Complications of ventilation tubes: - Dr. Nassem Talaat

B)Below the clavicle; Bronchogenic carcinoma, cancer breast, stomach &
intestine (virchow’s gland)
Management:
I. History:
1-Usually painless neck mass of insidious onset & rapid in size
2-ask about symptoms of: larynx, pharynx, nose & naso pharynx, oral cavity,
ear, chest & stomach.
II. Examination:
1-The lump site, size, shape, surface number, consistency, mobility…
2-Other LN 3-Full H & N exam 4-Abdominal exam
III. Investigations:
A) Radiology: x ray to head & neck CT from skull base to chest
B) Endoscopy: under GA
Barium swallow, meal & enema Thyroid scan
Pan endoscopy (naso pharyngoscopy, laryngoscopy hypo pharyngscopy
Bronchoscopy & oesophagoscopy )
If suspicious lesion …………..biopsy
If no suspicious lesion ……….blind biopsy
C) FNAC: (fine needle aspiration cytology) for the lump
NB: never to excise the neck node before exhaustive search for the primary because:
a. Biopsy does not give clue to site of the primary: as it is usually sq. cell carcinoma
b. Spillage of tumor cells may occur
c. Incision may interfere later with plane of neck dissection
d. Patient may have false sense of security
Ttt: If no primary was found: radical neck dissection with follow up
Velopharyngeal incompetence
Def: Failure of the soft palate to close the NPX, during speech or swallowing
Aet: congenital: cleft palate
Traumatic: perforation, radiotherapy & post operative
Inflammatory: scleroma(scarring), S (perforation)
Neuromuscular: palatal paralysis
Functional: faulty learning