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History andExamination ofHead
andNeck (Oncology andBenign
Diseases)
10
10.1 Head andNeck Oncology
Swelling/ulcer/growth in head and neck region
that do not heal are the common symptoms of
carcinoma. Other symptoms may be dysphagia,
unexplained weight loss, change of voice, etc. are
present depending on the site or system involved.
The carcinoma may involve various sites and
subsites in head and neck region and present with
specic symptoms and signs.
10.2 Sites forHead andNeck
Carcinoma
• Ear
• Nose and para-nasal sinuses
• Oral cavity
• Nasopharynx
• Oropharynx
• Larynx
• Laryngopharynx/hypopharynx
• Cervical oesophagus
• Cutaneous carcinoma of head and neck
• Thyroid and parathyroid
• Salivary glands
• Skull base
• Trachea
• Neurogenic tumour and paraganglioma
• Soft tissue tumour of head and neck
• Bone and odontogenic tumour
• Tumour of lymphatic system (lymphoma)
10.3 Common Complaints/
History/Symptom ofHead
andNeck Carcinoma
10.3.1 Swelling or Growth or Ulcer
This is a common symptom of head and neck
carcinoma.
(a) Site
• Swelling/growth/ulcer in head region—
It is separated from neck by mandible
anteriorly, skull base centrally, and inferior nuchal line posteriorly.
Differential diagnosis of swelling/mass
in head region (Table 10.1)
• Swelling/mass in neck region—The
neck is limited superiorly by mandible
and inferiorly by clavicle. Clinically
and anatomically, the sites in neck can
be classified into various groups and
sub-groups to make the diagnosis by
history.
Differential diagnosis of swelling/mass
in neck (Table 10.2)
(b) Duration
• Short duration—If the swelling/ulcer/
growth presented for <3 months, SCC,
metastatic lymph node.
• Long duration—Benign tumour, warthin’s tumour, branchial cyst, mastoid
osteoma, frontal osteoma, JNA, olfactory
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2025
S. K. Kashyap, S. Sagar, Clinical Methods of Otorhinolaryngology, Skull Base & Head Neck
Surgery, https://doi.org/10.1007/978-981-96-1765-4_10
323
324
Table 10.1 Differential diagnosis of tumours head region
Growth in head region D/D
Frontal region Frontal osteoma
Zygomatic area Infratemporal fossa tumour
Occipital region Neurobroma
Temporal region Soft tissue tumour
Parietal region Haemangioma, osteoma
Parotid region Parotid tumour
Pre-auricular region Pre-auricular lymphadenitis
Auricular region Tumour of EAC, Pinna and middle ear
Post-auricular region/mastoid region Mastoid osteoma, post- auricular lymphadenitis, dermoid cyst
Orbital region Orbital tumour,
Infraorbital region Maxillary sinus tumour
Nasal region Nasolabial cyst, dermoid, encephalocele
Oral region Lip tumour, oral cavity tumour
Buccal (cheek) region Buccal lymphadenitis, carcinoma cheek
Mandibular and mental region Adamantinoma, dentigerous cyst
Pterygoid region JNA
Anterior skull base region Olfactory neuroblastoma
Middle skull base Pituitary tumour, clival chordoma
Table 10.2 Differential diagnosis of tumour/mass/swelling of neck region
Midline/central
(a) Upper part—Submental lymphadenitis, plunging ranula, dermoid cyst, abscess, sublingual dermoid, lipoma,
Ludwig’s angina
(b) Middle part—Laryngocele, Delphian group of lymph node, thyroglossal cyst, dermoid cyst, lipoma
(c) Lower part—Thyroid swelling, dermoid, level iv lymph node (central group), parathyroid tumour, retrosternal
goiter, thymic swelling, dermoid cyst
Lateral
(a) Upper part—Submandibular sialadenitis, level 1b lymph node, level 2 a & b lymph node, carotid body tumour,
vagal schwannoma, Sjogren syndrome, warthin tumour, branchial cyst, sternomastoid tumour in newborn
(b) Middle part—Jugulo-omohyoid group of L.N., brachial cyst, lipoma
(c) Lower part—Lower cervical group of L.N.
