Neck masses

Presented by
Group B1
 Introduction
 Neck Anatomy:
It is a part of bady between occipital and clavicle bone
Boundaries
 anteriorly by Midian line
 posteriorly by anterior border of trapezius muscle
 superiorly by Base of mandible,lining join angle of mandible to
mastoid process
 inferiorly by Clavicle bone
Neck masses:

 Any abnormal enlargement, sweeling ,or growth form the level of

base of skull to clavicle
Neck masses can be divided into
Congenital
Acqiured
 Classification
Neck masses

Congenital Acquired
Inflammatory
Midline swellings Lateral swellings Traumatic
Neoplastic
Thyroglossal cyst Anterior Posterior
Dermoid cyst
Congenital Goitre Branchial cyst Cystic Hygroma
Teratoma Branchial Fistula Pharyngeal Pouch
Cervicle Ribs
 Classification
Neck masses

Congenital Acquired
Inflammatory
Midline swellings Lateral swellings Traumatic
Neoplastic
Thyroglossal cyst Anterior Posterior
Dermoid cyst
Congenital Goitre Branchial cyst Cystic Hygroma
Teratoma Branchial Fistula Pharyngeal Pouch
Cervicle Ribs
Thyroglossal cyst:
 Embryogenesis:
Thyroid gland is derived from the median endodermal thyroid diverticulum
Lower end of the diverticulum enlarged to form thyroid gland
The rest part of the diverticulum is called thyroglossal duct which begin at the
formen caecum .if this duct persist it form thyroglossal cyst
Loaction:
commonly found in isthmus of thyroid gland and hyoid bone
Above the hyoid bone
Age:
between 15 to 30 yr
Symtoms:
it move upward by protruding the tongue
 Invetigations:
Ultrasound,CT scan,MRI
Treatment:
Excision of the whole thyroglossal tract(Sistrunk,s Operation)

Dermoid cyst:
It is a saclike growth that is present at birth.derived from ectoderm
It develop when a piece of skin survives after forceilbly into the subcutaneous tissue
It contains structures such as hair, fluid, or skin glands that can be found on or in the
skin. Usually present as midline ,non tender,mobile neck masses
Cause dysphagia,respiratory compression
INVESTIGATION:
CT,MRI
Treatment:
Surgical Excision
Congenital goiter
 Congenital goiter is a diffuse or nodular enlargement of the thyroid gland present at birth. 
Causes:
Dyshormonogenesis
Maternal antibodies
Ingestion of antithyroid drugs during pregnancy
Complications:
Mental disability
Improper growth
Decreased activity
Feeding difficulties
Respiratory distress
Investigation & Treatment:

Plane radiograph of chest & thoracic inlet

Ultrasound
CT scan
FNAC
Thyroidectomy
Levothyroxine

Teratoma:
these tumors contain more than on cell types with components that
derived from ectoderm,endoderm & mesoderm
 Classification
Neck masses

Congenital Acquired
Inflammatory
Midline swellings Lateral swellings Traumatic
Neoplastic
Thyroglossal cyst Anterior Posterior
Dermoid cyst
Congenital Goitre Branchial cyst Cystic Hygroma
Teratoma Branchial Fistula Pharyngeal Pouch
Cervicle Ribs
Anterior midline swelling
Branchial Cyst
A branchial cyst is a vestigial remnant of branchial cleft ,
usually the 2nd cleft . Lined by squamous epithelium contain
fluid consist of cholesterol crystals.

Location
Junction between upper third and middle third anterior
border of the sternomastoid muscle .

Symptoms
 Painless swelling in the upper lateral part of the neck.
 Lateral attacks of pain may be associated with an
increase in size usually caused by infection in the
lymphoid tissue in the cyst wall
 A severe thrombin pain associated with moving the neck
and opening the mouth .
Clinical picture
 The cyst is usually ovoid
 Surface is smooth and the edge is distinct
 The cyst can not be reduced or compressed

Investigation
 physical examination and history
 CT scan is an accurate and noninvasive diagnostic tool

Treatment
Surgical excision of the cyst or complete sinus tract
If infected – Antibiotics +/- Needle aspiration followed by
excision after an interval
Branchial Fistula or Sinus
This is a rare congenital abnormality. It is the remnant of a
branchial cleft, usually the second cleft, which has not closed off.

