The document discusses the anatomy of the neck and classification of neck masses. It provides details on branchial cysts and thyroglossal duct cysts, including their pathophysiology, clinical features, investigations and treatment. It also discusses papillary thyroid carcinoma and goiter as common causes of neck masses. Papillary carcinoma is the most common type of well-differentiated thyroid cancer. Physical exam may reveal a solitary, hard nodule in the thyroid area. Investigations include thyroid function tests, ultrasound and fine needle aspiration biopsy.
A Practical Approach to differential diagnosis.
This presentation offers a practical approach in differential diagnosis in head and neck masses in children and it is based on the article by Dr. Bernadette L. Koch published on Statdx.com .
Neck Masses need to be divided in Cystic and Solid and according the location.
thyroidectomy-surgical seminare, prepared by Dr. Siddharth JINDAL, third year resident in dept. of general surgery at P.D.U. Government Medical College and Civil Hospital, Rajkot, Gujarat.
A Practical Approach to differential diagnosis.
This presentation offers a practical approach in differential diagnosis in head and neck masses in children and it is based on the article by Dr. Bernadette L. Koch published on Statdx.com .
Neck Masses need to be divided in Cystic and Solid and according the location.
thyroidectomy-surgical seminare, prepared by Dr. Siddharth JINDAL, third year resident in dept. of general surgery at P.D.U. Government Medical College and Civil Hospital, Rajkot, Gujarat.
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
Thyroid swelling and management. In detail case discussion of thyroid swelling and its management. Details of examination as well included in the slide.
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 17 years old male, presented with a painful neck swelling, The swelling was first noticed 10 years ago and was small and painless then. In the last two months, the swelling increased in size and became painful and started to cause slight discomfort on swallowing.
The presentation contains 50 slides, and is divided into the following parts :
1 - The case
2 - Thyroglossal cysts
3 - Imaging Thyroglossal cysts
4 - Differential diagnoses
This presentation was prepared by me and I will present it today in sha Allah in the tutorials of the Radiology Department of Sebha Medical Center.
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
Thyroid swelling and management. In detail case discussion of thyroid swelling and its management. Details of examination as well included in the slide.
A presentation about an interesting case that came to the Radiology Department of Sebha Medical Center.
A 17 years old male, presented with a painful neck swelling, The swelling was first noticed 10 years ago and was small and painless then. In the last two months, the swelling increased in size and became painful and started to cause slight discomfort on swallowing.
The presentation contains 50 slides, and is divided into the following parts :
1 - The case
2 - Thyroglossal cysts
3 - Imaging Thyroglossal cysts
4 - Differential diagnoses
This presentation was prepared by me and I will present it today in sha Allah in the tutorials of the Radiology Department of Sebha Medical Center.
Neck Masses in children by doctor okto. Describing various neck masses and differential diagnoses in children. This helps in proper diagnosis and management especially for ENT surgeons. Download and learn.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
2. OUTLINE
• ANATOMY OF THE NECK
• CLASSIFICATION OF NECK MASS
• MAIN CAUSES OF NECK MASS
3. ANATOMY OF NECK
Neck is part of the bpdy between occipital and clavicle.
Neck have more than 200 lymph node
4. Surface Anatomy
The prominent landmarks
of the neck are:
• Hyoid bone
• Thyroid cartilage
• Cricoid cartilage
• Trachea
• Sternocleidomastoid
muscles
5. What forms the neck?
● Skin
● Fascia of the neck
- Superficial cervical fascia
- Subcutaneous fat
- Platysma muscle
- Superficial lymph node
- Deep cervical fascia
- Investing layer
- Pretracheal layer
- Prevertebral layer
● Muscles
● Bone-cervical
vertebral
● Viscera of the neck
● Neurovascular
bundles
● Lymphatic system
11. What is in your neck?
Major
triangles
Sub-divisions Content
Anterior Submental Submental LN
Submandibular Submandibular gland and LN,
hypoglossal n, mylohyoid n., parts of
facial artery and vein
Carotid Carotid sinus and body, carotid
sheath (IJV, CCA, vagus n.), ECA,
hypoglossal n, ansa cervicalis
(superior root), spinal accessory n.,
deep cervical LN, branches of cervical
plexus, thyroid gland, larynx, pharynx
Muscular Infrahyoid muscles, thyroid and
parathyroid glands
12. Major
triangles
Sub-divisions Content
Posterior Occipital Transverse cervical artery, EJV,
spinal accessory nerve, post
branches of cervical nerve plexus,
of brachial plexus, cervical LN
Supraclavicular Subclavian artery (3rd part),
subclavian vein, suprascapular
artery, supraclavicular LN
13. • NECK MASS = Defined as any abnormal
enlargement, swelling or growth from the
level of base of skull to clavicles
• Clinically neck masses can be divided into
– Midline
– Lateral (grouped according to triangles of the
neck)
20. BRANCHIAL CYST
• Branchial cleft cysts are congenital epithelial
cysts, which arise on the lateral part of the
neck from a failure of obliteration of the
second branchial cleft in embryonic
development.
• Common in the 2nd decade of life but can
occur at any age with equal frequency in both
sexes.
21.
22. Pathophysiology
• At the 4th week of embryonic life, the development of
4 branchial (or pharyngeal) clefts results in 5 ridges
known as the branchial (or pharyngeal) arches, which
contribute to the formation of various structures of the
head, the neck, and the thorax.
• The second arch grows caudally and, ultimately, covers
the third and fourth arches. The buried clefts become
ectoderm-lined cavities, which normally involute
around week 7 of development.
• If a portion of the cleft fails to involute completely, the
entrapped remnant forms an epithelium-lined cyst
with or without a sinus tract to the overlying skin.
23.
24. Clinical features
• Swelling – upper part of neck, anterior to SCM
• Mass – smooth, round, fluctuant, non-tender, non-
transilluminant
• May be painful and increase in size at the time of URTI
• Anomalies of the 2nd branchial arch are the most common
• May be associated with a sinus or fistula
– External opening at the junction of lower and middle of the
anterior border of sternocleidomastoid, may exude mucoid
discharge
– Internal opening in the tonsillar fossa
– If both external and internal opening present = branchial fistula
25. Investigations
Imaging
• Sonogram
– If a sinus tract exists, radiopaque dye can be injected to delineate the course and to examine
the size of the cyst.
• Ultrasonography
– Delineate the cystic nature of these lesions.
• Contrast-enhanced CT scan
– shows a cystic and enhancing mass in the neck. It may aid preoperative planning and identify
compromise of local structures.
• MRI
– allows for finer resolution during preoperative planning. The wall may be enhancing on
gadolinium scans.
Histopathological
• Fine-needle aspiration
– May be helpful to distinguish branchial cleft cysts from malignant neck masses.
– Fine-needle aspiration and culture may help guide antibiotic therapy for infected cysts.
26. Second branchial cleft cyst. Contrast-
enhanced axial computed tomography scan
at the level of the hyoid bone reveals a large,
well-defined, non-enhancing, water
attenuation mass (m) on the anterior border
of the left sternocleidomastoid muscle(s).
First branchial cleft cyst, type II. Contrast-
enhanced axial computed tomography scan
at the level of the hyoid bone reveals an ill-
defined, non-enhancing, water attenuation
mass (m) posterior to the right
submandibular gland (g).
27. Treatment
Medical
• Antibiotics are required to treat infections or abscesses related to
branchial cleft cysts.
Surgical
• Surgical excision is definitive treatment for branchial cyst.
• A series of horizontal incisions, known as a stairstep or stepladder incision,
is made to fully dissect out the occasionally tortuous path of the branchial
cleft cysts.
• Branchial cleft cyst surgery is best delayed until the patient is at least age 3
months.
• Definitive branchial cleft cyst surgery should not be attempted during an
episode of acute infection or if an abscess is present.
• Surgical incision and drainage of abscesses is indicated if present, usually
along with concurrent antimicrobial therapy.
28. THYROGLOSSAL DUCT CYST
• Thyroglossal duct cysts are the most common
form of congenital neck cyst.
• The cyst is an epithelial remnant of the
thyroglossal tract, and as such is composed of
thick mucous material lined with secreting
columnar or squamous epithelium. A thick
fibrous capsule surrounds the cyst.
• TDC is found in between hyoid bone and the
thyroid cartilage in about 60% of the patients, it is
suprahyoid, supra-sternal and intra-lingual in
about 24%, 13% and 2% respectively.
Moorthy, S. N., & Arcot, R. (2010). Thyroglossal Duct Cyst—More Than Just an Embryological Remnant. Indian Journal of Surgery Indian J Surg, 73(1), 28-31.