Posterior
(a) Upper—Occipital L.N., cystic hygroma, lipoma, non-specic
(b) Lower—Supraclavicular L.N., subclavian aneurysm, madelung’s disease, cavernous haemangioma
10 History andExamination ofHead andNeck (Oncology andBenign Diseases)
neuroblastoma, metastatic lymph node,
lipoma, dermoid cyst, adamantinoma.
(c) Mode of onset
• Sudden—haematoma, infection, trauma,
aphthous ulcer.
• Gradual—benign or malignant neck
disease.
(d) Age of onset
• Congenital—If swelling or growth present since birth—dermoid, meningocelez
• Acquired—If swelling growths develop
later like haematoma, SCC.
(e) Progression
• Progressive
– Slow progressive—Benign tumour
(osteoma, olfactory neuroblastoma,
adamantinoma, lipoma), cystic lesions
(dermoid cyst).
– Fast progressive—Carcinoma (neoplas-
tic ulcer/swelling), haematoma.
• Non-progressive—Aphthous ulcer, trau-
matic ulcer
10.4 Site-Specic Symptoms ofHead andNeck Carcinoma
325
(f) Associated symptoms and history
• There are various symptoms that can be
associated with swelling like pain, dysphagia, odynophagia, Hoarseness of
voice, hot potato voice, nasal bleeding,
cranial nerve palsy, Horner’s syndrome,
facial palsy, loose teeth, neck swelling
• H/O tobacco exposure includes smoking
cigarettes, cigars, or pipes; chewing
tobacco; and using snuff, frequent alcohol exposure and heavy alcohol consumption raise the risk of developing
cancer in the mouth, pharynx, larynx and
oesophagus.
• H/O Guthakha chewing, chhutta
• Prolonged sun exposure
• Poor oral and dental hygiene—associated with oral carcinoma.
• Jagged and sharp teeth—may cause carcinoma cheek and tongue.
• Environmental or occupational
inhalants.
– Inhaling asbestos—can cause mesothe-
lioma, Pharyngeal and laryngeal
carcinoma
– wood dust—Nasal carcinoma
– paint fumes and certain chemicals may
increase a person’s risk of head and
neck cancer.
• Marijuana use—People who have used
marijuana may be at higher risk for head
and neck cancer.
• Poor nutrition—A diet low in vitamins A
and B can raise a person’s risk of head and
neck cancer.
• Gastroesophageal reux disease
(GERD) and laryngopharyngeal reux
disease (LPRD).
• Exposure to radiation. Exposure to radiation is associated with salivary gland
cancer.
• Habit of oral sex—HPV-associated oro-
pharyngeal carcinoma.
• Previous history of head and neck can-
cer—People who have had one head and
neck cancer have a higher chance of
developing another head and neck cancer
in the future.
10.4 Site-Specic Symptoms
ofHead andNeck Carcinoma
10.4.1 Nose andPara-Nasal Sinuses
• Persistent nasal congestion/obstruction that
doesn’t get better or even worsens.
• Pain—Orbital or facial
• Post-nasal drip (nasal drainage in the back of
the nose and throat)
• Nasal bleeding
• Decreased or loss of sense of smell.
• Numbness/paraesthesia or pain in parts of the
face.
• Nasal mass/swelling/growth
• Double vision/loss of vision/decrease in
vision
• Epiphora
• Ulcer over hard palate
• Loosening or fall of upper alveolus teeth
• Facial swelling
• Trismus (difculty in opening mouth)
• Past H/O smoking, snuff
• Occupational history—exposure to carcino-
gen at work places like wood dust, textile
fumes, leather industry, our dust, nickel dust,
chromium dust, fumes from rubbing alcohol
radium fume, etc.
