HEAD AND NECK MASS

GENERAL SURGERY2012-2013

FACE ANATOMY

FACE ANATOMY

FACE MASS ,LAMP, OR SWELLINGEPIDERMOID CYST (SEBACEOUS CYST) :COMMONIN SCALP & FACE BECAUSE OF EXCESSIVE SEBACEOUSGLANDS .IT IS BLOCKAGE OF THE MOUTH OF THE GLAND THATOPENS IN TO HAIR FOLLICLE AND SO GRADUAL DISTENSION OF THE GLAND FORMING A CYST CONTAINING SEBUM.IT IS LIABLE TO INFECTION.DERMOID CYST :COMMONLY OVER THE EXTERNAL ANGLE OF THE EYE BROW,OR INTERNAL ANGLE.IT IS FORMED BY PIECE OF SKIN WHICH TRAPPED DEEP TO NORMAL

SKIN WHICH IS EITHER DEVELOPMENTAL,OR AFTER INJURY.SO IT IS EITHER CONGENITAL AS IN FACE OR ACQUIRED AS IN HAND AND FINGERS ALSO CALLEDINCLUSION CYST.

DERMOID CYST..CONT,DDERMOID CYST LINED BY SQUAMOUS EPITHELIUM ,CONTAIN SEBUM AND HAIR & OTHER SKIN APPENDAGES ,WHICH DIFFERS FROM SEBACEOUS CYST.OTHER FACE MASS PAROTID DISEASE :INFLAMMATORY LIKE MUMPS OR BACTERIAL PAROTIT IS .NEOPLASTIC:BENIGN & MALIGNANT PLEOMORPHIC ADENOMA (MIXED PAROTID TUMOUMER). ADENOID CYSTIC CARCINOMA.

EPIDERMOID (SEBACEOUS) CYSTSSCALP SEBACEOUS CYSTS SEBACEOUS CYSTS --FACE

DERMOID CYSTEXTERNAL ANGULAR DERMOID INTERNAL ANGULAR DERMOID

ACQUIRED DERMOID IMPLANTATION DERMOID IMPLANTATION(INCLUSION)DERMOID .

DERMOID CYST—LINED BY SQUAM.EPITHELIUMCONTAINING HAIR AND SEBUM

HAIR AND SKIN APPENDAGES HAIR---COULD BE SEEN IN OVARY AS WELL

OTHER FACE MASSES LIPOMA(SOFT) OSTEOMA(HARD)

LIPOMA LIPOMA EXCISED LIPOMA

PAROTITISCHRONIC BACTERIAL PAROTITIS VIRAL PAROTITIS--MUMPS

MUMPS MIXED TUMOUR PLEOMORPHIC ADENOMA

PAROTID MALIGNANCY WITH FACIAL PALSY

NECK ANATOMY

NECK ANATOMY

NECK AND THYROID ANATOMY

NECK MASS,LUMP OR SWELLING MULTIPLE LUMPS:LYMPH NODES .ANTERIOR TRIANGLE THAT DOES NOT MOVE WITH

DEGLUTITION OR SWALLOWING:SOLID:LYMPH NODE,CAROTID BODY TUMOUR,LIPOMA.CYSTIC :COLD ABSCESS,DERMOID CYST,& BRANCHIAL

CYST.ANTERIOR TRIANGLE THAT MOVES WITH SWALLOWING :SOLID:THYROID GLAND ,DELPHIAN LYMPH NODE .CYSTIC:THYROGLOSSA L CYST.

NECK MASS,LUMP ,OR SWELLING….CONT,D

POSTERIOR TRIANGLE(NOT MOVED WITH SWALLOWING ) :

SOLID :LYMPH NODECYSTIC : CYSTIC HYGROMA,PHARANGEAL POUCH. PULSATILE CYSTIC:SUBCLAVIAN ANEURYSM.

MULTIPLE MASSES---LYMPH NODES

CAUSES OF MULTIPLE CERVICAL LYMPHADENOPATHY

INFECTION:NON-SPECIFIC & SPECIFIC (T.B.),GLANDULAR FVER.NEOPLASIA:PRIMARY:LYMPHOMA &LEUKAEMIA. SECONDARY.

ANTERIOR TRIANGLE MASSNOT MOVES WITH DEGLUTITION

SOLID:LYMPH NODE (INFECTION ,MALIGNANCY). CAROTID BODY TUMOUR ;IT IS RARE

TUMOUR,ARISES FROM CHEMORECEPTOR OF THE IN THE COMMON CAROTID A.BIFURCATION.ALSO CALLED CHEMODECTOMA.USUALLY BENIGN,BUT OCCASIONALLY MALIGNANT.DIAGNOSIS :CAROTID ANGIOGRAPHY AND MRI .

CAROTID BODY TUMOUR

ANT.SOLID

LIPOMA:BENIGN CONNECTIVE TISSUE TUMOUR ARISES FROM FATTY TISSUE OR ADIPOSE TISSUE.

