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122 Cards in this Set

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Masticator Space Lesions DDx – Most common
Odontogenic abcess
Sarcoma
NHL
SCC from oropharyn(retromolar trigone)
Rhadomyosarcoma in pediatric population
Accessory parotid gland
Benign Masseteric Hypertrophy
Masticator Space Lesions DDX – by category
Pseudotomor
Accessory parotid gland
Benign Masseteric hypertrop
V3 denervation atrophy
Congenital
Hemangioma
Lymphangioma
Inflammatory
Odontogenic abscess
Mandibular osteomyelitis
Benign tumor
Osteoblastoma
leiomyoma
Neural sheath tumor
Malignant Tumor
Sarcoma
soft tissue
chondrosarcoma
osteosarcoma
Malignant schwannoma
NHL
SCC from retromolar trigone of oropharynx
Mandibular mets
Rhabdomyosarcoma in peds
What is a complication of MS infection?
In which direction does infection spread?
Skull base osteomyelitis (destruction of pterygoid wing)
Upward via least resistance
What makes malignant tumor from MS unresectable?
Invasion of skull base

Check for suprazygomatic MS spread to adjust radiation ports!!
Which way is the PPF (prestyloid paraphyngeal fat) displaced in Masticator space lesions?
1. Posteriomedially
If tumor in MS, what cranial nerve should be inspected for perineural spread? What is the route?
1. V3
2. 2. via foramen ovale (medial pterygoid fascia inserts medial to FO)
Which motor nerve supplies muscles of mastication?
1. Masticator nerve (motor branch) of V3
What are the masticator muscles?
1. Masseter
2. Medial pterygoid
3. Lateral pterygoid
4. Temporalis
What are the two nerves that enter the masticator space?
1. Masticator nerve (to all masticator muscles)
2. Inferior alveolar nerve
What are the routes of infection/malignancy into the skull base?
1. Muscle attachments to skull base (infection goes up b/c firm attachment of periosteum to inferior mandible
2. V3 through foramen ovale à Meckel’s cave à root entry zone in lateral pons
What 3 clinical features suggest involvement of V3 by tumor?
1. Atrophy of masseter
2. Mandibular pain
3. Serous otitis media (due to tensor palatini dysfunction due to V3 branch involvement causig Eustachian tube malfunction)
What is the temporal fossa?
1. The suprazygomatic MS
What is the infratemporal fossa? Aka?
1. Between PPF and zygomatic arch at level of nasopharynx
2. Nasopharyngeal MS
What borders the MS?
1. Posteromedially = masticator space
2. Anteriorly – buccal space
3. Posteriorly – parotid space
4. What is in the buccal space?
5. Buccinator muscle
6. Parotid duct
7. Facial artery and vein
8. Buccal fat pad
What is a pitfall in perineural spread imaging for V3?
Not imaging along its entire course i.e.
Inferior alveolar nerve and masticator nerve
3. Mandibular foramen
4. Foramen ovale
5. Meckel’s cave
root entry zone along lateral pons
What is the significance of MS infection involving mandible (osteomyelitis)? Tumor?
1. Longer antibiotics
2. More likely perineural spread along IAN or V3 main trunk
Why is CT the initial study of choice in evaluating patients with suspected infection of MS?
1. Identify duct stone
2. R/o mandibular osteomyelitis
Name 3 pseudomasses of MS?
1. Accessory parotid gland
2. Benign masseteric hypertrophy
3. Cranial nerve V3 motor atrophy
Benign Masseteric hypertrophy – most common cause, pitfall, most characteristic appearance? Imaging recc if not pathognomonic?
1. Bruxism (molar grinding)
2. Unilateral mass with infiltrating margins – tumor/infection!
3. Well defined bilateral hypertrophy or if accompanied by pterygoid/temporalis hypertrophy and atrophy with hx of bruxism
4. Close radiologic f/u to r/o tumor
What muscles does the motor root of V3 innervate?
1. Masticator muscles
2. Anterior belly of digastric
3. Mylohyoid muscle
4. Tensor veli palatini, tensor tympani
What are imaging signs of V3 denervation atrophy? How long after injury?
1. Fatty infiltration
2. Volume reduction
3. 6 weeks
What is initial symptom in odontogenic Abscess?
Trismus
Odontogenic abscess with “lumpy jaw” – what should you think?
Actinomycosis
Sarcoma – where does chondrosarcoma arise from? Osteosarcoma?
1. Chondrosarcoma – from TMJ
2. Any along mandible
Tubular Mass in the MS?
1. Malignant schwannoma along IAN, V3
2. Perineural spread
What secondary feature of MS mass suggests NHL?
