Neck Swellings Final .
Neck Swellings Final .
Neck Swellings Final .
Neck swellings can be classified into midline and lateral neck swellings.
A) Dermoid cyst :
It may present anywhere along the midline (below or above mylohyoid
muscle)
It can be sub divided into epidermoid, true dermoid or teratoid type.
It usually presents between 10-25 years of age.
Incidence: Male = female
Clinically: smooth, spherical, opaque, fluctuant, and clearly defined
if infected Painful
Treatment: Surgical Excision
B) Sub-Hyoid bursitis:
Affecting old age group
Presents at the lower border of the hyoid bone.
Mobile with tongue protrusion
Translucent
D) Thyroglossal cyst:
Presents in children and young age
Females > males
Sites: Sub-hyoid (most common site)
Supra-hyoid, pre-tracheal
Clinical picture: Painless lump, mobile with tongue protrusion
spherical, smooth, well defined
cystic fluctuant swelling
translucent
Not tender and No hotness except if infected
may be complicated by fistula formation
Malignant transformation is rare (papillary type)
Treatment:
Sis-Trunk operation a) Removal of the cyst.
b) Removal of the tract.
c) Removal of central part of the hyoid bone.
d) Removal of core of tissues up to foramen
cecum.
N. B: Thyroglossal fistula is an acquired fistula. It is never congenital.
A) Lymphadenopathy:
Most common.
In children, it is mainly due to inflammatory causes due to recurrent
respiratory tract infections.
May be local disease in the neck or generalized disease as lymphoma.
Virchow’s lymph node (Troisier's sign) enlarged left supra-clavicular
lymph node level lV (metastatic from intra-abdominal malignancies).
Ultrasonographic features of malignant lymph node:
a) Globular in shape
b) Distorted or lost hilum
c) irregular
d) internal necrosis.
CT scan Extracapsular invasion, more accurate than US in assessment of
level VII.
Biopsy is a very important investigatory tool. US guided FNAC, Core biopsy
or Excisional biopsy may be done.
C) Schwannoma:
It is a benign tumor of the neurolemmal sheath.
It may arise from Vagus nerve, sympathetic chain,
glossopharyngeal nerve, or any nerve in the neck.
Clinically: Painless lump
may cause compression manifestations as
hoarseness of voice , dysphagia
Smooth, encapsulated, firm and mobile side to side
more than up and down
Treatment: surgical excision.
D) Sternomastoid tumor:
It is an arterial insult that occurs during birth.
It is not a congenital tumor.
It may lead to congenital torticollis.
Clinically: noticed at birth or 3-4 weeks of life
history of difficult labor
child’s head turned to one side
swelling in middle third of SCM muscle
fusiform in shape with smooth surface
Squint may be present
Treatment:
a) Physiotherapy.
b) Tenotomy sternomastoid is cut at its sternal end followed
by usage of a collar for few weeks.
c) Z- myoplasty may be needed.
A) Pyogenic abscess:
Painful and tender swelling
Skin is red and hot.
Signs of toxemia may be present.
Treatment incision and drainage + Antibiotics.
B) Branchial cyst:
Presents in adult age group.
congenital anomaly of the 2nd branchial arch.
The cyst is lined by stratified squamous epithelium.
The cyst is filled with fluid rich in cholesterol and mucoid
material.
Clinically: 15-25 y
male = female
painless swelling deep to the anterior
Border of sternomastoid (upper 1/3).
unilateral, smooth surface, ovoid in shape.
No tenderness unless cyst is inflamed
Trans-opaque
Complications:
A) abscess formation fistula formation.
B) Branchogenic carcinoma (SCC) is rare.
Treatment surgical excision.
if inflamed with abscess formation
incision and drainage + antibiotics.
c) Ludwig's Angina:
Rare surgical emergency ( serious connective tissue infection of the floor of the
mouth and/ or submandibular glands.
Mostly due to dental infections
Treatment immediate surgical intervention (drainage of pus + antibiotics).