A Pain in the Neck 7 th Annual Pediatric Otolaryngology Symposium October 4, 2012 Melissa M Dziedzic APRN, CORLN.

A Pain in the A Pain in the NeckNeck77thth Annual Annual

Pediatric Otolaryngology Pediatric Otolaryngology SymposiumSymposium

October 4, 2012October 4, 2012Melissa M Dziedzic APRN, Melissa M Dziedzic APRN,

CORLNCORLN

This is LauraThis is Laura

Both inside…..Both inside…..

……and outand out

HistoryHistory

10 day h/o right sided neck mass with 10 day h/o right sided neck mass with painpain

Started with swelling underneath the Started with swelling underneath the tonguetongue

No fever or preceding illnessNo fever or preceding illness Decreasing tenderness-using AdvilDecreasing tenderness-using Advil Affecting ability to eatAffecting ability to eat Evaluated by her PCP and prescribed Evaluated by her PCP and prescribed

AugmentinAugmentin

Physical ExaminationPhysical Examination

Swelling on the right side of her neckSwelling on the right side of her neck Soft palpable mass in the right sublingual Soft palpable mass in the right sublingual

area (tender)area (tender) Semi-firm mobile mass in the right Semi-firm mobile mass in the right

submandibular area (tender)submandibular area (tender)

Diagnosis: Sialectasis vs Infected RanulaDiagnosis: Sialectasis vs Infected Ranula Plan: Extend Augmentin and add heat,Plan: Extend Augmentin and add heat,

massage and sialogoguesmassage and sialogogues

2 weeks later…2 weeks later…

MRIMRI

RanulaRanula

Cyst underneath the tongue Cyst underneath the tongue

formed when the salivary formed when the salivary

duct is obstructed duct is obstructed Commonly d/t trauma>secretory back Commonly d/t trauma>secretory back

pressure >acini rupture>mucous pressure >acini rupture>mucous extravasation >cystic formationextravasation >cystic formation

Most frequently stems from sublingual Most frequently stems from sublingual glandgland

Normally above mylohyoid muscleNormally above mylohyoid muscle

Excision of the RanulaExcision of the Ranula

Postoperative CarePostoperative Care

Pain ManagementPain Management Oral AntibioticsOral Antibiotics Antibiotic RinsesAntibiotic Rinses No Diet RestrictionsNo Diet Restrictions No Activity RestrictionsNo Activity Restrictions

Postoperative Visit Postoperative Visit

Questions?Questions?