Clinical pictures
 It may be unilateral or bilateral
 The tract is lined by ciliated columnar epithelium
 Mucous or mucopurulent discharge onto the neck

Symptoms
patient complains of a small dimple in the skin at the junction of
the middle and the lower third of the anterior edge of the
sternomastoid muscle

Investigation
 Ultrasound and fine needle aspiration
 Preoperative CT and MRI scans of the neck clearly
demonstrated the fistula

Treatment
Complete Excision
 Classification
Neck masses

Congenital Acquired
Inflammatory
Midline swellings Lateral swellings Traumatic
Neoplastic
Thyroglossal cyst Anterior Posterior
Dermoid cyst
Congenital Goitre Branchial cyst Cystic Hygroma
Teratoma Branchial Fistula Pharyngeal Pouch
Cervicle Ribs
Posterior triangle of neck:
the posterior triangle is a space on the side of the neck situated
behind the sternocleidomastoid muscle

BOUNDARIES
ANTERIOR : posterior border of sternocliedomastiod
POSTERIOR:anterior border of trapezius
INFERIOR:middle one third of clavicle
APEX:lies on superior nuchal lines where trapezius and sternocleidomastoid
meet
ROOF: roof is formed by the investing layer of deep cervical fascia
Cystic hygroma:
Embrology
 it is a congential collection of lymphatic sac that contain clear colourless
lymph
 Probably derived from cluster of lymph channels that failed during intrauterine
development to connect with and become normal lymphatic pathway
 Lymph cysts commonly occur near the root of arm and the leg
LOCATION
 Cystic hygromas are commonly found around the base of the neck
 Usually in posterior triangle but can be very big and occupy the whole
subcutaneous tissue
CLINICAL PICTURE
 Soft easily compressible ,translucent , fluctuant, ill defined posterior neck
swelling
 May spread into cheeks , floor of the mouth ,tongue ,parotid
INVESTIGATION
 CT scan
TREATMENT
 Surgical resection via a neck incision
 Total excision is sometimes difficult and recurrences are infrequent
PHARYNGEAL POUCH
 Pharyngeal pouch is a protrusion of mucosa through killian’s dehiscence a weak area of the
posterior pharyngeal wall between the transverse fibers of cricopharyngeus and oblique fibers of
thyropharyngeus
 The bulge grows into sac which hangs down and presses against the side of the oesophagus
CLINICAL PICTURE
 Long history of halitosis
 Recurrent sore throats
 Regurgitation
INVESTIGATION
 CT scan
 Barium swallow
 Plain radiography
TREATMENT
 Endoscopic stapling of the diverticular wall
 CERVICAL RIB
cervical rib can cause serious neurological and vascular symptoms in
upper arm
 Abnormal rib is detected with an Xray
 Occasionally associated with aneurysmal change in subclavian artery
 Common neurological symptoms caused by a cervical rib are pain in C8 and T1
dermatomes weakness of small muscles in hand.
ACQUIRED NECK SWELLINGS :

 Acquired neck swellings can be

1- Inflammatory
a. Acute
b. Chronic
2- Traumatic
3- Neoplastic
TUBERCULOUS CERVICAL LYMPHADENITIS
AND ABSCESS
 Chronic infection of lymph nodes due to MYCOBACTERIUM TUBRCULOSIS.
 The human tubercle bacillus enters the body through the tonsils and from
there move to the cervical lymph nodes.
 Most commonly the upper deep cervical lymph nodes are affected.
 The condition is common in children ,young adults and the elderly.
 The patient complain lump in the neck that is with or without pain.
 If there is no abscess the overlying skin looks normal.
 The mass of the gland doesnot feel hot.
 The glands are slightly tender.
STAGES OF ABSCESS FORMATION:
Managment:
Incision drainage
with proper
evacuation of
fluid with anti-
tubercle medication.
NON-SPECIFIC CERVICAL
LYMPHADENOPATHY :
 It is due to inflammatory process or may be associated with any skin
condition or commonly it follows recurrent bouts of tonsillitis ,specially if
these attacks have been treated inadequately.
 Upper deep cervical glands most often affected.
 It causes painful lump below the angle of jaw.
 Pain becomes acute when the patient has a sore throat.
 If it is due to tonsillitis it occurs in children below 10 years of age.
 Tonsillar gland is spherical and 1-2cm in diameter.
 If infection is active , enlarged gland will be tender.
 Each gland is firm in consistency, solid, discrete and not very mobile.

