Neck Anatomy Neck muscles Neck muscles Main Categories
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Neck Anatomy : Neck muscles
Neck muscles
Main Categories of Neck Swellings THREE BROAD CATEGORIES 1 - CONGENITAL 2 -INFLAMMATORY 3 -NEOPLASTIC NB: IN ADULTS EXCLUDE MALIGNANCY, EVEN IN CYSTIC SWELLINGS THE LOCATION OF THE MASS CAN FOCUS THE DIFFERENTIAL DXES. WHICH NECK TRIANGLE? A SWELLING IN THE PAROTID AREA IS A PAROTID LESION TILL PROVEN OTHERWISE
The Three Main Neck Triangles M
Neck Triangles: The Site may suggest the Dx
Ranula Is a retention cyst Arises from sublingual gland duct obstruction & extravasation of mucoid contents Mostly located in the sub-mentum Ttt: Marsupialization for small intra-oral surgical resection with sublingual gland for extra-oral CT Scan
Dermoid cyst Due to epithelial entrapment Either developmental or traumatic Non-tender & mobile If congenital midline, submental Ttt: surgical excision
Thyro-glossal Cyst
Thyro-glossal Cyst MIDLINE CYST (ANY WHERE IN THE COURSE OF TG-TRACT) USUALLY, ASYMPTOMATIC TILL GETS INFECTED PRESENTS IN CHILDHOOD OR EARLY ADULTHOOD US SCAN CONFIRMS DX TTT : SURGICAL EXCISION, WITH THE CENTRAL PORTION OH HYOID BONE = ( SISTRUNK OPERATION)
Thyro-glossal cyst
Thyro-glossal Cyst: Inflamed
Thyro-glossal Cyst: Infected
Thyro-glossal Cyst
Branchial Cyst
Embryonic Branchial clefts
Branchial cyst ARISES IN EMBRYONIC BRANCHIAL CLEFTS(1 -4) USUALLY PRESENTS IN LATE CHILDHOOD OR EARLY ADULTHOOD RELATIVELY CONSISTENT IN THEIR LOCATION = ANTERIOR TO THE STERNOCLEIDOMASTOID MUSCLE PASS UNRECOGNIZED UNTIL IT GETS INFECTED IF RUPTURED CAN CAUSE FISTULA CYSTS FROM 2 ND BRANCHIAL CLEFT HAVE TO BE DISTINGUISHED FROM CYSTIC LN METS FROM NASOPHARYNGEAL CARCINOMA ! DX: US , CT TTT: CONTROL INFECTION THEN SURGICAL EXCISION
Branchial Cyst
Branchial Cyst
Laryngocele Air filled cyst Appears more with Valsalva maneuver
Carotid Body Tumor
Carotid Body Tumor (para-ganglionoma) BENIGN TUMOR ARISES FROM EXTRAADRENAL CHROMAFFIN CELLS IN PS PARAGANGLIA CLINICAL FEATURES: MOBILE SIDE TO SIDE BUT NOT VERTICALLY ( FONTAINE’S SIGN) HIGHLY VASCULAR: PULSATILE & BRUIT DX: SUGGESTED BY US & CONFIRMATION BY MRA /CAROTID ANGIOGRAM TTT: SURGICAL EXCISION
Carotid angiography
Vascular Anomalies Hemangioma
Vascular Anomalies: Hemangioma Strawberry H Red or bluish mass Soft & Compressible ourse : rapid growth followed by slow regression Intervention only if symptomatic (airway obst. /bleeding Ttt: corticosteroid / laser
Cystic Hygroma
Vascular Anomalies: Cystic Hygroma Lymphatic malformation during fetal develop. nonteder &compressible + transillumination Ttt: complete excision can be very difficult, ? sclerotherapy ? Laser, for debulking & contouring
Cervical Lymphadenopathy 1 - INFLAMATORY 2 - Malignant Primary: Lymphoma 2 ry : Metastatic
Cervical Groups of Lymph Nodes
Different Cervical Lymph Node Groups
Inflamed Lymph Nodes UNDERLYING DISEASE TESTS MICRO-ORGANISM LAB VIRAL LYMPHADENITIS NON-SPECIFIC IM TEST AIDS ADENO, RHINO, ENTERO VS -----(EB VIRUS) MONOSPOT (HIV) ELISA/PCR BACTERIAL LYMPHADENITIS PYOGENIC STAPH AURIUS& STRPS G. STAIN, C&S TB MYCOBACTERIUM TB PPD SKIN TEST(TUBERCULIN) BRUCELLOSIS TITER TOXOPLASMOSIS TEST BRUCELLA / (G-)BACILLUS PROTOZOAN BRUCELLA HEMAGGLUTINATION & CFT
Malign. Lymph Nodes LYMPHOMA METS FROM FACE / SCALP SQ, CELL CA MALIGN. MELANOMA PHARYNX /LARYNX BRONCHUS/ ESOPHAGUS THYROID SALIV. GLAND MALIGN.
