OTORHINOLARYNGOLOGY I
HEAD AND NECK 1
Dr. Daniel Jose Mendoza
TOPIC OUTLINE
PART 1: TUMORS IN THE NOSE,
NASAL CAVITY AND THE
NASOPHARYNX
I. Tumors
A. Benign vs. Malignant
II. Anatomy of the Neck
III. Relative Probabilities of Neck
Mass Etiologies
IV. Levels of the Neck
V. Head: Nose, Nasal Cavity
and Nasopharynx
A. Encephalocele
B. Glioma
C. Dermoids
D. Rhinophyma
E. Sinonasal/Inverted
Papilloma
F. Osteoma
G. Juvenile Nasopharyngeal
Angiofibroma (JNA)
PART 2: TUMORS IN THE ORAL
CAVITY AND OROPHARYNX,
CHEEK/PAROTID LINE, AND
MAXILLA AND MANDIBLE
I. Head: Oral Cavity and
Oropharynx
A. Torus
B. Lingual
C. Developmental Cysts
1. Dermoid Cyst
2. Duplication Cyst
3. Nasoalveolar Cyst
D. Inflammatory/Trauma
E. Mucocele
1. Ranula
II. Head: Cheek/Parotid Line
A. Salivary Gland Tumors
1. Pleomorphic Adenoma
2. Warthin Tumor
III. Head: Maxilla and Mandible
A. Radicular Cyst
B. Dentigerous Cyst
C. Ameloblastoma
1. Treatment
📢 - Lecturer’s notes/Audio Inputs
📖 - From Book (cite sources)
📝 - From Old Transes
🚩 - Important
You can put short notes here. (e.g., trans being lifted from elsewhere,
info is added from a certain reference, trans flow is different from lecture flow, etc.)
Group 6B
EVALS 18
TRANS 07
PART 1: TUMORS
I. TUMOR
PART 3: TUMORS IN THE NECK ● Abnormal mass of tissue (MedicineNet)
REGION
● An abnormal benign or malignant new growth of tissue that
I. Neck
possesses no physiological function and arises from
II. Central Neck
uncontrolled usually rapid cellular proliferation called
A. Thyroglossal Duct Cyst
NEOPLASM
B. Laryngocele
C. Plunging Ranula
● 📢
For this module, the focus is on benign tumors.of the head
and neck
D. Sialolithiasis
A. BENIGN VS. MALIGNANT
E. Cervical Trauma
Table 1. Benign vs. Malignant
III. Lateral Neck
Benign Malignant
A. Branchial Cleft Apparatus
B. Branchial Cleft Anomalies Slow growth (months to years) Rapid growth (weeks to months)
C. Paraganglioma Painless* May be painful in later stage
D. Fibromatosis Colli Soft movable Infiltrating, fixed
IV. Posterior Triangle Nerve involvement
A. Lymphangioma
Localized Lymph node involvement
PART 4: TUMORS IN THE THYROID
Metastasizes
AND ANYWHERE IN THE HEAD ● BENIGN TUMORS are usually:
AND NECK → Slow growing
I. Thyroid Region → Soft
A. Thyroid Adenoma → Movable
B. Thyroid Cyst → Localize masses
C. Other Conditions Related to → 📢
Pain is usually absent but presence of it does not always
Thyroid Gland mean malignancy.
D. Diagnosis of Thyroid ● MALIGNANT TUMOR on the other hand is usually
Nodules → Rapidly growing
E. Complications of → 📢
Can be tender especially in later stages of condition
Thyroidectomy → 📢
Can be infiltrating, fixed with structural involvement like
II. Anywhere in the Head and nerves, lymph node, and distant organs of the body known
Neck as METASTASIS.
A. Vascular Tumor II. ANATOMY OF THE NECK
1. Infantile Hemangioma
2. PHACE Syndrome
3. Congenital Hemangioma
4. Presentation: V3 /
“Beard” Distribution
5. Imaging Studies
6. Indications for Treatment
B. Vascular Malformation
1. Arteriovenous
Malformation
2. Neurilemoma
3. Lipoma
4. Sebaceous Cyst
Figure 1. Anatomical Landmarks of the Neck
LEGEND
● 📢 As a short review, the neck is bounded by the mandible
IMPORTANT TERMINOLOGIES
📌
Disclaimers/Transer’s notes superiorly and is divided by the sternocleidomastoid into two
💡
- Undiscussed Sections
- Nice to Know
triangles. Other structures seen are the anterior and posterior
bellies of the digastric, omohyoid and the trapezius muscle.
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OTORHINOLARYNGOLOGY I Head and Neck 1

→ (3) Nasopharynx
→ (4) Nasopharynx, oral cavity, pharynx or larynx
→ (5) Thyroid & Nasopharynx
→ (6) Nasopharynx, oral cavity, pharynx, thyroid
→ (7) Thyroid, pyriform sinus of upper esophagus, primary
below clavicle.
● We should also be familiar with the levels of the neck in order to
better describe the location of the mass as well as the lymphatic
involvement or spread especially in malignant tumors. The neck
is composed of six levels as seen in the picture . Please read on
this concept as an introduction to malignant neoplasm of the
Figure 2. Surface Anatomy head and neck. We will be discussing some common and rare
● 📢 The two triangles of the neck are known as the ANTERIOR benign head and neck masses in succeeding slides and will be
and POSTERIOR TRIANGLES which are divided again by the divided based on its location
SCM muscle. V. HEAD: NOSE, NASAL CAVITY AND NASOPHARYNX
→ Anterior triangle is subdivided into the: ● 📢 Congenital malformation of the nose and paranasal sinuses
▪ Submental are rare manifestations of disorder development ranging from
▪ Submandibular subtle cosmetic deformities to feeding difficulties and even life
▪ Carotid threatening acute upper airway obstruction in neonates.
▪ Muscular ● 📢Congenital lesions of the nose and paranasal sinuses result
→ Posterior triangle is divided into: from developmental errors in specific anatomic zones. These
▪ Occipital conditions frequently manifest as midline nasal-masses and
▪ Supraclavicular these can be encephaloceles, gliomas, and dermoids, which
📢 III. RELATIVE PROBABILITIES OF NECK MASS share a common embryologic origin.
ETIOLOGIES A. ENCEPHALOCOELE

Figure 3. Relative probabilities of neck mass etiologies Figure 5. Encephalocoele

● Masses in general are classified into: ● Extracranial herniation of cranial contents through a defect in
→ Inflammatory the skull.
→ Congenital 📢
→ MENINGOCELE
→ Malignant neoplasms ▪ When encephalocele includes meninges only
● Head and neck masses have different propensity depending on 📢
→ MENINGOENCEPHALOCELE
the age as shown in the table. ▪ When both brain and meninges are included
● Most neck masses in the pediatric age group are ● Manifests as intranasal masses and may not present until later
inflammatory as compared to adults which is neoplasm as in childhood when nasal obstruction and drainage ensues
the most common cause of neck masses. ● This appears as pulsatile bluish compressible lesions that
→ Pediatric age group = Inflammatory transilluminate
→ Adult age group = Neoplasm ● POSITIVE FURSTENBERG TEST
📢 IV. LEVELS OF THE NECK → 📢Classically, these lesions expand with crying, straining, or
compression of the jugular veins
B. GLIOMA