10.4.2 Lips andOral Cavity
• Swelling/growth/ulcer present over lips or
subsites of oral cavity
• Red or white patch in the cheek/tongue
• Lump or mass in neck, with or without pain
• Foul mouth odour not explained by hygiene
• Jaw pain
• Untting denture
• Numbness of the mouth or tongue
• Loosening of teeth
• Difculty or pain swallowing, chewing or
moving tongue or jaw
• Trismus
• Pain or bleeding in the mouth
• Associated symptoms or history of tobacco
chewing, sharp jagged tooth, smoking,
Guthakha chewing, reverse smoking
326
10 History andExamination ofHead andNeck (Oncology andBenign Diseases)
10.4.3 Nasopharynx
• Nasal obstruction U/L or B/L or difculty
breathing
• Blood-stained nasal discharge
• Blood in sputum, blood in sputum or saliva
• Numbness or weakness of a body part in the
head and neck region
• Past h/o exposure to Epstein-Barr virus
(EBV), symptoms of lower cranial nerve palsy
10.4.4 Oropharynx
• Red or white patch on the tonsil
• Lump on the neck, or throat or a feeling of
thickening in the cheek
• Persistent sore throat or feeling that something is caught in the throat
• Hoarseness or change in voice
• Difculty chewing, swallowing, or moving
the jaws or tongue
• Ear and/or jaw pain
• Chronic bad breath
• Changes in speech
• Unexplained weight loss
• Fatigue
• Loss of appetite, especially when prolonged;
this may happen during the later stages of the
disease
• Dysphagia
• Odynophagia
• Growth/ulcer/swelling
• Blood in sputum
• Trismus
• Change of voice (hot potato voice or mufed
voice)
• Earache
• Past H/o oral sex (exposure to HPV), smoking, alcohol intake
10.4.5 Laryngeal Tumours
• Change of voice (Hoarseness of voice)—This
is the rst symptoms of glottic carcinoma.
• Dysphagia (difculty in swallowing)—This is
a common symptom of supraglottic
carcinoma.
• Difculty in breathing—This is common
symptoms of subglottic carcinoma.
• Neck swelling/lump
• Long standing cough
• Haemoptysis
• A persistent sore throat
• Dyspnoea/stridor in severe cases
• Associated symptoms of persistent earache
• Unexplained weight loss
• History—smoking, alcohol, neck pain, asbestos, coal wood dust, paint or diesel fumes,
nickel, isopropyl exposure.
10.4.6 Laryngopharyngeal Tumours
• Dysphagia (solid > liquid)—This is a common symptom of laryngopharyngeal
carcinoma.
• Neck swelling—This is due to nodal metastasis and is present in the lower part of neck.
• Blood in sputum—This is usually present in
case of ulero-proliferative growth.
• Painful swallowing (odynophagia)
• Referred earache—This is due to vagus nerve
• Associated symptoms of H/O anaemia, smoking alcohol intake
10.4.7 Oesophageal Tumour
• Progressive dysphagia (solid> liquid)—This
is a common symptoms/complaint of oesophageal tumour.
• Burning, pressure or pain in the chest
• Coughing when drinking liquids
• Pain when swallowing (odynophagia)
• Ear pain (especially on only one side)
• Foreign body sensation
• Extreme weight loss (from lack of eating)
• Regurgitation of food
• Ulceration/growth
– Site—upper part (SCC), middle part
(SCC), lower part (adenocarcinoma), any
part (small cell carcinoma, sarcoma, lymphoma, melanoma, choriocarcinoma)
– Size
• Associated symptoms are hoarseness of voice,
bleeding
10.4 Site-Specic Symptoms ofHead andNeck Carcinoma
327
• History of GERD, smoking, obesity, alcohol
intake, bile reux, achalasia, not having
enough fruits, radiation of chest or upper
abdomen.