Other cervical nodes, extranodal lymphatic disease (i.e. waldeyer’s ring)
What is most typical for SCC of MS?
1. Prior hx of treatment of oral cavity or oropharyngeal SCC
2. Look for perineural spread by IAN
RETRO-OCULAR MASS (Intraconal)
. Hemangioma - - enhance - phleboliths seen in 10%
2. Optic nerve glioma
3. Optic nerve meningioma
4. Angioma
5. Lymphangioma
6. AVM
Extraconal-intraorbital Lesion – DDx
1. Benign Tumor
a. 1. Dermoid Cyst
b. Teratoma
c. Capillary Hemangioma
d. Lymphangioma
e. Plexiform neurofibroma
f. Inflammatory orbital pseuydotumor
g. Histiocytosis X (usually arises from bone)
2. Malignant Tumor
h. Lymphoma/Leukemia
i. Metastasis
j. Rhabdomyosarcoma
Extraconal-extraorbital Lesion – DDx
1. FROM SINUS
a. Tumor – SCC, adenoCa, adenoid cystic, lymphoma
b. Paranasal Sinusitis – most common cause of orbital infection (ethmoid in children, frontal in adolesc), mucormycosis in diabetics (destroys bone)
c. Mucocele
2. FROM SKIN
d. Orbital Cellulitis
3. FROM LACRIMAL GLAND – “MOLD”
e. Metastasis
f. Others (rhabdomyosarc, lymphangioma, sinus lesion)
g. Lymphoma, lacrimal gland tumor
h. Dermoid
Lacrimal Gland Lesion (superolateral orbit) – DDX
MOLD
1. Mets
2. Others
3. Lymphoma, lacrimal gland tumor
4. Dermoid
Orbital Mass in Childhood – DDX in desc order
1. Dermoid cyst – 46%
2. Inflammatory lesion – 16%
3. Dermolipoma – 7%
4. Capillary hemangioma <5%
5. Rhabdomyosarcoma
6. Leukemia/lymphoma
7. ON Glioma
8. Lymhangioma
9. Cavernous Hemangioma
Primary Malignant Orbital Tumors – DDx in desc order
1. Retinoblastoma – 86%
2. Rhabdomyosarcoma – 8.1%
3. Uveal Melanoma
4. Sarcoma
Secondary Malignant Orbital Tumors – DDx in desc order
1. Leukemia
2. Sarcoma
3. Hodgkins Lymphoma
4. Neuroblastoma
5. Wilms
6. NHL
7. Histiocytosis
8. Medulloblastoma
Orbital Vascular Tumors – DDx
1. Orbital Varix
2. Hemangioma (capillary/cavernous)
3. AVM
4. CC fistula
5. Blood Cyst
6. Arterial malformation
7. Glomus Tumor
8. Hemangiopericytoma
Orbital Masses – DDx
LO VISHON
1. Lymphoma/leukemia
2. Optic Nerve Glioma
3. Vascular Malformation: hemangioma, lymphangioma
4. Inflammation
5. Sarcoma: rhabdomyosarcoma
6. Histiocytosis
7. Orbital Pseudotumor, Osteoma
8. Neuroblastoma
Superolateral Quadrant of Orbit Masses – DDx
1. Lacrimal Gland Tumor
2. Dermoid Cyst
3. Leukemic infiltration/Lymphoma
4. Pseudotumor
5. Hemangioma
6. Abscess
7. Mets (breast, prostate, lung)
8. Sarcoid
9. Frontal Sinus Mucocele
10. Wegener’s granulomatosis
Extraocular Muscle Enlargement – DDx
1. Endocrine
a. Graves Dz
b. Acromegaly
2. Inflammation
c. Myositis – single muscle in adult, multiple muscles in children, positive response to steroids
d. Orbital Cellulitis
e. Sjogres disease, Wegener’s granulomatosis, lethal midline granuloma, SLE
f. Sarcoidosis
g. Foreign-body reaction
Extraocular Muscle Enlargement – DDx
3. Tumor
h. Pseudotumor
i. Rhabdomyosarcoma
j. Mets, lymphoma, leukemia
4. Vascular
k. Spontaneous/traumatic hematoma
l. AVM
m. CC fistula
Ocular Lesion Calcifications? – DDX
NMR CT
1. Neurofibromatosis
2. Melanoma
3. Retibnoblastoma
4. Choroidal Osteoma
5. Tuberous Sclerosis
Intraocular Calfications – DDx
1. RB - >50%
2. Astrocytic hamartoma
3. Choroidal Osteoma – young woman, very dense curvilinear mass aligned with choroidal margin of globe
4. Optic Drusen
5. Scleral Calcifications – systemic hypercalcemic states (HPT, hypervitaminosis D, sarcoidosis, chronic renal disease) OR elderly
6. Retrolental fibroplasia
7. Phthisis bulbi – trauma or infection sequela
Noncalcified Ocular Process – DDx
1. Uveal Melanoma