Figure 4. Lymph nodes (L) , Levels of the Neck (R)

● Lymph Nodes:
→ (1) Cancer of the Larynx, anterior floor of mouth, lip, anterior
2/3 of tongue, gums, and mucosa of cheek Figure 6. Glioma

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OTORHINOLARYNGOLOGY I Head and Neck 1
● Consist of heterotopic glial tissue that lacks a patent CSF
communication to the subarachnoid space
● Rare benign masses more common in males than females
● These are smooth, firm, noncompressible masses that occur
mostly at the glabella
● Pale polypoid masses that may protrude from the nostril
📢
→ The nasal fossa on the involved side may be obstructed
→ 📢 Intranasal gliomas most often arise from the lateral nasal
wall near the middle turbinate and occasionally from the
nasal septum
● Because they lack a patent CSF connection, they do not
change in size with crying or straining and do not
transilluminate
C. DERMOIDS
Figure 7. Dermoids
● A nasal dermoid usually manifest as a midline pit or mass
● 📢 In approximately 50% of cases, a DIMPLE is present at or
near the rhinion along with a widened nasal bridge.
→ 📢 However, the true spectrum of disease includes cysts,
sinuses, or fistulas that may occur anywhere along the
embryologic line from the nasal tip until the cranial space.
● 📢 Mass lesions are firm, lobulated, and non compressible, and
this may be associated with the sinus opening with
intermittent caseous discharge or infection.
● 📢 A PROTRUDING HAIR is a pathognomonic sign for a
nasal dermoid.
→ 📢 Although it is seen in only a minority of patients, a lesion
within the nasal septum may present as nasal obstruction.
● Contain ectodermal elements
● Can also be intracranial, intra/perispinal, ovary, omentum
● Do not enlarge with crying or straining and do not
transilluminate
DIFFERENTIATING THE THREE TUMORS
Figure 8. Image on the right shows that CNS communication is present in
encephalocoele while not seen in gliomas and dermoids
Group 6B
● 📢 TRANSILLUMINATION and NASAL ENDOSCOPY if
warranted should be done as an additional assessment for
nasal tumors
● 📢 HIGH RESOLUTION CT SCAN or MRI is needed to
determine the midline mass if with intracranial extension.
Figure 9. 📢 Summarizes the differences between encephaloceles,
gliomas and dermoid masses according to CNS communication,
transillumination, positive Furstenberg's Test, meningitis, histology, and
its management
D. RHINOPHYMA
Figure 10. Rhinophyma
● 📢Another condition that may present as nasal mass
● Development of large, bulbous bone nose due to hypertrophy
of sebaceous glands and untreated rosacea
● DERMABRASION or SECONDARY HEALING is the treatment
of option
E. SINONASAL/INVERTED PAPILLOMA
● 📢Second most frequent benign tumor of the sinonasal tract
● This lesion is estimated to represent 0.4-4.7% of all surgically
removed nasal tumors
● 📢 It predominantly arises from the lateral nasal wall and
maxillary sinus
● 📢 The MAXILLARY MEDIAL WALL in particular is the region
of the fontanels and is the most common site of origin
● 📢 Bilateral papillomas of any type are exceptional
● Locally aggressive
● With risk of malignant transformation is observed in 5-15% and
this present as:
→ Unilateral nasal obstruction with watery rhinorrhea
→ Headache
→ Facial pain
▪ Caused by mechanical obstruction of sinus discharge
📢
→ Epiphora, proptosis, and diplopia
▪ May be associated with advanced lesions involving the
orbit and may raise suspicion of malignant
transformation
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OTORHINOLARYNGOLOGY I Head and Neck 1

● Nasal obstruction, headache, occasional epistaxis (polyp like → Open approach

appearance) ▪ Open approach is usually employed for large sinonasal
tumors
→ Endoscopic approach
▪ Endoscopic endonasal surgery advantages:
− Absence of facial incision
− Negligible facial swelling
− Shorter in-patient time
− Reduction in post-operative pain and paresthesia.
F. OSTEOMA
Figure 11. Nasal endoscopy of Sinonasal Papilloma
● Nasal endoscopy typically shows a pale polypoid mass with a
papillary appearance protruding from the middle meatus.
● 📢
BIOPSY performed under endoscopic guidance is indicated
to establish definitive histology
● 📢
The presence of human papillomavirus or HPV in inverted
papilloma has been extensively investigated but its role remains
ambiguous
● Inverted Papillomas are reported to be positive for HPV 6,
HPV 11, HPV 16, HPV 18, and EBV.

Figure 13. Osteoma

●
Figure 11. CT scan (benign vs malignant)
📢 CT SCAN is performed to assess involvement of other
structures such as orbit, skull base, and carotid artery.
● 📢 We can also assess possible malignancy with loss of typical
cerebriform columnar pattern and evidence of aggressive
and infiltrative tumor growth such as bony destruction.
📌 Undiscussed Section Lifted from Trans 2022
● Left: inward papilloma (benign) because the bony structures are
intact.
→ Usually the papilloma starts at the lateral nasal wall, pushing off
the maxillary antrum.
→ Benign masses usually present as expansile masses that push
bone.
● Right: shows malignancy because bony structures have been
obliterated.
→ Malignant masses usually eat up bone.
DIAGNOSIS OF JNA
● 📢 A benign, slow growing, osteoblastic lesion found in 1% of
subjects undergoing plain sinus radiography and 3% in those
undergoing CT scan for sinus symptoms
● Osteomas are generally diagnosed in between the 2nd and 5th
decade
● Most of them are asymptomatic and are incidentally diagnosed
during radiographic examination performed for unrelated
reasons
→ 📢 Because of this, there is a general consensus in the
literature to adopt a wait and see policy for any lesions that is
asymptomatic and does not encroach upon critical structures
such as the anterior skull base or optic nerve.
● Rate of growth is very slow
● Removed only when symptomatic (e.g, obstructing sinus
drainage)
G. JUVENILE NASOPHARYNGEAL ANGIOFIBROMA (JNA)
● Accounts for 0.05% of all head and neck tumors
● Typically affects male adolescents (10-18 years old)
● Conductive hearing loss
● 📢 The most common presenting symptoms of small to
intermediate size JNA are UNILATERAL NASAL
OBSTRUCTION and EPISTAXIS
● 📢 In advance lesion, swelling of the cheek, proptosis with
diplopia or headache may be present indicating involvement of
the infratemporal fossa, orbit or cranial fossa, respectively
● Well circumscribed, vascularized mass in nasopharynx/posterior
nasal cavity

