- neck mass

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Neck Masses

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DefinitionThe general definition of a neck

mass is any abnormalenlargement, swelling, or growthfrom the level of the base of skull

to the clavicles.

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Anatomical Considerations

Prominent landmarks

Triangles of the neck Lymphatic levels

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1. Hyoid bone

2. Thyroid cartilage

. Cricoid cartilage!. Trachea

". #ternocleidomastoid

m$scles %#C&

Anatomical ConsiderationsThe prominent landmarks of the neck

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The SCM divides eachside of the neck intotwo major triangles,anterior and posterior.

The anterior triangle isdelineated by

. The anterior border of theSCM,

!. The midline,". The lower border of the

mandible.

Anatomical Considerations

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Anatomical Considerations The borders of the

posterior triangles are #

$ The posterior border of theSCM. $ The clavicle. $ The anterior border of the

trape%ius muscle.

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(enign leision &alignant t$mor )nflammantory

Primary&etastatic

Common *eck &asses

Classification of *eck &asses

(enign t$mor Congenital

!

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&eveloped by MemorialSloan-Kettering CancerCenter

'ase and uniformity indescribing regional nodalinvolvement in cancer of thehead and neck

Lymphatic nodal leveles+regions

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(evel )# $ Contains the submental "

and submandibulartriangles.

$ *ounded by the posterior belly of the

digastric muscle #$ %$ the hyoid bone the body of the mandible.

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(evel ))#

$ Contains the upper jugular lymph nodes

$ e+tends from the level ofthe hyoid bone to theskull base.


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(evel )))# $ Contains the middle

jugular lymph nodes $ from the hyoid bone to

the cricothyroidmembrane & - oromohyoid muscle '(

-.


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(evel ) # $ Contains the lower

jugular lymph nodes $ from the cricothyroid

membrane to theclavicle.


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(evel # $ Contains the lymph

nodes in the posteriortriangle

$ bounded by the anteriorborder of the trape%ius,the posterior border ofthe SCM, and theclavicle.


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(evel )# $ Contains the lymph

nodes of the anteriorcompartment from thehyoid bone to thesuprasternal notch.

$ /n each side the lateralborder is formed by themedial border of thecarotid sheath )*+, .

http://img.dxy.cn/upload/2007/07/02/33205390.jpg

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&etastasis Location according to

,ario$s Primary Lesions Level )

$ Submandibular primary0 oralcavity0 lip0 paranasal sinuses

Level )) $ 1asopharyn+0 oropharyn+,

ma+illary sinus Level )))

$ (aryn+0 hypopharyn+0 thyroid Level ),

$ Subglottic laryn+0 thyroid0 cervicalesophagus Level ,

$ Thyroid0 cervical esophagus0 Level ,)

$ Thyroid0 laryn+

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#taging of the neck -* classification / A0CC %1 '

$ Consistent for all m$cosal sites e3cept

the nasopharyn3 $ Thyroid and nasopharyn3 have different

staging based on t$mor behavior andprognosis

$ (ased on e3tent of disease prior to firsttreatment

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#taging of the neck *45

$ 6egional lymph nodes cannot be assessed *75

$ *o regional lymph node metastasis

*15 $ a single ipsilateral lymph node8 9

*2a5 $ a single ipsilateral lymph node to : cm

*2b5 $ m$ltiple ipsilateral lymph nodes8 none more

than : cm *2c5

$ bilateral or contralateral nodes 9 :cm * 5

$ a lymph node more than : cm in greatestdimension

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Approach of the neck massApproach of the neck mass

History

Physical e3aminations )mage st$dies ;*A( and (iopsy

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#kandalakis=s 6>L? @; 7B $

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Diagnostic #teps

History Physical ?3amination ?mpirical Antibiotics Diagnostic Tests

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Diagnostic #teps

History $ &evelopmental time course

$ =ssociated symptoms dysphagia, otalgia, voice- $ 2ersonal habits tobacco, alcohol- $ 2revious irradiation or surgery

