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 .

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

ETIOLOGIES- NEOPLASTIC ETIOLOGIES- NEOPLASTIC PRIMARY TUMORSPRIMARY TUMORS

• Lymphoma .Lymphoma .

• Thyroid .Thyroid .

• Salivary Gland .Salivary Gland .

• Vascular .Vascular .

• Neurogenic .Neurogenic .

ETIOLOGIES – NEOPLASTICETIOLOGIES – NEOPLASTICMETASTATIC TUMORSMETASTATIC TUMORS

• SUPRACLAVICULAR . SUPRACLAVICULAR .

• INFRACLAVICULAR .INFRACLAVICULAR .

• ANKNOWN ORIGIN.ANKNOWN ORIGIN.

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 .

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 .

PHYSICAL EXAMINATION PHYSICAL EXAMINATION

LYMPH NODE LYMPH NODE CHARACTERISTICSCHARACTERISTICS

• Hard , Fixed .Hard , Fixed .

• Rubbery , Matted .Rubbery , Matted .

• Fluctuant .Fluctuant .

• Tender .Tender .

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 .

PHYSICAL EXAMINATIONPHYSICAL EXAMINATIONGeneral examinationGeneral examination

• Breast .Breast .

• Lymph Nodes .Lymph Nodes .

• Prostate . Prostate .

• Rectum . Rectum .

FNAFNAتشخیص گام تشخیص اولین گام اولین

پاراکلینیکپاراکلینیک

است گردنی توده است در گردنی توده .. در

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 .

ROUTINE RADIOGRAPHICROUTINE RADIOGRAPHICSTUDIESSTUDIES

• Chest x – ray .Chest x – ray .

• Computerized Tomographr .Computerized Tomographr .

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.

PANENDOSCOPYPANENDOSCOPY

• Nasopharyngoscopy .Nasopharyngoscopy .

• Laryngoscopy .Laryngoscopy .

• Bronchoscopy .Bronchoscopy .

• Esophagoscopy .Esophagoscopy .

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

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