Neck Swellings

WWW.SMSO.NET
WWW.SMSO.NET
 Midline swellings

 Median dermoid
 Submental lymph node

 Thyroglossal cyst

 Pretracheal lymph node

 Thyroid

WWW.SMSO.NET
 Lateral neck swellings
 Chemodectoma (carotid body tumor)
 Sternomastoid tumor

 Branchial cyst

 Pharyngeal pouch

 Lymph node

 Thyroid

 Cystic hygroma

WWW.SMSO.NET
Branchial cyst
 Five branchial clefts
 1st forms external auditory meatus
 2,3,4 disappear
 Vestigial remnants of second
branchial cleft
 The cyst is lined by Squamous
epithelium
 Contain Thick , turbid cholesterol laden fluid

WWW.SMSO.NET
 Clinical picture
 Upper neck – early or, middle adulthood
 Junction of upper third and middle third of
anterior border of sternomastoid
 Fluctuant, soft , transilluminant
 Infection –causing reddness, and tenderness
 Diagnosis- USG,CT SCAN, MRI, FNAC
 Treatment – Surgical Excision

WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
Carotid Body tumor
 Neurogenic tumor, mainly in high altitude
 Chronic hypoxia –carotid body hyperplasia
 5th decade, 10% - family history
 Usually benign

 Long history, firm, rubbery,

pulsatile, emptied but refill slowly

WWW.SMSO.NET
Carotid body tumor
 Bruit +, displace tonsil medially
 Investigations- carotid angiogram,
carotid splay, carotid blush, MRI
 Aspiration or Biopsy is CONTRAINDICATED
 Rarely metastasize, slow growing-
Treatment is surgery,
 No radiotherapy

WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
Ludwig’s angina
 Brawny submandibular swelling
 Inflammatory swelling of mouth
 Cervical and intraoral – putrid halitosis Feature
 Virulent streptococci+ anaerobic
 Associated with Ca oral cavity
 Tongue displaced up – dysphagia,
airway obstruction

WWW.SMSO.NET
Ludwig’s angina
 Control infection – do not let
cellulitis go into the neck below
fascia to larynx – glottic oedema
 Treatment- IV broad spectrum AB,
combined with metronidazole
 Curved submental incision to drain
submental triangle, cut myelohyoid
 Tracheostomy – if needed

WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
Thyroglossal cyst
 Congenital- thyroglossal tract
 Sites – subhyoid, thyroid cartilage,
above hyoid bone
 Midline mass, moves with tongue
protrusion and swallowing
 Attached to foramen caecum
 Infection common- fistula
 Tract + hyoid bone + cyst – Sistrunk operation

WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
Cystic hygroma
 Neonate, early life –obstructed labour
 Swelling – neck face, parotid area
 Tongue, floor of mouth
 Soft, partially compressible,brilliantly
tranilluminant

WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
Cystic hygroma
 Less common sites- groin,axilla,
medistinum, cheek
 Aspiration needed in growing
hygromas- clear lymph, multilocular
 Infection – spontaneous regression
 Surgery, sclerotherapy reduces it

WWW.SMSO.NET
WWW.SMSO.NET
Cervical lymphadenopathy
 Inflammatory –reactive hyperplasia
 Infective

 Viral-inf mononucleosis, HIV

 Bacterial-Strep, staph, actinomycosis,
Tubercular
 Protozoa – toxoplasmosis
 Neoplastic –lymphoma, secondary.

WWW.SMSO.NET
Cervical lymphadenitis
 300/800 LN in the neck
 Infection- oral, nasal,pharynx,
larynx, ear, scalp,face

WWW.SMSO.NET
Acute lymphadenitis
 Enlarged, tender, fever, malaise
 Tonsillitis, dental infection/abscess

 Antibiotics- drainage

WWW.SMSO.NET
WWW.SMSO.NET
Chronic lymphadenitis
 Chronic, painless-TB, Ca, lymphoma, HIV
 Exclude primary lesion
 FNAC

WWW.SMSO.NET
WWW.SMSO.NET
Tubercular Lymphadenitis
 Children, young adults
 Deep cervical nodes – matting

 Bovine, human TB bacilli –tonsil

 Primary focus – lung

 Caseated nodes – cold abscess- collar stud abscess- cheesy material

 excision-
 ATT x 6-8 mon

WWW.SMSO.NET
Goiter (enlargement of thyroid)

 Solitary nodule, Nodular goiter,

diffuse hyperplastic
 Pain, sudden increase – bleeding

 Tracheal obstruction- airway

WWW.SMSO.NET
WWW.SMSO.NET
Thyroid function tests
 T3, T4 , TSH, free T3, freeT4, TRH
 Isotope scanning

 Thyroid autuantibodies

 Other – FNAC, USG, CT/ MRI scan

 Indirect laryngoscopy, trucut biopsy

WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
Complications
 Secondary thyrotoxicosis-30%
 Carcinoma –follicular

 Treatment- iodised salt, surgery,

supresssing dose of thyroxin
 Solitary nodule – TFT, AB, Isotope
scan, USG, FNAC, CT/MR

WWW.SMSO.NET
WWW.SMSO.NET
Thyrotoxicosis
 Diffuse Toxic goiter
 Toxic nodular goiter

 Toxic nodule

WWW.SMSO.NET
Thyrotoxicosis-Clinical features

 Tiredness, emotional lability, heat

intolerance, wt loss, good apetite
 Palpitations, moist
palms,exophthalmos, lidretraction,
agitation, bruit and goiter
 Signs –eye, pretibial myxedema

 Inv- TFT

WWW.SMSO.NET
WWW.SMSO.NET
WWW.SMSO.NET
Treatment
 Antithyroid drugs,
 surgery,

 radioiodine

WWW.SMSO.NET
Tumors of thyroid
 Benign – adenoma –follicular
 Malignant- Papillary 60%, Follicular
20%, Anaplastic 10%
 Medularry Ca – 5%, Malignant
lymphoma-5%

WWW.SMSO.NET
Diagnosis thyroid Ca
 Clinical
 FNAC

 Low risk - < 40 yrs, men,<50

women, no metastasis, <5cm
tumor, old, intra capsular
 High risk – distant mets, old,
extrathyroid spread, > 5cm tumor

WWW.SMSO.NET
Carcinoma thyroid-treatment
 Surgery
 Thyroxin, Radioiodine mets

 Measure – thyroglobulin- FU and to

detect mets

WWW.SMSO.NET
WWW.SMSO.NET
Thanks

WWW.SMSO.NET