ANT. TRIANGLE SOLID NOT MOVES WITH SWALLOWING

LIPOMA EXCISED LIPOMA SPECEIMENT

CYSTIC MASS IN ANT. TIANGLE NOT MOVES WITH DEGLUTITION

COLD ABSCESS: LIQUIFIED T.B. LYMPH NODE;IT IS NEITHER RED, NOR HOT OR TENDER.BRANCHIAL CYST:CONGENITAL IN ORIGIN DEVELOPEDFROM VESTIGEAL REMENANT OF THE SECOND BRANCHIAL CLEFT.IT IS LINED BY SQUAMOUS EPITHELIUM.IT IS LIABLE TO INFECTION AND IF IT RUPTURES

IT LEADS TO BRANCHIAL FISTULA.DERMOID CYST: .

SOFT CYSTIC MASS—COLD ABSCESS

COLD & HOT ABSCESSCOLD T.B. ABSCESS HOT NON-SPECIFIC ABSCESS

BRANCHIAL CYST &FISTULACONGENITAL BRANCHIAL CYST RUPTURED INFECTED CYST---BRANCHIAL FISTULA

DERMOID CYST--CYSTICDERMOID CYST RESEMBLE THYROGLOSSAL CYST BUT DOES NOT MOVE WITH SWALLOWING DERMOID

ANTERIOR TRIANGLE MASSMOVES WITH DEGLUTITION OR SWALLOWING

SOLID :THYROID GLAND ;GOITRE (DIFFUSE GOITRE,,OR SINGLE THYROID NODULE,TOXIC OR NON TOXICBENIGN OR MALIGNANT ). DELPHIAN LYMPH NODE :SOLID MOVES WITH SWALLOWING.CYSTIC:THYROGLOSSAL CYST:IT MOVES WITH TONGUEPROTRUSION AS WELL.IT IS CONGENITAL REMENANT OF

THYROGLOSSAL DUCT .COULD BE AT ANY LEVELFROM FLOOR OF THE MOUTH DOWN TO BELOW CRICOID

CARTILAGE .

GOITRE =ANY THYROID ENLARGEMENTSINGLE THYROID NODULE DIFFUSE THYROID ENLARGEMENT

DELPHIAN LYMPH NODE(THE ONLY L.N. MOVESWITH DEGLUTITION).

DELPHIAN L.N. ALSO CALLED PRELARYNGEAL L.N.

THYROGLOSSAL CYST MOVES WITH DEGLUTITION &TONGUE PROTRUSION

SEEN IN CHILDREN AND ADULT

THYROGLOSSAL CYSTMOVES WITH TONGUE PROTRUSION EXCISION OF THYROGLOSSAL CYST

POSTERIOR TRIANGLE MASS WHICH DOES NOT MOVE WITH SWALLOWING

SOLID :LYMPH NODE WITH ALL CAUSES OF CERVICALLYMPHADENOPATHY.CYSTIC:CYSTIC HYGROMA;ARISES FROM PRIMITIVELYMPH SACS DURING EMBRYONIC LIFE.IT APPEARSDURING NEONATAL OR EARLY INFANCY.IT IS COMPRESSIBLE.PHARYNGEAL POUCH:IT IS DEFECT IN THE PHARYNGEAL MUSCLE WALL WITH MUCOSAL PROTRUSION ORHERNIATION.SUBCLAVIAN ARTERY ANEURYSM :

POST.TRIANGLE L.N.

CYSTIC HYGROMA-CAVERNOUS LYMPHANGIOMA

PHARYNGEAL POUCH

DIAGNOSIS-HISTORY.-PHYSICAL EXAMINATION: LOCAL &SYSTEMIC EXAMINATION. LOCAL EXAMINATION OF ANY LUMP : SIZE,SITE,SHAPE,SURFACE,COLOR,TEMPERATURE, TENDERNESS,CONSISTENCY,COMPRESSIBILITY OR PULSATILITY.INVESTIGATION:HAEMATOLOGICAL & BIOCHEMICALEXAMINATION.

DIAGNOSIS…CONT,DIMAGING TESTS :CHEST X-RAY .PLAIN X-RAY SKULL ---DERMOID CYST .ULTRASOUND ---DIFFERENTIATE BETWEEN CYSTIC &

SOLID MASS.ALSO ULTRASOUND DIFFERENTIATES BETWEEN VASCULAR AND NON-VASCULAR AS IN CAROTID BODY TUMOUR OR ANEURYSM.

CT SCAN WITH IV CONTRAST--- FOR ALL LUMPS .MRI------ .

DIAGNOSIS…CONT,DBIOPSY:FINE NEEDLE ASPIRATION BIOPSY.INCISIONAL BIOPSY .EXCISIONAL BIOPSY.

PLAIN X-RAYBONE DEFECT DUE TO DERMOID CYST DERMOID CYST

X-RAYDERMOID CYST DERMOID CYST OF THE FINGER

BONE DESTRUCTION

FINE NEEDLE BIOPSY DIRECT OR UNDER US GUIDE

EXCISIONAL BIOPSY FNA BIOPSY SLIDES