2. Metastasis – 86% of ocular lesions in globe, usually in vascular choroid (breast, lung, Gi, GU, cutanesous melanoma, neuroblastoma), bilateral 30%
3. Choroidal Hemangioma – most common benign tumor in adults
4. Vitreous Lymphoma – diffuse ill-defined soft tissue density
5. Developmental anomalies
a. Primary glaucoma
b. Coloboma
c. Staphyloma
Microphthalmia – DDx
1. Bilateral with cataract
a. Congenital rubella
b. Persistent hyperplastic vitreous
c. Retinopathy of prematurity
d. Retinal folds
e. Loewe syndrome (Small globe and small orbit)
2. Unilateral
f. Trauma/surgery/rTX
g. Inflammation with disorganization of eye (pthisis bulbi
Dense Vitreous in Pediatric Age Group
1. Retinoblastoma
2. Persistent hyperplastic primary vitreous (PHPV)
3. coats Diseas
4. Norrie Disease
5. Retrolental fibroplasia
6. Sclerosing endophthalmitis
Leukokoria in normal-sized eye – DDX
1. Calcified Mass
a. Retinoblastoma
b. Retinal astrocytoma
2. Noncalcified mass
c. Toxocaral endophthalmitis
d. Coats disease
Leukokoria with microphthalmia – DDx
1. Unilateral
a. Persistent Hyperplastic Primary Vitreous (PHPV)
2. Bilateral
b. Retinopathy of Prematurity
c. Bilateral PHPV
Optic Nerve Enlargement – DDx
1. Tumor
a. ON Glioma
b. Optic Nerve Sheath Meningioma
c. Infiltration by Lymphoma/Leukemia
2. Fluid
d. Perineural hematoma
e. Papilledema of intracranial hypertension
f. Patulous subarachnoid space
3. Inflammation
g. Optic Neuritis
h. Sarcoidosis
Optic Nerve enlargement with fusiform thickening with central lucency = ___?
Meningioma
Optic Nerve enlargement with fusiform thickening without central lucency = ___?
Optic Nerve Glioma
Eccentric thickening (single or multiple nodules) -
tumor
Tubular ON enlargement
1. with central lucency
2. without central lucency
1. subarachnoid process: mets, perineuritis, menignioma, perineural hemorrhage)
2. papilledema, leukemia, lymphoma, sarcoid, ON glioma
Lacrimal Gland Lesion
1. Inflammation
a. Dacryoadenitis
b. Mikulicz syndomre – nonspecific enlargment of lacrimal and salivarty glands a/w sarcoid, lymphoma, leukemia
c. Sjogren syndrome – lymphocytic infiltration of lacrimal/salivary glands, with decreased lacrimation, xerostomia. A/w RA, SLE, scleroderma, polymyositis
d. Sarcoidosis
2. Benign Tumor
e. Granuloma, cyst, pleiomorphic adenoma/benign mixed tumor

3. Malignant Tumor
f. Malignant mixed tumor (pleimorphic adenoca), adenoid cystic Ca, lymphoma, mets (rare)
Lacrimal Gland Enlargement
MELD
1. Mets
2. Epithelial Tumor
3. Lymphoid Tumor
4. Dermoid
Bilateral Lacrimal Gland Masses
LACS
1. Lymphoma
2. AND
3. Collagen-vascular disease
4. Sarcoidosis
Opthalmoplegia – DDX
1. Lesions of CN III
2. IV
3. VI
Anopia
1. Monocular blindess – ON lesion in fx of optic canal, amaurosis fugax
2. Bilateral heteronomyous defects – bitemporal hemianopa (chiasmatic lesion)
3. Bilateral homonymous defects – CVA, Brain tumor
a. Homonymous hemianopia
b. Quandrantinopia
c. Central heianoptic scotomoa
Macropthalmia – DDx
1. Without intraocular Mass
a. Generalized enlargment
i. Axial myopia
ii. Buphthalmos
iii. Connective tissue disorder: Marfans syndromek, ehler-danlos, weill-Marchesani, homocystinuria
b. Focal enlargement
i. Staphyloma
2. With intraocular Mass
c. With Calcifications
i. Retinoblastoma
d. Without calcifications
i. Melanoma
ii. Mets
Mandibular Hypoplasia syndromes – DDx
1. Pierre-Robin syndrome
2. Treacher-Collins syndrome
3. Chromosomal abnormalities
4. pyknodysostosis
TMJ Destruction
HIRT
1. Hyperparathyroidism
2. Infection
3. Rheumatoid arthritis
4. Trauma
Tooth Masses – Major Categories (2) + DDx
1. Cystic Lesions
a. Radicular (periapical) Cyst - #1, non-vital tooth
