1. NECK MASS Assessment of a neck mass Assessment of a neck mass M. Hosseini M.D. M. Hosseini M.D. Head & Neck Surgeon Head & Neck Surgeon Rasool Akram Hspital Rasool Akram Hspital Iran University Iran University Assessment of a neck mass Assessment of a neck mass M. Hosseini M.D. M. Hosseini M.D. Head & Neck Surgeon Head & Neck Surgeon Rasool Akram Hspital Rasool Akram Hspital Iran University Iran University

2. Question : 1- What structure is the neck mass arising from ? 2- Is it a lymph node ? 3- Is the mass arising from a normally occurring structure (thyroid – never – vessel – muscle) ? structure (thyroid – never – vessel – muscle) ? 4- Abnormal structure (larngocele – brachial – cleft – cystic hygroma) ? cleft – cystic hygroma) ? 5- Is the mass soft, fluctuant – mobile – fixed ? 6- Palsato 7- Bruit 8- Superficial – deep 9- Is it attached to the skin ? 10 - Tender 1- What structure is the neck mass arising from ? 2- Is it a lymph node ? 3- Is the mass arising from a normally occurring structure (thyroid – never – vessel – muscle) ? structure (thyroid – never – vessel – muscle) ? 4- Abnormal structure (larngocele – brachial – cleft – cystic hygroma) ? cleft – cystic hygroma) ? 5- Is the mass soft, fluctuant – mobile – fixed ? 6- Palsato 7- Bruit 8- Superficial – deep 9- Is it attached to the skin ? 10 - Tender

3. - Duration - Growth rate ( M > B ) - Location (Congenital – Developmental) - Duration - Growth rate ( M > B ) - Location (Congenital – Developmental)

4. Risk Factor : TobaccoAlcoholLeukoplakiaErthroplakia Poor Hygiene Submucosal fibrosis Local inflammation due to trauma TraumaTobaccoAlcoholLeukoplakiaErthroplakia Poor Hygiene Submucosal fibrosis Local inflammation due to trauma Trauma

5. - Deletion of chromosomes 3p & 18q - Deletion of chromosomes 3p & 18q - Amplification of int – 2 and bcl -1 - Amplification of int – 2 and bcl -1 - Mutation of p 53 - Overexpression of transforming growth factor – (TGF – α) growth factor – (TGF – α) - Epidermal growth factor receptor (EGF 1 ) - Deletion of chromosomes 3p & 18q - Deletion of chromosomes 3p & 18q - Amplification of int – 2 and bcl -1 - Amplification of int – 2 and bcl -1 - Mutation of p 53 - Overexpression of transforming growth factor – (TGF – α) growth factor – (TGF – α) - Epidermal growth factor receptor (EGF 1 )

6. I. Muscle & fibrous tissue A. Congenital / developmental – fibromatosis colli B. Inflammatory – myositis C. Neoplastic 1. Benign – rhabdomyoma 1. Benign – rhabdomyoma 2. Aggressive – fibromatoses 2. Aggressive – fibromatoses 3. Malignant – rhabdomyosarcoma 3. Malignant – rhabdomyosarcoma D. Miscellaneous 1. Benign masseter muscle hypertrophy 1. Benign masseter muscle hypertrophy 2. Compensatory muscle hypertrophy (often seen after 2. Compensatory muscle hypertrophy (often seen after R. N. D) R. N. D) A. Congenital / developmental – fibromatosis colli B. Inflammatory – myositis C. Neoplastic 1. Benign – rhabdomyoma 1. Benign – rhabdomyoma 2. Aggressive – fibromatoses 2. Aggressive – fibromatoses 3. Malignant – rhabdomyosarcoma 3. Malignant – rhabdomyosarcoma D. Miscellaneous 1. Benign masseter muscle hypertrophy 1. Benign masseter muscle hypertrophy 2. Compensatory muscle hypertrophy (often seen after 2. Compensatory muscle hypertrophy (often seen after R. N. D) R. N. D)

