Hoyt's Neck Swelling

Front 1

Acute deep neck space infections

Back 1

(Acquired swellings of the neck)
• Dx is often difficult and fluctuation may be absent b/c infection is so deep
• Emergency airway management is often needed along with neck exploration for evacuation of the abscess & drain insertion
• CT scan very helpful as the extent of abscess formation & airway compromise is very difficult to judge accurately w/o proper imaging

Front 2

Ludwig’s Angina

Back 2

(Acquired swellings of the neck) (Acute deep neck space infections)
• Airway compromise from laryngeal edema & the tongue being pushed upward & backward can create a life-threatening event requiring an emergency airway

Front 3

Acute Lymphadenitis

Back 3

(Acquired swellings of the neck) (Lymphadenopathy)
• In childhood & adolescence the lymph nodes may remain enlarged for quite some time after the illness has resolved

Front 4

Caveats for determining if tonsillectomy is indicated

Back 4

• The appearance of the tonsils is variable & does NOT correlate will w/ symptoms of recurrent tonsillitis. Hx is more important than appearance in the management of tonsillitis.
• Obstructive sleep apnea syndrome (OSAS) in childhood is an increasingly recognized dz entity & is a definite indication for tonsillectomy along with adenoidectomy, if their hypertrophy is contributing to the upper airway obstruction.
• Rhinoviruses, adenoviruses & enteroviruses are probably responsible for about 50% of acute tonsillitis

Front 5

Thyroid & Parathyroid Neoplasms

Back 5

• Suppression with exogenous thyroid no longer indicated if there is any possibility of malignancy
•
• Rate of malignancy for all thyroid neoplasms (Papillary most common) is 10-20%. Incidence is higher in individuals with prior radiation exposure, older males, pts with solitary, hard, non-cystic or non-functioning (“cold”) lesions.

o Non-functioning = when it won’t take up isotopes on imaging study
• Papillary and anaplastic thyroid carcinomas can be dx via FNABx; Follicular thyroid cancer can NOT

Front 6

Chronic Salivary Gland Disorders

Back 6

Malignant neoplasms, the smaller the salivary gland the more likely the lesion is malignant (parotid 20%, submandibular 50%, minor salivary 75%), malignant tumors usually have more rapid growth and pain, if there is associated facial nerve palsy there is greater indication of malignancy & a poorer prognosis.

Front 7

Carcinomas of the Upper Aero-digestive System

Back 7

• Hoarseness is not a usual symptoms (unless advanced with extension to the larynx)
• 90+% of Upper Aero-digestive malignancy is squamous cell carcinoma
• High incidence of synchronous primary malignancies
• Fine needle aspiration biopsy (FNABx) of enlarged neck nodes is almost always useful in making a dx
• Biopsies of lymph nodes should always be excisional (capsule intact) rather than incisional (piecemeal) & the wound for excision should be planned along possible future lines of neck dissection in all cases where SCC might be a possibility
• All should be staged with TMN classification (need upper pan-endoscopic exams) as therapy options & recommendations are often dependent on staging.

Front 8

Oropharyngeal Carcinoma

Back 8

• Squamous cell carcinoma (SCC) is still the most common cancer but lymphomas (25%) & adenocarcinomas of the salivary glands (minor & paired major) are often found
• A unilaterally enlarged tonsil in an adult is an indication for tonsillectomy (esp with known risk factors).
• All should be staged with TMN classification (need upper pan-endoscopic exams) as therapy options & recommendations are often dependent on staging.

Front 9

Hypopharyngeal Carcinoma

Back 9

• Squamous cell carcinoma (SCC) is the most common cancer but lymphomas & adenocarcinomas of the minor salivary glands are found