b. Ameloblastoma (adamantinoma of jaw) – most at angle of mandible, uni/multiloculated lytic, scalloped expansion, more aggressive local recurrence after exicision, 4-5th decade)
c. Primordial cyst (dentigerous cyst around absent tooth)
d. Giant cell reparative granuloma (nonodontogenic, lucent smooth multiloculated lesion)
e. Traumatic bone cyst – associated with vital tooth, sharply marginated lucent lesion with fingerlike projections b/w roots
f. Dentigerous Cyst – around erupted tooth, maxilla, posterior mandible, cystic expansile lesion containing tooth, may rarely degenerate into ameloblastoma
Tooth Masses – Major Categories (2) + DDx
Sclerotic Lesions
g. Cementinoma – (periapical cemental dysplasia, women, 30-40, anterior mandible, at apex of vital tooth, often multicentric
h. True cementoma – benign cementoblastoma
i. Gigantiform cementoma
j. Hypercementosis – bulbous enlargment of root, idiopathic pagets
k. Benign fibro-osseous Lesions
i. Ossifying fibroma – young adults
ii. Monostotic fibrous dysplasia
iii. Condensing osteitis
l. Paget Dz – involves jaw 20%, bilateral symmetric involvement, loosening of teeth, hypercementosis
m. Torus mandibularis (exostosis
Wide Skull Sutures – DDx
1. Normal Variant
2. Congenital underossification – OI, hypophosphatasia, rickets, hypothyroidism, pyknodysostosis, cleidocranial dysplasia
3. Metabolic disease – hypoparathyroidism, lead intoxiciation, hpo/hypervitaminosis A
4. Raised ICP
a. Intracerebral tumor, subdural hematoma, hydrocephalus (< 10 yo)
b. Coronal ? sagittal
5. Infiltration of Sutures
c. Meningeal mets from neuroblastoma, leukemia, lymphoma
d. Poorly defined margings
6. Recovery
e. Deprivational dwarfism, chronic illness, prematurity, hypothyroidism
Craniosynostosis Causes – DDx
1. Primary craniosynostosis
2. Secondary craniosynostosis
a. Hematologic – SCD, thalassemia
b. metabolic – rickets, hypercalcemia, hyperthyroidism, hypervitaminosis D
c. bone dysplasia: hypophosphatasia, achondroplasia, metasphyseal dysplasia, Down syndrome, huerler disease, skull hyperostosis, rubinstein-Taybi syndrome
d. syndromes: Crouzon, Apert, Carpenter, Treacher-Collins, cloverleaf skull, craniotelencephalic dysplasia, arrhinencephaly
e. microcephaly: brain atrophy/dysgenesis
f. after shunting procedures
Craniosynostosis Types – DDx
1. Scaphocephaly (dolichocephaly) – 55%, premature closure of sagittal suture – long AP
2. Brachycephaly (turricephalyu) – 10%, coronal/lambdoid, short AP, tall
3. Plagiocephaly – 7% - unilateral early fusion of coronal and labdoidal = lopsided
4. Trigonocephaly – metopic suture – forward pointing skull
5. Oxycephaly – coronal, sagittal, lambdoid
6. Cloverleaf skull – Kleebattschadel – intrauterine closure of sag, coronal, lambdoid
Wormian Bones
PORK CHOPS I
1. Pyknodysostosis
2. OI
3. Rickets in healing phase
4. Kinky Hair syndrome
5. Cleidocranial dysostosis
6. Hypothyroidism/hypophosphatasia
7. Otopalatodigital syndrome
8. Primary acroosteolysis (hadju-cheney)/pachydermoperiostosis/progeria
9. Syndrome of Down
10. Idiopathic

Normal up to 6 months!!! (most common)
Increased Skull Thickness
HIPFAM
1. Hyperostosis Frontalis Interna
2. Idiopathic
3. Paget disease
4. FD
5. anemia
6. Mets
Button Sequestrum
1. Definition
2. DDx
1. radiodense focus in middle of rounded lytic focus
2. TORE ME
a. Tb
b. Osteomyelitis
c. Radiation
d. EG
e. Mets
f. Epidermoid
Absent Greater Sphenoid Wing
M FOR MARINE
1. Meningioma
2. Fibrous Dysplasia
3. Optic Glioma
4. Relapsing Hematoma
5. Metastasis
6. Aneurysm
7. retinoblastoma
8. Idiopathic
9. NF
10. EG
