0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44
Jaw Swelling and Masses 879■Exact location: tail of parotid, level I of neck (submandibular triangle)
level II of neck (jugulodigastric lymph node chain).
■Purulence expressible from Wharton’s or Stensen’s duct
■Condition of teeth: presence of caries, tenderness to percussion.
■Facial nerve evaluation and exam.
■Presence of swollen lymph nodes in other parts of the body.
■Presence or absence of fever.
■Complete head and neck examination including examinations of
the tympanic membranes, cranial nerves, nose, nasopharynx, oral
cavity, oropharynx, hypopharynx, and larynx. Complete neck exam-
ination.tests
■Blood:
➣CBC with platelets and differential
■Other:
➣PPD and anergy panel, Anti-Viral Capsid Antigen for Epstein-Barr
virus
■Imaging:
➣CT scan with contrast for suspected infectious etiology
➣MRI with Gadolinium for suspected neoplastic or congenital eti-
ology
■Pathology:
➣Fine Needle Aspiration (FNA) for cytological examination and
culture
➣Office endoscopic laryngeal examination
➣Open biopsy is contraindicated in most neoplastic situations
except where tissue is needed for lymphoma typing. FNA will
frequently yield the diagnosis, especially with squamous cell car-
cinoma and nasopharyngeal carcinoma.
➣Operative laryngoscopy, esophagoscopy, and bronchoscopy
sometimes necessary depending on results of abovedifferential diagnosis
Congenital Masses
■Branchial cleft cysts (Types I, II, III, IV), Hemangioma, Lymphan-
gioma (Cystic Hygroma), Vascular Abnormalities
Neoplastic Masses
■Parotid Tumors (80% benign, 20% malignant): Benign (Warthin’s
tumor, Benign Mixed Tumors, Benign Lymphoepithelial Cyst of