HEAD AND NECK MASS

GENERAL SURGERY

FACE ANATOMY

FACE ANATOMY

FACE MASS ,LAMP, OR

SWELLING
EPIDERMOID CYST (SEBACEOUS CYST) : COMMON

IN SCALP & FACE BECAUSE OF EXCESSIVE SEBACEOUS

GLANDS .due to BLOCKAGE OF THE MOUTH OF THE
GLAND THAT OPENS INTO HAIR FOLLICLE AND SO
GRADUAL DIS
TENSION OF THE GLAND FORMING A CYST CONTAINING
SEBUM. IT IS LIABLE TO INFECTION.
DERMOID CYST :COMMONLY OVER THE EXTERNAL
ANGLE OF THE EYE BROW,OR INTERNAL ANGLE.
IT IS FORMED BY PIECE OF SKIN WHICH TRAPPED DEEP
TO NORMAL SKIN WHICH IS EITHER DEVELOPMENTAL,
OR AFTER INJURY.SO IT IS EITHER CONGENITAL AS IN
FACE
OR ACQUIRED AS IN HAND AND FINGERS ALSO CALLED
INCLUSION CYST.

DERMOID CYST..CONT,D
LINED BY SQUAMOUS EPITHELIUM ,
CONTAIN SEBUM AND HAIR & OTHER SKIN
APPENDAGES ,WHICH DIFFERS FROM
SEBACEOUS CYST.
PAROTID DISEASE :
INFLAMMATORY LIKE MUMPS(viral) OR
BACTERIAL parotitis.
NEOPLASTIC:BENIGN & MALIGNANT
PLEOMORPHIC ADENOMA (MIXED PAROTID
TUMOR).
ADENOID CYSTIC CARCINOMA.

EPIDERMOID (SEBACEOUS)
CYSTS
SEBACEOUS CYSTS --FACE
SCALP SEBACEOUS CYSTS

DERMOID CYST
EXTERNAL ANGULAR DERMOID

INTERNAL ANGULAR DERMOID

ACQUIRED DERMOID
IMPLANTATION DERMOID

IMPLANTATION(INCLUSION)D
ERMOID .

DERMOID CYSTLINED BY
SQUAM.EPITHELIUM
CONTAINING HAIR
AND
SEBUM
HAIR---COULD
BE SEEN
IN OVARY AS
WELL

HAIR AND SKIN APPENDAGES

OTHER FACE MASSES

LIPOMA(SOFT)

OSTEOMA(HARD)

LIPOMA
LIPOMA

EXCISED LIPOMA

PAROTITIS
CHRONIC BACTERIAL PAROTITIS

VIRAL PAROTITIS--MUMPS

MUMPS

TUMOUR

PLEOMORPHIC ADENOMA

MIXED

PAROTID MALIGNANCY WITH

FACIAL PALSY

NECK ANATOMY

NECK ANATOMY

NECK AND THYROID

ANATOMY

NECK MASS,LUMP OR
SWELLING
MULTIPLE LUMPS:LYMPH NODES .

ANTERIOR TRIANGLE - DOES NOT MOVE

WITH DEGLUTITION OR SWALLOWING:
SOLID:LYMPH NODE,CAROTID BODY
TUMOUR,
LIPOMA.
CYSTIC :COLD ABSCESS,DERMOID CYST,&
BRANCHIAL CYST.
ANTERIOR TRIANGLE - MOVES WITH
SWALLOW
ING :
SOLID:THYROID GLAND ,DELPHIAN LYMPH
NODE .
CYSTIC:THYROGLOSSA L CYST.

NECK MASS,LUMP ,OR

SWELLING.CONT,D

POSTERIOR TRIANGLE(NOT MOVED WITH

SWALLOWING ) :
SOLID :LYMPH NODE
CYSTIC : CYSTIC HYGROMA,PHARANGEAL
POUCH.
PULSATILE CYSTIC:SUBCLAVIAN
ANEURYSM.

MULTIPLE MASSES---LYMPH
NODES

CAUSES OF MULTIPLE CERVICAL

LYMPHADENOPATHY
INFECTION:NON-SPECIFIC & SPECIFIC (T.B.),
GLANDULAR FEVER

NEOPLASIA:PRIMARY:LYMPHOMA
&LEUKAEMIA.
SECONDARY.

