NECK SWELLINGS

Neck Lumps
ANTERIOR TRIANGLE Bounded by the mandible superiorly, midline medially, anterior border of sternocleido mastoid laterally POSTERIOR TRIANGLE bounded by posterior border of sternocleido mastoid anteriorly, anterior border of trapezius laterally, clavivle inferior MIDLINE anterior area of neck, between 2 triangle from submental region superiorly to manubrium inferiorly

causes of neck lumps

most common cause is cervical lymphadenopathy from viral infection,Metastatic tumour,Primary Reticuloses,Sarcoidosis
ANTERIOR TRIANGLE
Thyroid thyroglossal cyst dermanoid cyst sebaceous cyst, lipoma

POSTERIOR TRIANGLE
lymph nodes salivary glands branchial cyst sebaceous cyst, lipoma

MIDLINE
lymph nodes cytic hygroma

sebaceous cyst, lipoma

Infection
Acute - Non specific tonsillitis - Glandular fever(EBV) Chronic - Toxoplasmosis - Tuberculosis - HIV Symptoms : painful lump, URTI Site : mostly on upper deep cervical LN Tenderness and temperature : tender + warm Shape : spherical Consistency : firm, discrete

Malignancy
Primary - papillary ca. of thyroid - squamous ca. of nasopharynx, oropharynx, larynx and paranasal sinus - squamous ca. of mouth and tongue Secondary - tumour from chest and abdomen Age : > 50 yrs old, common in men Sy : painless lump, grow slowly, new lumps may appears, lung and intraabdominal Ca causing anorexis and loss of weight Si : depends on site of ca. TT : non tender or warm Sh : vary in size and shape Co : stony hard

Anterior Triangle Swelling

LYMPH NODES lymphadenopathy ( infective, malignant, haematological) History fever, weight loss hoarseness, cough , dyspnoea recent travel, recent immigrate, sore throat

Examination solitary/ localised other lymph nodes hepatosplenomegaly position of lymph nodes Investigation lymph nodes biopsy bone marrow aspiration chest Xray Ent cytological examination

SALIVARY GLANDS present as submandibular and parotid glands swelling Causes : stones in the duct, benign tumours, infection examination mouth : feel the duct in the floor of mouth for stones investigation Xray of the floor of mouth Treatment excision of stone FNA

BRACHIAL CYST patient will complained of half filled hot water bottles FNA - pus material is obtained ( cholesterol crytals )

Posterior Triangle Swelling

LYMPH NODES symptoms and treatment same as in the anterior triangle CYSTIC HYGROMA swelling in early childhood, gives sign of transluminable, grow large and cause pressure

MIDLINE
History does it move with swallowing? - thyroid does it move when sticking out the tongue? - thyroglossal cyst not moving with swallowing/ sticking out tongue? - dermoid cyst

Thyroglossal Cyst
fibrous cyst that forms from a persistent thyroglossal duct Cyst may occur at any point commonly below hyoid bone Cyst results of persistence of small amount of epithelium that continues to secrete mucus Age : 15 30 yrs old, common in Female Sym: painless lump, symptomatic if infected Moves upward when tongue is protuded

Si : midline, below hyoid bone TT : tender + warm if infected Sh : spherical Sz : 0.5 5 cm Su : smooth + clearly defined edge Co : firm or hard, fluctuate, some transalluminate Treated with surgical removal

Branchial Cyst
It arises from embryonic remnants of the 2nd branchial cleft Age : early age 15 25 yrs old, also middle age of 40s Sym : painless swelling in upper lateral part of neck, painful when 1st appears if infected severe throbbing pain, worsen by moving neck + opening mouth

Si : beneath upper third of sternomastoid ms, bulges forward TT : tender + warm if inflamed Sh : ovoid Si : 5 10 cm Su : smooth + edge distinct Co : most are hard, fluctuate, transalluminate in some cysts, cant reduce or compressed Treated with surgical excision, inflamed cysts may required percutaneous drainage