Figure 12. Open vs Endoscopic approach. 📝 Treatment is usually wide

excision. Medial Maxillectomy is usually done wherein the lateral nasal wall
is excised along with the tumor. (14-17% recurrence rate) Figure 14. Endoscopic and Histologic Findings in JNA

● 📢 Two approaches to manage inverted papillomas:

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OTORHINOLARYNGOLOGY I Head and Neck 1

● 📢 Endoscopic finding: smooth hyper vascularized lesion
originating behind the middle turbinate which is usually laterally
displaced against the lateral wall is common
● 📢 Histologic finding: characterized by vascular endothelium
line spaces embedded in the fibrous stroma
● Vessel walls-lack elastic fibers, incomplete smooth muscle →
tend to bleed
● 📢 SURGERY is the mainstay treatment. After embolization, it
can be approached in a variety of ways such as endoscopic or
open approach via vestibular or transpalatal approaches.
PART 2: TUMORS IN THE ORAL CAVITY AND OROPHARYNX,
CHEEK/PAROTID LINE, AND MAXILLA AND MANDIBLE
I. HEAD: ORAL CAVITY AND OROPHARYNX
● A plethora of conditions may manifest as tumors involving the
oral cavity and oropharynx

Figure 15. Imaging finding in JNA.

● 📢 The diagnosis of JNA on CT and MRI is based on the
following three features:
→ Area of origin invariably located at the level of
pterygopalatine fossa with erosion of the base of the
medial pterygoid plate
→ Hypervascularized appearance after contrast
enhancement
→ Pattern of growth
● 📢🚩 Biopsy is not done in a teenage boy strongly suggesting a
diagnosis of JNA due to the high risk of hemorrhage.
Preoperative embolization is done instead.
MANAGEMENT OF JNA

Figure 18. Oral cavity and oropharynx conditions.

● For convenience, these conditions are grouped into:
→ Congenital
→ Inflammatory
→ Neoplastic
● This list (Figure 18) is just partial and common conditions
located in the oral cavity and oropharynx
Figure 16. Internal Maxillary Artery Angiography and Embolization.
Left image shows pre-embolization and the right image shows post- A. TORUS
angiography or embolization wherein the size decreases in preparation for
its removal.
● 📢 PREOPERATIVE EMBOLIZATION is done 48 hours prior
to surgery and revolutionized the treatment of this lesion by
dramatically decreasing intraoperative bleeding, and therefore,
making assessment of the tumor borders at dissection more
accurate.

Figure 19. Torus Palatinus

● 📢 TORUS PALATINUS or MANDIBULARIS represents
developmental anomalies of the mucosa-covered bony
outgrowths of the palate and mandible respectively.
● Asymptomatic most of the cases unless:
→ Interferes denture placement
→ Repeatedly traumatized when patient eats
● Removal with osteotomy or cutting bur
Figure 17. Types of surgery for JNA
→ 📢
In symptomatic patients, the tori can be treated by
removing them from the underlying cortex with
osteotomes or cutting burs.

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OTORHINOLARYNGOLOGY I Head and Neck 1

B. LINGUAL 3. NASOALVEOLAR CYST

Figure 20. Lingual Thyroid.

● Approximately 90% of all ectopic thyroid tissue is associated Figure 23. Nasoalveolar Cyst
with the dorsum of the tongue. ● Originate from trapped nasal epithelium between the
● Presence of a lingual thyroid reflects the lack of descent of the developing lateral and medial maxillary nasal processes.
thyroid tissue during development. ● Patients typically present with swelling in the nasolabial area
● 📢The lingual thyroid is found in the midline, in the area of the which causes unilateral elevation of the nasal ala
foramen cecum. ● 📢 Intraorally, a smooth mucosa-covered mass in the gingival
● Usually asymptomatic labial sulcus is seen.
→ Can be associated with hypothyroidism TREATMENT
▪ 📢
Studies have shown that this is up to 70% of patients ● Involves COMPLETE SURGICAL INCISION.
with lingual thyroid. → 📢 Care should be taken to repair any disrupted nasal
● Treatment: mucosa to prevent oronasal fistula.
📢
→ To address hypothyroidism D. INFLAMMATORY/TRAUMA
→ SURGERY: euthyroid patients with airway obstruction and/or
difficulty swallowing.
C. DEVELOPMENTAL CYSTS
● Congenital cystic conditions of the oral cavity and oropharynx
are relatively rare.
● This usually includes:
→ Dermoid cyst
→ Duplication cyst
→ Nasoalveolar cyst.
Figure 24. Inflammatory/Trauma
1. DERMOID CYST ● Pyogenic granuloma of the oral cavity or oropharynx can occur
on any mucosal surface subject to acute or chronic trauma or
infection.
● They typically present as raised or pedunculated lesions less
than 2.5 cm
● May bleed with minor trauma.
● Treatment is by EXCISION and removal of potential traumatic
or infective factors.
E. MUCOCELE
Figure 21. Dermoid Cyst
● 📢 Already been discussed in the first video.
2. DUPLICATION CYST

Figure 25. Mucocele

● Result of trauma and spillage of mucin into surrounding soft
tissues or obstruction of the salivary gland excretory duct
Figure 22. Duplication Cyst
● 📢 Appears at birth as an asymptomatic swelling that involves ● May spontaneously resolve, especially in infants and young
the tongue and floor of the mouth. children
📢 TREATMENT
● Treatment for both dermoid and duplication cysts:
→ Complete excision of the cyst

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OTORHINOLARYNGOLOGY I Head and Neck 1

1. RANULA 2. WARTHIN TUMOR (CYSTADENOMA, LYMPHOMATOSUM,

ADENOLYMPHOMA)

Figure 26. Ranula

● 📢RANULA means “little frog” in latin Figure 29. Warthin Tumor
● Mucocele that occur in the floor of the mouth usually involve the ● Smooth, soft, parotid mass, well-encapsulated and contain
major salivary glands particularly the body and ducts of the multiple cysts
sublingual glands ● Can be bilateral (10% of the cases)
● Radiographic evaluation, if sialoliths are a suspected ● Occurs in older males/smokers
contributing factor ● Usually located in the tail of the parotid gland
TREATMENT TREATMENT
● Involves aspiration of lesions and periodic follow up ● FNAB: 93.1% sensitivity and 99.2% specificity
● Surgery through excision or marsupialization → Procedure is somewhat operator-dependent
● CT scan or MRI for investigation of larger/deeper lesions of the
II. HEAD: CHEEK/PAROTID LINE
parotid gland
● Starts from the mastoid up to the angle of the mandible
PAROTIDECTOMY
A. SALIVARY GLAND TUMORS

