Head and Neck Surgery

A 25-year-old woman presents with a swelling located at the anterior border of the sternocleidomastoid muscle. The swelling is intermittent, and on examination, it is soft and fluctuant. What is the most likely diagnosis?

A 54-year-old woman with a history of a slowly growing parotid mass presents to the clinic with a sudden onset of facial weakness on the right side of her face. The facial weakness has progressively worsened over the past 48 hours. The patient reports that she previously underwent excision of a similar lesion from the same area five years ago, but it recurred gradually over the past year. On examination, the patient has right-sided facial nerve palsy affecting the upper and lower face, and there is tenderness along the preauricular region. A firm, mobile mass is palpable deep to the preauricular skin. The mass is not fixed to underlying structures. An ultrasound of the mass reveals a well-defined, heterogeneous lesion with both solid and cystic components. The patient is scheduled for repeat excision, and the histological report indicates a biphasic appearance with mucinous connective tissue. What is the most likely underlying diagnosis?

A 21-year-old man is brought to the emergency department after sustaining a blow to the head during a soccer match. He complains of weakness on one side of his face, particularly around the mouth and eyelid. On examination, he demonstrates right-sided facial nerve palsy with an inability to close the right eyelid completely and facial asymmetry during smiling. In addition, he is noted to have a watery, clear discharge coming from his right nostril. There is no history of loss of consciousness or other neurological deficits. The patient denies any prior history of similar symptoms. What is the most likely cause of these findings?

A 56-year-old man presents to the clinic with a 3-month history of episodic facial pain and discomfort while eating. He notes that the pain tends to intensify with meals, particularly when consuming acidic foods. The patient has also noticed an increase in his halitosis and a persistent dry mouth. On examination, a smooth swelling is palpable just beneath the right side of his mandible, in the area of the submandibular gland. The swelling is firm, non-tender, and slightly fluctuant. There are no signs of infection or facial nerve involvement. What is the most likely underlying diagnosis?

A 4-year-old child is brought to the clinic by his father, who is concerned about a small defect located anterior to the left ear. The father reports that the child has had foul-smelling discharge from this area for the past 2 days. On examination, there is an epithelial defect near the preauricular area, with some discharge noted. The child is otherwise well, with no signs of fever or systemic illness. What is the most likely explanation for this condition?

A 78-year-old man is referred to the clinic by his general practitioner. For many years, he has noticed a smooth swelling approximately 2 cm anterior to the tragus of his right ear. Apart from being a heavy smoker, he has no other comorbidities. What is the most likely diagnosis?

A 52-year-old woman with a 10-year history of rheumatoid arthritis presents to her dentist for evaluation of recurrent dental infections. She complains of persistent dry mouth, which has worsened over the past few months, and she has noticed increased difficulty in swallowing food. On examination, the dentist observes symmetrical enlargement of both the parotid and submandibular glands. The patient denies any recent weight loss, fever, or night sweats, but she has a history of mild dry eyes and difficulty wearing contact lenses. Given her autoimmune background and the clinical findings, what is the most likely diagnosis?

A 9-year-old child undergoes a routine tonsillectomy due to recurrent tonsillitis. The first 24 hours following the surgery are uneventful, and the child is stable, with no signs of bleeding. The child is discharged the following day with instructions to return if any unusual symptoms develop. Four days later, the child presents with fresh bleeding from the throat and is taken to the emergency department. The family reports no significant symptoms on day 3 post-surgery. What is the most likely time frame for the secondary hemorrhage to occur?

A 43-year-old woman presents to the clinic with a history of chronic ear discharge from her right ear. Over the past few months, she has noticed gradual weakness of the right side of her face, which has progressively worsened. On examination, foul-smelling fluid is noted draining from the right ear, and the patient has a complete right-sided facial nerve palsy. There is no history of head trauma or stroke-like symptoms. Based on her clinical presentation, what is the most likely diagnosis?

A 42-year-old professional singer undergoes thyroidectomy due to a thyroid nodule. Following the surgery, the patient experiences acute difficulty speaking and develops stridor. On examination, the patient is unable to produce normal vocalizations, and breathing becomes labored. Given the surgical context and the symptoms, what is the most likely cause of these post-operative complications?

A 40-year-old woman presents to the emergency department with a painful mass located underneath her right mandible. The mass has developed over the past week, with the pain intensifying as the lump has increased in size. On examination, a 4cm mass is palpable beneath the mandible, and there is no associated lymphadenopathy. Given the symptoms and clinical findings, what is the most likely diagnosis?

A 4-year-old girl is brought to the general practitioner by her mother. She has been in distress due to ear pain for the past 14 hours. The child is constantly touching and pulling at her ear. While waiting in the reception area, the mother notices a discharge of foul-smelling fluid from the ear, after which the pain resolves. Based on these clinical signs, what is the most likely cause?

A child is brought to the emergency department with complaints of a headache and a sensation of pressure between the eyes. Upon examination, the child is febrile and has a smooth swelling over the superomedial aspect of the right eye. The eye is uncomfortable, and there is purulent discharge from the inner canthus. Based on these symptoms and physical findings, what is the most likely cause of this child’s condition?

A 56-year-old man presents with nasal pain, anosmia (loss of smell), and rhinorrhea (nasal discharge). He has been otherwise healthy until recently and has worked as a wood carver for many years. Given his occupation and current symptoms, what is the most likely diagnosis?

A 18-year-old male presents to the emergency department with a history of sudden-onset severe abdominal pain, nausea, and vomiting for the past 24 hours. He also reports bilateral swelling of his cheeks, which has been progressively painful over the last 12 hours. The patient mentions that he recently attended a family gathering where he had close contact with a cousin who had similar symptoms a few days ago. Upon examination, the patient has noticeable swelling in both parotid glands, which is tender to palpation. He also shows signs of mild fever. Blood work reveals elevated pancreatic enzymes (amylase and lipase). Given these clinical features, what is the most likely underlying cause?

