NECK SWELLING

• History Taking• Causes & Classification

BY: IZATTY LIM (0308188) BATCH 4

BIODATA

HISTORY TAKING

Age

Gender

Occupation

HOPI NECK SWELLING

HISTORY TAKING

When do you first notice the lump? Rule of 7:

7 days = inflammatory/infection

7 weeks/months = tumour

7 years = congenital/development

What do you think is the cause? History of trauma Previous TB

How do you notice it? Noticed accidentally Told by others Painful

How does the lump disturbs you? Associated symptoms

pain, discharge, dysphagia, dyspnea, cosmetically disfiguring, fear of malignancy

Any changes to the lump since you first notice it? Size

Has the lump ever disappears before? Lying down supine Any activity

Do you ever had any other lumps before this? Multiplicity

Systemic Review

Head & Neck symptoms Pain in mouth / throat Mouth ulceration Nasal discharge Pain / blockage of airway Voice changes Difficulty breathing

Systemic illness Suggestive of malignancy

Anorexia, weight loss and symptoms from other systems Suggestive of infection

Malaise, fever, rigors, local symptoms

HISTORY TAKING

PAST MEDICAL HISTORY

DRUG & ALLERGY

FAMILY HISTORY

SOCIAL HISTORY

HISTORY TAKING

Thyroid cancer & radiation Previous skin cancer / lesion

Smoking Chewing tobacco Alcohol

Malignancy

Causes of Neck Swelling

CAUSES

Inflammatory / Infection Lymphadenopathy Bacterial / viral Granulomatous Tuberculous Cat-scratch Fungal Sarcoidosis Sialadenitis Parotid Submaxillary

Neoplasia Metastatic

• Unknown primary• Epidermoid carcinoma• Primary head & neck• Melanoma

Primary• Adenocarcinoma• Thyroid• Lymphoma• Salivary• Lipoma• Glomus vagale• Carotid body tumor• Rhabdomyosarcoma

Congenital / Developmental Sebaceous cysts Branchial cleft cysts Thyroglossal cysts Lymphangioma/hemangioma Dermoid cyst Ectopic thyroid tissue Layngocele Thymic cysts

SUPERFICIAL o Sebaceous cysto Lipomao Dermoid cysto Abscess

Lymph nodes

CAUSES & CLASSIFICATION

DEEP Anterior Triangle

o Move with swallowing Thyroid Thyroglossal cyst Lymph node

o Do not move with swallowing Salivary gland Brachial cyst Carotid body tumor Carotid aneurysm

Posterior Triangleo Cervical ribo Subclavian artery aneurysmo Pharyngeal pouch o Cystic hygroma

Miscellaneous cysts Dermoid cyst Thyroglossal duct cyst Brachial clelf cyst Cystic hygroma

CAUSES & CLASSIFICATION

Midline neck masses Thyroglossal duct remnants (cysts) Dephian lymph nodes Pryramidal lobe of thyroid gland

*Mass at sternal notch: tuberculous abscess, dermoid cyst, or a fatty tumor associated with Cushing's syndrome similar to the Dowager's hump. Fullness of the sternal notch can occur in leukemia (Jaccoud's sign)

Lateral neck masses Brachial cysts Carotid body tumors

Unilateral Neck swelling

Parotid & submandibular glands

Bilateral Neck Swelling Mikulicz’s disease Bilateral parotitis

Dehydration Drug effect (sulfonamides, iodides, propythiouracil) Infection (chriomeningitis or mumps) Malignancy (leukemia, lymphoma) Metabolic disease (alcoholism, malnutrition, vit A deficiency, DM) Autoimmune disease (SLE, sarcoidosis)

CAUSES & CLASSIFICATION

1) Jones N, Hibbert J, Luxon LM. Scott-Brown’s Otorhinolaryngology: Head

and Neck Surgery cd-rom (A Hodder Arnold Publication). 7th ed. Gleeson MJ, Clarke RC, Browning GG, editors. London: Oxford University Press, USA; 2008.

2) Schwetschenau E, Kelley DJ. The Adult Neck Mass [Internet]. 2002 [cited 2015 Sep 14]. Available from: http://www.aafp.org/afp/2002/0901/p831.html

3) Williams ME. Assessment of the Neck and Lymph Nodes in the Elderly Patient [Internet]. Medscape. 2009 [cited 2015 Sep 14]. Available from: http://www.medscape.com/viewarticle/712256_5

4) Neck Lump [Internet]. Fastbleep Biology Notes. [cited 2015 Sep 14]. Available from: http://www.fastbleep.com/biology-notes/9/11/356

REFERENCES

Thank You For

Listening!