Benign+Pterygium

Deep parotid lymph nodes which can be broken down into 2 groups: The first group is embedded in the parotid gland. Its superior border is the TMJ, posterior border is the mastoid process, inferior border is the angle of the mandible, and the anterior border is the anterior ramus. The second group is the subparotid nodes which are located deep to the gland and lie on the lateral wall of the pharynx. Submaxillary lymph nodes which are scattered over the infraorbital region. They are located from the groove between the nose and cheek to the zygomatic arch.
 * **Epidemiolgy:** || Pterygium is a condition of the eye where a wedge shaped vascular section of the conjunctiva grows toward and can grow over the cornea.3 ||
 * **Etiology:** || Ultra-violet light is the main factor causing physical changes in the exposed conjunctiva, which grows onto the cornea. For this reason individuals exposed to the sun for long periods of time as well as populations closest to the equator are at a higher risk.3 ||
 * **Signs & Symptoms:** || * Pink spot, or pinkish appearance of the eye
 * Irritation
 * Watering
 * Foreign body sensation3 ||
 * **Diagnostic Procedures:** || Imaging Studies1 * Corneal topography can be very useful in determining the degree of irregular astigmatism induced by advanced pterygia.
 * External photography can assist the ophthalmologist in following the progression of the pterygium. ||
 * **Histology:** || Squamous Cell Carcinoma, Conjunctival1 ||
 * **Lymph node drainage:** || Lymph drainage from the eye is:2

 Buccal lymph nodes which are scattered over the buccinator muscle. ||
 * **Metastatic spread:** || Pterygium is a benign process and while it will recur, it does not metastasize.3 ||
 * **Grading:** || There is not a staging or grading system for this benign disease. Early symptoms of a pterygium include eye irritation.3 ||
 * **Staging:** || There is not a staging or grading system for this benign disease. Early symptoms of a pterygium include eye irritation.3 ||
 * **Radiation side effects:** || Common side effects of radiation therapy for pterygium include conjunctival irritation, corneal, ulceration, scleral thinning, granuloma formation, and telangiectasia formation. 4 The rate of serious complications from irradiation is low .4 ||
 * **Prognosis:** || Pterygium is not considered to be life threatening. ||
 * **Treatments:** || Various surgical (keratectomy, conjunctival grafts) and medical therapies along with postoperative radiation have been used to reduce recurrence rates. 4 Radiation is normally applied via a strontium-90 applicator. The applicator is applied directly to the surgical bed with a 1 to 2 millimeter margin. 4 Dose-fractionation schemes vary, and vary from 18 Gy in one fraction, to 60 Gy in 6 fractions. 4 ||
 * **TD 5/5:** || There is no TD 5/5 associated with pterygium . ||
 * **References:** || # Pterygium. Medscape Reference. Available at: []. Accessed on: June 3, 2012.
 * 1) Washington CM, Leaver D. Principles and Practice of Radiation Therapy. 2nd edition. St. Louis, MO: Mosby, Inc. 2004: 389.
 * 2) WordPress. Pterygium. Available at: []. Accessed July 5, 2012.
 * 3) Hoppe RT, Phillips TL, Mack III M. Leibel and Phillips Textbook of Radiation Oncology. 3rd ed. Philadelphia Pa: Elsevier Saunders; 2010. ||

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