ANTERIOR TRIANGLE MASS

NOT MOVES WITH DEGLUTITION
SOLID:LYMPH NODE (INFECTION
,MALIGNANCY).
CAROTID BODY TUMOUR ;IT IS RARE
TUMOUR,ARISES FROM CHEMORECEPTOR
OF THE
COMMON CAROTID A.BIFURCATION.
ALSO CALLED CHEMODECTOMA.USUALLY
BENIGN,
BUT OCCASIONALLY MALIGNANT.
DIAGNOSIS :CAROTID ANGIOGRAPHY AND
MRI .

CAROTID BODY TUMOUR

ANT.SOLID
LIPOMA:BENIGN CONNECTIVE TISSUE
TUMOUR
ARISES FROM FATTY TISSUE
OR ADIPOSE TISSUE.

ANT. TRIANGLE SOLID NOT MOVES

WITH
SWALLOWING
LIPOMA

EXCISED LIPOMA SPECEIMENT

CYSTIC MASS IN ANT. TIANGLE

NOT MOVES WITH
DEGLUTITION
COLD ABSCESS: LIQUIFIED T.B. LYMPH NODE;

COLD ABSCESS: LIQUIFIED T.B. LYMPH NODE;

IT IS NEITHER RED, NOR HOT OR
TENDER.
BRANCHIAL CYST:CONGENITAL IN ORIGIN
DEVELOPED
FROM VESTIGEAL REMNANT OF THE SECOND
BRANCHIAL CLEFT.IT IS LINED BY
SQUAMOUS EPITHELIUM.
IT IS LIABLE TO INFECTION AND IF IT RUPTURES
IT LEADS TO BRANCHIAL FISTULA.
DERMOID CYST: .

SOFT CYSTIC MASSCOLD

ABSCESS

COLD & HOT ABSCESS

COLD T.B. ABSCESS

HOT NON-SPECIFIC ABSCESS

BRANCHIAL CYST &FISTULA

CONGENITAL BRANCHIAL CYST

RUPTURED INFECTED CYST---BRANCHIAL

FISTULA

DERMOID CYST--CYSTIC
DERMOID CYST RESEMBLE THYROGLOSSAL
CYST BUT DOES NOT MOVE WITH
SWALLOWING

DERMOID

ANTERIOR TRIANGLE MASS

MOVES WITH DEGLUTITION OR
SWALLOWING

SOLID :THYROID GLAND ;GOITRE (DIFFUSE GOITRE,

,OR SINGLE THYROID NODULE,TOXIC OR NON TOXIC
BENIGN OR MALIGNANT ).
DELPHIAN LYMPH NODE :SOLID MOVES WITH
SWALLOWING.
CYSTIC:THYROGLOSSAL CYST:IT MOVES WITH
TONGUE
PROTRUSION AS WELL.IT IS CONGENITAL REMNANT
OF THYROGLOSSAL DUCT .COULD BE AT ANY LEVEL
FROM FLOOR OF THE MOUTH DOWN TO BELOW
CRICOID CARTILAGE .

GOITRE =ANY THYROID

ENLARGEMENT
SINGLE THYROID NODULE

DIFFUSE THYROID ENLARGEMENT

DELPHIAN LYMPH NODE(THE ONLY L.N.

MOVES
WITH DEGLUTITION).
DELPHIAN L.N.

ALSO CALLED PRELARYNGEAL L.N.

THYROGLOSSAL CYST MOVES WITH

DEGLUTITION &TONGUE PROTRUSION
SEEN IN CHILDREN

AND ADULT

THYROGLOSSAL CYST
MOVES WITH TONGUE PROTRUSION

EXCISION OF THYROGLOSSAL CYST

POSTERIOR TRIANGLE MASS

WHICH DOES NOT MOVE WITH
SWALLOWING

SOLID :LYMPH NODE WITH ALL CAUSES OF

CERVICAL
LYMPHADENOPATHY.
CYSTIC:CYSTIC HYGROMA;ARISES FROM
PRIMITIVE
LYMPH SACS DURING EMBRYONIC LIFE.IT
APPEARS
DURING NEONATAL OR EARLY INFANCY.
IT IS COMPRESSIBLE.
PHARYNGEAL POUCH:IT IS DEFECT IN THE
PHARYNGEAL MUSCLE WALL WITH
MUCOSAL PROTRUSION OR HERNIATION.
SUBCLAVIAN ARTERY ANEURYSM :

POST.TRIANGLE L.N.