A 53-year-old male presents with a slowly enlarging mass located just inferior to the tragus of his right ear. The mass has been present for several months and is not associated with any significant pain. An ultrasound (USS) and fine needle aspiration (FNA) are performed, revealing a 2 cm pleomorphic adenoma. What is the most appropriate course of action for managing this patient?

A 50-year-old female presents with complaints of bilateral parotid gland swelling and symptoms of a dry mouth. On examination, she is found to have bilateral facial nerve palsies. After receiving steroid treatment, her symptoms improve significantly. What is the most likely underlying diagnosis?

A 74-year-old diabetic male with a history of poorly controlled blood sugar presents to the emergency department with a 3-day history of severe, deep-seated pain in his right ear. He describes the pain as throbbing and constant, worse at night, and radiating to his jaw and the back of his head. He also reports weakness and drooping of the right side of his face, which has progressively worsened over the last 24 hours. Despite being treated with amoxicillin for a suspected ear infection, there has been no relief in his symptoms. He is also diabetic, and his blood glucose levels have been erratic. On examination, his right ear canal appears swollen with signs of erythema, and there is a partial facial nerve palsy on the right side. There is no history of trauma, and no vesicular rash is noted around the ear. What is the most likely diagnosis?

A 1-year-old child is brought to the clinic by his parents who are concerned about a lump that has appeared on his neck over the past few days. The swelling is located in the posterior triangle of the neck and appears to transilluminate when a light is shone through it. The child does not have a fever, and there are no signs of respiratory distress or systemic illness. On physical examination, the lump is soft, fluctuant, and non-tender. What is the most likely diagnosis?

A 32-year-old woman presents to the clinic with a history of recurrent neck infections and abscesses. She has noticed a lump in the midline of her neck for several years, but it has become more prominent and troublesome recently due to multiple episodes of inflammation and infection. On examination, there is a palpable mass in the midline of the neck, covered by an overlying scab. Notably, the mass moves upwards when the patient protrudes her tongue. What is the most likely diagnosis?

A 34-year-old woman presents with a long-standing history of offensive ear discharge and a noticeable reduction in her hearing. On examination, the hearing loss is found to be 40 decibels compared to the opposite ear. The discharge has been persistent, and the patient is concerned about the odor. What is the most likely diagnosis?

A 40-year-old professional singer undergoes a right thyroid lobectomy. After the surgery, she notices difficulty in singing high notes, which she could previously perform with ease. What is the most likely muscle to be affected, leading to this issue?

A 22-year-old man presents to the clinic with complaints of increasing lethargy over the past few weeks. He is also experiencing bilateral facial nerve palsy, with a noticeable weakness in both sides of his face. On examination, bilateral parotid gland enlargement is noted. The swelling is soft and non-tender, with no discrete masses palpable. The patient has no history of trauma or recent infections. Given his presentation with bilateral facial nerve palsy and parotid gland enlargement, what is the most likely underlying diagnosis?

A 42-year-old professional singer undergoes a thyroidectomy. Post-operatively, she is only able to produce a gargling sound and her voice sounds breathy. What is the most likely explanation for her symptoms?

A 10-year-old girl presents with a history of recurrent epistaxis over the past several weeks. Her parents report that the episodes are often spontaneous and are accompanied by mild discomfort. Upon examination, the bleeding is noted to originate from the front part of the nasal cavity. The child is otherwise healthy and has no history of bleeding disorders. Based on the examination and typical presentation, which area is most likely the source of the bleeding?

A 50-year-old woman presents with a progressive, diffuse swelling in the right parotid region that has been associated with increasing facial pain over the past few weeks. On examination, she is noted to have right-sided facial nerve palsy. The swelling is firm, and there is tenderness in the area. What is the most likely underlying cause of her symptoms?

A 25-year-old woman presents with a slowly enlarging mass on the side of her face. The mass is located in the tail of the parotid gland, and she reports that it has been growing gradually over the past few months. On clinical examination, there is no evidence of facial nerve involvement, and the mass is smooth, firm, and mobile. What is the most likely cause of this mass?

A 45-year-old man presents with a facial swelling. On examination, the swelling is located inferolaterally to the nose. When the area is palpated, it feels as though the underlying bone is cracking. What is the most likely diagnosis?

A 56-year-old man presents with a painless swelling in the upper part of the anterior triangle of his neck. On examination, a mass lesion involving the submandibular gland is identified. A CT scan confirms the presence of a solid lesion without any regional lymphadenopathy. Two fine needle aspirates have failed to be diagnostic. What is the most appropriate management option?

A 45-year-old man presents with painless bilateral parotid enlargement. After performing a thorough history and examination, the physician considers several potential causes for this condition. Which of the following is least likely to cause parotid enlargement?

A 35-year-old man presents with a painless swelling in the anterior triangle of his neck. The lump has been present for several months and does not move on swallowing. Upon further investigation, the physician considers the possibility of a branchial cyst. Which of the following statements about branchial cysts is untrue?

A 50-year-old woman presents to the clinic with complaints of a persistent dry mouth that has been bothering her for the past few months. She also describes a sensation of grittiness in her eyes, especially in the morning. On examination, there is noticeable diffuse swelling of both parotid glands. The swelling is non-tender and there is no evidence of facial nerve involvement. The patient reports no significant systemic illness or recent infections. She is postmenopausal and does not have a history of trauma or surgery to the area. Based on her symptoms and clinical examination findings, what is the most likely underlying diagnosis?