ENT Benign Neck Masses

ENT BENIGN NECK MASSES Dra. Maria Karen R. Alcantara - Capuz 091009 Midline -

Neck Masses Thyroid nodules Cervical lymphadenopathy Thyroglossal duct cyst Thymus gland anomalies Plunging ranula

Lateral Neck Masses Branchial cleft anomalies Laryngoceles Dermoid and teratoid cysts Anatomical Considerations Prominent landmarks Triangles of the neck Carotid bulb Lymphatic levels Triangles of the Neck Anterior cervical triangle o Submaxillary (digastric) triangle o Carotid triangle o Submental triangle o Muscular triangle Posterior cervical triangle o Occipital triangle o Subclavian triangle Levels of the Neck Level I: Submaxillary and Submental Level II: Jugulo-digastric LN Level III: Hyoid – cricoid Level IV: Below cricoid Level V: Posterior triangle Level VI: thyroid General Considerations Age group o Pediatric (0-15), young adult (16-40), older adult (>40) Location of the neck mass o Midline/lateral, anterior/posterior triangle Characteristic of the neck mass o Rapid/slow growth, cystic/solid, tender/nontender, movable/fixed Evidence of source of infection or malignancy elsewhere in the head and neck *tender neck in mass denotes: inflammatory reaction *CA: fixed, rapid growth Diagnosis History o Evolution of mass lesion Physical examination o Visualization  Indirect mirror or flexible endoscopic exam of all mucosal surfaces of upper aerodigestive tract o Palpation  Help determine location, size and relationship (fixation) Indirect tests Supply information about the physical characteristics or position of the mass o UTZ, CT scan, MRI, angiography Direct tests

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BENIGN NECK MASSES

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Seek histologic diagnosis o FNAB, open biopsy

Ultrasound Distinguish solid from cystic lesions Angiography Evaluate vascularity and blood supply of mass, status of carotid artery CT/MRI -

Provide info about physical characteristics, vascularity and relationship to adjacent structures CT: relationship to bone

*thyroid mass: UTZ enough, unless entertaining malignancy Biopsy -

Fine needle aspiration biopsy (FNAB) o Gauge 23 to 25 needle Needle biopsy o Large bore, more possibility of seeding Open biopsy o Incision, excision, wedge  Incision: get small part  Excision: get the whole thing

Differential Diagnosis Patient age 0-15 years Freq of dse Inflammatory groupings Congenital Neoplastic Traumatic Location

Congenital

Inflam Neoplastic

Midline/Anteri or

Thyroglossal duct cyst Dermoid Laryngocele Adenitis Thyroid Lymphoma

16-40

40+

Inflammatory Congenital Neoplastic Traumatic

Neoplastic Inflammatory Congenital Traumatic

Anterior

Posterior triangle

Branchial cyst Thymic cyst Sialadenopath y Adenitis sialadenitis Metastatic Lymphoma

Lymphangioma

Adenitis

THYROGLOSSAL DUCT CYST Protrude the tongue, mass moves up Located more superiorly than thyroid mass o Top of hyoid MC congenital anomaly of central portion of neck Tract of thyroid tissue along pathway of embryologic migration of thyroid gland from base of tongue to neck Intimately related to hyoid bone, elevates wit larynx when swallowing Tx: sistrunk operation (excision of the mass along with the tract and hyoid bone, central portion of hyoid bone with mass) DERMOID CYST Cyst of midline of upper neck or anterior floor of the mouth Young patients Derived from remnants of embryonic skin Consists of a lumen lined by keratinizing squamous epithelium Located adjacent to or within thyroid lobe Tx: excision

ENT LARYNGOCOELE Abnormal dilation or herniation of saccule of larynx MC submucosal laryngeal mass lesion Common in players of wind instrument Enlarges when the patient exhales or blows BRANCHIAL CYST MC congenital mass in the lateral neck o Anterior triangle Vestigial remnant of the fetal branchial apparatus Presents as bulge or sinus tract opening at the border of SCM Internal tract or opening of cyst o MC: 2nd branchial cleft anomaly First Branchial Cyst Type I Parallel to EAC Pretragal, post auricular Connection with TM or malleus>incus Surgical excision Type II Second -

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Sq epithelium and other ectodermal components Anterior neck, superior to hyoid bone Courses over the mandible and through the parotid in variable position to facial nerve Branchial Cyst MC Painless, fluctuant mass in anterior triangle Inferior – middle 2/3 junction of SCM. Deep to platysma, lateral to Ix, X, XII, between the internal and external carotid and terminate in the tonsillar fossa Surgical treatment may include tonsillectomy

Third Branchial Cyst Rare malignancy DX evaluation o Thyroid function test (TSH, FT3, FT4) o Thyroid scan- determine function of gland and determine if nodule is hot or cold o UTZ o CT scan o FNAB (direct test)