This document provides information on evaluating a parotid mass. It begins by classifying parotid masses as nonneoplastic, lymphoepithelial, or neoplastic. The evaluation involves obtaining a clinical history focusing on duration and symptoms. On physical examination, the examiner evaluates the extent of the mass, effects on surrounding areas, and facial nerve function. Imaging may be used to further characterize indeterminate masses. Fine needle aspiration is sometimes used but is controversial. Treatment depends on whether the mass is benign or malignant.
Nasopharyngeal carcinoma has unique features including association with Epstein-Barr virus and a high risk of distant metastases. Definitive radiotherapy is the primary treatment, with intensity-modulated radiotherapy improving outcomes. Concurrent chemoradiotherapy provides significantly improved progression-free and overall survival compared to radiotherapy alone for locally advanced disease based on a landmark randomized trial. Brachytherapy may be used as a boost for early-stage tumors following external beam radiotherapy.
Nasopharyngeal carcinoma presenting as multiple cranial nerves involvementDr.sahar Alshamary
A 60-year-old man presented with pain in his left face and double vision for two months. Over the next week, he developed drooping of his left eyelid, difficulty swallowing, and nasal regurgitation of food. Examination found involvement of multiple cranial nerves on the left side. Imaging showed a mass in the left nasopharynx extending into surrounding areas. Biopsy indicated non-keratinizing undifferentiated nasopharyngeal carcinoma. The patient was diagnosed with stage 4 NPC and treated with chemotherapy and radiation.
Physicians frequently encounter neck masses in adult patients. A careful medical history and physical examination are important for evaluating neck masses. The patient's age, location, size, and duration of the mass provide clues to potential causes. Neck masses can be caused by infections, inflammation, congenital anomalies, trauma, or neoplasms. A thorough examination and consideration of risk factors aids in determining the appropriate diagnostic testing or treatment.
This document discusses the anatomy and clinical presentation of nasopharyngeal carcinoma (NPC). It describes the anatomy of the nasopharynx including its walls, foramina, and spaces. It then covers the epidemiology, etiology, local extension patterns, lymph node spread, distant metastasis, clinical presentation, diagnostic workup and staging of NPC. It also provides details of the treatment approach including radiation therapy techniques such as conventional 2D radiation versus intensity modulated radiation therapy (IMRT).
ENE refers to extracapsular extension or spread of cancer from a lymph node. The AJCC 8th edition guidelines describe clinical signs of ENE as a matted lymph node mass, involvement of overlying skin or soft tissue, or signs of cranial nerve or nerve plexus invasion. Radiologically, ENE is suggested by an indistinct nodal margin, irregular capsular enhancement, or infiltration into fat or muscle on CT or MRI. The presence or absence of clinical or radiologic ENE is designated ENE(+) or ENE(-) respectively.
Nasopharyngeal carcinoma (NPC) arises from the epithelial lining of the nasopharynx. It is most common in Chinese and North African populations. Radiotherapy is the primary treatment, with chemotherapy added for advanced stages. Follow up care involves regular endoscopy and imaging to monitor response and detect recurrence, which most often occurs in the first three years. Salvage treatments include additional radiotherapy, brachytherapy, surgery, or chemotherapy depending on the location and extent of recurrence. Prognosis depends on stage, with 5-year survival rates ranging from over 80% for early stages to less than 50% for late stages.
Neck node management of unknown primaryDr Rekha Arya
The document discusses the management of neck nodes with an occult primary tumor. It begins by defining an occult primary tumor as one that presents with lymph node or distant metastases when investigations fail to identify the primary site. It then discusses the diagnostic workup, which includes history, physical exam, imaging studies like PET CT, and biopsy of lymph nodes. Treatment depends on the lymph node level and stage. For early stage disease, neck dissection may be sufficient, while advanced disease requires chemoradiation. Post-treatment neck dissection may be needed depending on response. Radiation techniques like IMRT can help reduce toxicity compared to conventional radiation. Complications of treatment include risks of surgery and side effects of high-dose radiation.
Nasopharyngeal carcinoma has unique features including association with Epstein-Barr virus and a high risk of distant metastases. Definitive radiotherapy is the primary treatment, with intensity-modulated radiotherapy improving outcomes. Concurrent chemoradiotherapy provides significantly improved progression-free and overall survival compared to radiotherapy alone for locally advanced disease based on a landmark randomized trial. Brachytherapy may be used as a boost for early-stage tumors following external beam radiotherapy.
Nasopharyngeal carcinoma presenting as multiple cranial nerves involvementDr.sahar Alshamary
A 60-year-old man presented with pain in his left face and double vision for two months. Over the next week, he developed drooping of his left eyelid, difficulty swallowing, and nasal regurgitation of food. Examination found involvement of multiple cranial nerves on the left side. Imaging showed a mass in the left nasopharynx extending into surrounding areas. Biopsy indicated non-keratinizing undifferentiated nasopharyngeal carcinoma. The patient was diagnosed with stage 4 NPC and treated with chemotherapy and radiation.
Physicians frequently encounter neck masses in adult patients. A careful medical history and physical examination are important for evaluating neck masses. The patient's age, location, size, and duration of the mass provide clues to potential causes. Neck masses can be caused by infections, inflammation, congenital anomalies, trauma, or neoplasms. A thorough examination and consideration of risk factors aids in determining the appropriate diagnostic testing or treatment.
