1
Forth stage
Surgery
Lec-1
د
.
خلف اللويزي
1/1/2014
Neck mass
Cervical triangle:
Med line neck swelling
a-solid
1-submandibular LN enlargement
2-nodule in the isthmus of thyroid gland
b-cystic lesions
1-dermoid cyst
2-thyroglossal cyst
3-cold abscess
4-subhyoid bursitis
5- laryngocele
6-cystadenoma of the thyroid isthmus.
Swelling in digastric triangle
1-LN enlargement in submandibular
2-submandibularsalivary gland
enlargement
How we differentiate both?
Swelling in carotid triangle
a-solid
1-upper deep cervical LN enlargement
2-lat thyroid lobe enlargement
3-carotid body tumor
b-cystic lesion
1-cold abscess
2-branchial cyst
3-aneurysm of the carotid
2
Mass of posterior triangle
a-solid
1-LN enlargement
2-neurofibroma from brachial plexus
3-cervical rib
b-cystic lesion
1-cystic hygroma
2-pharyngeal pouch
3-cold abscess
Dermoid cyst
How it origin
What is it
’
s histology
Type of Dermoid
DD(ectopic thyroid, thyroglossal cyst , LN)
Thyroglossal cyst:
Common sites(beneath the foramen cecum , floor of the mouth, above
hyoid, beneath the hyoid on thyroid cartilage, at the level of cricoid cartilage
Definition
Clinical features and complications
Recu infections
Abscess and fistula
Papillary carcinoma
Treatment
Thyroglossal fistula
Structures move up with deglutition:
1-thyroid mass
2-subhyoid bursitis
3-pretracheal and prelaryngeal LN
4-thyroglossal cyst
Branchial cyst :
Origin
Clinical features
1-age=20-25 y
2-swelling
3-cyst lining by squamous
epithelium so contain cheesy,
toothpaste
–like material
4-sternomastoid contraction test
3
5-aspiration of cyst showed cholesterol crystal
6-LNexamination
Cysts which are positive for cholesterol crystals are:
1-cystic hygroma
2-thyroglossal cyst
3-hydrocel
4-dental and dentigerous cyst
DD:
1-cold abscess
2-cervical Dermoid cyst
3-carotid body tumor
4-submandibular salivary gland swelling
5-Solitary LN enlargement
Cystic hygroma
Definition
Collection of lymphatic sacs which contain clear colorless lymph
Origin
Congenital and consist of a cluster of lymph channels that failed to connected
into the normal lymphatic pathway
Sites:
1-post triangle
2-axilla
3-groin
4-mediastinum 5-tongue and buccal mucosa
Cold abscess:
Causes
1-TB
2-actinomycosis
3-leprosy
Why it is called cold abscess
Pathology
Stage of inflammation
1-lymphadenitis
2-periadenitis
3-cold abscess
4
Carotid body tumor(chomodectoma, potato tumor)
1-Originate at carotid body at bifurcation of carotid
2-age 40-70 ys
3-slow growing take ys
4-occasionally press on the carotid sinus produces attack of faintness
DD:
1-LN
2-sternomastoid tumor
3-branchial cyst
4-aneurysm of carotid
Sternomastoid tumor
1. 3-4wks of childhood
2.hard smooth non-tender mass adherent to muscle
3.Head point toward the same affected muscle and chin to opposite side(torticollis)
4.Delay in correction may produce facial deformity