📢
Figure 30. Parotidectomy
● Most benign and malignant neoplasms of the parotid
Figure 27. Salivary Gland Tumor requires surgical intervention for its definitive management
● Most (70%) salivary gland tumors originate in the parotid gland ● Complete removal with adequate margin of tissue to avoid
● 75% of parotid gland tumors are benign as compared to other recurrence
salivary glands THE FACIAL NERVE
→ 50% in the submandibular gland and 60-80% of minor

📢
salivary gland tumors are found to be malignant
● The parotid is found in front and below the ear producing
predominantly serous saliva
1. PLEOMORPHIC ADENOMA (BENIGN MIXED TUMOR)

📢
Figure 31. The facial nerve
● During parotidectomy the facial nerve is always
Figure 28. Pleomorphic Adenoma
encountered. This passes through the substance of the gland
● Most common tumor of the salivary gland

📢
separating it into superficial and deep lobes.
● Contains epithelial and connective tissue components
● Care should be done to prevent injury to this nerve to
● With pseudocapsule
prevent facial paralysis of the involved side

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B. OTHER SALIVARY GLAND TUMORS B. DENTIGEROUS CYST

● HEMANGIOMAS
→ Most common salivary gland tumor in children involving the

📢
parotid gland
→ Asymptomatic, unilateral, compressible masses
● LYMPHANGIOMA (CYSTIC HYGROMA)
→ Manifest as painless masses that may involve parotid
glands, submandibular glands, or both
III. HEAD: MAXILLA AND MANDIBLE
● 📢 Benign tumors of the maxilla and mandible involves the Figure 34. Dentigerous cyst is seen as unilocular radiolucency on x-ray
● Associated with the CROWN of an unerupted tooth,
● 📢 Tumors of the jaws comprised of the maxilla and mandible
bony portions of these structures
developing tooth, or odontoma
have complicated nomenclature and classification. However, we → 3rd molars and maxillary canines are most commonly
will limit the discussion to several common benign tumors and impacted and so are most likely associated with dentigerous
its approaches cyst; however,
→ any impacted tooth has an increased risk
● Unilocular radiolucency, which is associated with an
unerupted tooth
● Treatment:
→ Easily enucleated at the time of tooth extraction
→ In large lesions, decompression with subsequent
enucleation
C. AMELOBLASTOMA

Figure 32. Classification of Odontogenic With Other Selected Maxillofacial

📢 What is important concept to remember is the tumors of the

Cysts
●
maxilla and mandible can come from odontogenic or
non-odontogenic etiology
A. RADICULAR CYST

Figure 35. Ameloblastoma

● Rare, benign slow growing tumor of odontogenic nature
→ Much more commonly appears in the mandible than maxilla

📢
● Has low malignancy and metastatic potential
→ Resulting lesion can cause severe abnormalities of the

📢
face and mandible leading to severe disfiguration
● Symptoms include a slow-growing, painless swelling that

📢
leads to deformity.
● As the swelling becomes progressively larger, it may
impinge on other structures resulting in LOOSE DENTITION
Figure 33. (Bottom) Radicular cyst at the apical portion of the tooth on and MALOCCLUSION

📢
x-ray. Although well-defined, the border may vary from corticated to ● SWELLING: Loose dentition, Malocclusion
scleorotic. ● Bone can also be perforated leading to soft tissue

📢
● Must be associated with a nonvital tooth involvement. The lesion has the tendency to expand to the bony
→ The tooth may rendered nonvital by trauma, carries, cortices because the slow growth of the lesion allows time for

📢
developmental defect or periodontal space extension the periosteum to develop a thin shell of bone ahead of the
→ Commonly associated with PERMANENT TOOTH rather
📢
expanding lesion.
than deciduous tooth → The shell of bone usually cracks when palpated.
● Unilocular radiolucency ● EGG-SHELL APPEARANCE on imaging
● Treatment: SIMPLE ENUCLEATION → SOAP BUBBLE

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OTORHINOLARYNGOLOGY I Head and Neck 1

1. TREATMENT II. CENTRAL NECK

● Treatment is primarily surgical but this can vary A. THYROGLOSSAL DUCT CYST
● It can be as conservative as incision and curettage
● or aggressive as segmental resection with 1cm margin
(standard treatment). After resection, reconstruction of the

📢
defect should be done
● RECONSTRUCTION
→ Reconstruction of the mandible due to extirpation of tumor
needs bony reconstruction
→ Standard reconstruction requires vascularized bone flaps
such as ischium, scapula, and fibula

Figure 37. Embryology of the Thyroid Gland

● At 3RD TO 7TH WEEK  AOG, the thyroid descends to reach
its normal adult position in the neck

📢
● It creates a track which obliterates at 10TH WEEK
● Failure to obliterate causes formation of THYROGLOSSAL
DUCT CYST
PHYSICAL EXAMINATION
Figure 36. Reconstruction using bone flap (fibula)
● Use of reconstructive titanium plates and screws to fixate the
harvested bone is done and return of function for mastication
and occlusion as well as contour for good aesthetic results is
optimal with the use of these flaps.
PART III: TUMORS OF THE CENTRAL NECK, LATERAL NECK AND
POSTERIOR TRIANGLE
I. NECK
📢 It is a passageway connecting the trunk and the head
📢 This carries vital structures such as nerves, blood vessels
● Figure 38. PE Findings of Thyroglossal Duct Cyst
● ● The mass that forms as fluid accumulates in the persistence of

● 📢 Tumors of the neck may actually impinge any of these

and lymphatics the track moves on tongue protrusion
● This can rupture spontaneously or maybe due to infection or
conduits trauma creating a sinus 
Table 1. Differential Diagnosis of Masses Distinguished by Central vs. IMAGING
Lateral Neck Complications
● NECK ULTRASOUND is routinely done to check the mass as
Central Neck Lateral Neck
📢
well as the presence of thyroid
Thyroglossal duct cyst Lymphadenitis ● Absence of thyroid gland may indicate that the mass can be
Thymic cyst Granulomatous disorder possibly an ectopic thyroid tissue necessitating scintigraphy
Thyroid cyst Branchial cleft cyst
scan
Follicular adenoma Sialadenitis
Benign MANAGEMENT
Dermoid cyst Neurofibroma
Lipoma Paraganglioma
Thyroid goiter Neuroma
Fibromatosis colli
Thyroid carcinoma Metastatic carcinoma
Lymphoma Salivary gland carcinoma
Malignant Thyroglossal duct carcinoma Lymphoma
Metastatic carcinoma Sarcoma
Chondrosarcoma Fibrous histiocytoma
● This table summarizes common masses on the neck depending

📢
on its location
● Let us focus our attention on benign central and lateral neck

📢
Figure 39. Sistrunk Procedure
masses
● Medical management is needed if patient has infection
● Once resolved, surgery is the mainstay treatment known
as “SISTRUNK PROCEDURE” which include removal
of the cyst or mass, body of the hyoid and a cuff of muscle 
● 4% recurrence rate