Widened superior Orbital Fissure
A FAN
1. Aneurysm (ICA)
2. Fistula (CCF)
3. Adenoma (pituitary)
4. Neurofibroma
Central Skull Base Tumors/Lesions
1. Developmental
a. Encephalocele
2. Infection/Inflammation
b. Extension from paranasal sinus/mastoid infection
c. Fungal disease (mucor in diabetics, aspergillosis in immunocompromised)
d. Sinus + nasopharyngeal sarcoidosis
e. Radiation Necrosis
Central Skull Base Tumors/Lesions
3. Benign Tumor
f. Juvenile Angiofibroma
g. Meningioma
h. Chordoma
i. Pituitary Tumor
j. Paget Dz
k. Fibrous dysplasia
l. Glomus Tumor
4. Malignant
m. Mets: prostate, lung, breast
n. Chondrosarcoma
o. Nasopharyngeal
p. Rhabdomyosarcoma
q. Perineural tumor spread: head and neck neoplasm
Basilar Invagination
1. definition
2. Causes
3. associations
primary developmental anomaly of abnormally high position of vertebral colum prolapsing into skull base
2. Causes
a. Condylus tertius – ossicle at distal end of clivus forming pseudojoint with dens/ant C1 arch
b. Condylar hypoplasia
c. Basiocciput hypoplasia (shortening of clivus)
d. Atlanto-occipital assimilation – complete/partial failure of segmentation /w skull and C1
3. Chiari malformation
4. syndrohydromyelia in 25-35
Basilar Impression
1. Definition
2. Causes
1. aquierd form of basilar invagination (cranial settling) with bulging of cspine/foramen magnum into cranial cavity
2. PF ROACH
a. Paget Disease
b. Fibrous dysplasia
c. Rickets
d. OI, Osteomalacia
e. Achondroplasia
f. Cleiodocranial dysplasia
g. Hyperparathyroidism, Hurler syndrome
3. Also skull base infection, RA
Temporal Bone Fractures
1. Longitudinal
2. Transverse
a. Injury site
b. Hearing loss type
c. Middle ear involvement
d. Ossicular dislocation
e. Labyrinth involvement
1. Longitudinal
a. Temporoparietal bone
b. Conductive
c. Injured
d. Common
e. Spared
2. Transverse
f. Occipital
g. Sensorineural
h. Spared
i. Rare
j. Injured
Vascular Intratympanic Mass
Glomus tympanicum
2. Aberrant ICA
3. Carotid artery aneurysm
4. Persistent stapedial artery
5. exposed jugular bulb
6. exposed carotid artery (ecstatic/tortuous)
7. hemangioma
8. Extensive glomus jugulare
Absence/Stenosis of EAC - DDx
Congenital
a. Stenosis of the EAC
b. Bony or membranous atresia of EAC
c. Treacher-Collins syndomre
d. Crouzon’s disease
e. Klippel-Feil syndrome
f. Goldenhar’s dyndrome
g. Cleidocranial dysostosis
h. Osteopetrosis
i. Thalidomide emryopathy
j. Congenital rubeolla
2. Acquired
k. Exostosis of the EAC
l. Osteom of EAC
m. Postsurgical changes
n. Recurrent external otitis
Increased Bone density of Temporal Bone
Otic capsule involved
a. Michel deformity
b. Labyrinthitis ossificans/obliternas
2. Otic capsule spared
c. Paget disease
d. Fibrous dysplasia
e. OI
f. Osteopetrosis
Osteolysis of Temporal Bone – DDx
Focal:
a. Otosclerosis/spongiosis
b. EG
c. Tertiary symphilis (gumma)
d. Osteitis of late congenital syphilis
2. Diffuse:
e. OI
f. Paget’s disease
g. Fibrous dysplasia
Petrous Apex Destructive Lesions – DDx
Infectious /inflammatory:
a. Petrous apicitis/petrous apex abscess
b. Malignant otitis externa (skull base osteomyelitis)
2. Benign Tumors
c. Cholesteotoma
d. Meningioma
e. Paraganglioma
f. Cholesterol granuloma
3. Malignant Tumors
g. Skull base Chondrosarcoma
h. Metastasis
i. Chordoma
j. Lymphoma
k. Plasmacytoma/multiple myeloma
l. Nasopharyngeal carcinoma
Abnormal Soft Tissue Mass in EAC a/w Bony Erosion
1. Inflammatory:
a. Malignant external otitis
b. Benign necrotizign otitis externa
c. Cholesteatoma of EAC
2. Neoplastic
d. SCC of EAC
e. BCC of EAC
f. Salivary gland malignancies (adenoid cystic/mucoepidermoid ca)