7. II. Lymphatic & reticuloendothelial systems A. Congenital – cystic hygroma, hamartoma B. Inflammatory lymphadenitis 1. Viral 1. Viral a. Cat – scratch disease a. Cat – scratch disease b. Infectious monoucleosis b. Infectious monoucleosis 2. Bacterial 2. Bacterial a. Routine ( strept. Staph. ) a. Routine ( strept. Staph. ) b. Syphilis b. Syphilis c. T.B. c. T.B. d. Actinomycosis d. Actinomycosis 3. Fungal 3. Fungal a. Histoplasmosis a. Histoplasmosis b. Blastomycosis b. Blastomycosis 4. Parasitic 4. Parasitic a. Toxoplasmosis a. Toxoplasmosis b. Leishmaniasis b. Leishmaniasis A. Congenital – cystic hygroma, hamartoma B. Inflammatory lymphadenitis 1. Viral 1. Viral a. Cat – scratch disease a. Cat – scratch disease b. Infectious monoucleosis b. Infectious monoucleosis 2. Bacterial 2. Bacterial a. Routine ( strept. Staph. ) a. Routine ( strept. Staph. ) b. Syphilis b. Syphilis c. T.B. c. T.B. d. Actinomycosis d. Actinomycosis 3. Fungal 3. Fungal a. Histoplasmosis a. Histoplasmosis b. Blastomycosis b. Blastomycosis 4. Parasitic 4. Parasitic a. Toxoplasmosis a. Toxoplasmosis b. Leishmaniasis b. Leishmaniasis

8. II. Lymphatic & reticuloendothelial systems C. Neoplastic (Primary & metastatic lymphnode) 1. Sarcomas 1. Sarcomas a. Lymphomas (Hodgkin’s & non- hodgkin) a. Lymphomas (Hodgkin’s & non- hodgkin) b. Soft part sarcoma b. Soft part sarcoma c. Leukemias c. Leukemias 2. Carcionomas ( all – metastatic) 2. Carcionomas ( all – metastatic) a. Squamous cell a. Squamous cell b. Melanoma b. Melanoma c. Thyroid malig. c. Thyroid malig. d. Salivary gland malig. d. Salivary gland malig. D. Miscellaneous Drug reaction (Phenytoin) Drug reaction (Phenytoin) C. Neoplastic (Primary & metastatic lymphnode) 1. Sarcomas 1. Sarcomas a. Lymphomas (Hodgkin’s & non- hodgkin) a. Lymphomas (Hodgkin’s & non- hodgkin) b. Soft part sarcoma b. Soft part sarcoma c. Leukemias c. Leukemias 2. Carcionomas ( all – metastatic) 2. Carcionomas ( all – metastatic) a. Squamous cell a. Squamous cell b. Melanoma b. Melanoma c. Thyroid malig. c. Thyroid malig. d. Salivary gland malig. d. Salivary gland malig. D. Miscellaneous Drug reaction (Phenytoin) Drug reaction (Phenytoin)

9. III. Salivary glands A. Congenital – cysts B. Inflammatory 1. Acute viral sialoadenitis (mumps) 1. Acute viral sialoadenitis (mumps) 2. Acute bacterial sialoadenitis 2. Acute bacterial sialoadenitis 3. Chronic sialoadenitis 3. Chronic sialoadenitis C. Enlargement secondary to systemic disease – obesity, alcoholism, malnutrition A. Congenital – cysts B. Inflammatory 1. Acute viral sialoadenitis (mumps) 1. Acute viral sialoadenitis (mumps) 2. Acute bacterial sialoadenitis 2. Acute bacterial sialoadenitis 3. Chronic sialoadenitis 3. Chronic sialoadenitis C. Enlargement secondary to systemic disease – obesity, alcoholism, malnutrition