CYSTIC HYGROMA-CAVERNOUS
LYMPHANGIOMA

PHARYNGEAL POUCH

DIAGNOSIS
-HISTORY.
-PHYSICAL EXAMINATION:
LOCAL &SYSTEMIC EXAMINATION.
LOCAL EXAMINATION OF ANY LUMP :

SIZE,SITE,SHAPE,SURFACE,COLOR,TEMPERATURE,
TENDERNESS,CONSISTENCY,COMPRESSIBILITY
OR
PULSATILITY.
INVESTIGATION:HAEMATOLOGICAL &
BIOCHEMICAL
EXAMINATION.

DIAGNOSISCONT,D
IMAGING TESTS :
CHEST X-RAY .
PLAIN X-RAY SKULL ---DERMOID CYST .
ULTRASOUND ---DIFFERENTIATE BETWEEN
CYSTIC & SOLID MASS.ALSO ULTRASOUND
DIFFERENTIATES BETWEEN VASCULAR
AND NON-VASCULAR AS IN CAROTID
BODY TUMOUR OR ANEURYSM.
CT SCAN WITH IV CONTRAST--- FOR ALL
LUMPS .
MRI------ .

DIAGNOSISCONT,D
BIOPSY:
FINE NEEDLE ASPIRATION BIOPSY.
INCISIONAL BIOPSY .
EXCISIONAL BIOPSY.

PLAIN X-RAY
BONE DEFECT DUE TO DERMOID CYST

DERMOID CYST

X-RAY
DERMOID CYST

DERMOID CYST OF THE FINGER

BONE
DESTRUCTIO

FINE NEEDLE BIOPSY DIRECT OR

UNDER US GUIDE

EXCISIONAL BIOPSY
BIOPSY SLIDES

FNA

Physical Examination and Diagnosis of the Head and

Neck

What is your physical diagnosis based on the

data & picture?
Unusual Findings /
Location
Disorder
Disease
Abnormality?

Physical Examination and Diagnosis of the Head and

Neck

What is your physical diagnosis based on the

data & picture?
Unusual Findings /
Location
Disorder
Disease
Abnormality?

Physical Examination and Diagnosis of the Head and

Neck

What is your physical diagnosis based on the

data
& picture?
Unusual Findings /
Location
Disorder
Disease
Abnormality?

Physical Examination and Diagnosis of the Head and

Neck

What is your physical diagnosis based on the

data & picture?
Unusual Findings /
Location
Disorder
Disease
Abnormality?

Physical Examination and Diagnosis of the Head and

Neck

What is your physical diagnosis based on the

data & picture?
Unusual Findings /
Location
Disorder
Disease
Abnormality?

Physical Examination and Diagnosis of the Head and

Neck

By prevalence

What is your physical diagnosis based on the

data & picture?

Unusual Findings /
Abnormality?

Location

Disorder

Disease

Physical Examination and Diagnosis of the Head and

Neck

Perihyoid area

What is your physical diagnosis based on the

data
& picture?
Unusual Findings /
Location
Disorder
Disease
Abnormality?

Physical Examination and Diagnosis of the Head and

Neck

Cystic
Present at birth

What is your physical diagnosis based on the

data & picture?

Unusual Findings /
Abnormality?

Location

Disorder

Disease

Physical Examination and Diagnosis of the Head and

Neck

With pus
Long-standing

What is your physical diagnosis based on the

data & picture?

Unusual Findings /
Abnormality?

Location

Disorder

Disease

Physical Examination and Diagnosis of the Head and

Neck

Moves with
deglutition

What is your physical diagnosis based on the

data & picture?

Unusual Findings /
Abnormality?

