Neck swelling

In any neck swelling you must take complete history

and full head and neck examination{ including mouth
and larynx}.the most important are the age of the
patient and location of the mass [ in children most of
the masses are congenital or inflammatory while in
old age groups mostly are malignant ]
Deferential diagnosis :-
a. Lymph nodes
Enlargement could be
1.Benign .secondary to infection in the head or neck
2. Malignant.either primary like in lymphoma or
secondary due to other primary in the head and neck
or some time even from the body
Cervical LN are divided to 7 groups
1.Submental and submandibular group
2.upper jugular group
3.Middle jugular group
4.Lower jugular group
5. Posterior triangle group[post of the neck]
6. Supra caviculer group
7. Upper mediastinal group
Primary infection or tumor of the oral cavity or lips
will go to group No 1. 2. and 3.
tongue diseases will go to group 4 mostly
Diseases of oropharynx and larynx will go to group 2.
3 and 4
Nesopharynx and thyroid diseases will go to group 5
and 2
Hypopharynex .esophagus and thyroid diseases will
Go to group 7
Group 6 takes from all of the above but some times
Mainly from the GIT
Benign neck masses
abscess:- is the suppuration of the LN secondary to
Primary infection . Treatment is drainage
Note:- cold abscess is an abscess without signs of
inflammation [TB]
Thyroglossal cyst:- is tract remnant from foramen
cecum during thyroid descendent situated between
the hyoid bone and thyroid gland . Presented usually
in early childhood . Treatment is by excision but first
we must do thyroid scan[sistrunk operation]
Branchial cyst :- also congenital anomaly which is
situated laterally below the upper end of
sternocleidomastoid muscle presented usually at
Young adult as painless swelling .treatment is by
surgery
Dermoid cyst :- usually accrue in lines of skin fusion
due to entrapment of some epithelial tissue in
embryonic life. Treatment is by excision
Cystichygroma or lymphangioma:-it is mobile usually
big cystic swelling situated laterally and may reaches
big size presented usually in infant time . Treated by
wide extensive resection
Salivary glands tumors
1.parotid gland:- usually pleomorphic adenoma
which is usually locally malignant so you excise it
Widely and completely also you may face
adenocarcinoma in parotid gland but it is not so
common
2.Submandibular and submental salivary glands:-
these will show either infection or malignancies
Thyroid gland enlargement [goiter]
1.benign
a.cold nodule
b. toxic nodule
c. colloid diffuse goiter
d. diffuse toxic goiter [graves disease].
e. thyroid abscess
f. Thyroid hemorrhagic cyst
Treatments of these conditions are different
according to the case . Drainage. Surgery. Thyroxin.
Neomercazol and radio active iodine
2. Malignant
a.follicular ca
b. papillary ca
treated by radio active iodine andsurgery
Diagnosis of neck swelling
1.Ultrasound
2. CT SCAN
3. MRI
4. FNA {fine needle aspiration }
5. Excisional biopsy