This document discusses the anatomy and clinical presentation of nasopharyngeal carcinoma (NPC). It describes the anatomy of the nasopharynx including its walls, foramina, and spaces. It then covers the epidemiology, etiology, local extension patterns, lymph node spread, distant metastasis, clinical presentation, diagnostic workup and staging of NPC. It also provides details of the treatment approach including radiation therapy techniques such as conventional 2D radiation versus intensity modulated radiation therapy (IMRT).
ENE refers to extracapsular extension or spread of cancer from a lymph node. The AJCC 8th edition guidelines describe clinical signs of ENE as a matted lymph node mass, involvement of overlying skin or soft tissue, or signs of cranial nerve or nerve plexus invasion. Radiologically, ENE is suggested by an indistinct nodal margin, irregular capsular enhancement, or infiltration into fat or muscle on CT or MRI. The presence or absence of clinical or radiologic ENE is designated ENE(+) or ENE(-) respectively.
Nasopharyngeal carcinoma (NPC) arises from the epithelial lining of the nasopharynx. It is most common in Chinese and North African populations. Radiotherapy is the primary treatment, with chemotherapy added for advanced stages. Follow up care involves regular endoscopy and imaging to monitor response and detect recurrence, which most often occurs in the first three years. Salvage treatments include additional radiotherapy, brachytherapy, surgery, or chemotherapy depending on the location and extent of recurrence. Prognosis depends on stage, with 5-year survival rates ranging from over 80% for early stages to less than 50% for late stages.
Neck node management of unknown primaryDr Rekha Arya
The document discusses the management of neck nodes with an occult primary tumor. It begins by defining an occult primary tumor as one that presents with lymph node or distant metastases when investigations fail to identify the primary site. It then discusses the diagnostic workup, which includes history, physical exam, imaging studies like PET CT, and biopsy of lymph nodes. Treatment depends on the lymph node level and stage. For early stage disease, neck dissection may be sufficient, while advanced disease requires chemoradiation. Post-treatment neck dissection may be needed depending on response. Radiation techniques like IMRT can help reduce toxicity compared to conventional radiation. Complications of treatment include risks of surgery and side effects of high-dose radiation.
Nasopharyngeal carcinoma is a prevalent malignancy in Southeast Asia. External beam radiation therapy is the primary treatment, but recurrent disease remains challenging. Salvage nasopharyngectomy is used in some institutions for recurrent NPC after failed radiation. The nasopharynx has a complex anatomy near critical structures like the carotid artery. Staging involves imaging like CT and MRI to determine tumor extent and involvement of surrounding areas. Prognosis depends on staging, with 5-year survival rates from 24-95% depending on stage.
- Metastatic neck disease is an important prognostic factor in head and neck cancer.
- Management of neck disease involves choices of treatment modality, timing, and combination of treatments which are controversial.
- Assessment of cervical lymphadenopathy involves clinical examination, fine needle aspiration cytology, imaging like ultrasound, CT, MRI, and PET.
- Treatment depends on neck stage - elective neck treatment for N0, neck dissection for N1, neck dissection with postoperative radiation for N2, and debate over treatment for massive N3 nodes.
This document discusses nasopharyngeal carcinoma (NPC), including its epidemiology, pathogenesis, clinical presentation, diagnosis, staging, treatment with radiotherapy and chemotherapy, and areas of ongoing research. NPC arises from the epithelial lining of the nasopharynx and is more common in certain racial groups. Diagnosis involves clinical examination, imaging such as CT/MRI, and biopsy. Treatment of locally advanced NPC involves concurrent chemoradiotherapy, with some studies exploring additional benefit from induction or adjuvant chemotherapy. Ongoing areas of research include optimizing staging criteria and determining which patients benefit most from additional chemotherapy.
This document provides an overview of nasopharyngeal carcinoma (NPC), including its epidemiology, etiology, histological classification, clinical features, diagnosis, staging, treatment and prognosis. NPC has a unique geographical and ethnic distribution. It is caused by an interaction between genetic factors, Epstein-Barr virus infection and environmental exposures. Diagnosis involves biopsy of suspicious nasopharyngeal lesions. The main treatment is radiotherapy, while chemotherapy may be added for advanced cases. Prognosis depends on stage, with 5-year survival rates ranging from 80-90% for early stage to 20-40% for stage IV disease.
This document discusses the management of nasopharyngeal carcinoma. It begins with a case presentation and outlines the standard of care for early, intermediate, and advanced disease stages. Radiation therapy is the primary treatment, and intensity-modulated radiation therapy provides better local control than 2D techniques. Concurrent chemotherapy with cisplatin improves outcomes for advanced stages. Adjuvant chemotherapy after radiation may provide additional benefits. Recurrent and metastatic disease can be challenging to treat and may involve re-irradiation, surgery, or palliative chemotherapy.
The document discusses the anatomy, histology, epidemiology, clinical features, diagnosis, staging, and treatment of nasopharyngeal carcinoma (NPC). Key points include:
- NPC originates from the epithelial lining of the nasopharynx.
- It has a strong association with Epstein-Barr virus.
- Risk factors include genetic predisposition and environmental exposures like salted fish consumption.
- Common symptoms are cervical lymphadenopathy, epistaxis, ear symptoms, and neurological deficits.
