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Published byGerard Stocke Modified over 9 years ago
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EDWARD WEISBERGER MD OTOLARYNGOLOGY/HEAD AND NECK SURGERY INDIANA UNIVERSITY MEDICAL CENTER
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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
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AGE PEDIATRIC-INFLAMMATORY, CONGENITAL TEENAGE-INFLAMMATORY, LYMPHOMA, THYROID CA ADULT-METASTATIC SCC, THYROID CANCER, LYMPHOMA
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NEOPLASTIC (BENIGN) NEUROGENIC (NEUROLEMMOMA) VASCULAR (PARAGANGLIOMA OF CAROTID BODY OR VAGAL BODY) VASCULAR (ANEURYSM) PAROTID (BENIGN MIXED TUMOR, WARTHIN’S TUMOR)
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AYSYMETRICAL ENLARGEMENT OF CERVICAL LYMPH NODES IN AN ADULT ALWAYS DUE TO METASTASIS FROM A HEAD AND NECK PRIMARY (OFTEN SCC) HAYES MARTIN 1952
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NEOPLASTIC (MALIGNANT) METASTATIC SQUAMOUS CELL CARCINOMA LYMPHOMA THYROID CANCER METASTATIC MELANOMA METASTIC TESTICULAR CANCER
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CHARACTERISTICS OF A METASTAIC NECK MASS PAINLESS UNILATERAL ADULT AGE GROUP
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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%
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ORAL CAVITY ULCERATIVE LESION
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FIBEROPTIC LARYNGOSCOPY
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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
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CAROTID BODY TUMOR LOCATED CAROTID BIFURCATION MORE DISCREET IN ANT/POSTERIOR DIRECTION THAN SUPERIOR/INFERIOR SOMETIMES A BRUIT
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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
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EVALUATION OF A NECK MASS IF PRIMARY NOT IDENTIFIED AND PATIENT HAS TONSILS- TONSILLECTOMY WILL DISCLOSE A PRIMARY IN 30% OF PATIENTS
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TERATOMA
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LYMPHANGIOMA
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VIRCHOW’S NODE LEFT SUPRACLAVICULAR NODE REPRESENTING METASTASIS FROM BELOW THE CLAVICLE-OFTEN FROM BELOW THE DIAPHRAGM
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VIRCHOW’S NODE
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AVOID ANTIBIOTIC THERAPY FOR A PAINLESS NECK MASS IN AN ADULT EXAMINE ORAL CAVITY REFER FOR DEFINITIVE DIAGNOSIS
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UNKNOWN PRIMARY MOST COMMON SOURCE- HYPOPHARYNX, TONSIL, BASE OF TONGUE IN PAST-NASOPHARYNX (MORE COMMON IN CHINESE, AMERICAN INDIAN, ALASKAN NATIVE)
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UNKNOWN PRIMARY
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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
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