10. III. Salivary glands D. Neoplastic 1. Benign – hemangioma, mixed tumor, warthin’s 1. Benign – hemangioma, mixed tumor, warthin’s 2. Malignant – nucoepidermoid ca., adenoid cystic ca. 2. Malignant – nucoepidermoid ca., adenoid cystic ca. E. Obstructive enlargement 1. Sialolithiasis 1. Sialolithiasis 2. Ductal stricture 2. Ductal stricture F. Miscellaneous enlargements of salivary glands 1. Sjogren’s synd. 1. Sjogren’s synd. 2. Drug reaction (iodine) 2. Drug reaction (iodine) D. Neoplastic 1. Benign – hemangioma, mixed tumor, warthin’s 1. Benign – hemangioma, mixed tumor, warthin’s 2. Malignant – nucoepidermoid ca., adenoid cystic ca. 2. Malignant – nucoepidermoid ca., adenoid cystic ca. E. Obstructive enlargement 1. Sialolithiasis 1. Sialolithiasis 2. Ductal stricture 2. Ductal stricture F. Miscellaneous enlargements of salivary glands 1. Sjogren’s synd. 1. Sjogren’s synd. 2. Drug reaction (iodine) 2. Drug reaction (iodine)

11. IV. Vascular system A. Developmental / degenerative / traumatic 1. Aneurysm 1. Aneurysm 2. Arteriovenous malf. 2. Arteriovenous malf. 3. Tortuous arteries 3. Tortuous arteries 4. Hematoma 4. Hematoma B. Neoplastic 1. Hemangiomas 1. Hemangiomas 2. Angiosarcomas 2. Angiosarcomas 3. Hemangiopericytoma 3. Hemangiopericytoma 4. Carotid body tumor 4. Carotid body tumor A. Developmental / degenerative / traumatic 1. Aneurysm 1. Aneurysm 2. Arteriovenous malf. 2. Arteriovenous malf. 3. Tortuous arteries 3. Tortuous arteries 4. Hematoma 4. Hematoma B. Neoplastic 1. Hemangiomas 1. Hemangiomas 2. Angiosarcomas 2. Angiosarcomas 3. Hemangiopericytoma 3. Hemangiopericytoma 4. Carotid body tumor 4. Carotid body tumor

12. V. Nervous system A. Benign 1. Neurofibroma 1. Neurofibroma 2. Neuroma 2. Neuroma 3. Neurilemmoma (schwannoma) 3. Neurilemmoma (schwannoma) 4. Paragangliomas (carotid body, vagal body, & 4. Paragangliomas (carotid body, vagal body, & glomus jugulare tumors) glomus jugulare tumors) B. Malignant (rare) 1. Neurogenous sar. 1. Neurogenous sar. 2. Neuroepithelioma 2. Neuroepithelioma 3. Malig. schwannoma 3. Malig. schwannoma A. Benign 1. Neurofibroma 1. Neurofibroma 2. Neuroma 2. Neuroma 3. Neurilemmoma (schwannoma) 3. Neurilemmoma (schwannoma) 4. Paragangliomas (carotid body, vagal body, & 4. Paragangliomas (carotid body, vagal body, & glomus jugulare tumors) glomus jugulare tumors) B. Malignant (rare) 1. Neurogenous sar. 1. Neurogenous sar. 2. Neuroepithelioma 2. Neuroepithelioma 3. Malig. schwannoma 3. Malig. schwannoma

13. VI. Thyroid gland A. Congenital / developmental – cysts B. Inflammatory 1. Acute thyroiditis 1. Acute thyroiditis 2. Subacute (de Quervain’s) 2. Subacute (de Quervain’s) 3. Chronic thyroiditis 3. Chronic thyroiditis a. Lymphocytic (Hashimoto’s) a. Lymphocytic (Hashimoto’s) b. Fibrous/ ligneous (Riedel’s) b. Fibrous/ ligneous (Riedel’s) A. Congenital / developmental – cysts B. Inflammatory 1. Acute thyroiditis 1. Acute thyroiditis 2. Subacute (de Quervain’s) 2. Subacute (de Quervain’s) 3. Chronic thyroiditis 3. Chronic thyroiditis a. Lymphocytic (Hashimoto’s) a. Lymphocytic (Hashimoto’s) b. Fibrous/ ligneous (Riedel’s) b. Fibrous/ ligneous (Riedel’s)