- Diagnosis involves biopsy and serological testing for EBV markers.
- Staging systems consider tumor size, node involvement, and serological factors.
- Primary treatment is radiotherapy,
This document provides an overview of nasopharyngeal carcinoma. It begins with an introduction defining nasopharyngeal carcinoma as a non-lymphomatous, squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx. It then covers the epidemiology, risk factors, clinical presentation, investigations including imaging and biopsy, histopathological classification, staging, and treatment options. The key points are that nasopharyngeal carcinoma most commonly presents with neck swelling, is strongly associated with Epstein-Barr virus, and is classified into three types by the WHO based on differentiation and presence of lymphoid stroma.
1. The document discusses changes to the TNM staging system for head and neck cancers, including nasopharynx, oropharynx, and oral cavity cancers.
2. Key changes include incorporating depth of invasion instead of tumor thickness for oral cavity cancers, and adding extra-nodal extension as a prognostic variable for nodal metastases.
3. For oropharynx cancers, HPV-positive and HPV-negative cancers now have different N category classifications, with HPV-positive cancers not including N3a/N3b categories.
This document discusses the lymph node levels of the neck and management of unknown primary cancers of the neck. It begins with an overview of neck anatomy and the different lymph node groups. It then covers the classification of lymph node levels, evaluation and diagnosis of unknown primary neck cancers, and treatment approaches based on nodal staging. Physical exam, biopsy, imaging, and endoscopy are used to diagnose while treatment involves neck dissection and/or radiation depending on nodal stage and characteristics.
This document discusses the management of neck metastasis. Some key points:
1. Neck metastasis, also called neck nodes, refers to cancer spreading from a primary site to lymph nodes in the neck. The presence, level, size and number of metastatic nodes are important prognostic factors.
2. Cancer cells can spread passively through lymph vessels from a primary tumor to regional lymph nodes. They then proliferate, remain dormant, or enter blood vessels to metastasize further.
3. Assessment of neck nodes involves medical history, physical exam, imaging like ultrasound, CT, MRI, and biopsy of suspicious nodes. Nodes are grouped by anatomical levels that correlate with primary drainage patterns.
4. Treatment depends
This document provides information about pharyngeal cancers, including nasopharyngeal carcinoma, oropharyngeal cancer, and hypopharyngeal carcinoma. It discusses the relevant anatomy, risk factors, signs and symptoms, diagnostic tests, staging, treatment options including radiation, chemotherapy, and surgery, as well as reconstruction techniques and prognosis. The surgical approaches covered include transoral, transcervical, mandibular swing, and others. Reconstruction options like skin grafts, flaps, and free tissue transfer are also summarized.
This document summarizes key information about nasopharyngeal carcinoma (NPC):
1. NPC is a type of head and neck cancer most common in Southeast Asia, especially southern China. Risk factors include genetic susceptibility and Epstein-Barr virus infection.
2. The document discusses NPC epidemiology, histology, clinical presentations, and differences between high- and low-incidence areas. Cranial nerve involvement and symptoms like neck lumps and nasal discharge are also covered.
3. The anatomy of the nasopharynx and surrounding structures important to NPC are described.
The para-pharyngeal space is an inverted pyramid-shaped area located between the muscles of mastication and muscles of deglutition. It has important structures passing through like the internal carotid artery and cranial nerves. Lesions in this space can be benign like pleomorphic adenomas or malignant like metastases. Imaging with CT or MRI is important for evaluating these lesions. The transcervical approach is most commonly used for surgery but transoral, transparotid, and infratemporal fossa approaches may also be used depending on the location and extent of the lesion. Complications can include nerve injuries, bleeding, and infection. New advances like transoral robotic surgery may help access some lesions with fewer complications.
A 60-year-old female presented with swelling in both sides of her neck for 30 days. Examination revealed enlarged lymph nodes. Biopsy of a nasopharyngeal mass showed features of undifferentiated nasopharyngeal carcinoma with sheets of tumor cells. Staging identified metastases to cervical lymph nodes. Nasopharyngeal carcinoma is most common in Southeast Asia and Africa, associated with genetic and environmental factors like Epstein-Barr virus. Prognosis depends on staging, with younger patients and non-keratinizing types having better responses to treatment combining radiation and chemotherapy.
Neck lumps are common and can arise from a variety of structures in the neck. Most neck lumps are benign, but those exhibiting symptoms of potential malignancy like enlarged lymph nodes require prompt investigation and treatment. A history and physical exam can often identify the cause of the lump based on location and characteristics. Common benign causes of neck lumps include salivary gland calculi, thyroglossal cysts, and branchial cysts. Malignant causes indicate the need for further testing such as biopsy.
The document discusses juvenile nasopharyngeal angiofibroma (JNA), a benign but locally invasive vascular tumor that primarily affects adolescent males. It arises near the sphenopalatine foramen and can spread medially into the nasopharynx and laterally into surrounding structures. Presentation varies from nasal obstruction to cranial nerve palsies. Imaging shows a hypervascular mass often with bone erosion. Diagnosis is confirmed histologically. Staging guides surgical approach, with endoscopic resection increasingly used for early-stage tumors. Complete resection while preserving function is the goal.
