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Neck Lumps Notes

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This is an extract of our Neck Lumps document, which we sell as part of our ENT Notes collection written by the top tier of University Of Leicester students.

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Neck lumps 80:20 rule
- Paediatric neck lumps o 20% malignanct o 80% benign
- Adult neck lumps o 80% malignant o 20% benign

Salivary gland lumps

Parotid 80% benign, 20% malignant Submandibular 50% benign 50% malignant Sublingual 80% malignant 20% benign

20:40 rule
- Age < 20 years o Inflammatory neck nodes e.g due to tonsillitis o Congenital lesions e.g thyroglossal cyst, branchial cyst o Lymphoma
- Age 20-40 years o Salivary gland pathology (calculi, infection, tumour) o Thyroid pathology (tumour, thyroiditis, goiter) o Chronic infection (TB, HIV)
- Age > 40 years o Primary/secondary malignant disease

Paediatric neck lumpsMainly benign (80:20) Commonly anterior to sternocleidomastoid i.e in anterior triangle Isolated neck lump in posterior triangle has increase risk of being malignant

Thyroglossal cyst-

Commonest midline mass in children Formed from a persistent thyroglossal duct o Embryological remnant as thyroid descends, remains connected to tongue via thyroglossal duct. Normally atrophie and closes before birth) Fibrous cyst arises at any point along route of duct o Most commonly below hyoid bone Moves on swallowing or sticking out tounge Usually asymptomatic, apart from presence of lump If it becomes infected - pain and swelling persist

Management: USS - check they have a thyroid as cyst can be only thyroid tissue + excision

Dermoid cystUsually present as submental swellings in the midline Are dermal remnants occurring along lines of fusion in the embryo
- Lined by epidermis + may contain hair, teeth and debris
- Don't move on swallowing/tongue protrusion Management: excision

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