Location

Disorder

Disease

PE and DX of hd.&neck
mass

Physical Examination of the Head and Neck

Diagnostic Algorithm for Pathology of Head
and Neck Lymph Nodes
1. Look for clues for secondary
malignancy another mass nearby
suspicious for malignancy
2. Look for clues for reactive hyperplasia
inflammation /infection nearby
3. Look for clues for primary malignancy
multiple regional lymph node
enlargement
4. Look for clues for tuberculosis

Physical Examination
and Diagnosis of the
Head and Neck

Physical Examination of the Head and Neck

Diagnostic Algorithm for Pathology of Head
and Neck Lymph Nodes
Differentials:
Reactive hyperplasia of lymph nodes
Tuberculous lymphadenopathy
Primary malignancy Lymphoma
Secondary malignancy Spread from a
primary cancer

Physical Examination
and Diagnosis of the
Head and Neck
Physical Examination of the Head and Neck
Diagnostic Algorithm for Pathology of Masses
1. Look for signs of inflammation / infection:
Pus; erythema; tenderness; warmth
2. Look for signs of malignancy:

Distant mass suspicious for metastasis; regional

mass (lymph node) suspicious for spread;
signs of invasion (fixation); ill-defined border;
hard
consistency

3. Look for sign of benignity:

Cystic nature of mass with no signs of
malignancy and no signs of
inflammation /
infection

Physical Examination
and Diagnosis of the
Head and Neck
Physical Examination of the Head and Neck
Diagnostic Algorithm for Masses
1. Location of mass
2. Possible / probable organ or tissue of origin
3. Pathology: General / Specific
General:
Inflammatory / infectious mass
Malignant mass
Non-malignant mass

Physical Examination
and Diagnosis of the
Head and Neck

Physical Examination of the Head and Neck

Methods:
Inspection Usual / Unusual:
Comparison of Sides :
ASYMMETRY;
Abnormal Findings such as
JAUNDICE / PALE CONJUNCTIVAE /
etc.
Palpation Usual / Unusual:
Comparison of sides:
MASS /
TENDERNESS / THRILL / etc.
Auscultation Usual / Unusual:

Physical Examination
and Diagnosis of the
Head and Neck
Physical Examination of the Head and Neck
Methods:
Inspection Look - Eyes
Palpation Feel Fingers (gloved / nongloved)
Auscultation Listen - Stethoscope

Physical Examination
and Diagnosis of the
Head and Neck
Physical Examination of the Head and Neck
Findings
Anatomical (Structure)
Physiological (Function)

Diagnosis
Physical Diagnosis
Clinical Diagnosis

PE & DX of Hd ,neck
mass
Specific Learning Objectives:
6.Process data derived from physical
examination of the head and neck to come
out with a physical diagnosis.
Data from physical examination:
Usual vs Unusual:
Nothing unusual Normal
Unusual but asymptomatic Normal
variant
Unusual and symptomatic Abnormal
Diagnostic label: name of disorder,
involved area, organ or tissue
Descriptive label of unusual findings: if
name of disorder is not known, state

PE & DX of hd ,neck
mass

Specific Learning Objectives:

5.Make a written record of findings of a
physical examination of the head and neck.
Line drawing of head and neck, whole
or involved areas

PE & DX of hd, neck

mass
Specific Learning Objectives:
5.Make a written record of findings of a
physical examination of the head and neck.
Line drawing of head and neck, whole
or involved areas
Illustrative findings with description
and explanation

PE & DX Hd ,neck mass

Specific Learning Objectives
3.Gather essential data from examination of
the head and neck.
Inspection
With eyes, look for anything unusual in
structure and function
Palpation
With fingers, feel for anything unusual in
structure and function
Auscultation
With a stethoscope, listen for anything
unusual in structure and function

PE &DX hd ,neck mass

Specific Learning Objectives:
2.Identify the areas that should be included
in the physical examination of the head and
neck.
Scalp
Face
External ears, nose, eyes
Lips, oral cavity, throat
Neck (thyroid and lymph nodes)
Nape

PE & DX of hd,neck
mass
General Learning Objectives:
1.Systematically and proficiently perform a
physical examination of the head and neck
on adults.
2.Correlate physical examination findings
with anatomic and physiologic
characteristics of the head and neck.