10.4.8 Salivary Gland Tumours
• Presentation/History of salivary gland tumour
Parotid gland tumour
– Lump or swelling behind the mandible or
antero-inferior to lobule, retromandibular
area, pre-auricular area, upper part of neck,
lateral wall of oropharynx—This is com-
mon symptom.
– Muscle weakness on one side of face.
– Numbness in part of face or one side of
face.
– Facial nerve paralysis
– Trismus
– Difculty swallowing
– Persistent pain in parotid area
– H/O exposure of low-dose radiation, chronic
exposure to softwood dust, exposure to
chemical in the leather industry—minor
salivary gland tumour (adenocarcinoma).
– Parotid gland—Pleomorphic adenoma
occurs in fth and sixth decades, more
common in female, slow-growing tumour,
h/o smoking for Wartin’s tumour.
Submandibular gland
– Progressive swelling in submandibular tri-
angle—This is a common symptom.
– Paralysis of the marginal mandibular
branch of the facial nerve.
– Paraesthesia over the lower lip or angle of
mouth.
Minor salivary gland
– Commonly seen over hard palate, cheek
and lips
– Solitary swelling/ulceration over the hard
palate—This is a common symptom.
– Paraesthesia over palate
– Dryness of mouth
– Facial pain
– Pain while eating food
– Positive history of radiation, smoking,
exposure to pollutants
Differential diagnosis of tumour of salivary
gland (Table 10.3).
Table 10.3 Differential diagnosis of salivary gland tumour
Parotid gland tumours
Benign Intermediate Malignant tumour
Pleomorphic adenoma
Wartin’s tumour Oncocytoma
Submandibular gland
Benign tumours Malignant tumour
Pleomorphic adenoma, basal cell adenoma, canalicular
adenoma, oncocytoma
Minor salivary gland
Benign tumour Malignant tumour
Pleomorphic adenoma, basal cell adenoma Mucoepidermoid carcinoma, adenoid cystic
Monomorphic adenoma
Basal cell adenoma
Canalicular adenoma
Clear cell adenoma
Mucoepidermoid carcinoma
Carcinoma ex pleomorphic adenoma
Acinic cell carcinoma adenocarcinoma
Actinic cell carcinoma
Adenoid cystic carcinoma
Low grade
Epithelial—Myoepithelial carcinoma
Low grade with poor prognosis
Basal cell adenocarcinoma
Acinic cell carcinoma, adenocarcinoma, adenoid
cystic carcinoma, clear cell carcinoma, malignant
mixed tumour, mucoepidermoid carcinoma
carcinoma, acinar cell carcinoma, epithelial
myoepithelial carcinoma
328
10 History andExamination ofHead andNeck (Oncology andBenign Diseases)
10.4.9 Cutaneous Carcinoma ofHead
andNeck
(a) Presentation/history/chief complaints
• Malignant melanoma—This is presented
as
– A change in character in preexisting
mole, such as a raised or irregular border,
irregular shape, change in colour,
increase in size, itching or bleeding
– A large brown spot over the skin with or
without dark speckled spots
– Dark lesion on skin or mucosa
– A small red, pink, white, blue- or blue-
black lesion with an irregular boarder
• Squamous cell carcinoma
– A rm, red bump on the skin
– Crusted and scaly patches on the skin
– Growths that look like warts
– Sores that bleed, scab, and either don’t
heal or heal and return regularly
• Basal cell carcinoma—It often appears as
a slightly transparent bump on the skin,
though it can take other forms. It occurs
most often on areas of the skin that are
exposed to the sun, such as your head and
neck.
– A shiny, skin-coloured bump that’s
translucent. The bump can look pearly
white or pink on white skin. On brown
and Black skin, the bump often looks
brown or glossy black. Tiny blood vessels might be visible, though they may
be difcult to see on brown and Black
skin. The bump may bleed and scab
over.