Physical ?3amination $ Complete head and neck e+am visuali%e >

palpate- $ 'mphasis on location, mobility and consistency

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Diagnostic #teps

?mpirical Antibiotics -./0123 $ )nflammatory mass suspected

$ Two week trial of antibiotics $ ?ollow4up for further investigation

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Diagnostic Tests $ @ltrasonography 45 $ Computed tomography CT- $ Magnetic resonance imaging MA)- $ ?ine needle aspiration biopsy ?1=*-

6789:; $ *iopsy

Diagnostic #teps

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Diagnostic Tests >ltrasonography

@ltrasonography

@seful indifferentiating solidfrom cystic massesand congenital cystsfrom solid lymphnodes and glandulartumors.

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Diagnostic Tests Comp$ted Tomography %CT'

Comp$ted Tomography %CT'5

. &istinguish cystic from solid lesions .

!. &efine the origin and full e+tent ofdeep, ill4defined masses .

". Bhen used with contrast candelineate vascularity or blood flow.

:. &etect an unknown primary lesion5. To help with staging purposes.

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&6) $ Similar information

as CT $ *etter for upper neck

and skull base $ ascular delineation

with infusion

Diagnostic Tests &6)

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Diagnostic Tests ;*A(

=ny neck mass that is not an obviousabscess

2ersistence after a ! week course ofantibiotics

Small gauge needle

Aeduces bleeding

Seeding of tumor $ not a concern

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Treatment of 1eck Mass

(enign leision

&alignant t$mor

)nflammantory

#$rgery

3

Chemotherapy

?3

#$rgery

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Standardi%ed until 66 Academys Committee for Head and

Neck Surgery and Oncology publici%ed standard classificationsystem.

Classification of *eck Dissections

)@A=BCD

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Classification of *eck Dissections

Academy=s classification1. 6adical neck dissection %6*D' E2 )@A=

2. &odified radical neck dissection %&6*D' F E2 )@A=. #elective neck dissection %#*D' GH)@A=

Supra4omohyoid type

(ateral type2osterolateral type

=nterior compartment type

!. ?3tended radical neck dissection )IJ@A=

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)KLM cervical lymphadenitis

NOPO)QR STUVWX)QKLMYZ [\

$ )QKLM J]

$ ^ _R`O OaObcdeUf bghQia] $ j _S kUialmn] $ o1p;qr * 4st[\ $ uvTwKLM89xyz:;]

23

$ -YZO{/O $ 89ry|}~O

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t$berc$losis of cervical lymph nodes

V x O$cBM [\

$ x)KLM JUV U r ] $ . Ux l] $ KLM89x:;[]

23 $ -M23UhQ23]

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_S ] )KLM J)%HU

VfR$cKLM JO bOOO6cS ] [\

$ Ogo1p;q]

23 $ 323]

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adenoma of the thyroi

)QVB]

!7 B ] [\

$ )a U *]

$ ( 4O>/AO $ 89:;st[\]

23

$

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mi3ed t$mor of salivary gland [\

$ $ x , $ U.jUS lmn] $ * 4O CT g MA) t[\]

23 $

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lymphoma

XKL ] CD] [\

$ KLM JdU)QVQ]

$j O Oa KLM J]

$ KLM89xyz:;[]

23>3r?3

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metastatic carcinoma

$ N)Q 4 $ O$O $ lm

[\ $ E OS Ot;q

45 >/@c CU[

23 $ E r BlU >3O?3

O

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*asopharyngeal carcinoma

.)KL URT B S ] V ) KLMU _ ) x KL

M]

23 >3UhQ x>3%

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Hypopharyngeal carcinoma .KL U _V )*+HKLMU

r KLM]

23 yz )@A=UM>O?3

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Laryngeal carcinoma

5 r5 V O O r) +KLM] 23

$ yz )@A=U xl >O?3]

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Thanks for your attentionD.

- neck mass

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