g. Melanoma
h. Mets
i. Ceruminoma (ceruminous adenoca
Soft Tissue in Middle Ear
1. cholesteatoma
2. Chronic Otitis Media
3. Granulation Tissue
4. Cholesterol Granuloma
5. Malignant otitis externa
6. Glomus tympanicum
7. Neoplasm (SCC in adults, rhabdomyosarcoma in children)
Acquired Middle Ear Cholesteatoma –
1. What are the two types?
a. Site of TM performation
b. Location
c. Effect on ossicles
d. bone erosion
e. ossicles erosion
Attic cholesteatoma
a. Pars flaccida
b. Prussak’s space
c. Displace medially
d. Laterael tympanic wall
e. Malleus and body of incus
2. Sinus Cholesteatoma
f. Pars tensa
g. Sinus Tympani
h. Laterally
i. Initially subtle
j. Long process of incus
Cholesteatoma Complications
1. Labyrinthine Fistula
2. FN paralysis
3. Sinus Thrombosis
4. Meningitis
5. Encephalitis
6. Abscess
7. Petrous apex syndrome (Gradenigo’s syndrome)
CPA MASS – DDX
1. Mimics/pseudotumors
a. Cerebellar flocullus
b. Tuft of choroids plexus
c. Proimient AICA
d. Prominent jugular bulb
2. Tumors arising primarily in CPA cistern
e. Vestibular schwannoma
f. Meningioma
g. Epidermoid cyst
h. Arachnoid cyst
i. Nonacoustic schwannoma (trigeminal, facial nerve)
CPA MASS – DDX
Tumors with direct extension from adjacent structures
j. Glomus jugulare
k. Brainstem glioma
l. Ependymoma of fourth ventricle
m. Cerebellar astroctyoma
n. Chordoma
o. Chondrosarcoma (spheno-occipital synchondrosis)
4. Vascular Lesions
p. Vertebrobasilar dolichoectasia
q. Aneurysms – vertebrobasilar, AICA
r. AVMs
5. Infectious/inflammatory:
s. Basilar meningitis (bacterial, fungal, TB cryptococcosis, syphilis)
t. Arachnoiditis
u. Sarcoid
v. Leptomeningeal metastasis
Multiple Cranial Nerve and CNS Tumors – DDx
1. Neurocutaneous Syndromes (phakomatoses)
a. NF1
b. Nf2
c. VHL
d. TS
2. Schwannomatosis
3. NF1/NF2 mosaicism
4. multiple meningiomas
Vascualr Middle Ear Mass – DDx
1. Glomus Tympanicum
2. Aberrant Internal Carotid artery
3. Persistent stapedial artery
4. Carotid Artery aneurysm
5. exposed jugular bulb
6. exposed carotid artery
7. hemangioma
8. extensive glomus jugulare
Types of Mastoidectomy
1. Simple (closed canal) Mx
a. Remove some/all mastoid cells
b. Maintain EAC/ossicles
2. Radical (open cavity) Mx
c. Modified Radical (Bondy)
i. Remove mastoid air cells and EAC
ii. Ossicular chain intact
d. Radical Mastoidectomy
i. Remove mastoid cells and EAC
ii. Preservation of stapes suprestrucutre
iii. Often with tympanoplasty
Acute Peripheral FN palsy – DDx
1. Inflammatory/Infectious
a. Bell’s palsy
b. Herpes zoster otticus (Ramsay-Hunt)
c. Other viral infections (EBV, HIV, rubella, mumps, polio, coxsackie, influenza)
d. Otitis Media/mastoiditis (bacterial, fungal)
e. Lyme disease
f. Syphilis
2. Trauma
g. Temporal bone fracture
h. Temporal bone contusion
3. Tumors: benign, malignant, e.g. facial nerve schwannoma ddx
4. Iatrogenic: post-surgical from transmastoid approach
5. Others: (usually more gradual)
i. DM
j. Hypothyroidism
k. Sarcoid
l. Guillain-Barre syndrome
FN Palsy – DDx
1. Inflammatory/infectious
a. Bell’s palsy
b. Herpes zoster otticus
2. Trauma
c. Temporal bone fractures
3. Benign Tumors
d. FN tumors (schwannoma, hemangioma, lipoma)
e. Acoustic schwannoma
f. CPA meningioma
g. Epidermoid cyst (congential cholesteatoma)
h. Choristoma
i. Glomus tympanicum
FN Palsy – DDx
4. Malignant Tumor:
j. Perineural spread (parotid/Eac malignancy)