– A brown, black or blue lesion—or a
lesion with dark spots—with a slightly
raised, translucent border.
– A at, scaly patch with a raised edge.
Over time, these patches can grow quite
large.
– A white, waxy, scar-like lesion without
a clearly dened border.
• Site of lesion—Scalp (worst prognosis),
ear, cheek, neck, nose, face, forehead,
scalp.
• Lymphadenopathy—Enlarge lymph node
can be present.
• Associated/past H/o
– For cutaneous SCC—UV light from
sunlight, previous H/O SCC, fair skin,
use of tanning bed
– For melanoma—(UV light exposure,
family history, personal characteristic
like fair skin, blond hair, blue eye,
lower socioeconomic status, large congenital nevi, atypical mole syndrome,
xeroderma pigmentosa), preexisting
mole
– For basal cell carcinoma—Long-term
exposure to ultraviolet (UV) radiation
from sunlight, H/O radiation, Fair skin,
family H/O skin cancer, H/o immunosuppressive drugs, naevoid basal cell
carcinoma syndrome (Gorlin Goltz syndrome) and xeroderma pigmentosa.
• Associated symptoms—Neck and head
lymph node swelling indicates tumour
thickness more than 2 mm, actinic
keratosis.
(b) Differential diagnosis
• Melanoma—Melanoma is a malignant
tumour of melanocytes, neural crest
derivatives that contain melaninproducing organelles known as melanosomes. Melanocytes are normally found
in the basal layer of the epidermis but are
also found in the eye, gallbladder, anus,
and vagina, and throughout the upper
aerodigestive tract. ABCDE of melanoma: A refers to asymmetry of the lesion,
B to border irregularity, C to variegated
colour, D to a diameter >6mm and E to
elevation.
• Basal cell carcinoma—It is a tumour of
skin, which arises or develops on exposed
part of skin such as face.
• Cutaneous SCC—This is the second
most common non-melanoma skin cancer
that commonly develops in sun-exposed
areas like face, in old man, H/O exposure
to UVB light (200–320 nm), which is
more carcinogenic.
10.4 Site-Specic Symptoms ofHead andNeck Carcinoma
329
10.4.10 Thyroid andParathyroid:
Discussed inDetail in
Chapter
• Presentation of thyroid
– Differentiated carcinoma lump in neck,
change of voice, dysphagia, lymphadenop-
athy, pain
– Age more than 40. Female gender
– Associated symptoms difculty in breath-
ing, cough
– Family history—thyroid carcinoma, H/O
radiation
• Presentation of parathyroid gland
– Severe fatigue, nephrolithiasis, pathologic
fractures, brown tumours, hypercalcaemic
crises, lump in neck
• Differential diagnosis of thyroid and para-
thyroid gland
– Thyroid gland
– Differentiated carcinoma—papillary carci-
noma, follicular carcinoma
– Undifferentiated carcinoma—anaplastic
carcinoma
10.4.11 Skull Base Tumour:
Discussed in Chapter
• Presentation of skull base tumour
• Differential diagnosis of skull base tumour
10.4.12 Neurogenic Tumour
andParaganglioma ofHead
andNeck
• Neurogenic tumour—The most common
peripheral nerve tumours (PNTs) are benign
schwannomas and neurobromas. One of the
most common sites of schwannomas is the
head and neck region.
– Presentation of various neurogenic
tumour (Table10.4)
– Differential diagnosis/classication of
neurogenic tumour (Table10.5)
• Paragangliomas—Paragangliomas are rare,
usually benign tumours that develop from
cells of the paraganglia. Paraganglia are a collection of cells that came from embryonic nervous tissue and are found near the adrenal
glands and some blood vessels and nerves.
