2. Lymphomas of Head & Neck arise from
Nodal or Extranodal sites or both
Hodgkins and Non-Hodgkins Lymphoma
commonly present as lymphnode
enlargement in the neck
Hodgkins disease is rare in oropharynx but
NHL account 15-20%
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5. Needle aspiration :- not recommended
Incisional or excisional biopsies are preferred
Immunohistochemistry
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6. C. T. Scan of Head & Neck, Chest, Abdomen,
Pelvis
Staging of disease is based on C.T.Scan
findings
Performed at primary evaluation in all patients
with NHL
Nodal and extra nodal sites
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7. MRI
Role is limited
Infiltration to Bone marrow or involvement of
meninges
Positron Emission Tomography (PET Scan )
imaging is modality of choice for diagnosis, staging
and survillance.
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8. Stage I
Single Extra Nodal
StageII
Nodal Invovement
Stage III
Both sides of Diaphragm
Stage IV
metastases
staging
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10. CASE REPORT
41 Years lady presented
to E.N.T.clinic with pain in
oral cavity since two
months which was not
relieved by medication.
Patient was reffered
from facio-maxillary
dept.
Patient did not have any
medical illness .
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11. On examination :-
Left Palatal swelling was
noticed on examination which
was firm in consistency on
palpation .
Associated inflammatory
response to surrounding tissue
Neck :- No cervical
lymphadenopathy.
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12. RADIO-IMAGING
C.t. Scan of
Neck revealed
soft tissue
mass in left
Soft Palate.
No associated
lymphnode
enlargement
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20. Patient was referred to oncology department.
Patent received Radiotherapy ( 30 doses )
Recently have completed chemotherapy (8)
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22. The oral cavity is an anatomically complex region
and lesions can prove exceptionally challanging to
diagnosis.
Isolated extranodal B-cell lymphoma of the palate
is extremely rare. It usually present as an
inflammatory lesion. Early diagnosis are
important as the disease is confined to palate
only,therefore respond well to irriadiation.
PET is the imaging modality of choice for diagnosis,
staging and survillance
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25. RETROPHARYNGEAL SPACE
RPS is potential space
between middle and deep
layers of deep cervical
fascia.
Extends from base of
skull to T4 level.
At C6 level it goes more
posteriorly and forms a
danger space which
communicates with
mediastrinum.
For practical purposes:-
on imaging studies it is
indistinuishable.
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26. Non- traumatic retropharyngeal abscess is very
rare in adults
Retropharyngeal abscess alone occur in children
from 6 months to 6 years of age.
Recent reports suggest that Necrotizing
retropharyngeal abscess (NRPA) occurs in adults
who are immunocompromised.
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29. mortality remains high because of occurrence of
lethal complications :-
Acute Respiratory obstruction
Aspiration Pneumonia
Juglar Thrombophelibitis
Descending necrotizing mediastinitis
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30. 54 years old male presented to our E.R. with h/o
difficulty in swallowing, breathing and bleeding
per mouth.
Patient known case of diabetes and had h/o sore
throat for six days for which he had taken
medication from outside.
On examination patient was ill looking with mild
dyspnea, but hemodynamically stable.
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31. CASE REPORT
Oral and laryngeal
examination failed as
oral cavity was fullof
blood clots.
Urgent C.T. scan of
neck was done which
revealed widening of
RPS with gas shadows
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33. Patient developed Respiratory Distress in E.R.
and started desaturating.
Urgent laryngeal intubation was planned but
failed due to non-visualization of larynx.
As patients condition worsened he was shifted to
O.R. on laryngeal mask.
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34. Airway established by surgical Tracheotomy
General Anesthesia induced through
tracheotomy tube.
Retropharyngeal abscess drained along with
necrotic tissue per oral approach
Hypopharyngoscopy and laryngoscopy done using
rigid endoscope.
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35. Necrotic tissue found upto cricopharynx, but
larynx was found normal.
Post operatively combination of
pipercillin/Tazobactam along with clindamycin
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36. Day IV
• Follow up fiberoptic endoscopic
examination
• Pharynx and Larynx :- revealed no
residual abscess or necrotic tissue
DayV
• follow up C.T Scan neck
• Contrast study of pharynx
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37. Day XI to Day XIV Decannulation
Decannulation
Planned
Tracheotomy
tube repalced by
fenestrated one
and closed.
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38. Day to Day Events during Hospitalization
Day XV :- patient
developed acute Renal
failure due to
contrast induced
tubular injury.
Oliguria with rise in
cretinine levels.
Day XVI :- underwent
hemodialysis
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39. Day to Day Events during Hospitalization
Follow up C.T.
Was not possible
because of
contrast induced
acute renal
injury.
Contrast study
by gastrograffin
of pharynx .
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41. Day to Day Events during Hospitalization
Day XVII to day XX
Kidney function
improved with adequate
urine output and
gradually decrease of
cretinine levels.
Day XVIII :- oral
feeding started
Day XXV :- Discharged.
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