k. Direct invasion
i. Glomous jugulare, embryonal rhabdomyosarcoma
ii. Langerhan’s cell tumor
iii. Cystadenocarcinoma of endolymphatic sac
l. Lymphoma
m. Mets
n. Facial nerve sarcoma
Cystic Nasopharyngeal Mass – DDx
1. Tornwaldt Cyst
2. Encephalomeningocele
3. Phayngeal Cyst
4. Atypical Lymph Node
Expansile Nasopharyngeal Mass - DDx
1. JAF
2. Chordoma
3. rhabdomyosarcoma
4. Schwannoma of 5th Cranial Nerve
5. Nasopharyngeal polyp
Solid Mass in Carotid Sheath – DDx
1. Inflammatory/infectious
a. Lymphadneopathy
b. Traumatic neuroma
2. Benign Neoplasm
c. Nerve sheath tumor
i. Schwannoma
ii. Neurofibroma
iii. Ganglioneuroma
iv. Ganglioblastoma
v. Ganglioneuroblastoma
d. Paraganglioma
i. Glomus vagale
ii. Glomus jugulare
iii. Carotid body tumor
e. Lipoma
f. Hemangiolymphangioma
g. Granular cell tumor (rhabdomyoblastoma)
h. Thyroid/parathyroid tumor
3. Malignant neoplasm
i. Metastatic lymphadenopathy
j. lymphoma
Post-styloid Parapharyngeal (Carotid) Space Mass
1. Glomus Vagale
2. Glomus jugulare
3. schwannoma
4. meningioma
5. metastasis
Nsopharyngeal Mass – DDx
1. Carcinoma
2. Lymphoma
3. Rhabdomyosarcoma
4. Adenoidal tissue
5. Tornwaldt cyst
6. Retropharygneal adenopathy
Fatty Lesions in PPS – DDx
1. Lipoma
2. Angiolipoma
3. Dermoid cyst/teratoma
4. Hibernoma
5. Lipoblastoma/lipoblastomatosis (peds)
6. Benign symmetric lipomatosis (Madelung disease)
7. Liposarcoma
Aggressive nasopharyngeal Mass in a Child
1. Rhabdomyosarcoma
2. Lymphoma
3. Chloroma
4. Langerhans cell tumor
5. Nasopharyngeal carcinoma
6. Metastatic neuroblastoma
7. Esthesioneuroblastoma
8. Hemangiopericytoma
9. Minor salivary gland malignancy
10. Aggressive infection (fungal, TB, Cocci)
Anterior Cystic Neck Mass – DDx
1. Branchial Cleft Cyst
2. External Laryngocele
3. Thyroglossal duct cyst
4. Necrotic Lymph node
5. Abscess
6. Cystic hygroma
7. Dermoid
8. Thrombosed anterior jugular vein
9. Aneurysm
Cystic Neck Mass – DDx
1. Thyroglossal cyst
2. Branchial cleft cyst
3. Cystic hygroma/lymphangioma
4. necrotic lymph node
5. laryngocele
6. Sebaceous cyst
7. Jugular vein
8. Lipoma
Prevertebral Soft Tissue Widening – DDx
1. Abscess
2. Neoplasm
3. Post-traumatic change
4. Lymph fluid
5. Tortuous Carotid artery
Anterolateral Neck Mass – DDx
1. Pseudomasses
a. Hypertrophy of the sCM
b. S/p radical neck dissection
2. Vascular masses
c. Asymmetry of jugular veins
d. Jugular vein ectasia
e. Aneurysm of jugular vein
f. Jugular vein thrombosis (bland, septic or metastatic clot)
g. Aneurysm of carotid artery
h. AV fistula
i. Hemangioma
j. Lymphangioma
Anterolateral Neck Mass – DDx
Cystic Masses
k. Branchial cleft cyst
l. External laryngocele
m. Cystic adenopathy
n. Thyroid cysts
4. Solid masses
o. Adenopathy
p. Paraganglioma
q. Schwannoma
r. Abscess
s. Neurofibroma
t. Thyroid tumors
u. Lipoma
Fatty Tumors of the Neck – DDx
1. Solitary fatty tumor – no contrast enhancement
a. Lipoma
b. Dermoid cyst
2. Solitary fatty tumor with contrast enhancement
c. Angiolipoma, hibernoma, lipoblastoma/lipblastomatosis, liposarcoma
3. Multiple fatty tumors
d. Benign symmetric lipomatosis (Madelung disease)
e. Cushing syndrome
Diffuse Lipomatosis of Neck – DDx
1. without inflammatory signs:
a. benign or multiple symmetric lipomatosis
b. multiple familial lipomatosis
c. morbid obesity
d. Cushing diseas/syndrome
e. Lipoblastomatosis (children)
f. Liposarcoma
2. With inflammatory signs:
