE GROUP

  8. EVALUATION OF A NECK MASS • HX-HOARSNESS, DYSPHAGIA, PAIN ORAL CAVITY, TOBACCO USE • PE-EXAM OF ORAL CAVITY AND OROPHARYNX DISCLOSES PRIMARY 50% OF TIME • MIRROR OR FIBEROPTIC EXAM WILL FIND THE PRIMARY IN AN ADDITIONAL 35%

  9. ORAL CAVITY ULCERATIVE LESION

  10. FIBEROPTIC LARYNGOSCOPY

  11. FIBEROPTIC LARYNGOSCOPY

  12. FIBEROPTIC LARYNGOSCOPY

  13. EVALUATION OF A NECK MASS • LOCATION-UPPER NECK ANT. TO SCM-MOST COMMON FOR H & N PRIMARIES (SENTINAL NODE) • POSTERIOR TRIANGLE-NASOPHARYNX • SUPRACLAVICULAR-THYROID OR SITE BELOW THE CLAVICLES

  14. CAROTID BODY TUMOR • LOCATED CAROTID BIFURCATION • MORE DISCREET IN ANT/POSTERIOR DIRECTION THAN SUPERIOR/INFERIOR • SOMETIMES A BRUIT

  15. EVALUATION OF A NECK MASS • OFFICE BX. IF IN ORAL • FNA-MIGHT DIRECT WORK-UP; IF LYMPHOMA OR THYROID CANCER • CT AND/OR PET SCAN • EXAMINATION UNDER ANESTHESIA-PALPATE TONGUE BASE, VISUALIZE APEX OF PYRIFORM SINUS AND POST-CRICOID AREA

  16. EVALUATION OF A NECK MASS • IF PRIMARY NOT IDENTIFIED AND PATIENT HAS TONSILS-TONSILLECTOMY WILL DISCLOSE A PRIMARY IN 30% OF PATIENTS

  17. TERATOMA

  18. TERATOMA

  19. LYMPHANGIOMA

  20. LYMPHANGIOMA

  21. VIRCHOW’S NODE • LEFT SUPRACLAVICULAR NODE REPRESENTING METASTASIS FROM BELOW THE CLAVICLE-OFTEN FROM BELOW THE DIAPHRAGM

  22. VIRCHOW’S NODE

  23. AVOID ANTIBIOTIC THERAPY FOR A PAINLESS NECK MASS IN AN ADULT • EXAMINE ORAL CAVITY • REFER FOR DEFINITIVE DIAGNOSIS

  24. UNKNOWN PRIMARY • MOST COMMON SOURCE-HYPOPHARYNX, TONSIL, BASE OF TONGUE • IN PAST-NASOPHARYNX (MORE COMMON IN CHINESE, AMERICAN INDIAN, ALASKAN NATIVE)

  25. UNKNOWN PRIMARY

  26. HUMAN PAPILLOMA VIRUS • INCREASINGLY COMMON ETIOLOGY • EXPLAINS INCREASING INCIDENCE OF SCC OF THE HEAD AND NECK IN NON-SMOKERS • INCREASED RISK OF HPV WITH SEXUAL PROMUSCUITY • ? VACCINATE YOUNG MALES

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