14. VI. Thyroid gland C. Neoplastic 1. Benign – adenomas 1. Benign – adenomas 2. Malignant 2. Malignant a. Papillary car. a. Papillary car. b. Follicular car. b. Follicular car. c. Medullary car. c. Medullary car. d. Poorly diff. car. d. Poorly diff. car. D. Miscellaneous 1. Diffuse colloid goiter 1. Diffuse colloid goiter 2. Diffuse goiter with hyperthyroidism 2. Diffuse goiter with hyperthyroidism 3. Nodular goiter 3. Nodular goiter C. Neoplastic 1. Benign – adenomas 1. Benign – adenomas 2. Malignant 2. Malignant a. Papillary car. a. Papillary car. b. Follicular car. b. Follicular car. c. Medullary car. c. Medullary car. d. Poorly diff. car. d. Poorly diff. car. D. Miscellaneous 1. Diffuse colloid goiter 1. Diffuse colloid goiter 2. Diffuse goiter with hyperthyroidism 2. Diffuse goiter with hyperthyroidism 3. Nodular goiter 3. Nodular goiter

15. VII. Miscellaneous soft tissue neop. A. Benign 1. Lipoma 1. Lipoma 2. Myxoma 2. Myxoma 3. Hibernoma 3. Hibernoma B. Malignant 1. Synovial cell sarc. 1. Synovial cell sarc. 2. Liposarcoma 2. Liposarcoma A. Benign 1. Lipoma 1. Lipoma 2. Myxoma 2. Myxoma 3. Hibernoma 3. Hibernoma B. Malignant 1. Synovial cell sarc. 1. Synovial cell sarc. 2. Liposarcoma 2. Liposarcoma

16. VIII. Larynx, pharynx, & deep neck structures A. Developmental 1. Malformed laryngeal cartilage 1. Malformed laryngeal cartilage 2. External laryngocele 2. External laryngocele 3. Branchial cleft abnormalities 3. Branchial cleft abnormalities B. Inflammatory 1. Deep neck infection / abscess 1. Deep neck infection / abscess 2. Osteomyelitis of cervical spine 2. Osteomyelitis of cervical spine C. Neoplastic 1. Car. Of larynx & pharynx 1. Car. Of larynx & pharynx 2. Chordoma of larynx 2. Chordoma of larynx 3. Neoplasm of cervical spine 3. Neoplasm of cervical spine A. Developmental 1. Malformed laryngeal cartilage 1. Malformed laryngeal cartilage 2. External laryngocele 2. External laryngocele 3. Branchial cleft abnormalities 3. Branchial cleft abnormalities B. Inflammatory 1. Deep neck infection / abscess 1. Deep neck infection / abscess 2. Osteomyelitis of cervical spine 2. Osteomyelitis of cervical spine C. Neoplastic 1. Car. Of larynx & pharynx 1. Car. Of larynx & pharynx 2. Chordoma of larynx 2. Chordoma of larynx 3. Neoplasm of cervical spine 3. Neoplasm of cervical spine

17. IX. Other assorted lesions A. Bezold’s (mastoid) abscess B. Cholesteatoma from mastoid C. Thymoma D. Epidermoid inclusion cyst A. Bezold’s (mastoid) abscess B. Cholesteatoma from mastoid C. Thymoma D. Epidermoid inclusion cyst