This document discusses the anatomy, staging, treatment and techniques for carcinoma of the nasopharynx. It describes the parapharyngeal space and lymphatic drainage of the nasopharynx. It discusses the AJCC staging system and Ho's staging system. It covers treatment techniques including two-field and three-field approaches, doses used, treatment volumes, nodal volumes, planning and field matching considerations.
This document provides information on juvenile nasopharyngeal angiofibroma (JNA), a rare benign tumor seen in adolescent males. It discusses the pathogenesis, clinical features, investigations, diagnosis, differential diagnosis, and various surgical treatment approaches for JNA. The document also covers nasopharyngeal carcinoma, including risk factors, histopathology, staging, diagnosis, and treatment involving radiotherapy, chemotherapy, and surgery. Overall, the document is a comprehensive overview of benign and malignant tumors that can arise in the nasopharynx.
Vocal cord nodules, polyps, and Reinke's edema are common laryngeal lesions caused by phonotrauma or repetitive vocal trauma. Vocal cord nodules appear as small, whitish lesions at the junction of the anterior and posterior vocal folds. Treatment involves speech therapy and possible microlaryngoscopy or laser excision. Vocal cord polyps are usually unilateral and pedunculated lesions located on the vocal folds. Treatment is surgical excision to confirm diagnosis and prevent recurrence. Reinke's edema causes diffuse swelling of the vocal folds and is associated with smoking. Treatment involves smoking cessation and possible surgery.
This document provides information on paediatric musculoskeletal infections, focusing on acute haematogenous osteomyelitis (AHO). It describes the typical presentation of AHO, including the most common causative organisms like Staphylococcus aureus. It outlines the diagnostic workup and emphasizes the importance of early diagnosis and treatment with intravenous antibiotics to prevent complications. Surgical debridement may be needed for abscesses. Chronic osteomyelitis can develop if not properly treated and presents additional challenges.
Nasopharyngeal carcinoma is a prevalent malignancy in Southeast Asia. External beam radiation therapy is the primary treatment, but recurrent disease remains challenging. Salvage nasopharyngectomy is used in some institutions for recurrent NPC after failed radiation. The nasopharynx has a complex anatomy near critical structures like the carotid artery. Staging involves imaging like CT and MRI to determine tumor extent and involvement of surrounding areas. Prognosis depends on staging, with 5-year survival rates from 24-95% depending on stage.
- Metastatic neck disease is an important prognostic factor in head and neck cancer.
- Management of neck disease involves choices of treatment modality, timing, and combination of treatments which are controversial.
- Assessment of cervical lymphadenopathy involves clinical examination, fine needle aspiration cytology, imaging like ultrasound, CT, MRI, and PET.
- Treatment depends on neck stage - elective neck treatment for N0, neck dissection for N1, neck dissection with postoperative radiation for N2, and debate over treatment for massive N3 nodes.
This document discusses nasopharyngeal carcinoma (NPC), including its epidemiology, pathogenesis, clinical presentation, diagnosis, staging, treatment with radiotherapy and chemotherapy, and areas of ongoing research. NPC arises from the epithelial lining of the nasopharynx and is more common in certain racial groups. Diagnosis involves clinical examination, imaging such as CT/MRI, and biopsy. Treatment of locally advanced NPC involves concurrent chemoradiotherapy, with some studies exploring additional benefit from induction or adjuvant chemotherapy. Ongoing areas of research include optimizing staging criteria and determining which patients benefit most from additional chemotherapy.
This document provides an overview of nasopharyngeal carcinoma (NPC), including its epidemiology, etiology, histological classification, clinical features, diagnosis, staging, treatment and prognosis. NPC has a unique geographical and ethnic distribution. It is caused by an interaction between genetic factors, Epstein-Barr virus infection and environmental exposures. Diagnosis involves biopsy of suspicious nasopharyngeal lesions. The main treatment is radiotherapy, while chemotherapy may be added for advanced cases. Prognosis depends on stage, with 5-year survival rates ranging from 80-90% for early stage to 20-40% for stage IV disease.
This document discusses the management of nasopharyngeal carcinoma. It begins with a case presentation and outlines the standard of care for early, intermediate, and advanced disease stages. Radiation therapy is the primary treatment, and intensity-modulated radiation therapy provides better local control than 2D techniques. Concurrent chemotherapy with cisplatin improves outcomes for advanced stages. Adjuvant chemotherapy after radiation may provide additional benefits. Recurrent and metastatic disease can be challenging to treat and may involve re-irradiation, surgery, or palliative chemotherapy.
The document discusses the anatomy, histology, epidemiology, clinical features, diagnosis, staging, and treatment of nasopharyngeal carcinoma (NPC). Key points include:
- NPC originates from the epithelial lining of the nasopharynx.
- It has a strong association with Epstein-Barr virus.
- Risk factors include genetic predisposition and environmental exposures like salted fish consumption.
- Common symptoms are cervical lymphadenopathy, epistaxis, ear symptoms, and neurological deficits.
- Diagnosis involves biopsy and serological testing for EBV markers.
- Staging systems consider tumor size, node involvement, and serological factors.
- Primary treatment is radiotherapy,
This document provides an overview of nasopharyngeal carcinoma. It begins with an introduction defining nasopharyngeal carcinoma as a non-lymphomatous, squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx. It then covers the epidemiology, risk factors, clinical presentation, investigations including imaging and biopsy, histopathological classification, staging, and treatment options. The key points are that nasopharyngeal carcinoma most commonly presents with neck swelling, is strongly associated with Epstein-Barr virus, and is classified into three types by the WHO based on differentiation and presence of lymphoid stroma.