MANAGEMENT :
Cervical lymphadenopathy is managed by treating the
underlying cause.
CERVICAL LYMPHADENOPATHY
ACUTE BACTERIAL PAROTITIS

 The most common cause infection of the parotid gland is mumps.

 Can be unilateral or bilateral.
 The condition is more common in the elderly and the debilitated.
 The patient complains of sudden onset of pain and selling in the side of face.
 In acute parotitis, the whole gland is swollen.
 The skin over the swelling is discolored a reddish brown, feelss hpt and is
smooth and shiny.
 The swelling is very tender.
 The swollen gland is three or four times larger than a normal gland.
 The gland has firm consistency but is indentable.
Management:
 Antibiotics
 Rehydration stimulating salivary
flow.
Chronic Parotitis
Chronic parotitis is the inflammation of parotid gland that is usually
caused by a small calculi or a fibrous stenosis blocking the drainage
of Stensen’s duct.

Symptoms:
•Recurrent parotid swelling, can be unilateral or bilateral.
•Aching pain while chewing or swallowing.
•Fever
•Headache.
•Loss of appetite.
•Weakness or fatigue.
Diagnosis:
•Ultrasound.
•Sialography.
•Radiographs.

Management:
•Mostly treated symptomatically.
•Remove the underlying cause(such as
remove stones or any blockage, treat the
underlying disease etc).
•Sialagogues.
•Adequate hydration to stimulate salivary
flow.
•Surgery
Sternocleidomastoid tumor of
infancy:
This is a swelling of middle third of the
sternocleidomastoid muscle. Present in a newborn
usually between 2nd and 8th weeks of life.

Etiology:
Birth trauma: venous obstruction or hematoma
formation during labor which leads to infarction of
central portion of SCM leading to fibrosis and
contraction and shortening of SCM.

Signs and Symptoms:

•Circumscibed firm mass palpable in middle third
of SCM.
•Torticolis.
•Asymmetry of head and neck.
•Flat spot on the side of head
Diagnosis:
•Ultrasonography.

Management:
•Conservative treatment: Regular physiotherapy including active
and passive neck movement to avoid contraction.
•Repositioning techniques.
•Surgery
ACQUIRED = NEOPLASTIC SWELLINGS

 Neoplastic swellings are further is of two types :

a Benign
b Malignent (primary and secondary)
Benign neck swellings

 Salivary gland tumors

Pleomorphic adenoma
Warthin’s tumor
• Carotid body tumor
 PLEOMORPHIC ADENOMA
(Mixed parotid tumor /Sialoma)
 Benign tumor:
 It is often called mixed tumor because it consists of both
epithelial and mesenchymal elements
 90% in parotid glands, less than 10% in other salivary glands
 CHARACTERISTICS:
 Slow growing with an incomplete capsule
 Pseudopods(Tiny pieces tumor that protude through the
defects in its capsule)
 Gross appearance is firm smooth mass within pseudocapsule
History :
Age, sex and symptoms
Symptoms:
Painless swelling
Present for months or year and is slowly growing
Lump may be prominent when mouth is open or when
eating Investigations :
Later symptom=confusion FNAC
Examination: CT SCAN
Position, colour and temperature, tenderness, shape, MRI
size, surface, edge, composition, relations, lymph
drainage and local tissues
Management :
Surgical Excision
Superficial parotidectomy
Enucleation is contraindicated
due to high recurrence
 WARTHIN’S TUMOuR
(adenolymphoma)
 Also called papillary cystadenoma lymphomatosum
 It is a benign hamartomatous proliferation of ductal
salivary gland cells and lymphoid elements OR cystic
tumour contains epithelial and lymphoid tissues
 CHARACTERISTICS :
 Spherical and encapsulated
 Cystic
 Mucoid /brownish fluid
 Soft consistency
History :
Age, sex and symptoms
Symptoms :
Patient complain of slow growing painless
swelling over angle of jaw. The swelling May
be bilateral
Examination : Investigations
FNAC
Position, Temperature, colour, tenderness,
CT SCAN
shape, size, surface, edges, composition,
MRI
relations and local tissues
Tc99 =hot-spot (due to high
mitochondrial content)