18. AGE ( YEARS ) 0 - 15 Inflammatory Neoplastic Adenitis Lymphoma (AT/PT) Bacterial (AT/PT) Thyroid Carcinoma (M) Viral (AT/PT) Sarcoma (AT/PT) Granlomatous (PT/AT) Congenital Branchial cyst (AT) Thyroglossal cyst (M) Vascular Lesion (PT) Dermoid (M) Inflammatory Neoplastic Adenitis Lymphoma (AT/PT) Bacterial (AT/PT) Thyroid Carcinoma (M) Viral (AT/PT) Sarcoma (AT/PT) Granlomatous (PT/AT) Congenital Branchial cyst (AT) Thyroglossal cyst (M) Vascular Lesion (PT) Dermoid (M)

19. AGE ( YEARS ) 16 - 40 Inflammatory Neoplastic Adenitis Lymphoma (AT/PT) Viral (AT/PT) Thyroid Carcinoma (M) Bacterial (AT/PT) Salivary (AT) Granlomatous (PT/AT) Metastatic (AT/PT) Aids (AT/PT) Vascular (AT/PT) Congenital Neurogenic (AT) Branchial cyst (AT) Thyroglossal cyst (M) Dermoid (M) Inflammatory Neoplastic Adenitis Lymphoma (AT/PT) Viral (AT/PT) Thyroid Carcinoma (M) Bacterial (AT/PT) Salivary (AT) Granlomatous (PT/AT) Metastatic (AT/PT) Aids (AT/PT) Vascular (AT/PT) Congenital Neurogenic (AT) Branchial cyst (AT) Thyroglossal cyst (M) Dermoid (M)

20. AGE ( YEARS ) 40 + Neoplastic Metastatic carcinoma (AT/PT) Thyroid carcinoma (M) Inflammatory Adenitis Viral (AT/PT) Bacterial (AT/PT) Granlomatous (PT/AT) Aids (AT/PT) Congenital Neoplastic Metastatic carcinoma (AT/PT) Thyroid carcinoma (M) Inflammatory Adenitis Viral (AT/PT) Bacterial (AT/PT) Granlomatous (PT/AT) Aids (AT/PT) Congenital Branchial cyst (AT) Thyroglossal cyst (M)

21. Chronic infection 1- T.B 2- Fungal 3- Syphilis 4- Cat – scratch fever 5- Aids 6- Sarcoidosis 7- Mononucleosis 1- T.B 2- Fungal 3- Syphilis 4- Cat – scratch fever 5- Aids 6- Sarcoidosis 7- Mononucleosis

22. Infection – inflammation ( Fever – Pain – Tenderness ) T.B Sarcoidosis Fungal infection Dental problems Trauma to H. & N. ‍Cancer ( Skin lesion – Head & Neck Tumor ) Night sweats ( lymphoma ) Exposure to the sun ( Skin cancer ) Smoking or excessive alcohol consumption ( S.C.C of the fead & Neck ) Infection – inflammation ( Fever – Pain – Tenderness ) T.B Sarcoidosis Fungal infection Dental problems Trauma to H. & N. ‍Cancer ( Skin lesion – Head & Neck Tumor ) Night sweats ( lymphoma ) Exposure to the sun ( Skin cancer ) Smoking or excessive alcohol consumption ( S.C.C of the fead & Neck )

23. Nasal obstruction Nasal bleeding Otalgia Odynophagia Dyspahgia Hoarseness Nasal obstruction Nasal bleeding Otalgia Odynophagia Dyspahgia Hoarseness } Malignancy of upper aerodigestive tract Exposure to low – dose therapeutic radiation ( risk factor for thyroid Cancer)

24. Biopsy 1- Preferred method 2- Cystic form solid 3- Often diagnose malignancy 4- Standard for making treatment decisions in patiets with thyroid nodules 5- Bleeding from it make problem for CT & MRI 6- Fna is not valuable in : Nodul of thyroid with History of Radiation, Lymphoma. 1- Preferred method 2- Cystic form solid 3- Often diagnose malignancy 4- Standard for making treatment decisions in patiets with thyroid nodules 5- Bleeding from it make problem for CT & MRI 6- Fna is not valuable in : Nodul of thyroid with History of Radiation, Lymphoma. FNA

25. Thyroid Nodules - Childern, young men, pregnant women, radiation, family history of the thyroid cancer. radiation, family history of the thyroid cancer. - Childern, young men, pregnant women, radiation, family history of the thyroid cancer. radiation, family history of the thyroid cancer.