Paragangliomas that develop in the adrenal
gland are called pheochromocytomas. Those
that develop outside of the adrenal glands near
blood vessels or nerves are called glomus
tumours or chemodectomas. Paraganglioma
of head and neck is a rare tumour that often
forms near the carotid artery. It may also form
along the nerve pathway. HNPs are parasympathetic paragangliomas that rarely secrete
active substances. Only 1–3% of HNPs are
vasoactive and associated with elevated catecholamine, such tumours can induce tachycardia, hypertension and sweating attacks
(Table10.6).
• Presentation of Paraganglioma
– General symptoms of paragangli-
oma—The general symptoms are headache, palpitation, ushing, perspiration
and cough.
– Site-specic symptoms of paragangli-
oma.
Ear—Pulsatile tinnitus, bloody otorrhoea,
otalgia, hearing loss, aural fullness and
vertigo.
Nose—Nasal obstruction, snoring, purulent rhinorrhoea, epistaxis, anosmia,
nasal mass, swelling or deviated nasal
pyramid.
Throat—Altered speech, swelling, dysphagia, dyspnoea, mouth breathing, cough,
haemoptysis and aspiration.
Neck (Carotid body tumour)—Neck
swelling, most common above 45 years,
slow growth, pulsatile tinnitus, soft or rm
elastic pulsatile mass, vagal nerve palsy.
Head—Headache, facial paralysis, facial
pain, epiphora, loss of vision.
– Disease-specic symptoms/history of
paraganglioma (Tables 10.7, 10.8, 10.9,
10.10).
330
Table 10.4 Different neurogenic tumours and their presentation
Type of tumour Presentation/history/symptoms
Schwannoma (25–45% of neurogenic tumours
of the head and neck)
Neurobroma (it is a rare tumour) These lesions present as slowly progressive masses that can
Nerve sheath myxoma It is presented as solitary painless swelling in head neck area in
Neuroectodermal tumour It is a benign tumour of neuroectodermal origin usually present
Malignant nerve sheath tumour Pain in the affected area.
Malignant peripheral nerve sheath tumour MPNSTs usually present as an enlarging palpable mass or rapid
Malignant granular cell tumour It is a rare high-grade mesenchymal tumour of Schwan cell
Malignant triton tumour It is a malignant nerve sheath tumour with rhabdomyoblastic
Olfactory neuroblastoma previously called as
esthesioneuroblastoma, olfactory placode
tumour, esthesioneurocytoma,
esthesioneuroepithelioma, and esthesioneuroma
10 History andExamination ofHead andNeck (Oncology andBenign Diseases)
Oral cavity schwannoma—It presents as a slow enlarging
submucosal movable nodule in oral cavity.
Schwannomas of mid-neck are sporadic and present with medial
tonsillar displacement, hoarseness, Horner syndrome
(sympathetic chain).
Sinonasal schwannoma—It presents as nasal obstruction, nasal
mass and anosmia.
either compress to the adjacent vital structures or interfere with
normal physiology.
adolescent, young adult.
in tongue, as slow slow-growing mass.
Weakness when trying to move the affected body part.
A growing lump of tissue under the skin.
enlargement occurs more often in the setting of NF1 and should
raise concern for malignant degeneration of a neurobroma.
Pain is a variable complaint
MPNSTs arising from peripheral nerves may result in a variety
of clinical patterns, including radicular pain, paraesthesia and
motor weakness.
tumour.
It presents in oral mucosa, jaws and salivary gland.
differentiation. It is a rare tumour.
It is a neuroectodermal tumour, presented as unilateral nasal
obstruction, epistaxis, while fewer common symptoms include
headache, pain, excessive lacrimation, rhinorrhoea, anosmia and
visual disturbance. There are isolated case reports of ONB
secreting vasopressin with resultant hypertension and
hyponatraemia.
