Neck

ENT

• Neck Anatomy

Differential Diagnosis of Neck Swelling

Definition Any abnormal enlargement, swelling, or growth between the clavicles and mandible.

• Midline swelling

• Lateral swellings

• Submental & submandibular LN swellings

• Submandibular salivary gland swelling

• Swellings in the posterior triangle

• Other swelling that may arise anywhere

  In addition, swellings of the skin and subcutaneous tissue are common in the neck and should be put in mind. They are added to any of the previous lists.
  1. Lipomas.
  2. Sebaceous cysts.
  3. Haemangioma

The Differential Diagnosis of Neck Masses

HISTORY

• Symptoms (timing is everything)
  • Onset , course ,Duration, recent changes, associated symptoms, sick contacts, recent travel, previous surgery
• Associated symptoms
  • Fever, dysphagia, weight loss, otalgia, hearing loss, respiratory difficulty, night sweats
• Past medical/surgical history, allergies, medications, family history
• Social history - Alcohol, tobacco, drugs, occupation

PHYSICAL

• Full head and neck exam
  • Skin
  • Ears
  • Mouth/oropharynx
    • Look at the tongue and tonsils
  • Nose and nasopharynx
  • Neck
    • Characterize the mass!
    • Tender, mobile, firm, move with swallowing, overlying skin changes, other lesions
  • Neurologic
    • Full cranial nerve exam

Diagnostic imaging

• Ultrasound (US)

  • Helpful with children because no sedation needed, inexpensive, avoid ionizing radiation, useful for soft tissue imaging, cystic vs solid, thyroid
  • bad for invasion or bone

• Computed Tomography (CT)

  • Soft tissue and bone
  • iodinated IV contrast
  • Ideal study for neck mass (CT neck with contrast) – CT without contrast almost useless

• Magnetic Resonance Imaging (MRI)
  • Superior soft tissue
  • less available, more expensive
  • Often complementary with CT
  • Radionuclide, angiography, plain radiography

Tissue Diagnosis

• Fine needle aspiration (FNA) biopsy
  • Sens/spec 97%
  • Enhanced with ultrasound
  • Always before an open procedure
  • Cytology and culture
  • If unsuccessful or inconclusive, repeat before an open procedure
  • If failed again, core needle biopsy
  • Open biopsy as last resort
    • Incisional or Excisional biopsy

---

---

Clinical Medicine

• Ranula

• Sublingual , Cervical Dermoid Cyst

• Thyroglossal cyst (tubuloembryonic Dermoid cyst)

• Branchial cyst

• Cystic Hygroma

• Cold Abscess

• Cervical Lymphadenopathy

• Carotid Body Tumour

• Salivary gland swellings

• Calcular disease (Sialolithiasis)

• Thyroid diseases