g. Weber-Christian’s disease (painful adiposities)
h. Dercum’s disease (acute panniculitis)
i. Progressive nodular lipomatosis
Neck Mass with Central Lucency – DDx
1. BCC
2. Lymphangioma
3. Necrotic Lymph nodes
4. Abscess
5. Benign node with fatty degeneration
Ill-defined Enlargemetn of Thyroid Gland with Extrathyroid Extension – DDx
1. Infectious/inflammatory:
a. Acute suppurative thyroiditis (bacterial or fungal)
b. Riedel’s thyroiditis (invasive fibrous thyroiditis)
2. Neoplastic
c. Anaplastic thyroid carcinoma
d. Thyroid lymphpoma
3. Iatrogenic
e. Post-surgical changes
f. Postradiation therapy (radiation induced thyroiditis)
Multinodular Thyroid Gland Enlargement – DDx
1. Multinodular goiter
2. Thyroiditis (subacute, Hashimoto’s, Quervain’s, post-partum)
3. Primary or secondary lymphoma
4. metastatic disease
5. Undifferentiated/anaplastic carcinoma
6. Thyroid sarcoma
7. Graves disease
Aggressive Looking Thyroid Mass – DDx
1. Infection:
a. Acute suppurative thyroiditis
2. Inflammatory: Reidel’s thyroiditis
3. Malignant tumors:
b. Anaplastic carcinoma
c. Lymphoma
d. Sarcoma
e. SCC
f. metastasis
Discrete Mass in the Tracheo-esophageal Groove
1. Exophytic thyroid nodule
2. Lymphadenopathy
3. Parathyroid adenoma/carcinoma/cyst
4. Nerve sheath tumor (cervical roots/vagus nerve)
Primary Tracheal Carcinoma – DDx
1. Papilloma
2. Granuloma
3. Foreing Body
4. Primary tracheal carcinoma
5. Secondary invasion from adjacent neoplasm
6. Amyloid
7. Ectopic thyroid
Epiglottitis, Supraglottitis – DDx
1. SCC
2. Supraglottitis/epiglottitis
3. Atypical laryngocele
4. Post-traumatic deformity
Paralaryngeal Cyst – DDx
1. Laryngocele
2. Congenital laryngeal cyst
3. Cyst of epiglottis
4. BCC
5. Neoplsm with necrosis simulating cyst
6. Thyroglossal duct cyst
Vocal Cord Paralysis – DDx
1. Old trauma
2. arytenoids dislocation
3. laryngocele
4. Carcinoma
Abnormal Shape of the Laryngeal Cartilage – DDx
1. Abnormal shape of the laryngeal cartilage
2. Chronic posttraumatic deformity
3. Postsurgical changes
4. Acute laryngeal trauma
5. Chondroid neoplasm of the larynx
6. Metastatis to the cartilage
7. Congenital deformity
Vallecular Mass – DDx
1. Cystic
a. Vallecular cyst
b. Cyst in base of tongue
c. Dermoid/teratoma
d. Lymphangioma/cystic hygroma
e. Laryngocele
2. Solid
f. Ectopic thyroid
g. Hemangioma
h. SCC
Expansile Lesion of Laryngeal Cartilage – DDX
1. Chondroma
2. Chondrosarcoma
3. Metastasis
4. Post-traumatic deformity
Vocal Cord Assymetry – DDx
1. Glottic carcinoma
2. Recurrent Nerve Paralysis
3. Teflon injection of vocal cord
4. SCC of vocal cord
Supraglottic Mass – DDx
1. Carcinoma
2. Laryngocele
3. Post-traumatic deformity (pseudo-mass)
4. Papilloma
5. Chondroma
6. Metastasis
7. amyloid
8. Hemangioma
9. Lymphoma
Pyriform Sinus Mass – DDx
1. Pyriform sinus carcinoma
2. Post-operative scarring
3. Post-radiation edema
4. Metastases
5. Mesenchymal tumor
6. Lymphoma
Destructive Laryngeal Mass centered in the Cartilage – DDx
1. atypical SCC of larynx
2. Primary chondral tumor
3. Metastasis to larynx (e.g. osteosarcoma)
Enlargement of Prevertebral Soft Tissue – DDx
1. Prevertebral Mass
2. Retropharyngeal Mass
a. Adenitis/cellulites
b. Abscess
c. Edema
d. Hematoma
e. Lipoma
f. Metaststic lymphadenopathy
g. Direct invasion from nasopharyngeal or oropharyngeal SCC
h. Kawasaki’s disease
i. Atypical 3rd BCC
j. Hemangioma/lymphangioima