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OTORHINOLARYNGOLOGY I Head and Neck 1

B. LARYNGOCELE MANAGEMENT

Figure 40. Laryngocoele. (Left) DIstended saccule or early laryngocele

compared to a normal saccule. (Right) Isolated internal and external

📢 Formed by increased intra-glottic pressures like in horn

laryngocele.
●
players and glass blowers or from obstruction of the laryngeal
ventricle and its distal appendix by inflammatory or

📢
neoplastic lesions
● INTERNAL LARYNGOCELE Figure 43. Salivary Stones
● Management can be conservative to aggressive removal of
→ Tracts superiorly within the paralaryngeal fat

📢
stone
→ Air or fluid filled
● Management of salivary stones depend on the
📢
→ Causes variable compromise of the supraglottic larynx
→ Size, location, orientation, shape, number
● MIXED OR EXTERNAL LARYNGOCELE
→ Whether the stone is impacted or mobile
→ Extends further superolaterally

📢
→ Surgeons experience
→ Pierces the thyrohyoid membrane
● Initial non-surgical management of sialolithiasis consists of
→ May appear as a neck mass
using sialogogues, local heat, hydration, and massage of
C. PLUNGING RANULA
📢
the involved gland
● If salivary gland infection is suspected
→ Prompt antimicrobial treatment should be initiated
→ Surgery can be manual milking, endoscopic extraction, or
open approach for larger stones
E. CERVICAL TRAUMA
● Tumors containing tissue elements derived from all three
germinal layers
● Usually discovered at birth, rarely present after 1 year of age

📢 If the mass extends from the floor of the mouth piercing the
Figure 41. Plunging Ranula ● Maternal hydramnios has been incriminated as a predisposing
● factor.
mylohyoid muscle, separating it from the neck, a PLUNGING

📢
RANULA forms.
● This presents as a cystic bulge in the submental triangle
D. SIALOLITHIASIS

📢 It is the formation of calculi in the ductal system of the

Figure 42. Sialolithiasis Figure 44. Cervical Teratoma.
● MANAGEMENT
salivary gland ● Ex-utero Intrapartum Treatment (EXIT) procedure
● It is the most common cause of inflammation of the salivary → Extension of a standard classical Cesarean section
→ Baby is partially delivered through the opening but remains
📢
gland
● The SUBMANDIBULAR GLAND is the most commonly attached by its umbilical cord to its placenta
affected gland and 80-90% of stones develop in the Wharton’s ▪ This is to ensure that airway is established so the fetus
duct can breathe

Group 6B Page 10 of 19
OTORHINOLARYNGOLOGY I Head and Neck 1

III. LATERAL NECK Table 3. Common pharyngeal (branchial) cleft anomalies

A. BRANCHIAL CLEFT APPARATUS Pharyngeal

● 📢 At approximately 4 to 5 weeks of gestation, the area of the (Branchial) Cleft
Anomaly
Description

future face and neck of the embryo consists of 4 or 5 pairs of

finger-like masses of tissue named the PHARYNGEAL
ARCHES.
● 📢 Prominent in lateral profile, these masses are aligned
transversely to the plane of the neck and are separated
externally by indentations termed as PHARYNGEAL CLEFTS.
● 📢 The outer surfaces of the arches as well as the clefts are
lined by ectoderm whereas the substance of the pharyngeal
arches contains mesoderm and neural crest cells. Thus, the
pharyngeal arches give rise to structures composed of muscle,
bone, or like derivatives.
● 📢 The first pharyngeal cleft contributes to the external auditory
First Work type 1: cyst located close proximity to the
external auditory canal and below level of the
tragus
Work type 2: cyst located near tail of parotid,
more likely to pass deep to facial nerve trunk or in
close proximity
Second Cyst located deep to the anterior border of the
SCM, level II or III
External fistulas usually drain on the anterior neck
along the anterior border of the SCM
Internal fistula connection drains to the
tonsillar fossa

canal in the outer layer of the tympanic membrane.
● 📢 The remaining 2nd, 3rd, and 4th branchial clefts do not give
rise to identifiable structures in normally developed individuals,
and they fuse with the epicardial ridge in the lower part of the
neck.
DIAGNOSIS AND MANAGEMENT
Figure 45. Embryo at 32 days AOG (left) and pharyngeal arches, clefts,
and pouches in the floor of the mouth
B. BRANCHIAL CLEFT ANOMALIES
● 📢 Anomalies of the pharyngeal clefts are the most common
Third/Fourth Cyst located deep to the anterior border of the
SCM (sternocleidomastoid muscle), level III
Internal fistula arising from pyriform sinus of
hypopharynx
Rarely present with external fistula rare on
anterior neck
Closely associated with the superior thyroid gland
and may present as thyroiditis of the
corresponding lobe.
● CT SCAN or MRI is the imaging of choice
● Surgical management entails complete excision of cyst wall and
any fistula tracts
→ To prevent recurrence
C. PARAGANGLIOMA
● Arise from the GLOMUS CELLS
→ Chemoreceptors located along blood vessels that have a
role in regulating blood pressure and blood flow
● Found in the abdomen (85%), thorax (12%) and head and neck

● 📢 The complicated morphodynamics of the pharyngeal arch

congenital cervical cystic lesions.
(3%)

📢
● Head and neck paragangliomas rarely secrete catecholamines
region may result in a spectrum of abnormalities that range from
● These are lesions that develop from the neural crest

📢
minor cysts to major orofacial malformations.
derivatives and may arise in the jugular foramen along the
Table 2. Different anomalies and their corresponding description
course of the vagus nerve or the carotid bifurcation
ANOMALY DESCRIPTION ● Most occur as a single tumor
Cyst No communication with the body surface
Sinus Communicates with a single body
surface – either the skin or the pharynx
Fistula Communicates with two body surfaces
Second arch anomalies Most common
Isolated pharyngeal May present as accessory auricles or
arch remnants subcutaneous cartilaginous tags along
the anterior border of the SCM

Figure 47. Paraganglioma.

