Differential Diagnosis of Head and Swelling

Differential Diagnosis of Head and Swelling - Differential...

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Unformatted text preview: Differential Diagnosis of Head and Neck Swellings and it’s management Swellings M.D.S Department College of Dentistry College King Saud University King Head and Neck Swellings Head A number of masses may develop in the head and neck, number and these may also be called swellings, growths, swellings, tumors, lumps, and bumps. tumors, While some head and neck masses are cancerous, many While are not. are However, it is important to investigate if any abnormal However, bump or swelling persists for more than two weeks. more Head and Neck – Complex region Numerous Lymph nodes are located in the Head & Neck region Salivary glands Thyroid gland, Parathyroid glands, Thymus gland etc., What Causes Head and Neck Swellings ? What (i) Cysts, thyroid masses, vascular masses, salivary Cysts, gland masses e.t.c, can cause swellings in the head and neck. and (ii) Enlargement of lymph nodes in the head and neck Enlargement can also cause a swelling. can (iii) Inflammatory / Infectious conditions can also cause lumps of the head and neck region. (iv) Benign & Malignant masses can cause swelling of the head and neck. Symptoms Associated with Neck Lumps Symptoms Lump in the neck persisting for more than two weeks, Lump especially if it is not associated with a cold, flu, or other infection. Cancers of the mouth, throat, voice box (larynx), Cancers thyroid, and some lymphomas can appear first as a painless, growing neck lump. painless, Symptoms Associated with Head & Neck Lumps Lumps Change in the voice including hoarseness that persists for more than two weeks persists Growth in the mouth Growth Swollen tongue Swollen Blood in the saliva or phlegm Blood Swallowing problems Swallowing Diagnosing Head and Neck Masses Diagnosing Examination of some masses / swelling may allow a Examination physician to determine their cause based on location, size, and consistency. size, In other cases, however, additional tests may be required. required. Diagnosing Head and Neck Masses Diagnosing Changes in the skin – It is important to examine changes in the skin that could indicate basal cell carcinoma, squamous cell cancer, and malignant melanoma. Persistent Ear Pain or ear pain while swallowing may be Persistent a symptom of infection or a growth in the throat. symptom Radiographic Investigation of the Head and Neck Masses Masses MRI – Magnetic Resonance Imaging can clearly highlight soft tissue pathologies better than the C.T. soft Scan. Scan. It uses a magnetic field rather than x-rays (radiation). Radiographic Investigation of the Head and Neck Masses Masses CT SCAN – Computed tomography is less accurate than M.R.I for the soft tissue examination, but is very useful to locate bony tumors and their dimensions and extensions. tumors C.T with contrast is used to enhance the visibility of abnormal C.T tissue during examination. tissue Radiographic Investigation of the Head and Neck Masses Masses PET (Positron Emission Tomography) and SPECT (Single PET Photon Emission Tomography) are useful after diagnosis to help Photon determine the grade of a tumor or to distinguish between cancerous and dead or scar tissue. They involve injection with a radioactive tracer. They Diagnosing Head and Neck Masses Diagnosing F.N.A.C – Fine Needle Aspiration Biopsy is Safe Safe Rapid Rapid Inexpensive Inexpensive Presurgical planning Presurgical Avoids open biopsy Avoids Head and Neck Swellings Head (i) Enlargement of lymph nodes (i) This is the most common cause of new neck swellings. This Lymph nodes, which are part of the immune system, Lymph can enlarge when the body rallies to fight an infection. can When the infection recedes, lymph swelling subsides as When well. well. (ii) Benign Swellings of the Head and Neck of Benign Swellings / masses do not spread (metastasize) Benign to surrounding tissue and are not cancerous. to Nevertheless, benign masses can be serious if they impact nerves or exert pressure in the head and neck, and are therefore often removed surgically. These include cysts, thyroid masses, vascular masses, These salivary gland masses, and others. salivary (ii) Benign Swellings of the Head and Neck (ii) of Congenital/ Developmental Cysts (i) Thyroglossal cyst (i) (ii) Branchial cyst (ii) (iii) Sebaceous cyst (iii) (iv) Dermoid cyst Dermoid Developmental Cyst - ThyroglossalCyst Most common congenital neck mass Arrested migration of thyroid 50% present before age 20 Midline (75%) or near midline (25%) Elevates on swallowing/protrusion of tongue Surgery is the only treatment. Developmental Cyst - Branchial Cyst Branchial Remnants of incompletely obliterated branchial clefts/pouches Located anterior & deep to sternomastoid muscle. Painless swelling Young adults M = F ratio Unilateral, 75%of cases on left side. Developmental Cyst - Branchial Cyst Branchial Cystic mass anterior to SCM, below mandible May get infected Persistence of 2nd branchial cleft May have small sinus tract into tonsillar fossa Contains cholesterol crystals Surgical Management of the Branchial Cyst Surgical Developmental Cyst Sebaceous cyst Sebaceous A sebaceous cyst is a a benign, harmless growth that sebaceous occurs under the skin and tends to be smooth to the touch. Ranging