midline swellings of the neck
DESCRIPTION
DhingraTRANSCRIPT
Midline Swellings of
the Neck
Aetiology• Congenital
• Infectious
• Inflammatory
• Neoplastic
• Inflammatoryo Reactive
lymphadenopathyo Thyroiditis
• Neoplastico Thyroido Parathyroido Pharyngeal/
laryngeal
• Congenitalo Thyroglossal duct
cysto Laryngocoeleo Dermoid cyst
• Infectiouso Ludwig’s Angina
Thyroglossal Duct Cyst
• Moves on protrusion of tongue
• Increases in size during URTI
• Treatment – Sistrunk’s operation
• Fibrous cyst due to persistence of thyroglossal duct
• Cystic midline swelling
• Rounded – 2-3 cm diameter
Laryngocele• Dilatation of laryngeal
saccule
• Extends between thyroid cartilage and ventricle
• Treatment - excision
Ludwig’s Angina• Infection of
submandibular space
• Aetiologyo Dental infections
o Submandibular sialadenitis
o Injuries of oral mucosa
o Fractures of mandible
Clinical Features
Odynophagia with Trismus
Localised infection Spread of infection
Localised to sublingual space
Structures in floor of mouth are
swollen
Tongue pushed up and back
Submental & submaxillary regions
become swollen, tender.
Cellulitis, laryngeal oedema
Tongue pushed up and back
Treatment Complications
• Systemic antibiotics
• Incision & drainageo Intraoral o External
• Tracheostomy
• Spread of infection
• Airway obstruction
• Septicaemia
• Aspiration pneumonia
Sublingual Dermoid Cyst
• Almost always benign.
• Management: Complete surgical removal without spillage of contents.
• Midline swelling
• Does not move on protrusion of tongue
• Contains developmentally mature and well-differentiated tissue.
Reactive Lymphadenopathy
• History of local infection or generalised viral illness.
• Should resolve spontaneously.
• No specific treatment required.
• By far the most common cause of neck swellings.
• Affects all age groups.
• Tender to touch.
Thyroid Swelling
• Most likely due to hyperthyroidism or hypothyroidism.
• Thyroid disease F > M.
• Typically young female patients.
• Moves upwards on swallowing.
• Accompanied by thyroid symptoms.
• FNA may be useful to rule-out more sinister pathology.
• Manage underlying thyroid disorder.
Laryngeal MalignancyGrowth of anterior
commissure and subglottic region
Spreads through cricothyroid membrane
Produces midline swelling
• May invade thyroid cartilage o Perichondritiso Tender on palpation
• Thyroid gland and strap muscles may also be invaded
Treatment
• Radiotherapy• Surgery
o Conservation laryngeal surgery
o Total laryngectomy
• Combined therapy• Endoscopic CO2
laser excision• Organ
preservation
• Depends on o Site of lesiono Extent of lesiono Metastasis
• Nodal• Distant
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