29. Pathophysiology
• Thyroglossal duct cysts may arise during the 5th week of embryonic life after the
descent of the thyroid gland from the base of the tongue to its position in the
neck.
• The failure of the tract to involute by the 7th week results in the presence of a
sinus tract and cyst(s) in the midline of the neck.
• If the lower part of the duct alone persists, it prevails as the pyramidal lobe of the
thyroid.
• The foramen cecum, which typifies the ductal opening into the tongue, remains a
small blind pit in the mid line between the anterior two thirds and the posterior
one third of the tongue.
• The cyst can occur anywhere along the thyroglossal duct tract from the foramen
cecum at the base of the tongue to the level of the suprasternal notch.
• The cysts are most commonly located inferiorly to the hyoid bone within 2 cm of
the midline with a close relationship to the hyoid, thyrohyoid membrane, or
thyroid cartilage.
Karmakar S, Saha AM, Mukherjee D; Thyroglossal cyst: an unusual presentation. Indian J Otolaryngol Head Neck Surg. 2013 Jul;65(Suppl 1):185-7. doi: 10.1007/s12070-011-0458-5. Epub 2012 Jan
6.
30.
31. Clinical features
• Cystic midline swelling, usually affecting young children but
can occur at any age.
• Usually rounded with a diameter of 2-4 cm.
• May transilluminate – contains mucoid fluid or blood
• Increases in size with URTI.
• Sometimes it presents as a draining sinus if it has burst due
to infection or has been surgically drained.
• Moves with tongue protrusion - it is attached to the
thyroglossal tract which attaches to the larynx by the
peritracheal fascia.
• (Rare) Can cause swallowing or breathing difficulty in
neonates if it is located at the base of the tongue.
32. Investigations
Imaging
• Ultrasound
– unilocular lesions with thin walls and posterior acoustic enhancement.
• CT scan
– The most helpful features in the differential diagnosis are the midline
location, most often at or below the hyoid bone, and the intimate
relationship of infrahyoid TDCs to the strap muscles.
– Can show capsular enhancement.
– CT better evaluates the potential for thyroglossal duct carcinoma and
is thus preferred in adult patients.
• MRI
– provides a high degree of diagnostic accuracy for TDC but it is rarely
required for the diagnosis.
– Although TDCs are invariably hyperintense on T2-weighted images, T1-
weighted signal intensity is variable.
34. Investigations (cont)
• Thyroid function test
– However, ectopic thyroid gland cannot be ruled out even
in the presence of normal TSH levels and a clinically
euthyroid history.
• Thyroid scanning
– To demonstrate any functioning ectopic thyroid.
– Ectopic thyroid tissue may accompany TGCs in their
location along the line of embryological thyroid descent.
– This can also be used to demonstrate normal thyroid
position and function before removal of any thyroid tissue
which may accompany the cyst.
35. Treatment
Complete surgical excision
• Including with it the
body of hyoid bone and
core of tongue tissue
around the tract in the
suprahyoid tongue base
to the foramen caecum
(Sistrunk’s operation).
• Simple excision of cyst
without removal of its
tract leads to recurrence.
42. • Clinal approach once it is established that the neck
swelling is indeed a thyroid swelling :
1) Diffuse enlargement :
(a) Toxic ( Grave's disease)
(b) Non toxic
- other thyroiditis
( exp : Hashimoto thyroiditis , de Quervain's
thyroiditis)
- simple colloid goitre
45. Papillary Thyroid Carcinoma ( PTC )
• Papillary carcinoma (PTC) is the most common form of
well-differentiated thyroid cancer, 75% to 85% and the
most common form of thyroid cancer to result from
exposure to radiation.
• 20-40 years of age
• Aetiology :
1) Genetic factor : mutation in RET or NTRK1 / RAS , BRAF
oncogene,
2) Exposure to ionizing radiation, particularly during 1st two
decades of life, especially head & neck region
47. Histological findings :
• •Branching papillae (fibrovascular stalk covered by
single to multiple layers of cuboidal epithelial cells)
• •Diagnostic nuclear features → clear or empty
(ground glass or Orphan Annie eye nuclei) or
intranuclear inclusion or intranuclear grooves
• •Psammoma bodies – concentrically lamellated
calcified structures within the cores of papillae
• •Foci lymphatic invasion
48.
49.
