Part 2 book “Clinical surgery pearls” has contents: Cervical metastatic lymph node and neck dissections, carcinoma tongue with submandibular lymph node, parotid swelling, submandibular sialadenitis, soft tissue sarcoma, branchial cyst, branchial fistula, cystic hygroma, malignant melanoma, and other contents. | 24 Case Cervical Metastatic Lymph Node and Neck Dissections Case Capsule Contd. A 65-year-old male patient presents with a hard lymph node swelling of 3 cm size involving the level III group on right side. The swelling is mobile. The superficial temporal artery is palpable. The cranial nerves are normal. There are no abdominal, chest or ENT complaints. The patient is apparently healthy. Read the diagnostic algorithm for a neck swelling. 10. Difficulty in hearing—from nasopharynx 11. Hoarseness of voice—carcinoma glottis and carcinoma thyroid 12. History of prior SCC. Checklist for history 1. Alcohol and tobacco use in history 2. Pain around the eyes – referred from the nasopharynx 3. Otalgia—carcinoma base of tongue, tonsil, and hypopharynx can cause otalgia 4. Odynophagia—as a result of cancers of the base of the tongue, hypopharynx, cervical node metastasis, etc. 5. Bleeding from the nose (epistaxis)—cancers of the nasal cavity 6. Hemoptysis 7. Alteration of phonation 8. Difficulty in breathing 9. Difficulty in swallowing—late symptom of base of tongue, hypopharynx and cervical esophagus Contd. Checklist for examination 1. Careful examination of oral cavity after removal of dentures 2. Bimanual palpation of the floor of the mouth 3. Check for nasal block 4. Check for sensory loss in the distribution of infraorbital nerves—maxillary sinus cancer 5. Examine the cranial nerves III–VII and IX–XII (involvement in nasopharyngeal cancer) 6. Look for Horner’s syndrome—involvement of cervical sympathetic chain, extralaryngeal spread of laryngeal cancer and extracapsular invasion of cervical lymph node 7. Look for trismus 8. A thorough ENT examination 9. Examination of thyroid 10. Examination of salivary glands 11. Examination of breast 12. Examination of chest 13. Examination of abdomen. Cervical Metastatic Lymph Node and Neck Dissections Q 1. What is the most probable diagnosis in this case? Metastatic lymph node. Q 2. Why .
