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 CONGENITAL-THYROGLOSSAL DUCT CYST, LYMPHANGIOMA, DERMOID CYST, BRANCHIAL CLEFT CYST, TERATOMA NEOPLASM

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

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

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

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

CHARACTERISTICS OF A METASTAIC NECK MASS PAINLESS UNILATERAL ADULT AGE GROUP

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%

ORAL CAVITY ULCERATIVE LESION

FIBEROPTIC LARYNGOSCOPY

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

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

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

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

TERATOMA

LYMPHANGIOMA

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

VIRCHOW’S NODE

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

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

UNKNOWN PRIMARY

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