50. History
• The most common presentation of thyroid cancer is an
asymptomatic thyroid mass or a nodule that can be felt in the
neck. For any patient with a thyroid lump that has developed
recently, record a thorough medical history to identify any risk
factors or symptoms. In particular, obtain a history regarding
every prior exposure to ionizing radiation and the lifetime
duration of the radiation exposure. Consider a family history of
thyroid cancer.
• Some patients with thyroid cancer have persistent cough,
difficulty breathing, or difficulty swallowing. Pain is seldom an
early warning sign of thyroid cancer. Other symptoms (eg, pain,
stridor, vocal cord paralysis, hemoptysis, rapid enlargement) are
rare, and can be caused by less serious problems.
51. Physical Examination
The clinician should palpate the patient's neck to evaluate
the size and firmness of the thyroid and to check for any
thyroid nodules. The principal sign of thyroid carcinoma is
a palpable nodule, usually solitary, in the thyroid area that
has the following characteristics:
• Painless
• Hard consistency
• Average size of less than 5 cm
• Ill-defined borders
• Fixed in respect to surrounding tissues
• Moves with the trachea at swallowing
52. Investigations
• Thyroid function studies
• TSH suppression test
• Thyroid ultrasound
• Fine-needle aspiration biopsy (FNAB)
• FNAB is considered the best first-line
diagnostic procedure for a thyroid nodule.
53. Management
• Surgery is the definitive management of papillary
thyroid cancer. Approximately 4-6 weeks after surgical
thyroid removal, patients may have radioiodine
therapy to detect and destroy any metastasis and
residual tissue in the thyroid.
• External beam radiotherapy has been used as
adjuvant therapy in patients with papillary thyroid
cancer who were older than 45 years and had locally
invasive disease. Some improvements in 10-year
survival rates have been reported with this approach.
54. • Patients require lifelong thyroid hormone replacement
therapy, especially after total thyroidectomy. Treatment
consists of levothyroxine in a dosage of 2.5-3.5
mcg/kg/d.
http://emedicine.medscape.com/article/282276-overview
http://emedicine.medscape.com/article/2007769-overview
55. Goitre
• A goiter is an enlarged thyroid gland.
• Classification :
a) Simple goitre : - Diffuse hyperplastic
- Multinodular goitre
b) Toxic goitre : - Diffuse ( Graves disease )
- Multinodular
- Toxic adenoma
56. History and Physical examination
A goiter may present in various ways, including the following:
• Incidentally, as a swelling in the neck discovered by the patient or on routine physical
examination
• A finding on imaging studies performed for a related or unrelated medical evaluation
• Local compression causing dysphagia, dyspnea, stridor, plethora or hoarseness
• Pain due to hemorrhage, inflammation, necrosis, or malignant transformation
• Signs and symptoms of hyperthyroidism or hypothyroidism
• Thyroid cancer with or without metastases & proceeds to neck examination.
64. Carotid body tumour
• Arises from the chemoreceptor cells in the
carotid body a.k.a chemodectoma
• Mostly present after 40 y.o, very slow growing
tumour
• About 5% of carotid body tumors are
bilateral and 5-10% are malignant
65. Presentation
• Painless, pulsatile mass in the anterior triangle of
the neck
• Bruit can be heard
• Moves from side to side but not vertically
(attachement to bifurcation of carotid artery )
• May extend into parapharyngeal space and
present in oropharynx
• As the tumor enlarges and compresses the
carotid artery and the surrounding nerves - pain,
tongue paresis, hoarseness, Horner syndrome,
and dysphagia.
66. Investigation
• Simple ultrasonography with color Doppler
– assess the vascularity of the neck mass
• Contrast-enhanced CT & MRI with
gadolinium
– Diagnostic & show extent of the tumor
• MRI angiography : splaying of internal &
external carotid arteries— Lyre’s sign
• FNAC should not be done d/t vascularity of
the tumor
67.
68. Treatment
• Surgical remoral ( <50y/o or tumour extend to
oropharynx causing difficult in speech,
swallow/breathing)
• Radiotherapy (older pt, those unfit/refuse
surgery/metastatic diseases)
73. Lymph Nodes Level of Neck
Level Division
I Submental (1a)
Submandibular (1b)
II Upper Jugular
III Mid Jugular
IV Lower jugular
V Posterior triangle group:
Spinal accessory (Va)
Transverse cervical chain (Vb)
VI Prelaryngeal
Pretracheal
Paratracheal
VII Nodes of upper mediastinum
75. Examination of nodes
• For head and neck malignancies
• Systematic approach
• Better palpated while standing at the back of
patient
• Neck slightly flexed
77. Lymphadenopathy
Neoplasm – Lymphoma
• 1° malignant tumour of lymphatic tissues
• Both Hodgkin’s & non- Hodgkin’s lymphoma
• present with cervical lymphadenopathy
– Can occur at any age
– Presents with painless, rubbery lymphadenopathy often in the
posterior triangle, & sometimes nodes in the axillae & inguinal
areas.