Figure 46. Diagram of incomplete internal and external fistulas

Group 6B Page 11 of 19
OTORHINOLARYNGOLOGY I Head and Neck 1
Figure 48. These are the common locations of paraganglioma in the
head and neck. Depending on the location, they can be called Carotid
Body Tumor, Glomus Vagale, Glomus Jugulare, and Glomus
Tympanicum
PHYSICAL EXAMINATION
● On physical examination, paragangliomas are palpable neck
masses that are more mobile in a lateral direction than in a
craniocaudal orientation known as FONTAINE SIGN.
● This may compress other adjacent nerves that can cause
hoarseness, dysphagia, and vocal cord paralysis.
D. FIBROMATOSIS COLLI
Figure 49. Fibromatosis Colli
● Aka as STERNOCLEIDOMASTOID TUMOR
PSEUDOTUMOR OF INFANCY
● Accounts for 0.3 -2.0% of live births
● Can manifest at birth or in the first 2 weeks of life
● 80-90% may disappear within the 6 months
● 10-20% may progress into Congenital Muscular Torticollis
● Due to malposition of the fetus in utero, birth trauma, infection,
or vascular injury
DIAGNOSIS
● Ultrasound has 100% sensitivity, while CT scan, MRI, and
biopsy can also be employed in Fibromatosis Colli.
MANAGEMENT
● Conservative Management is usually done through:
→ Stretching exercises (Physiotherapy)
→ Possibly injection of BOTULINUM TOXIN
● Surgery can be performed in 10% of cases due to progressive
torticollis at an older age known as TENOTOMY
Group 6B
IV. NECK: POSTERIOR TRIANGLE
Figure 50. Borders and floors of Posterior Triangle of the Neck
A. LYMPHANGIOMA
● 📢🚩The most common benign mass of the posterior triangle of
the neck is LYMPHANGIOMA also called CYSTIC HYGROMA.
However, Lymphangioma can also be seen in other locations of
📢
the neck.
● Collection of lymph vessels filled with serous fluid.
● 50% apparent at birth while 90% appear before 2 years old.
● It reflects failure of lymphatic ducts to connect with the venous
system.
● Found in patients with other syndromes such as Turner,
Klinefelter, and Noonan’s.
MICROCYSTIC
● Confined to superficial skin, forming small, vesicle-like lesions
MACROCYSTIC
● Located in the tongue, cheek, floor of the mouth, lips, and nose.
● Most common in the neck (posterior triangle) but may extend to
the head, face, axilla, or mediastinum.
MULTICYSTIC
● Tend to spread along the vital structures with high incidence of
recurrence.
● CT Scan and MRI are done for large and deep lesions.
or
Figure 51. Lymphangioma
● In localized disease:
→ A conservative period of watchful waiting is appropriate if the
lesion causes no immediate compromise to life functions.
→ Fewer than 15% of lesions spontaneously regress. Thus,
excision should be performed sooner in larger lesions to
avoid complications such as infection and encroachment to
vital structures
→ Multistage operation for diffuse disease can be used
→ Sclerosing agents such as BLEOMYCIN for recurrences.
Page 12 of 19
OTORHINOLARYNGOLOGY I Head and Neck 1

PART 4: TUMORS IN THE THYROID AND ANYWHERE ELSE IN D. DIAGNOSIS OF THYROID NODULES
THE HEAD AND NECK ● Sequential Approach to patients presenting with Thyroid
I. THYROID REGION Nodules:
● Contains the thyroid gland
📢
→ TSH
● Located in the lower central compartment of the neck ▪ Abnormal TSH → medical attention through
A. THYROID ADENOMA exogenous thyroid hormone replacement or antithyroid
● One of the common benign thyroid nodules coming from medications
follicular cells
📢
→ THYROID ULTRASOUND
● Common in women >30 y.o.
📢
▪ Done once euthyroid is reported based on TSH
● Usually presents as solitary nodule ▪ Reported using the TIRADS Scoring
● 🚩 Histology: − High score means presence of several sonographic
→ Follicular cells with colloid features of malignancy: MICROCALCIFICATIONS,
→ Differentiated from follicular carcinoma TALLER THAN WIDE, IRREGULAR BORDERS
● May be “hot” nodules
📢
→ FINE NEEDLE ASPIRATION BIOPSY (FNAB)
● 🚩 Treatment of choice is LOBECTOMY
📢
▪ Done after ultrasound
▪ Done for cytopathologic diagnosis to rule out

📢
malignancy
▪ Uses Bethesda System of reporting for thyroid
cytopathology

Figure 52. Thyroid Adenoma on PE

B. THYROID CYST
● 📢 Benign condition
● Irregularly enlarged follicles with flattened epithelium
● 🚩 Management of choice:
→ Aspiration for smaller lesions
→ Lobectomy or Thyroidectomy for larger lesions
Figure 54. TIRADS Scoring (See appendix for better view)
E. COMPLICATIONS OF THYROIDECTOMY
● If patients will need surgical intervention such as thyroid
lobectomy or total thyroidectomy, complications should be
addressed. This could be hypocalcemia, hematoma, recurrent
laryngeal nerve injury, and wound infection
● HYPOCALCEMIA (3-5%)

Figure 53. Thyroid Cyst Histology

C. OTHER CONDITIONS RELATED TO THYROID GLAND

📢
● HYPOTHYROIDISM with nodules
→ Has a higher malignancy potential compared to
hyperthyroidism

📢
● GRAVE’S DISEASE
→ Autoimmune disorder that results in the overproduction of

📢
thyroid hormones
📢 Occurs due to injury to the blood supply of the
Figure 55. Parathyroid Glands

📢
→ Initially mimics hyperthyroidism
→
→ Destruction of the thyrocytes eventually leading to
→ 📢 Often transient
parathyroid glands situated behind the thyroid
hypothyroidism
→ 📢 If complete removal of the parathyroid glands occur, this
📢
● THYROIDITIS

📢
→ Inflammation of the thyroid gland
may lead to permanent hypocalcemia
→ Causes the gland to be tender and hard on palpation
● HEMATOMA (1-2%)

📢
● RECURRENT LARYNGEAL NERVE INJURY (0.77%)
→ The RECURRENT LARYNGEAL NERVE is a motor
nerve which supplies the intrinsic muscles of the vocal folds.

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OTORHINOLARYNGOLOGY I Head and Neck 1

Figure 59. Vascular Tumor

1. INFANTILE HEMANGIOMA

📢 A UNILATERAL RECURRENT LARYNGEAL NERVE

Figure 56. Recurrent Laryngeal Nerve
→
INJURY will cause hoarseness in aspiration, causing
immobility of the vocal fold of the injured side.

Figure 60. Infantile Hemangioma

● Completely absent or present as slight pallor at birth
→ This may be absent at birth and appear at infancy
● They then proliferate for 6-9 months and involute partially or
completely over several years
● Infantile hemangioma endothelium has several unique surface
markers that can be detected by immunohistochemistry
→ Detection of Glucose Transporter 1 or GLUT-1 in infantile
Figure 57. Unilateral Right Recurrent Laryngeal Nerve Injury (visible hemangioma endothelium distinguishes them from other

📢
immobility of the right vocal fold)

📢
vascular anomalies
→ A BILATERAL RECURRENT LARYNGEAL NERVE
● At birth, it can be completely absent or present as slight
INJURY causes the immobility of both vocal folds

📢
redness or pallor.
▪ Air cannot enter the larynx, causing the patient to feel
● In the first several months of life, this hemangioma grows
choking and difficulty of breathing

📢
rapidly.
▪ The patient has a good voice but bad airway
● Ultrasound will demonstrate characteristic high vascularity
▪ EMERGENCY PROCEDURE which should be addressed

