Common Neck Swellings

Dr. Shaheer

Presentations

Midline swelling

Solid

1. Submental lymph nodes
2. Adenoma of thyroid isthmus
3. Calcular disease (Sialolithiasis)

Cystic

• Ranula
• Sublingual, Cervical Dermoid Cyst
• Thyroglossal cyst
• Thyroglossal Fistula

Lateral Swellings

Solid

• Carotid Body Tumour
• Sternomastoid tumor
• Cervical Lymphadenopathy
• Salivary gland swellings - Viral
• Bacterial Infection
• Lipoma
• Thyroid swelling

Cystic

• Branchial cyst
• Cold Abscess
• Cystic Hygroma
• Pharyngeal Pouch

Investigations (General for neck swellings) :

• CBC, Serology, Tuberculin
• Thyroid function (TSH, T3, T4, Antibody) (very important)
• CXR, U/S, CT scan, MRI, Angio.
• FNAC
• Laryngoscopy, Endoscopy (preop, to check if both vocal cords are functioning or not)
• Open biopsy

Anatomy:

The anterior triangle is situated at the front of the neck.

• It is bounded:
  • Superiorly
    • Inferior border of the mandible (jawbone).
  • Laterally
    • Anterior border of the sternocleidomastoid.
  • Medially
    • Sagittal line down the midline of the neck from the chin to the manubrium.

The posterior triangle is situated posterior to SCM

• Its boundaries are as follows:
  • Anterior
    • Posterior border of the SCM.
  • Posterior
    • Anterior border of the trapezius muscle.
  • Inferior
    • Middle 1/3 of the clavicle.

• Which triangle of the neck is involved

• Does it move with swallowing? This indicates it is deep to the pretracheal fascia and likely to be thyroid. (thyroid, lymph nodes pretracheal fascia)

• Does it move with protrusion of the tongue? This applies to upper anterior neck lumps, and the physical sign refers to thyroglossal cysts.

Objectives

• Triangles of the neck, & lymph node distribution
• Clinical presentations, investigation, & management of common neck swellings
• Differentiate the presenting features, use of different investigations and management of neck swellings