Table 10.5 Neurogenic tumours
Benign tumour Malignant tumour
Traumatic neuroma
Palisading encapsulated neuroma
Hamartoma—Mucosal neuroma and neuromuscular hamartoma
Neurobroma/neurobromatosis
Schwannoma
Granular cell tumour
Nerve sheath myxoma
Table 10.6 Site-specic paraganglioma
Site-specic paraganglioma of head and neck
Ear—Glomus tympanicum, glomus jugulare
Nose—Sinonasal paraganglioma
Throat—Laryngeal paraganglioma
Neck—Carotid body tumour (intracarotid paraganglioma), vagal paraganglioma
Head—Orbital
MPNST
Olfactory neuroblastoma
Malignant granular cell tumour
Peripheral neuroectodermal tumour
Autonomic nerve tumour
Neuroectodermal tumour (Askin tumour)
Neurobrosarcoma
10.4 Site-Specic Symptoms ofHead andNeck Carcinoma
Table 10.7 Presentation of carotid paraganglioma
Carotid paraganglioma (carotid body tumours)—CBTs arise from paraganglia located within the covering of
the carotid artery bifurcation in the neck.
Presentation of carotid body tumour—CBTs often remain clinically silent before presenting as a painless, slowly
enlarging mass in the lateral neck (at the angle of mandible). The initial symptoms can also be a pulsating mass in
the neck.
Large CBTs may induce dysfunction of the vagal nerve and, less frequently, of cranial nerves IX, XI, and
XII.Occasionally, Horner’s syndrome or decits of the facial nerve may result from extremely large tumours.
Table 10.8 Presentation of vagal paraganglioma
Vagal paragangliomas—Vagal paragangliomas are rare tumours that develop in the retro-styloid compartment of
parapharyngeal space. They arise from paraganglion tissue derived from the neural crest located at the vagus nerve.
Most VPs arise from the glomus nodosum, that is, the inferior ganglion. They either grow in a superior direction or
an inferior direction. Vagal paragangliomas (VPs) are located more cephalad in the neck, between the jugular vein
and the internal carotid artery, sometimes extending to the base of the skull through the jugular foramen or
posterior to the mastoid tip.
Presentation—The symptoms of a VP depend on the location of the tumour along the vagal nerve from the skull
base to the lower neck.
Typically, VPs present with an asymptomatic neck mass behind the angle of the mandible. Other symptoms of VPs
are pulsatile tinnitus or ringing in the ear heard with each heartbeat. At times, this can be heard by placing the
stethoscope over the ear.
Less than 50% of VPs present with decits of cranial nerves, which manifest as hoarseness (X), dysphagia (IX),
shoulder drop (XI), nasal reux of uids, aspiration and hemi atrophy of the tongue (XII).
The intracranial extension, which is the main cause of death, occurs in 22% of the cases.
Oropharyngeal involvement caused by bulging of the pharyngeal wall into the pharyngeal lumen and medial
displacement of the tonsil may occasionally be observed.
VP at jugular foramina can develop into dumb—Bell lesion with both cranial and cervical part.
Lesion at jugular foramina presents as last four cranial nerve paresis whereas lesion at nodose ganglion develop
vagal nerve paresis.
331
Table 10.9 Presentation of tympanic paraganglioma
Laryngeal paraganglioma:
Supraglottic paraganglioma—Lesions in the supraglottis (the more common type) present with hoarseness,
shortness of breath and dysphagia. Hoarseness usually recovers after treatment, and, for this reason, is generally
considered to be due to a mass effect rather than a neurological impairment.
– It represents only 15 per cent of laryngeal paragangliomas and presents with hoarseness, haemoptysis and
dyspnoea due to tracheal obstruction.
Temporal paragangliomas (glomus tumour)—Temporal paragangliomas entail tympanic and jugular
paragangliomas. They arise from structures in close vicinity and are sometimes summarized in one group.
Tympanic paragangliomas (glomus tympanicum)—Tympanic paragangliomas (TPs) are mostly small- sized
tumours originating in the middle ear.