📢
on doppler imaging
with intubation or tracheostomy
● MRI can be helpful in differentiation of infantile hemangioma
from other vascular anomalies
2. PHACE SYNDROME
● Composed of:
→ Posterior fossa structural brain abnormalities
→ Hemangioma
→ Arterial lesions
→ Cardiac abnormalities and coarctation
→ Eye abnormalities is associated with infantile hemangioma

Figure 58. Bilateral Recurrent Laryngeal Nerve Injury

(visible immobility of both vocal folds)
● Wound Infection (0.2 - 0.5%)
II. ANYWHERE IN THE HEAD AND NECK
● 📢 Some benign tumors can be found anywhere in the head
and neck region
→ One of which is VASCULAR ANOMALIES which can be
subdivided into vascular tumor and vascular malformation
A. VASCULAR TUMOR
● 📢 This is due to the disordered vascular development and
may demonstrate certain neoplastic characteristics Figure 61. PHACE syndrome
● There are also certain conditions such as profound ● Suspected PHASE patients should undergo:
thrombocytopenia and PHACES syndrome which may → Head imaging → Cardiac evaluation
regress in time → Ophthalmologic examination

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OTORHINOLARYNGOLOGY I Head and Neck 1
3. CONGENITAL HEMANGIOMA
● Present at birth
● Histologically similar to infantile hemangioma, however, there is
ABSENCE OF GLUT-1 staining in congenital hemangioma
● Diagnosis remains uncertain until clinical behavior can be
observed
● Can be classified as:
→ RICH or Rapidly Involuting Congenital Hemangioma
▪ Managed through observation
→ NICH or Noninvoluting Congenital Hemangioma
▪ This may require laser or surgical therapy
Figure 62. Congenital Hemangioma
RAPIDLY INVOLUTING CONGENITAL HEMANGIOMA
● Three Phases:
→ PROLIFERATIVE: Rapid growth of the mass
→ PLATEAU: Quiescence which occurs at 9-12 months of age
→ INVOLUTION
▪ 30% will resolve by 3 years
▪ 50% by 5 years
▪ 80-90% resolves by 9 years
Figure 63. Rapidly Involuting Congenital Hemangioma
4. PRESENTATION: V3 / “BEARD” DISTRIBUTION
→ Of note, V3 / BEARD DISTRIBUTION on the face or neck
may signify the presence of airway hemangioma
Figure 64. Airway Hemangioma
Group 6B
5. IMAGING STUDIES
● CT Scan and MRI for deep and large hemangiomas
● Ultrasonography with color flow is cost effective but is
operator dependent and does not accurately depict the relation
of the lesion to other anatomic structures
● Sometimes, angiography is needed to check for the vascular
involvement of the tumor
Figure 65. Ultrasound and angiography of hemangioma
6. INDICATIONS FOR TREATMENT
● 📢 Most hemangiomas can be managed conservatively through
observation, however, approx. 40% of hemangiomas require
treatment (Haggstrom et al, 2006). Some of the indication for
treatment are as follows:
→ Involvement of a vital organ, like the eye or ear, or larynx
→ Bleeding
→ Ulceration
→ Crusting or Infection
→ Rapid growth and deformity of the surrounding tissues
MEDICAL TREATMENT
● PROPRANOLOL
→ 1st line; inhibits angiogenesis
→ Contraindications: Cardiac problems (ie, PHACES), asthma
● SYSTEMIC STEROIDS
→ PREDNISONE: decreases proangiogenesis proteins
→ Intralesional Steroids
▪ TRIAMCINOLONE: for small, bulky, localized lesions
→ Topical Steroids
▪ MOMETASONE: for thin, superficial lesions
● Vincristine, α-interferon, Imiquinod for recalcitrant lesions
only
● Rapamycin (Antiangiogenic agents)
SURGICAL TREATMENT
● 📢 Large infantile hemangiomas and non-involuting congenital
hemangiomas may require surgical treatment provided that we
have the indications
● PULSED DYE LASER for superficial lesions/part of larger
lesion, persistent telangiectasia
● Embolization
● Surgery (excision, cosmetic correction)
B. VASCULAR MALFORMATION
● Lesions that contain all vessel types: ARTERIAL, VENOUS,
LYMPHATIC
● Present at birth and demonstrate growth parallel to the
individual’s growth
● Never regress
Page 15 of 19
OTORHINOLARYNGOLOGY I Head and Neck 1

2. NEURILEMOMA

Figure 68. Case of Neurilemoma

● Also known as SCHWANNOMA
● Slow-growing nerve sheath tumor
→ Encapsulated neoplasms from Schwann cells
● Common along lateral neck region
● Diagnosis: CT Scan, MRI, Biopsy
→ Antoni A and B
Figure 66. Summary of different vascular tumors and vascular
● Excision
malformation
→ Definitive treatment of choice
1. ARTERIOVENOUS MALFORMATION
3. LIPOMA

Figure 67. A case of Arteriovenous Malformation

● High-flow vascular malformation that usually present anywhere
in the head and neck as localized pulsatile masses or diffuse
areas of increased blood flow
→ Cheek or auricle (most frequently involved area)
● This arise from a nidus of blood vessel that have abnormal
precapillary communication from arteries to veins with
EARLY VENOUS FILLING ON ARTERIOGRAPHY as
Figure 69. Case of Lipoma
● Benign condition which is composed of mature adipose cells
● Smooth, soft, encapsulated, freely movable masses that almost
always arise in the subcutaneous tissue
● Presence of capsule differentiates the tumor from simple

📢
pathognomonic findings for AVMS aggregation of fat
● The natural history of this malformation is often unclear but ● Excision (complete surgical excision is the treatment of choice)
has 4 clinical stages known as DORMANCY, EXPANSION, 4. SEBACEOUS CYST
DESTRUCTION and HEART FAILURE, and has been
described and correlated with treatment outcome
● Diagnosis:
→ MRI or CT angiography
● Treatment
→ Observation/Intervention
→ Preoperative embolization + Surgery (surgical excision of the

📢
nidus)
Figure 70. Case of Sebaceous Cyst
● Lesions contained within the bone can be managed with
● EPIDERMAL CYST or KERATIN CYSTEPIDERMOID CYST
embolization alone but once the lesion involves adjacent soft
● Closed sac found just under the skin, most often arising from
tissue, surgery may be necessary.
swollen hair follicles
● Recur commonly, thus, treatment decisions should be carefully
● Contains cheesy-looking skin secretions
planned
● Skin trauma can also induce a cyst to form
● Excision with meticulous removal of all cyst remnants should be
done to prevent recurrence

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OTORHINOLARYNGOLOGY I Head and Neck 1