in size, sebaceous cysts are usually found on Ranging the scalp, face, neck and ears. They are formed when the release of sebum, a mediumthick fluid produced by sebaceous glands in the skin, is thick blocked. Developmental Cyst Sebaceous cyst Sebaceous Unless they become infected and painful or large, Unless sebaceous cysts do not require medical attention or treatment, and they usually go away on their own. treatment, If they become infected, the physician may drain the If fluid and cells that make up the cyst wall. Or, if the cyst causes irritation or cosmetic problems, it may be removed through a simple excision procedure. removed Dermoid cyst Dermoid A dermoid cyst is a congenital defect (present from birth) that occurs during embryonic development when the skin layers do not properly grow together. A dermoid cyst is lined with epithelium, which contains tissues and cells normally present in skin layers, including hair follicles, sebaceous (skin oil), and sweat glands. These glands and tissues secrete their normal substances which collect inside the cyst, causing it to grow and enlarge. Ranula Ranula presents as a Cystic swelling in the floor of mouth. It occurs as a mucous extravasation from sublingual salivary gland.• May extend through the mylohyoid muscles into the neck“Plunging Ranula” Surgical treatment is by removal of the Sublingual gland associated with the swelling. (iii) Inflammatory Lumps of the Head and Neck Cervical Adenitis secondary to acute URTI-tonsillitis, EBV etc- are common and is detected from history. Inflammatory Lumps of the Head and Neck Chronic inflammatory disease like Tuberculosis, Sarcoidosis, Cat Scratch disease. These disease processes have to be treated medically. For example, Patients with tuberculous lymphadenitis should undergo anti-tuberculosis drug therapy. Surgical Management of Infections in the Head and Neck Region Submandibular Abscesses, Ludwig’s Angina occur secondary to odontogenic infections and Parotid or submandibular gland abscesses etc, need to undergo incision and drainage under G.A, along antibiotic treatment. along (iv) Neoplastic Masses of the Head and Neck Neoplastic Masses can be classified into two types (i.e) benign and malignant masses. Neoplastic Masses of the Head and Neck Benign Head and Neck Masses •Any structure of the head and neck may be involved. Skin, SC Tissue, fat, nerve muscle, blood vessel can be affected. For example, Lipoma (Fat), Fibroma (Fibrous tissue), Hemangioma( Blood vessel), Neuroma (Nerve). Benign Head and Neck Masses Benign tumors of the Salivary gland like Pleomorphic Benign adenoma, Warthins tumour etc., can present with a significant head and neck swelling. Multinodular goitre, cyst, adenoma can affect the Thyroid glands. Malignant Masses of the Head and Neck Malignant Masses of the Head and Neck - Malignant masses can occur anywhere in the upper aero-digestive tract. - May also arise from skin and soft and hard tissues of head and neck-SCC, melanoma - It can occur from the salivary glands, thyroid gland, parathyroid gland. Malignant Swellings of the Head and Neck Malignant Head and neck masses are malignant, if they spread to Head surrounding tissue. In the head and neck, tumors may be either primary or secondary. secondary What are primary tumors? What Primary tumors originate in the head or neck itself, including the thyroid, throat, larynx, salivary gland, brain, or other locations. Primary tumors of the head and neck typically spread to Primary the lymph nodes in the neck. What are secondary tumors ? What Secondary cancers are tumors that have spread from primary tumors in other parts of the body to the head or neck. Most often, secondary tumors of the neck originate in Most the lung, breast, kidney, or from melanomas in the skin. the Cancers in the nasal and sinus passages may spread to the brain through nerves in the skull. the Head and Neck Cancer- Squamous Cell.Carcinoma 6th most common cancer worldwide HNSCC ~ 5% all cancers S.C.C most common upper aero digestive tract malignancy Smoking 50% HNSCC occur in oral cavity Management presents considerable functional and aesthetic problems Multidisciplinary approach imperative Treatment of Head and Neck - Squamous Cell Carcinoma Carcinoma Removal of Primary tumor + cervical nodes Surgery / Radiation / Chemotherapy Sometimes palliation Cervical neck disease reduces survival by 50% Lymphomas Lymphomas Lymphomas are malignant cell infiltrations of the lymphatic Lymphomas system. system. Once a malignancy begins in one part of the lymph system, Once it often spreads throughout the rest of the system before it is detected. Lymphomas Lymphomas Lymphomas share similar symptoms such as painless Lymphomas swelling of the lymph nodes, fever and fatigue. Broadly, they are classified as either non-Hodgkin's and Broadly, non-Hodgkin's Hodgkin's. Hodgkin's Summary Head and Neck lumps are not that uncommon Usually benign in kids Don’t ignore adult neck lump especially when cause not apparent. History and Examination, radiology, FNA Surgical, Medical, Chemotherapy and radiation treatment options are available for malignant masses. ...
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This note was uploaded on 11/10/2011 for the course PDBIO 220 taught by Professor Tomco during the Winter '09 term at BYU.

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