26. Imaging Studies Ultrasonography A - Solid – Cystic B - Congenital – developmental ( cyst ) C - Vascular, thyroid & parathyroid abnormality Ultrasonography A - Solid – Cystic B - Congenital – developmental ( cyst ) C - Vascular, thyroid & parathyroid abnormality

27. CT A - Solid – Cystic B- Mass is within or outside a gland or nodal chain C- Small tongue – base, tonsillar mass that have minimal mucosal component A - Solid – Cystic B- Mass is within or outside a gland or nodal chain C- Small tongue – base, tonsillar mass that have minimal mucosal component

28. MRI T2 – Weighted gadolinium enhanced scans is Useful for invasion of soft tissue by tumor. T2 – Weighted gadolinium enhanced scans is Useful for invasion of soft tissue by tumor.

29. ArteriographyArteriography A- evaluating vascular lesions B- fixation of tumor to the carotid C- vascularity of mass D- specific blood supply A- evaluating vascular lesions B- fixation of tumor to the carotid C- vascularity of mass D- specific blood supply

30. Thyroglossal duct cysts 1- 70% of all congenital abnormalities of the neck 2- First decade of life 3- Midline 4- Move side to side but not up to down 5- 1% contain cancer ( papillary ca-S.c.c. ) 1- 70% of all congenital abnormalities of the neck 2- First decade of life 3- Midline 4- Move side to side but not up to down 5- 1% contain cancer ( papillary ca-S.c.c. )

31. Branchial cleft cysts 1- Five branchial arches & four clefts 2- Internal tract or opening is situated at pharyngeal groove such as tonsil ( second Arch ) or piriform groove such as tonsil ( second Arch ) or piriform Sinus ( Third & fourth arches ) Sinus ( Third & fourth arches ) 3- The Second arch is the most common 4- Anterior border of S.C.M 5- Most are diagnosed in the first two decades of life ( any age ) ( any age ) 6- Lateral neck ( smooth, painless, slowly enlarging mass ) mass ) 1- Five branchial arches & four clefts 2- Internal tract or opening is situated at pharyngeal groove such as tonsil ( second Arch ) or piriform groove such as tonsil ( second Arch ) or piriform Sinus ( Third & fourth arches ) Sinus ( Third & fourth arches ) 3- The Second arch is the most common 4- Anterior border of S.C.M 5- Most are diagnosed in the first two decades of life ( any age ) ( any age ) 6- Lateral neck ( smooth, painless, slowly enlarging mass ) mass )

32. Cystic Hygroma 1- Second year of life 2- 80% in P.T. 3- Floor of the mouth- supraclavicular, root of the neck, angle of the jaw – may involved the neck, angle of the jaw – may involved parotid – tongue – larynx. parotid – tongue – larynx. 4-Diffuse, soft, doughy, irregular mass. 5- Transilluminated 6- Aspiration yields straw – colored fluid 1- Second year of life 2- 80% in P.T. 3- Floor of the mouth- supraclavicular, root of the neck, angle of the jaw – may involved the neck, angle of the jaw – may involved parotid – tongue – larynx. parotid – tongue – larynx. 4-Diffuse, soft, doughy, irregular mass. 5- Transilluminated 6- Aspiration yields straw – colored fluid ( Lymphangiomas )