SUMMARY → Diagnostics for thyroid nodule in the sequence of priority

● ORAL CAVITY AND OROPHARYNX ▪ TSH
→ Torus represents developmental anomalies of the ▪ Thyroid Ultrasound with TIRADS Scoring
mucosa-covered bony outgrowths of the palate and mandible ▪ Fine Needle Aspiration Biopsy (FNAB) with Bethesda
respectively. System
→ Lingual Thyroid presents the lack of descent of the thyroid → Complications of Thyroidectomy
during development. ▪ Hypocalcemia
→ Developmental Cysts: ▪ Hematoma
▪ Dermoid Cyst ▪ Unilateral or Bilateral Recurrent Laryngeal Nerve Injury
▪ Duplication Cyst ▪ Wound Infection
▪ Nasoalveolar Cyst ● ANYWHERE IN THE HEAD AND NECK
→ Inflammatory/Trauma is due to acute or chronic infection, → Vascular Tumor is due to disordered vascular development
may bleed. and may present with neoplastic characteristics
→ Mucocele is the result of spillage of mucin into the ▪ Infantile Hemangioma (present GLUT-1)
surrounding tissue. ▪ Phace Syndrome (stands for: Posterior fossa structural
→ Ranula is a type of mucocele that occurs in the floor of the brain abnormalities, Hemangioma, Arterial lesions,
mouth. It means little frog in Latin Cardiac abnormalities, and Eye abnormalities)
● PAROTID: CHEEK/PAROTID LINE ▪ Congenital Hemangioma (absent GLUT-1)
→ Salivary gland tumor − Rapidly Involuting Congenital Hemangioma
▪ 70% originate from the parotid gland and 75% are benign. o Proliferative - rapid growth
→ Pleomorphic Adenoma (Benign MIxed Tumor) o Plateau - quiescence
▪ Most common benign salivary gland tumor. o Involution
→ Warthin Tumor is a smooth, soft, parotid mass, well ▪ Presentation
encapsulated and contains multiple cyst. − V3/ Beard Distribution on the face or neck
→ Parotid Tumors are mostly benign and malignant tumors ▪ Imaging
require parotidectomy. − CT and MRI for deep and large hemangiomas
→ Hemangioma is the most common salivary gland tumor in − Ultrasonography with color flow
children involving the parotid gland. − Angiography
→ Lymphangioma manifests as painless masses ▪ Indications
● MAXILLA AND MANDIBLE − Treatment is conservative if it does not involve a vital
→ Radicular Cyst must be associated with a non vital tooth. organ, bleed, have ulcer, crust, have infection, have
→ Dentigerous Cyst must be associated with the crown of an rapid growth
unerupted tooth, developing tooth or odontoma. ▪ Medical Treatment
→ Ameloblastoma is a rare benign slow growing tumor of − PROPRANOLOL is the first line for the inhibition of
odontogenic nature. angiogenesis
● NECK − Systemic steroids such as prednisone,
→ a passageway connecting the trunk and the head that carries triamcinolone, mometasone depending on size of
vital structures such as nerves, blood vessels and lymphatics lesions
→ Central Neck − Vincristine, α-interferon, imiquinod for recalcitrant
▪ Thyroglossal Duct Cyst ▪ Sialolithiasis lesions only
▪ Laryngocoele ▪ Cervical Teratoma − Rapamycin
▪ Plunging Ranula ▪ Surgical Treatment
→ Lateral Neck − Excision if indicated
▪ Branchial Cleft Apparatus − Pulsed dye laser
▪ Paraganglioma − Embolization
▪ Fibromatosis colli → Vascular malformation
→ Posterior Triangle: Lymphangioma ▪ Arteriovenous malformation arises from abnormal
● THYROID REGION precapillary communication from arteries to veins
→ Lower central compartment of the neck − EARLY VENOUS FILLING on arteriography is the
→ Thyroid Adenoma is usually a solitary nodule composed of pathognomonic finding
follicular cells with colloid on histology − most common on the cheek or auricle
→ Thyroid Cysts are irregularly enlarged follicles with flattened ▪ Neurilemoma slow-growing nerve sheath tumor or
epithelium schwannoma
▪ small lesions - aspiration ▪ Lipoma is a benign lesion composed of mature adipose
▪ large lesions - lobectomy / thyroidectomy cells
→ Other related conditions ▪ Sebaceous Cyst is an epidermal or cyst epidermoid cyst
▪ Hypothyroidism ▪ Thyroiditis arising from swollen hair follicles
▪ Grave’s Disease

Group 6B Page 17 of 19
OTORHINOLARYNGOLOGY I Head and Neck 1

REVIEW QUESTIONS
1. Patients with benign head and neck tumor will present with 8. A 40 year old male presented with left nasal cavity
the following findings? obstruction of 6-month duration with accompanying on and
a. Rapid growth c. Nerve involvement off nasal discharge. There was no epistaxis, loss of smell
b. Presence of lymph nodes d. Localized mass and fever. PE showed polypoid mass on the left nasal
2. Which of the following is part of the posterior triangle of cavity. What is your next step?
the neck? a. Ultrasonography c. Endoscopic Biopsy
a. Supraclavicular c. Muscular b. Endoscopic Surgery d. Open Surgery
b. Submandibular d. Carotid 9. A patient came to our OPD with plain radiographic xray
3. What is the most common probable etiology of head and done showing well-defined, radio opaque mass on the
neck mass in children? maxillary sinus. Patient does not complain of any
a. Inflammatory c. Neoplastic symptoms before and during the consultation. What is your
b. Malignancy d. Congenital assessment?
4. Which of the following disease entity always presents with a. Juvenile nasoangiofibroma
CNS connection? b. Nasal polyp
a. Dermoid c. Glioma c. Inverted Papilloma
b. Encephalocoele d. Teratoma d. Osteoma
5. Lesions that expand with crying, straining or compression 10. Ranula is a type of mucocele that forms in the floor of the
of the jugular vein is known as? mouth. Which of the following is true regarding ranula?
a. Transillumination c. Fontaine’s Sign a. Sialolith is not related to its development
b. Furstenberg’s Test d. None of the above b. None of the above
6. A patient presents with a bulge in the nasal dorsum which c. Extension in the neck is called plunging ranula
expand on crying and transilluminate. What is the primary d. Injury to the Stensen’s duct
treatment of choice? Answers: D, A, A, B, B/ A, D, C, D, C,

a. Excision with neurosurgical consult

b. Excision alone REFERENCES
c. Incision biopsy ● Doc Mendoza’s Video Lecture
d. Medical treatment ● Batch 2022 Trans
7. Which of the following HPV strains is reported to be
involved in the etiogenesis of inverted papilloma?
a. 20 b. 1 c. 14 d. 18

Appendix A.
Difference of the Three Tumors of the Nose, Nasal Cavity and Oropharynx

Group 6B Page 18 of 19
OTORHINOLARYNGOLOGY I Head and Neck 1

Appendix B.
Different Vascular Tumors and Different Vascular Malformations

Appendix C.
TIRADS Scoring

Group 6B Page 19 of 19