3. HOPI
NECK SWELLING
When do you first notice the lump?
Rule of 7:
7 days = inflammatory/infection
7 weeks/months = tumour
7 years = congenital/development
What do you think is the cause?
History of trauma
Previous TB
How do you notice it?
Noticed accidentally
Told by others
Painful
How does the lump disturbs you?
Associated symptoms
pain, discharge, dysphagia, dyspnea,
cosmetically disfiguring, fear of
malignancy
Any changes to the lump since
you first notice it?
Size
Has the lump ever disappears before?
Lying down supine
Any activity
Do you ever had any other lumps
before this?
Multiplicity
4.
5.
Systemic Review
Head & Neck symptoms
Pain in mouth / throat
Mouth ulceration
Nasal discharge
Pain / blockage of
airway
Voice changes
Difficulty breathing
Systemic illness
Suggestive of malignancy
Anorexia, weight loss and symptoms from other systems
Suggestive of infection
Malaise, fever, rigors, local symptoms
6.
PAST MEDICAL HISTORY
DRUG & ALLERGY
FAMILY HISTORY
SOCIAL HISTORY
Thyroid cancer & radiation
Previous skin cancer / lesion
Smoking
Chewing tobacco
Alcohol
Malignancy
10. SUPERFICIAL
o Sebaceous cyst
o Lipoma
o Dermoid cyst
o Abscess
Lymph nodes DEEP
Anterior Triangle
o Move with swallowing
Thyroid
Thyroglossal cyst
Lymph node
o Do not move with swallowing
Salivary gland
Brachial cyst
Carotid body tumor
Carotid aneurysm
Posterior Triangle
o Cervical rib
o Subclavian artery aneurysm
o Pharyngeal pouch
o Cystic hygroma
11.
Miscellaneous cysts
Dermoid cyst
Thyroglossal duct cyst
Brachial clelf cyst
Cystic hygroma
Midline neck masses
Thyroglossal duct remnants (cysts)
Dephian lymph nodes
Pryramidal lobe of thyroid gland
*Mass at sternal notch: tuberculous abscess,
dermoid cyst, or a fatty tumor associated with
Cushing's syndrome similar to the Dowager's
hump. Fullness of the sternal notch can occur in
leukemia (Jaccoud's sign)
Lateral neck masses
Brachial cysts
Carotid body tumors
13.
1) Jones N, Hibbert J, Luxon LM. Scott-Brown’s Otorhinolaryngology: Head
and Neck Surgery cd-rom (A Hodder Arnold Publication). 7th ed.
Gleeson MJ, Clarke RC, Browning GG, editors. London: Oxford
University Press, USA; 2008.
2) Schwetschenau E, Kelley DJ. The Adult Neck Mass [Internet]. 2002 [cited
2015 Sep 14].
Available from: http://www.aafp.org/afp/2002/0901/p831.html
3) Williams ME. Assessment of the Neck and Lymph Nodes in the Elderly
Patient [Internet]. Medscape. 2009 [cited 2015 Sep 14].
Available from: http://www.medscape.com/viewarticle/712256_5
4) Neck Lump [Internet]. Fastbleep Biology Notes. [cited 2015 Sep 14].
Available from: http://www.fastbleep.com/biology-notes/9/11/356
How do you notice it?Below are the 3 commonest answers :a) It's painfulb) I noticed it accidentallyc) Others told me about itGenerally, if the lump is painful, the commonest aetiology is inflammation.Most of the patients thought that only painful lumps are cancerous.