neck swellings [compatibility mode]

8/8/2019 Neck Swellings [Compatibility Mode]

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Neck swellingsNeck swellings

ByBy

Prof.Dr. Mohamed WardaProf.Dr. Mohamed Warda


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Neck swellingsNeck swellings

Midline swellingsMidline swellings

Lateral SwellingsLateral Swellings


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A neck mass is very commonA neck mass is very commonA variety of clinical condiitons areA variety of clinical condiitons are

assoc a e w a mass n eassoc a e w a mass n eneckneck


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Midline neck swellingsMidline neck swellings

Sublingual dermoid cystSublingual dermoid cyst Dermoid cystDermoid cyst

..

Throglossal cystThroglossal cyst

Thyroid nodule in the isthmusThyroid nodule in the isthmus

Subhyoid bursaSubhyoid bursa Thymic cystThymic cyst

LaryngocoeleLaryngocoele


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Lateral neck swellingsLateral neck swellings

Solid SwellingsSolid Swellings

Anterior triangleAnterior triangle Posterior trianglePosterior triangle


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Lymph nodesLymph nodes

Parotid swellingParotid swelling

Submandibular SwSubmandibular Sw

Cervical ribCervical rib

Lymph nodesLymph nodes

Thyroid glandThyroid gland

Sternomastoid trSternomastoid tr

Carotid body trCarotid body tr


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Thyroid cystThyroid cyst

Plun in ranulaPlun in ranula

Cystic hygromaCystic hygroma

Branchial cystBranchial cyst

LaryngoceleLaryngocele

abcessabcess

LaryngoceleLaryngocele


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Enlarged lymph nodesEnlarged lymph nodes

InfectionInfection

-- non specificnon specific

-- specificspecific

MalignantMalignant

11ry lymphomary lymphoma

22ry metastasisry metastasis

. .. .

SyphilisSyphilis

ToxoplasmosisToxoplasmosis


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FIGUREFIGURE 22.. Lymph node groups with the most likely sites ofLymph node groups with the most likely sites ofthe primary lesion.the primary lesion.


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EtiologyEtiology

CongenitalCongenital

raumaticraumatic

InflammatoryInflammatory

NeoplasticNeoplastic


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CongenitalCongenital

Pediatric age groupPediatric age group

Benign: thyroglossal duct cyst,branchialBenign: thyroglossal duct cyst,branchialcleft cyst, cystic hygroma, hemangiomacleft cyst, cystic hygroma, hemangioma

,, Lateral: inflammatory or hyperplastic LNLateral: inflammatory or hyperplastic LN

Maligant is rare: lymphoma thyroid ca orMaligant is rare: lymphoma thyroid ca or

other soft tissue tumorother soft tissue tumor


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Thyroglossal duct cystThyroglossal duct cyst


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Thyroglossal duct cysts are remnants of theembryonic thyroglossal duct that may occuranywhere from the base of the tongue to thethyroid gland. The majority, however, are found

a e eve o e yro yo mem rane, un erthe deep cervical fascia. hey are midline or just

off the midline, and move up and down upon

swallowing


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A dermoid cyst is a pocket or cavity under thekin h n in i n rm ll r n in

Dermoid cystDermoid cyst

the outer layers of the skin. The pocket formsa mass that is sometimes visible at birth or inearly infancy but often is not seen until lateryears. Dermoid cysts are usually found on thehead or neck, and sometimes on the face.


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A dermoid cyst is a congenital defect (present

from birth) that occurs during embryonicdevelopment when the skin layers do notro erl row to ether. A dermoid c st is lined

with epithelium, which contains tissues and cellsnormally present in skin layers, including hairfollicles, sebaceous (skin oil), and sweat glands.


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Branchial cystBranchial cyst


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BRANCHIAL CLEFT CYSTS are congenitalcysts, that arise in the lateral aspect of the neck

when the second branchial cleft fails to closeduring embryonic development. At about thefourth week of embryonic life, 4 branchial (or

p aryngea c e ts eve op etween r gesknown as the branchial (or pharyngeal) arches.These arches and clefts contribute to theformation of various structures of the head andneck.


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Branchial cleft cysts are the most commonof congenital neck masses. They are

bilateral in about 2-3% of thecases. Usually, they do not appear at

,life. If they get infected, they may form adeep neck abscess or a draining fistula.

The treatment of branchial cleft cysts issurgical excision.


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Cystic hygromaCystic hygroma


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are)lymphangiomasCystic hygromas (

multiloculated cystic structures that arebenign in nature. They form as the result ofbudding lymphatics and, thus, may occur

anywhere in the body, although they are mostfrequently encountered in the neck (75%)and axilla (20%).


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Often the tongue, base of tongue,

supraglottic larynx and mediastinum areinvolved, causing severe respiratory

. .

Surgery is the treatment of choice


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TraumaticTraumatic

Rarely produce a solitary massRarely produce a solitary mass

Hematoma, sternomastoid tumor AVMHematoma, sternomastoid tumor AVM


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InflammationInflammation

Sign of inflammation and tendernessSign of inflammation and tenderness

, ,, ,toxoplasomosis, cattoxoplasomosis, cat--scratch fever,scratch fever,

Hyperplastic lymphadenopathy in AIDSHyperplastic lymphadenopathy in AIDS


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NeoplasticNeoplastic

Benign: Lipoma , neurofibroma, CarotidBenign: Lipoma , neurofibroma, Carotidbody tumor, neurogenic tumor adenomabody tumor, neurogenic tumor adenoma

of thyroid and parathyroid.of thyroid and parathyroid. Malignant: primary or metastaticMalignant: primary or metastatic


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An asymptomatic solitary neck mass in theAn asymptomatic solitary neck mass in the

lateral aspect of the neck in an adultlateral aspect of the neck in an adultshould be considered a metastatic lymphshould be considered a metastatic lymph

..


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DiagnosisDiagnosis HistoryHistory

Physical examinationPhysical examination X ray & ultrasoundX ray & ultrasound

Fine neddle aspiration or biopsy: sensitivity ,Fine neddle aspiration or biopsy: sensitivity ,lymphoma is difficultlymphoma is difficult

Excional biopsy : small or movableExcional biopsy : small or movable

Incisional biopsy : large , multiple unresectable.Incisional biopsy : large , multiple unresectable.


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Open biopsy , it is best performed in theOpen biopsy , it is best performed in the

operating roomoperating room To proceed with definite surgicalTo proceed with definite surgical


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Thank youThank you

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