Mass, Fever & generalized Lymphadenopathy LYMPHOMA OTHER MALIGNANCIES PYOGENIC INFECTION TB BRUCELLOSIS ACTINOMYCOSIS NON-SPECIFIC VIRAL INFECTION IM HIV INFECTION TOXOPLASMOSIS
Medical ttt for TB 1 - ISONIAZID 2 -RIFAMPICIN 3 -PYRAZINAMIDE 4 -ETHAMBUTOL 5 -VIT B 6 FOR 2 MONTHS FOLLOWED BY ISONIAZID +RIFAMPICIN FOR 6 MONTHS
Medical ttt for Brucellosis A COMBINATION OF 2 DRUGS , ONE FROM EACH GROUP: DOXYCYCLINE OR CIPROFLOXACIN & RIFAMPICIN OR STREPTOMYCIN
Medical TTT for Actinomycosis ACTINOMYCOSIS IS CAUSED BY A BACTERIUM THAT IS PRESENT NORMALLY AMONG FLORA IN THE MOUTH & THROAT CAUSE IS ACTINOMYCES ISRAELI FOLLOWS BAD DENTAL SURGERY FORMS FLUCTUATING MASS( GRANULOMA) THAT DISCHARGES SULFUR GRANULES FROM SINUSES IN SUB-MAND. REGION TTT: HIGH DOSE OF PENICILLIN IF ALLERGIC, GIVE ERYTHROMYCIN OR CLINDAMYCIN
Thyroid Anatomy
Thyroid Anatomy Venous Drainage of Thyr. Gland The course of Rec. Laryng. Nrv
Thyroid Nodule
Fine Needle Aspiration of Thyroid cyst
Big Thyroid Nodule
Thyroid Nodule: Nuclear scan=Hot Nodule
Multi-nodular Goiter
Grave’s Diesase
Exophthalmos
Exophthalmos: complicated
Grave’s Disease : Diffuse Increased Isotope Uptake
Treatment For Grave’s Disease 1 - MEDICAL ANTI- THYROID DRUGS CARBIMAZOLE OR PROPYL-THIO-URACIL + PROPRANOLOL ( BETA –BLOCKER) 2 -RADIO-ACTIVE IODINE 3 - SURGICAL RESECTION
Thyroid Anatomy
Laryngeal Nerves
Sub-mandibular gland
Sub-mandibular gland: Adenoma
Sub-mandibular gland: Sialadenitis
Sub-mandibular salivary duct stone
Submandibular salivary duct stone
Stone In the Duct Of L Submandibular Salivary Gland
Sialogram
Submandibular salivary duct stone
Marginal Branch Of the Fascial Nerve
Parotid swellings
Fascial Nerve
Swelling of parotid gland
SJOGREN’S SYNDROME Auto-immune disease Involes all salivary glands & lacrimal glands leading to their Hypertrophy & destruction& resulting in very dry mouth & dry Eyes Ttt: symptomatic & supporative Heavy lymphocytic infiltration
Cervical Groups of Lymph Nodes
External jugular Vein
Neoplastic Disorders PRIMARY MALIGNANCIES IN THE: SKIN SUB-CUT. MUSCLES THYROID SALIVARY GLAND.
Other Benign Disorders SEBACEOUS CYST LIPOMA / FIBROMA /MAYOMA NON -MALIGN. GOITER PLEOMORPHIC ADENOMA OF SALIVARY GLAND: PAROTID / SUB-MAND. CAROTID BODY TUMOR SCHWANOMA
Characteristic Features for some Neck Swellings Branchial Cyst Thyro-glossal Cyst id Anterior To Sternomastoid Muscle Cyst In upper half & lateral + Cholesterol Crystals Midline, moves With tongue Sub-mandibular Pain Aggr. By Salivation( food) Hemangioma Compressible AV Fistula Pulsitile /Thrill & bruit Cystic Hygroma Compressible /Trans-illumintion. Larygocele Air-filld cyst, at Larynx Actinomycosis Sinuses discharging. Sulfur granules
The Course of the Accessory Nerve
Other Dxic Modalities CLINICAL IMAGING: US SCAN CT SCAN MRI/ MRA PET SCAN ANGIOGRAPHY ENDOSCOPY LARYNGOSCOPY BRONCHOSCOPY ESOPHAGO-GASTROSCOPY BIOPSY (FNA, TRU_CUT) NEEDLE OR EXCISIONAL BPSY
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