Management
Enucleation
Superficial parodectomy
CAROTID BODY TUMOUR

 Rare tumour of the chemoreceptor

tissue in carotid body.
 Also called chemodectoma
 Located at the side of neck where the
large carotid artery braches into smaller
vessels while cells around branching are
called carotid body or carotid glomus
History :
Age, symptoms, development and multiplicity
Symptoms :
Painless, slowly growing lump
Suffer from symptoms of transient cerebral
ischaemia (blackouts, transient paralysis or
patasthesia)
Bilateral
Examination
Position, tenderness, colour, temperature,
Investigations
CT scan
shape, size, composition and relations
Carotid angiogram

Management
Surgical removal
Radiotherapy if patient refuse to surgery or
elderly patients
 MALIGNANT NECK
SWELLINGS
Carcinoma of parotid gland
Carcinomatous lymph glands
Reticuloses , Lymphoma
CARCINOMA OF PAROTID
GLAND
AETIOLOGY
 Radiation
 Smoking
 Genetic
 Environmental and diet
 Infection

HISTORY
 Age
 Sex
 Symptoms
CARCINOMA OF PAROTID GLAND
ASYMMETRY OF MOUTH
EXAMINATION
 Position
 Color
 Temperature
 Tenderness
 Shape
 Size
 Surface
 Edge
o Composition
o Relation
 INVESTIGATIONS
 Plain radiographs
 Ultrasound scanning
 CT and MRI Scanning
o Fine needle aspiration
o Incisional biopsy
o MANAGEMENT
 Surgery
 Radiotherapy
 Chemo therapy
 Targeted therapy
 Immunotherapy
CARCINOMATOUS LYMPH GLANDS

 Malignant metastatic deposits in the cervical lymph

glands.

 Primary tumor is most often in the buccal cavity.

> But every possible primary site must be examined when

cervical glands are enlarged by secondary deposits,
including skin.
HISTORY

 Age over the age of 50 years.

 Sex more common in males than females.
 Local Symptoms painless lump in the neck.
grow slowly.
 General Symptoms sore tongue, hoarse voice,
cough, haemoptysis
dyspepsia, abdominal pain.
 GENERAL PHYSICAL EXAMINATION.
EXAMINATION

 SITE
 COLOR
 TEMPERATURE
 SHAPE AND SIZE
 COMPOSITION
 RELATIONS
 LOCAL TISSUES
 LYMPH DRAINAGE
PRIMARY NEOPLASMS OF LYMPH GLANDS

 RETICULOSES AND LYMPHOMA

 The most common primary tumor of lymphoid
tissue is malignant lymphoma.
 Divided
into Hodgkin’s and non-Hodgkin’s
lymphoma.
HISTORY

 Age common in children and young adult.

 Sex males are affected more than females.
 Symptoms Most common painless lump in the neck,
Malaise, Weight loss,
Itching of the skin, fever with rigors
May be abdominal pain after drinking alcohol.

GENERAL PHYSICAL EXAMINATION.

EXAMINATION
 SITE
 TENDERNESS
 SHAPE,SIZE AND SURFACE
 CONSISTENCY
 RELATIONS
 LOCAL TISSUES