1. The document discusses changes to the TNM staging system for head and neck cancers, including nasopharynx, oropharynx, and oral cavity cancers.
2. Key changes include incorporating depth of invasion instead of tumor thickness for oral cavity cancers, and adding extra-nodal extension as a prognostic variable for nodal metastases.
3. For oropharynx cancers, HPV-positive and HPV-negative cancers now have different N category classifications, with HPV-positive cancers not including N3a/N3b categories.
This document discusses the lymph node levels of the neck and management of unknown primary cancers of the neck. It begins with an overview of neck anatomy and the different lymph node groups. It then covers the classification of lymph node levels, evaluation and diagnosis of unknown primary neck cancers, and treatment approaches based on nodal staging. Physical exam, biopsy, imaging, and endoscopy are used to diagnose while treatment involves neck dissection and/or radiation depending on nodal stage and characteristics.
This document discusses the management of neck metastasis. Some key points:
1. Neck metastasis, also called neck nodes, refers to cancer spreading from a primary site to lymph nodes in the neck. The presence, level, size and number of metastatic nodes are important prognostic factors.
2. Cancer cells can spread passively through lymph vessels from a primary tumor to regional lymph nodes. They then proliferate, remain dormant, or enter blood vessels to metastasize further.
3. Assessment of neck nodes involves medical history, physical exam, imaging like ultrasound, CT, MRI, and biopsy of suspicious nodes. Nodes are grouped by anatomical levels that correlate with primary drainage patterns.
4. Treatment depends
This document provides information about pharyngeal cancers, including nasopharyngeal carcinoma, oropharyngeal cancer, and hypopharyngeal carcinoma. It discusses the relevant anatomy, risk factors, signs and symptoms, diagnostic tests, staging, treatment options including radiation, chemotherapy, and surgery, as well as reconstruction techniques and prognosis. The surgical approaches covered include transoral, transcervical, mandibular swing, and others. Reconstruction options like skin grafts, flaps, and free tissue transfer are also summarized.
This document summarizes key information about nasopharyngeal carcinoma (NPC):
1. NPC is a type of head and neck cancer most common in Southeast Asia, especially southern China. Risk factors include genetic susceptibility and Epstein-Barr virus infection.
2. The document discusses NPC epidemiology, histology, clinical presentations, and differences between high- and low-incidence areas. Cranial nerve involvement and symptoms like neck lumps and nasal discharge are also covered.
3. The anatomy of the nasopharynx and surrounding structures important to NPC are described.
The para-pharyngeal space is an inverted pyramid-shaped area located between the muscles of mastication and muscles of deglutition. It has important structures passing through like the internal carotid artery and cranial nerves. Lesions in this space can be benign like pleomorphic adenomas or malignant like metastases. Imaging with CT or MRI is important for evaluating these lesions. The transcervical approach is most commonly used for surgery but transoral, transparotid, and infratemporal fossa approaches may also be used depending on the location and extent of the lesion. Complications can include nerve injuries, bleeding, and infection. New advances like transoral robotic surgery may help access some lesions with fewer complications.
A 60-year-old female presented with swelling in both sides of her neck for 30 days. Examination revealed enlarged lymph nodes. Biopsy of a nasopharyngeal mass showed features of undifferentiated nasopharyngeal carcinoma with sheets of tumor cells. Staging identified metastases to cervical lymph nodes. Nasopharyngeal carcinoma is most common in Southeast Asia and Africa, associated with genetic and environmental factors like Epstein-Barr virus. Prognosis depends on staging, with younger patients and non-keratinizing types having better responses to treatment combining radiation and chemotherapy.
Neck lumps are common and can arise from a variety of structures in the neck. Most neck lumps are benign, but those exhibiting symptoms of potential malignancy like enlarged lymph nodes require prompt investigation and treatment. A history and physical exam can often identify the cause of the lump based on location and characteristics. Common benign causes of neck lumps include salivary gland calculi, thyroglossal cysts, and branchial cysts. Malignant causes indicate the need for further testing such as biopsy.
The document discusses juvenile nasopharyngeal angiofibroma (JNA), a benign but locally invasive vascular tumor that primarily affects adolescent males. It arises near the sphenopalatine foramen and can spread medially into the nasopharynx and laterally into surrounding structures. Presentation varies from nasal obstruction to cranial nerve palsies. Imaging shows a hypervascular mass often with bone erosion. Diagnosis is confirmed histologically. Staging guides surgical approach, with endoscopic resection increasingly used for early-stage tumors. Complete resection while preserving function is the goal.
This document discusses the anatomy, staging, treatment and techniques for carcinoma of the nasopharynx. It describes the parapharyngeal space and lymphatic drainage of the nasopharynx. It discusses the AJCC staging system and Ho's staging system. It covers treatment techniques including two-field and three-field approaches, doses used, treatment volumes, nodal volumes, planning and field matching considerations.
