Lateral

Branchial cysts

• branchial cleft cysts are congenital cysts

  • lateral part of neck due to failure of obliteration of second branchial cleft in embryonic development

• anterior triangle

• present early adulthood

• solitary painles smass in neck

• history of intermittent swelling adn tenderness of lesion during URTI

• discharge if associated with sinus tract

• aspirate = pus like and is rich in ccholesterol crystals

Parotid masses

• all facial masses lying superior to a line drawn from mastoid tip to angle of mandible should be assumed to be a parotid mass until proved otherwise

Pleomorphic adenoma

• most common benign tumour of the parotid gland

• if left untreated potential for malignnat change

Acinic cell tumour

• rare malignnat tumour

• arises most frequently in parotid gland

• other site:

  • submandibular gland

  • minor salivary glands

Adenoid cystic tumour

• malignant

• associated with hgih incidence of perineural invasion

warthin’s tumour

• rounded lobulated heterogenous mass

  • may have cystic changes with hyperechoic internal septation

• benign neoplasm of salivary glands

• 4-15% of salivary gland neoplasms

• elderly men

• parotid gland only

• bilateral and multifocal

• present with painless swelling

• usually lower portion of salivary gland

Sialadenosis

• non-inflammatory swelling

• symmetrical usually

• cause = secondary to a systemic process

  • diabetes

  • vitamen def.

  • chronic alcoholism

Sialothiasis of submandibular gland

• stone formation

• usually tender and swollen

• 3rd-4th decade

• predominately affect males

• 70-80% seen in submandibular gland

• 70% stones radio-opaque

• secondary infection may occur

• managmenet

  • conservative initially

    • increase oral fluids

    • sialogogues (citrus drops)

  • distal stones

    • incise excretory duct in floor of mouth and extract stone

    • duct then marsupialised

      • duct epitherlium sutured to oral mucosa

        • try prevent recurrnace

  • proximal stones/in glands

    • removal of gland

acute suppurative sialadenitis of submandibular gland

• short history

• swollen with associated pain and fever

• overlying skin warm and red

• often occurs in debilitated patients

• staph species

• Treatmnet

  • re-hydration

  • abx

  • oral hygiene

midline

Tyroglossal cyst

• congenital defect

• thyroid begins development at base of tongue

  • moves down neck through canal

    • thyroglossal duct

    • portions of duct remain

      • pockets = cysts

• cysts

  • become filled with mucus

  • may enlarge if get infected

• commonly diagnosed in children/mid-adolescence

• may appear after URTI

  • enlarge

  • painful

• o/e

  • midline

  • move on swallowing

  • move on tongue protrusion

    • attached to tongue

Dermoid cyst

• midline

• easily felt under skin

• lined with epitherlium

• contains tissues and cells normally present in skin layers

  • hair follicles

  • sebaceous and sweat glands

Ranula

• retention cyst

• forms in floor of mouth

• lies above mylohyoid muscle

• produces swelling of neck +/- swelling in floor of mouth

• doens’t increase size when eating

Goitre

Papillary carcinoma

• single solitary nodule

  • raise suspicion

• hoarseness

  • invasion of recurrnet laryngeal nerve

Physiological

• common:

  • pregnancy

  • puberty

  • resolves spont. as the period of maximal hormonal activity passes

Multinodular

• uss = multiple nodules

Posterior

Nasopharyngeal carcinoma

• commonly metasise to posterior triangle

• common in chinese origin

cystic hygroma

• lymphangioma

• commonly occuring in posterior triangle

• develop from sequestered portions of lymphatic that begin to sprout in 6wk of embryonic development

• 90% manifest in first 2 weeks of life

Lymphoma

• sjogren’s - small risk

• hasimoto’s

Malignant node containing SCC

• smoker

• earache and thorat pain x2/52

  • ear pain = referred

• firm, mobile, non-fluctuant

• overlying skin normal and mass not attached

• assume with this history until proven otherwsie

sebaceous cyst

• cannot be separated from the skin

  • unlike LN which lie deep to skin