Pulsatile tinnitus—TPs become symptomatic as pulsatile tinnitus in the vast majority of patients.
Hearing loss—Hearing loss is initially present in about half of patients and predominantly conductive in character,
but can be sensorineural if the labyrinth is involved by tumour.
Bleeding form ear—The tympanic membrane can be eroded, leading to a patient presenting with bleeding from
the ear, but this is a late symptom.
332
Table 10.10 Presentation of jugular paraganglioma
Jugular paragangliomas (Glomus Jugulare)—Jugular paragangliomas (JPs) arise from paraganglia in or around
the jugular bulb. Occlusion of venous ow happens when these tumours increase in size. Consequently, venous
blood from the brain shifts toward the unaffected sigmoid sinus and jugular bulb.
Pulsatile tinnitus—It is a frequent and primary symptom.
Conductive hearing loss—It is seen with the progression of the tumour, which either causes impairment of
vibration of the ossicles or invades the bones behind the eardrum. Sensorineural hearing loss and/or dizziness are
reported by patients when the tumour has invaded the inner ear.
Cranial nerve dysfunctions—Occasionally, JPs can cause decits of other cranial nerves and create dysfunctional
swallowing and huskiness of the voice. However, due to the relatively slow growth, the swallowing mechanism and
vocal cord function of the opposite side may initially compensate and mask the disease symptoms.
Facial nerve paralysis—When these tumours grow, they can also invade the facial nerve leading to facial
paralysis, or they can encompass the hypoglossal nerve, leading to paralysis of half of the tongue.
Mass/swelling—Mass in neck little cranial to carotid body tumour site.
Other symptoms—Further growth can lead to compression of the brain and/or brainstem.
10 History andExamination ofHead andNeck (Oncology andBenign Diseases)
10.4.13 Soft Tissue Tumour ofHead
andNeck
• Classication of soft tissue tumours with
presentation
– Benign soft tissue tumour with specic
symptoms/chief complaints (Table10.11)
– Malignant soft tissue tumour (Table10.12)
10.4.14 Bone andOdontogenic
Tumour
(a) Classication of bone and odontogenic
tumour
• Types/classication according to the origin of tumours of bone and odontogenic
(Table10.13)
• Cystic lesion of bone and odontogenic origin (Table10.14)
• Site-specic differential diagnosis of
bone and odontogenic tumour
(Table10.15)
• Age specic bone and odontogenic
tumour (Table10.16)
(b) General presentation of bone and odonto-
genic tumour
• Swelling is the most common symptom
with which patient of odontogenic and
bone tumour presents. Other symptoms
included are trismus, loose teeth, absent
tooth, lump on gum, delayed tooth
eruption.
• Pain—Benign cementoblastoma, malignant odontogenic tumour, osteoblastoma,
osteoid osteoma.
• Paraesthesia or anaesthesia—Malignant
odontogenic tumour.
(c) Site-specic symptoms
• Mandible
– Body—Ameloblastoma (Caucasians),
ameloblastic broma, ameloblastic
brodentinoma, benign cementoblastoma, focal osseous dysplasia
Anterior—Ameloblastoma (Black),
central giant cell granuloma, peri
apical osseous dysplasia, torus
mandibularis
Posterior mandible—Ossifying
broma, central giant cell lesion
– Gingiva—Peripheral ameloblastoma
– Wisdom teeth—Dentigerous cyst
– Any part—Odontogenic myxoma,
Juvenile trabecular ossifying broma
– Condyle and coronoid—Osteochon-
droma
• Maxilla—Fibrous dysplasia, Juvenile
psammomatoid ossifying broma, juvenile trabecular ossifying broma.
• Sinonasal—Juvenile sesamoid ossifying
broma, osteoma.
• Both—Odontogenic broma, brous
dysplasia, orid osseous dysplasia, familial gigantiform dysplasia, cherubism,
osteoblastoma.
• Palatal—Torus palatinus.