This document provides information on juvenile nasopharyngeal angiofibroma (JNA), a rare benign tumor seen in adolescent males. It discusses the pathogenesis, clinical features, investigations, diagnosis, differential diagnosis, and various surgical treatment approaches for JNA. The document also covers nasopharyngeal carcinoma, including risk factors, histopathology, staging, diagnosis, and treatment involving radiotherapy, chemotherapy, and surgery. Overall, the document is a comprehensive overview of benign and malignant tumors that can arise in the nasopharynx.
Vocal cord nodules, polyps, and Reinke's edema are common laryngeal lesions caused by phonotrauma or repetitive vocal trauma. Vocal cord nodules appear as small, whitish lesions at the junction of the anterior and posterior vocal folds. Treatment involves speech therapy and possible microlaryngoscopy or laser excision. Vocal cord polyps are usually unilateral and pedunculated lesions located on the vocal folds. Treatment is surgical excision to confirm diagnosis and prevent recurrence. Reinke's edema causes diffuse swelling of the vocal folds and is associated with smoking. Treatment involves smoking cessation and possible surgery.
This document provides information on paediatric musculoskeletal infections, focusing on acute haematogenous osteomyelitis (AHO). It describes the typical presentation of AHO, including the most common causative organisms like Staphylococcus aureus. It outlines the diagnostic workup and emphasizes the importance of early diagnosis and treatment with intravenous antibiotics to prevent complications. Surgical debridement may be needed for abscesses. Chronic osteomyelitis can develop if not properly treated and presents additional challenges.
This document provides information about soft tissue tumors. It discusses the epidemiology, classification, etiology, diagnosis and treatment of both benign and malignant soft tissue tumors. Some key points include:
- Benign soft tissue tumors are more common than sarcomas. Common benign tumors include lipomas, schwannomas and giant cell tumors of the tendon sheath.
- Risk factors for soft tissue sarcoma include exposure to herbicides/pesticides, radiation exposure, genetic conditions and viral infections.
- MRI is usually the best imaging modality for evaluating soft tissue tumors. Biopsy is needed for diagnosis.
- Treatment depends on whether the tumor is benign or malignant. Benign tumors may
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document provides guidelines for evaluating neck masses. It discusses obtaining a thorough patient history, including details on mass growth, symptoms, medical history and social history. Physical examination involves carefully examining the mass characteristics and location. Important investigations include a complete blood count, inflammation markers, specific infection serologies depending on risk factors, and contrast CT scan of the neck, which is usually the initial preferred imaging study. Fine needle aspiration may be guided by ultrasound if indicated.
this presentation discusses how to approach to the neck mass
and important DDx according to the site and age of onset
with clinical points about important etiologies
1) Pleural effusion results from perturbations in normal pleural fluid transport and can be caused by abnormalities in Starling's equilibrium, increased capillary and mesothelial permeability, or interference with lymphatic drainage.
2) Evaluation of a patient with a suspected pleural effusion involves a thorough history, physical exam, imaging such as chest x-ray or CT, and thoracentesis to analyze pleural fluid.
3) Analysis of pleural fluid aims to determine if the effusion is a transudate or exudate, which provides clues to potential underlying causes and guides further diagnostic testing and treatment.
This document discusses retroperitoneal sarcomas (RPS), a rare group of tumors located in the retroperitoneum. The most common subtypes are liposarcoma, leiomyosarcoma, and undifferentiated sarcoma. Complete surgical resection is the main treatment, but recurrence rates are high, ranging from 20-55%. Preoperative radiation therapy may improve outcomes by allowing higher doses to be delivered safely. Prognosis is generally poor due to the anatomy making wide resection difficult and surrounding tissues having low radiation tolerance. Local recurrence is the most common pattern of treatment failure.
1. Juvenile nasopharyngeal angiofibroma is a rare, benign tumour that occurs primarily in adolescent males and is highly vascular.
2. It originates from the posterior nasal cavity near the sphenopalatine foramen and can extend into local structures like the sinuses, orbit and cranium.
3. Treatment involves preoperative embolization followed by surgical excision via various approaches depending on tumour extent. Endoscopic removal is used for smaller tumours while more extensive approaches are needed for larger or invasive tumours.
Digital Rectal Examination for Surgical Traineeshosam hamza
Digital Rectal Examination (DRE) is an important procedure in surgical practice used to examine the rectum and surrounding structures. It involves visual inspection of the external anal area and digital palpation of the internal rectum. The 12 key steps of a DRE are outlined, including introducing the procedure to the patient, inspecting externally, lubricating the finger, inserting the finger to palpate internal structures, and communicating findings to the patient. DRE allows examination of the prostate, cervix, and other pelvic structures to detect abnormalities like masses, hemorrhoids, or tenderness that can indicate various diseases.
The liver is commonly injured in abdominal trauma, with blunt injuries more frequent than penetrating injuries. Liver trauma can cause contusions, lacerations, or avulsions. Management involves addressing associated injuries, resuscitation, injury assessment with imaging, and treatment such as correcting coagulopathy, suturing lacerations, or resection for major vascular injuries. Complications include hematoma, abscess, bile collections, or fistulas.
This document outlines the principles and techniques of biopsy for oral and maxillofacial lesions. It discusses the importance of a systematic approach including health history, lesion history, clinical and radiographic exams, and laboratory tests. Different types of biopsies are described such as incisional, excisional, needle and their indications. Principles of biopsy surgery include anesthesia, hemostasis, specimen handling and closure. Characteristics suggesting malignancy and indications for biopsy are provided. Biopsy of hard and intraosseous tissues also discussed.