– Systemic symptoms such as fever, night sweats, fatigue, and
weight loss may occur, and hepatosplenomegaly is an associated
finding
• Excision biopsy is often required to confirm dx
Tx : chemo- &/or radiotherapy
78. Secondary metastasis
• Lymph node metastases usually present as a unilateral
progressive swelling of single or multiple nodes.
• Any lymph nodes group can be involved depending on the site of
1° site of primary malignancy:
1. Upper cervical LN :
o Commonly involved in malignancies of upper
aerodigestive tract
2. Accessory chain of nodes in posterior triangle :
o Nasopharyngeal malignancies
3. Nodes in supraclavicular area :
o Possibility of an infraclavicular 1° in lung, breast,
stomach, colon, kidney, ovary & testis
• Principle of management
• Identify primary lesion
• Treat with combination of surgical excision, chemotherapy
and radiotherapy
• Palliative care for terminal cases
80. 80
Lymphadenitis
• Very common, especially during 1st decade
• Marked tenderness, torticollis, trismus, and
dysphagia
• Systemic signs of infection
• Initial treatment - directed antibiotics
• Close follow up
81. 81
Lymphadenopathy
• Failure of antibiotics necessitates biopsy after
complete head and neck work-up
• FNAC indications
– Progressively enlarging nodes
– Solitary, asymmetric nodal mass
– Supraclavicular mass
– Persistent nodes without infectious signs
82. 82
Granulomatous Lymphadenitis
• Develop over weeks and months
• Minimal systemic complaints or findings
• Firm glands, fixation and injection of skin
• Common etiologies
– Typical Mycobacterium tuberculosis (adults)
– Atypical Mycobacterium tuberculosis (children)
– Cat-scratch fever (Bartonella henselae)
(children)
– Actinomycosis, Sarcoidosis
83. 83
Granulomatous Lymphadenitis
• Atypical TB
– Anterior triangle lymph nodes
– Induration and pain
– Usually responds to complete surgical excision
• Typical TB (rarely seen, posterior nodes)
84. Patients with a clinical history of any of the following may be at risk for developing
lymphadenitis:
• Symptoms of an upper respiratory tract infection, sore throat,
earache, coryza, conjunctivitis, or impetigo
• Fever, irritability, or anorexia
• Contact with animals, especially kittens or livestock
• Recent dental care or poor dental health
• Physical examination findings suggestive of infection are as follows:
• Soft
• Fluctuant
• Tender
• Overlying erythema
86. Investigation
Laboratory studies are as follows :
• Gram stain of aspirated tissue - To evaluate bacterial etiologies
• Culture of aspirated tissue or biopsy specimen - To determine the causative
organism and its sensitivity to antibiotics
• Monospot or Epstein-Barr virus (EBV) serologies - To confirm the diagnosis
of infectious mononucleosis
• Bhenselae serologies - To confirm the diagnosis of catscratch disease (if
exposed to cats)
• Skin testing or purified protein derivative (PPD) - To confirm the diagnosis
of tuberculous lymphadenopathy; alternative is interferon-gamma release
assays (IGRA)
• CBC count - Elevated WBC count may indicate an infectious etiology
• Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) - Elevated
ESR and CRP are nonspecific indicators of inflammation
• Liver function tests - May indicate hepatic or systemic involvement; elevated
transaminase levels can be seen in infectious mononucleosis
Imaging Studies
• Ultrasonography may be useful for verifying lymph node involvement and
taking accurate measurements of enlarged nodes.
Treatment
Treatment depends on the causative agent and may include expectant
management, antimicrobial therapy, or chemotherapy and radiation (for
malignancy).
Superficial cervical fascia covered the platysma muscle
important in the body's acute adaptation to fluctuating concentrations of oxygen, carbon dioxide, and pH. The carotid body protects the organs from hypoxic damage by releasing neurotransmitters that increase the ventilatory rate when stimulated.