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Neck Masses
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DefinitionThe general definition of a neck
mass is any abnormalenlargement, swelling, or growthfrom the level of the base of skull
to the clavicles.
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Anatomical Considerations
Prominent landmarks
Triangles of the neck Lymphatic levels
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1. Hyoid bone
2. Thyroid cartilage
. Cricoid cartilage!. Trachea
". #ternocleidomastoid
m$scles %#C&
Anatomical ConsiderationsThe prominent landmarks of the neck
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The SCM divides eachside of the neck intotwo major triangles,anterior and posterior.
The anterior triangle isdelineated by
. The anterior border of theSCM,
!. The midline,". The lower border of the
mandible.
Anatomical Considerations
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Anatomical Considerations The borders of the
posterior triangles are #
$ The posterior border of theSCM. $ The clavicle. $ The anterior border of the
trape%ius muscle.
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(enign leision &alignant t$mor )nflammantory
Primary&etastatic
Common *eck &asses
Classification of *eck &asses
(enign t$mor Congenital
!
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&eveloped by MemorialSloan-Kettering CancerCenter
'ase and uniformity indescribing regional nodalinvolvement in cancer of thehead and neck
Lymphatic nodal leveles+regions
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Lymphatic nodal leveles+regions
(evel )# $ Contains the submental "
and submandibulartriangles.
$ *ounded by the posterior belly of the
digastric muscle #$ %$ the hyoid bone the body of the mandible.
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(evel ))#
$ Contains the upper jugular lymph nodes
$ e+tends from the level ofthe hyoid bone to theskull base.
Lymphatic nodal leveles+regions
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(evel )))# $ Contains the middle
jugular lymph nodes $ from the hyoid bone to
the cricothyroidmembrane & - oromohyoid muscle '(
-.
Lymphatic nodal leveles+regions
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(evel ) # $ Contains the lower
jugular lymph nodes $ from the cricothyroid
membrane to theclavicle.
Lymphatic nodal leveles+regions
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(evel # $ Contains the lymph
nodes in the posteriortriangle
$ bounded by the anteriorborder of the trape%ius,the posterior border ofthe SCM, and theclavicle.
Lymphatic nodal leveles+regions
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(evel )# $ Contains the lymph
nodes of the anteriorcompartment from thehyoid bone to thesuprasternal notch.
$ /n each side the lateralborder is formed by themedial border of thecarotid sheath )*+, .
Lymphatic nodal leveles+regions
http://img.dxy.cn/upload/2007/07/02/33205390.jpg -
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&etastasis Location according to
,ario$s Primary Lesions Level )
$ Submandibular primary0 oralcavity0 lip0 paranasal sinuses
Level )) $ 1asopharyn+0 oropharyn+,
ma+illary sinus Level )))
$ (aryn+0 hypopharyn+0 thyroid Level ),
$ Subglottic laryn+0 thyroid0 cervicalesophagus Level ,
$ Thyroid0 cervical esophagus0 Level ,)
$ Thyroid0 laryn+
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#taging of the neck -* classification / A0CC %1 '
$ Consistent for all m$cosal sites e3cept
the nasopharyn3 $ Thyroid and nasopharyn3 have different
staging based on t$mor behavior andprognosis
$ (ased on e3tent of disease prior to firsttreatment
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#taging of the neck *45
$ 6egional lymph nodes cannot be assessed *75
$ *o regional lymph node metastasis
*15 $ a single ipsilateral lymph node8 9
*2a5 $ a single ipsilateral lymph node to : cm
*2b5 $ m$ltiple ipsilateral lymph nodes8 none more
than : cm *2c5
$ bilateral or contralateral nodes 9 :cm * 5
$ a lymph node more than : cm in greatestdimension
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Approach of the neck massApproach of the neck mass
History
Physical e3aminations )mage st$dies ;*A( and (iopsy
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#kandalakis=s 6>L? @; 7B $
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Diagnostic #teps
History Physical ?3amination ?mpirical Antibiotics Diagnostic Tests
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Diagnostic #teps
History $ &evelopmental time course
$ =ssociated symptoms dysphagia, otalgia, voice- $ 2ersonal habits tobacco, alcohol- $ 2revious irradiation or surgery
Physical ?3amination $ Complete head and neck e+am visuali%e >
palpate- $ 'mphasis on location, mobility and consistency
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Diagnostic #teps
?mpirical Antibiotics -./0123 $ )nflammatory mass suspected
$ Two week trial of antibiotics $ ?ollow4up for further investigation
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Diagnostic Tests $ @ltrasonography 45 $ Computed tomography CT- $ Magnetic resonance imaging MA)- $ ?ine needle aspiration biopsy ?1=*-
6789:; $ *iopsy
Diagnostic #teps
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Diagnostic Tests >ltrasonography
@ltrasonography
@seful indifferentiating solidfrom cystic massesand congenital cystsfrom solid lymphnodes and glandulartumors.
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Diagnostic Tests Comp$ted Tomography %CT'
Comp$ted Tomography %CT'5
. &istinguish cystic from solid lesions .
!. &efine the origin and full e+tent ofdeep, ill4defined masses .
". Bhen used with contrast candelineate vascularity or blood flow.
:. &etect an unknown primary lesion5. To help with staging purposes.
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&6) $ Similar information
as CT $ *etter for upper neck
and skull base $ ascular delineation
with infusion
Diagnostic Tests &6)
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Diagnostic Tests ;*A(
=ny neck mass that is not an obviousabscess
2ersistence after a ! week course ofantibiotics
Small gauge needle
Aeduces bleeding
Seeding of tumor $ not a concern
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Treatment of 1eck Mass
(enign leision
&alignant t$mor
)nflammantory
#$rgery
3
Chemotherapy
?3
#$rgery
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Standardi%ed until 66 Academys Committee for Head and
Neck Surgery and Oncology publici%ed standard classificationsystem.
Classification of *eck Dissections
)@A=BCD
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Classification of *eck Dissections
Academy=s classification1. 6adical neck dissection %6*D' E2 )@A=
2. &odified radical neck dissection %&6*D' F E2 )@A=. #elective neck dissection %#*D' GH)@A=
Supra4omohyoid type
(ateral type2osterolateral type
=nterior compartment type
!. ?3tended radical neck dissection )IJ@A=
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)KLM cervical lymphadenitis
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t$berc$losis of cervical lymph nodes
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_S ] )KLM J)%HU
VfR$cKLM JO bOOO6cS ] [\
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adenoma of the thyroi
)QVB]
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$ )a U *]
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$
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mi3ed t$mor of salivary gland [\
$ $ x , $ U.jUS lmn] $ * 4O CT g MA) t[\]
23 $
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lymphoma
XKL ] CD] [\
$ KLM JdU)QVQ]
$j O Oa KLM J]
$ KLM89xyz:;[]
23>3r?3
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metastatic carcinoma
$ N)Q 4 $ O$O $ lm
[\ $ E OS Ot;q
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23 $ E r BlU >3O?3
O
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*asopharyngeal carcinoma
.)KL URT B S ] V ) KLMU _ ) x KL
M]
23 >3UhQ x>3%
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Hypopharyngeal carcinoma .KL U _V )*+HKLMU
r KLM]
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Laryngeal carcinoma
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Thanks for your attentionD.