This document outlines the principles and techniques of biopsy for oral and maxillofacial lesions. It discusses the importance of a systematic approach including health history, lesion history, clinical and radiographic exams, and laboratory tests. Different types of biopsies are described such as incisional, excisional, needle, and intraosseous. Key principles of biopsy surgery are emphasized like anesthesia, hemostasis, specimen handling, and closure. The goal is to obtain an adequate tissue sample for accurate histopathologic evaluation while following principles of safe excisional surgery.
Bone tumors introduction and general principlesBarun Patel
This document discusses bone tumors. It covers the initial evaluation, presenting symptoms, history taking, physical examination, laboratory tests, investigations such as x-rays and scans, biopsy procedures and principles, classification, staging, principles of surgery including amputation vs limb salvage and achieving appropriate surgical margins, and treatment techniques such as curettage.
Dr. Brijesh Maheshwari presented on neuroblastoma. Key points:
1. Neuroblastoma originates from neural crest cells and most commonly affects children under 5, often presenting with abdominal pain or mass.
2. Staging systems include International Neuroblastoma Staging System (INSS) and International Neuroblastoma Risk Group (INRG) system. Over half of cases present with metastatic disease.
3. Prognostic factors include age at diagnosis, tumor biology like MYCN amplification, and response to initial treatment. A multidisciplinary approach is used including surgery, chemotherapy, radiation, stem cell transplant, and immunotherapy.
Management Of Malignant Salivary Gland Tumors Take note of the peculiarities
Management Of Malignant Salivary Gland Tumors Take note of the peculiarities
Appendicular Mucinous Neoplasms are rare pathologies of the appendix that can lead to rupture and the development of Pseudomyxoma Peritonei. In this lecture we present the difference between 4 cases of appendicular Mucinous Neoplasm in which the proper management and early surgical intervention prevented the development of Pseudomyxoma Peritonei
It is a complete presentation on carcinoma penis, covering all aspects starting from premalignant lesions to details of squamous cell carcinoma penis including recent NCCN guidelines and steps of penectomy and lymph node dissection
The parapharyngeal space lies laterally on either side of the pharynx and contains fat and connective tissue. It is divided into prestyloid and poststyloid compartments. Tumors in this space can be salivary gland tumors, usually pleomorphic adenomas arising from the deep lobe of the parotid gland in the prestyloid compartment. Neurogenic tumors like schwannomas and paragangliomas commonly involve the poststyloid compartment. Symptoms include a neck mass or bulging in the pharynx. Imaging helps characterize the tumor and surgical approaches aim to completely remove the tumor while preserving nearby structures.
The document summarizes updates to the 2020 WHO classification of soft tissue tumours. Key changes include more precise definitions of categories through integration of morphology, immunohistochemistry, and molecular genetics. Rare subtypes are challenging to diagnose due to low incidence. The classification aims to support more rational therapeutic approaches through involvement of sarcoma experts and definition of clinicopathological categories. Major changes were made to adipocyte, fibroblastic/myofibroblastic, vascular, pericytic, smooth muscle tumour classifications and new entities were introduced.
Acs0522 procedures for benign and malignant biliary tract disease-2005medbookonline
This document discusses procedures for benign and malignant biliary tract diseases. It provides guidance on preoperative evaluation and management of biliary obstruction. Specific considerations are given to infection, renal dysfunction, impaired immunity, malnutrition, and coagulation issues. The document outlines operative planning details such as patient positioning, exposure techniques, and guidelines for biliary anastomoses including suture placement and techniques for difficult access situations.
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to the skin. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and attached to form a mucosal lined tube to prevent regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach heals and functions return to normal.
This document describes the Billroth I gastric resection procedure, which involves removing part of the stomach and reattaching it to the duodenum. Key steps include transecting the stomach, attaching it to the duodenum using a circular stapler, and closing the gastrotomy site. The procedure aims to control peptic ulcers by combining hemigastrectomy with vagotomy while restoring normal gastrointestinal continuity. Postoperative care focuses on gradual advancement of oral intake and monitoring for complications.
This document describes the Billroth I procedure for gastroduodenostomy. It involves extensive mobilization of the stomach and duodenum to allow for an end-to-end anastomosis between the stomach and duodenum, restoring normal continuity of the gastrointestinal tract. The stomach is divided and sutured closed, then sutured to the duodenum in layers to create the gastroduodenal connection. Postoperative care focuses on gradual advancement of diet and monitoring for gastric retention to support healing and prevent complications.
Gastrostomy is commonly used as a temporary procedure to avoid discomfort from prolonged nasogastric suction after major abdominal surgery. It can also be used permanently when the esophagus is obstructed to nonresectable cancer. The Stamm gastrostomy is most common temporary procedure where a catheter is placed through the stomach wall and anchored to prevent leakage. The Janeway gastrostomy is a permanent alternative where a flap of stomach is brought through the abdominal wall and lined with mucosa to form a permanent opening, preventing regurgitation. Postoperative care involves gradual advancement to oral intake as the stomach and bowel recover function.
