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82 Cards in this Set
- Front
- Back
What is the classification of cystic head and neck masses?
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1) Congenital
2) Inflammatory 3) Vascular 4) Visceral saccular cysts 5) Parenchymal cysts 6) Benign tumors 7) Malignant tumors |
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What are the congenital cystic masses?
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Branchial cleft cysts
Thyrogolssal duct cyst Lymphangioma/cystic hygroma Epidermoid/dermoid Thymic cyst Tornwaldt cyst |
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What are the branchial cleft custs?
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First
Second Third |
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What is the location of the first branchial cleft cyst?
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Periparotid
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What is the location of the second branchial cleft cyst?
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Posterior submandibular space
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What is the location of the third branchial cleft cyst?
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Posterior cervical space
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What are the most common congenital cystic head/neck masses?
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Brancial cleft cysts
Thyroglossal duct cyst Cystic hygroma Dermoid/epidermoid |
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What are possible cystic lesions of the parotid space?
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First branchial cleft cyst
Cystic hygroma Abscess Obstructed parotid duct/sialocele Warthin tumo Cystic neural sheath tumor Malignant tumor |
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Which malignant tumor of the parotid is particularly likely to be cystic?
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Mucoepidermoid
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What is the differential diagnosis of posterior submandibular space cystic lesions
(i.e. angle of mandible lesions) |
Second branchial cleft cyst
Cystic hygroma Lateral thyroglossal duct cyst Dermoid External laryngocele Submandibular gland mucocele Abscess or suppurative node Diving ranula Malignant adenopathy |
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What is DDx of sublingual space cystic lesion?
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Epidermoid
Simple ranula Obstructed submandibular duct (sialocele) |
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Carotid space?
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Juular vein thrombosis
Carotid artery aneurysm Abscess Malignant nodes |
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Visceral space?
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Thyroglossal duct cyst
Internal laryngocele Cystic benign thyroid or parathyroid tumor Cystic malignant thyroid tumor Malignant laryngeal SCCa |
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Posterior cervical space?
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Cystic hygroma
Abscess/suppurative node Cystic neural sheath tumor Malignant adenopathy |
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What is typical history of patient with a first branchial cleft cyst?
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Multiple parotid abscesses unresponsive to treatment
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What sometimes occurs clinically?
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Otorrhea
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Why?
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cyst connect to external auditory canal
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Where?
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At bony carilaginous junction
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What else can be seen clinically?
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Cutaneous opening.
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Where?
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Angle of mandible
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What is imaging appearance?
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Cystic mass in parotid space
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Where exactly is cyst?
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May be superficial to, within, or deep to parotid
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Where can it extend?
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Parapharyngeal space if deep part of gland involved
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How common is the lesion?
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RARE
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Second branchial cleft cyst--Where can it protrude to?
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Posterior cervical space
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What can this then be confused with?
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Third branchial cleft cyst
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How common is third branchial cleft cyst?
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RARE cyst located in posterior cervical space
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Where can thyroglossal duct cyst present?
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Anywhere from foramen cecum to pyramidal lobe of thyroid
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Where does is present, in most cases?
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Between hyoid and pyramidal lobe of thyroid
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What is it called when thyroglossal duct cyst dissects from hyoid region back up through tongue base towards foramen cecum?
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Suprahyoid thyroglossal duct cyst
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What percentage of thyroglossal duct cysts are suprahyoid?
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20%
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What percent are at or just below hyoid?
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80%
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What does the cyst look like on imaging?
Position? |
Midline
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In what structures is the TDC nestled?
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Strap muscles
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What is its appearance in relationship to them?
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Seems to "beak" over the edges of the cyst
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What is true of the TDC as it gets closer to the thyroid?
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Can be off midline, as it approaches the thyroid lobes
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What is important in imaging?
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Must image the whole course of the cyst, which will be above the cyst.
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What modality is best?
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MRI, T2W (fat sat)
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What is treatment
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Removal
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What is the surgery like?
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Meticulous
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Why?
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Whole cyst/duct removed
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Why?
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It will recurr otherwise
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What are the most common sites for cystic hygroma, in order?
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Posterior cervical space
Submandibular Parotid Sublingual |
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What is true of spatial localization of cystic hygromas?
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They are transspatial
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Where is epidermoid most commonly located?
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Under the tongue
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What is the source of 1/3 of all neck infections?
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Pharyngitis
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What precedes most cases of peritonsillar abscess?
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Pharyngitis
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How does multispatial infection occur sometimes?
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Rupture of suppurative lymph node
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What is evidence of Tb adenitis?
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Multiple mixed high and low density nodes
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What is a retention cyst?
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Blocked secretion
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What is retention cyst of the sublingual gland called?
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Ranula
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What is retention cyst of the submandibular gland called?
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Mucocele
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What is retention cyst of the tonsil (faucial or adenoidal) called?
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Retention cyst
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What is retention cyst of lingual tonsil (tongue base)?
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Vallecular cyst
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Paranasal sinus?
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Retention cyst
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What is a laryngocele?
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Obstruction of the laryngeal ventricle or its sacculus (appendix) is functionally obstructed, and presses into the submucosal space.
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What types of things functionally obstruct?
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Increased intraglottic pressure, such as excessive coughing, playing instrument, blowing glass
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What is other cause of laryngocele?
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Obstruction of the proximal aspect (i.e. stump) of the saccule by tumor, trauma, or postinflammatory stenosis
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What is a simple laryngocele?
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Laryngocele in submucosal location within the paralaryngeal (paraglottic) space of the supraglottis.
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What clinches the diagnosis of simple laryngocele?
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Can follow the lesion back to the supraglottis
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What is an external laryngocele?
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The laryngocele continues to dissect through the submucosal space, and pops out of the larynx.
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How does it pop out?
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Thyrohyoid membrane
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Where is it when it pops out?
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Lower submandibular space
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What is the other name for external laryngocele?
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Mixed larnyngocele
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What is a secondary laryngocele?
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Those forming secondary to tumor obstruction at the opening to the laryngeal ventricle
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In which patients should laryngocele be cause for alarm?
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Any adult smoker.
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What should be done?
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Search of the lower supraglottis radiographically AND clinically for tumor.
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What is a complication of laryngocele?
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Infection
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What is this called?
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Pyolaryngocele
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What is the appearance
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Wall thicking of laryngocele
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What is Zenker's diverticulum?
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Outpouching of the posterior wall of the upper esophagus
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What is CT appearance?
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Oval mass in posterior visceral space
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What does it contain?
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"foamy" material
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What is the name of typical thyroid cyst?
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Colloid cyst
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What is presentation of colloid cyst?
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Rapidly enlarging tense lower neck mass
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What may make it painful?
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Hemmorhage into lesion
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How easy is the diagnosis to make?
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Easy if very small, but if large may be unsure where lesion arises. Also, cannot always differentiate from other lesions in DDx.
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What is in DDx of unilocular thyroid cyst?
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Degenerated goiter
Necrotic tumor Abscess |
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What is characteristic displacement pattern of thyroid lesions?
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Trachea displaced contralaterally
Carotid space displaced to ipsilateral side |
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What else can have cyst in this region as well, further confusing issue?
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Parathyroid
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How common are thymic cysts?
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Very rare
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When do they occur?
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2/3 in 1st decade
1/3 in 10s-20s |