33. Vascular Malformation - Congenital - Bluish – purple coloration, increased warmth, compressibility, bruit, thrill – most of them compressibility, bruit, thrill – most of them resolve spontaneously resolve spontaneously - Congenital - Bluish – purple coloration, increased warmth, compressibility, bruit, thrill – most of them compressibility, bruit, thrill – most of them resolve spontaneously resolve spontaneously ( Hemangiomas )

34. Salivary gland Tumors (B) - Complete submandibular resection & superficial parotidectomy superficial parotidectomy - Complete submandibular resection & superficial parotidectomy superficial parotidectomy

36. PATIENT AGE ( YEARS ) 16 - 40 FREQUENCY OF DISEASE GROUPINGS INFLAMMATORY CONGENITAL / DEVELOPMENTAL NEOPLASTIC MALIGNANT BENIGN TRAUMATIC LOCATION Anterior triangle INFLAMMATORY CONGENITAL / DEVELOPMENTAL NEOPLASTIC MALIGNANT BENIGN TRAUMATIC LOCATION Anterior triangle

37. PATIENT AGE ( YEARS ) 40 + FREQUENCY OF DISEASE GROUPINGS NEOPLASTIC MALIGNANT BENIGN INFLAMMATORY LOCATION Posterior triangle NEOPLASTIC MALIGNANT BENIGN INFLAMMATORY LOCATION Posterior triangle CONGENITAL / DEVELOPMENTAL TRAUMATIC

38. PATIENT AGE ( YEARS ) 0 - 15 FREQUENCY OF DISEASE GROUPINGS INFLAMMATORY CONGENITAL / DEVELOPMENTAL NEOPLASTIC MALIGNANT BENIGN TRAUMATIC LOCATION Midline and anterior neck INFLAMMATORY CONGENITAL / DEVELOPMENTAL NEOPLASTIC MALIGNANT BENIGN TRAUMATIC LOCATION Midline and anterior neck

39. PATIENT AGE ( YEARS ) 16 - 40 CAUSATIVE DISEASES BY LOCATION Congenital / Developmental Thymic cyst Sialadenopathy Parotid Submandibular Congenital / Developmental Thymic cyst Sialadenopathy Parotid Submandibular

40. INFLAMMATORY Adenitis Sialadenitis Viral Parotid Bacterial Submandibular Granulomatus Adenitis Sialadenitis Viral Parotid Bacterial Submandibular Granulomatus

41. Neoplastic Metastatic Lymphoma Upper jugular (II) Primary vascular Oropharynx Carotid body Oral cavity Glomus Oral cavity Hemangioma Nasal sinus Face Mid – jugular (III) Hypopharynx Larynx Traumatic False aneurysm

42. PATIENT AGE ( YEARS ) 0 - 15 CAUSATIVE DISEASES BY LOCATION Congenital / Developmental Thyroglossal duct cyst Dermoid Laryngocele Inflammatory Adenitis Neoplastic Thyroid Lymphoma Traumatic Sternocleidomastoid Hematoma / fibroma Congenital / Developmental Thyroglossal duct cyst Dermoid Laryngocele Inflammatory Adenitis Neoplastic Thyroid Lymphoma Traumatic Sternocleidomastoid Hematoma / fibroma

43. INFLAMMATORY Adenitis Sialadenitis Viral Parotid Bacterial Submandibular Granulomatus Adenitis Sialadenitis Viral Parotid Bacterial Submandibular Granulomatus

44. PATIENT AGE ( YEARS ) 40 + CAUSATIVE DISEASES BY LOCATION Congenital / Developmental Lymphangiom Neoplastic Inflammatory Lymphoma Adenitis Metastatic (V) Bacterial Superior Viral Lung Gastrointestinal Genitourinary Gyneocologic Congenital / Developmental Lymphangiom Neoplastic Inflammatory Lymphoma Adenitis Metastatic (V) Bacterial Superior Viral Lung Gastrointestinal Genitourinary Gyneocologic Nasopharynx SCALP Granulomatous Supraclavicular Traumatic Breast Neuroma