Gastrojejunostomy is a surgical procedure that connects the stomach directly to the jejunum. It is indicated for patients with duodenal ulcers complicated by pyloric obstruction or nonresectable stomach or pancreatic cancers causing obstruction. The procedure involves opening the stomach and jejunum, suturing them together to form a stoma, then closing in multiple layers. Postoperatively, gastric emptying is monitored and diet advanced gradually to ensure proper healing.
This document provides guidance on treating a perforated ulcer or subphrenic abscess. It describes:
1) Preparing patients preoperatively by administering IV fluids/antibiotics and gastric suction.
2) Closing perforations by suturing the ulcer and reinforcing it with omentum, or sealing it if too indurated.
3) Draining subphrenic abscesses extraperitoneally by making incisions below the costal margin or through the 12th rib bed and inserting drains into the abscess cavity.
A C S0103 Perioperative Considerations For Anesthesiamedbookonline
This document discusses perioperative considerations for anesthesia. It notes advancements in modern surgical care and alterations in anesthetic management to maximize patient benefit. A preoperative evaluation is important to assess medical history and current medications. Certain medications may need to be adjusted or discontinued before surgery, such as MAOIs, oral anticoagulants, and some herbal supplements, to reduce risks of adverse reactions or bleeding complications during the procedure. The risks and options for anesthesia should be discussed with the patient.
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
Postoperative pain is a complex experience involving sensory, emotional, and mental components. Effective pain management is important for patient comfort and recovery. Guidelines for postoperative pain treatment have been developed for specific procedures. Multimodal analgesic regimens targeting multiple pathways are recommended over reliance on opioids alone to prevent tolerance and hyperalgesia. Nonpharmacological complementary therapies can be combined with drug treatments to enhance pain control.
The document discusses the approach to a patient experiencing ongoing bleeding. It outlines the following key steps:
1. First consider the possibility of a technical cause like an unligated vessel and examine for injuries.
2. If no technical cause is found, check the patient's temperature and perform laboratory tests. Hypothermia can cause coagulopathy.
3. Evaluate test results along with the patient's history for clues to underlying causes like platelet dysfunction, coagulation factor deficiencies, or inherited bleeding disorders. Treat the specific condition while continuing evaluation.
A C S0812 Brain Failure And Brain Deathmedbookonline
This document discusses brain failure and brain death. It defines different levels of impaired consciousness from cloudy consciousness to coma. It describes how brain failure results from cardiac arrest and the challenges of restarting the brain after lack of oxygen. It outlines the criteria for diagnosing brain death, including absence of brain stem reflexes and apnea testing. It also discusses the evolution of determining death as technology has allowed life support to prolong vital signs indefinitely.
This document summarizes key points about surgical treatment of early rectal cancer and care of elderly surgical patients. It discusses that radical resection for early rectal cancer achieves excellent local control but has risks, while local excision may be preferable but has a higher local recurrence rate. Adjuvant therapy after local excision may help address this. It also notes that the elderly population is growing and physiologic changes with aging, like cardiac function decline, must be considered in surgical planning and risk assessment for elderly patients. Functional status is more important than age alone.
This document provides information on parotidectomy surgery and the Fundamentals of Laparoscopic Surgery (FLS) program.
It describes the technique for parotidectomy surgery, including identifying and dissecting around the facial nerve. It notes that most parotid tumors are benign and complications are usually temporary facial nerve paralysis.
It then discusses the development of the FLS program to standardize laparoscopic surgery training. The program includes cognitive training and manual skills assessment. Many residency programs and hospitals now require surgeons to complete the FLS. A large grant will help make the program more accessible to residency programs.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
1. The document discusses various sources of data for benchmarking surgical outcomes, including public reporting programs, public use administrative databases, and clinical registries. It notes limitations of using administrative data including problems with accuracy, completeness, and clinical precision of coding.
2. Clinical registries like the National Surgical Quality Improvement Program (NSQIP) and the Society of Thoracic Surgeons database are described as better sources of benchmarking data as they provide risk-adjusted outcomes while protecting individual hospital and surgeon confidentiality.
3. Limitations of all surgical benchmarking sources include small sample sizes, lack of generalizability between databases, and lack of external auditing to ensure accuracy and completeness of submitted data.
This document discusses organ procurement from cadaveric donors. It describes the coordination between donor and recipient activities, including matching organs to recipients based on factors like blood type, medical urgency, and waiting time. The evaluation of donor organs is outlined for different organs. Careful donor management aims to optimize organs while respecting donor dignity.
Hand-assisted laparoscopic surgery (HALS) is a hybrid technique that provides many of the advantages of traditional open surgery and laparoscopic colectomy. HALS employs a special access device that allows the surgeon to place a hand in the abdomen to assist with retraction, dissection, and visualization while maintaining pneumoperitoneum and laparoscopic instrumentation through trocars. Studies have shown HALS results in shorter operative times and lower conversion rates to open surgery compared to traditional laparoscopic colectomy while preserving similar short-term clinical outcomes. HALS may help expand the use of minimally invasive approaches for complex colectomies by providing an easier transition from open surgery than traditional laparoscopic techniques.
The document summarizes the evolution of trauma surgery training and practice in the United States. It discusses how trauma surgery originated in large city hospitals but has since expanded to regional trauma centers. It also notes changes in surgical training away from generalist models towards increased specialization. Trauma surgery is increasingly encompassing broader emergency general surgery duties due to workforce shortages, while training programs emphasize specialized rather than broad skills.