Neck Swelling

Neck triangles .

Neck tumour.

Cyst .

Sinus .

Fistulas .

Ulcer.

Thyroglosal cyst.

Cystic hygroma.

Lymph nodes of the neck.

Anatomic landmarks

of the neck

Mandible Hyoid bone

at the level of C3.

Thyroid cartilage

at the level of C4-C5 Cricoid cartilage

at the level of C6 .

Tracheal rings Sternomastoid muscle.

Suprasternal notch.

AnatomyAnatomy

Each sides of the neck is divided by sternomastoid muscle in to two main triangles :-

1. The anterior triangle.

2. The posterior triangle.

Anterior Triangle

of the Neck

Anterior triangle of the neckAnterior triangle of the neck

Boundaries :

Anterior border of sternomastoid muscle.

The midline.

The inferior margin of the mandible

The anterior triangle is sub divided in to four triangles by

Anterior belly of digastric muscles .

Posterior belly of digastric muscles .

Superior belly of omohyoid

1. Submentum triangle.

2. Submandibular triangle.

3. Carotid triangle.

4. Muscular triangle.

Boundaries of Carotid TriangleBoundaries of Carotid Triangle

The Submental TriangleThe Submental Triangle

Boundaries:

Anterior belly of digastric muscles.

The midline .

The hyoid bone.

• Anterior Triangle of the Neck Triangles of the Neck Anterior Triangle Posterior Triangle

                                             

         

Submandibular triangleSubmandibular triangle

Boundaries:

Body of mandible.

Antrior belly of digastric muscle.

postrior belly of digastric muscle .

• Anterior Triangle of the Neck Triangles of the Neck Anterior Triangle Posterior Triangle

                                             

         

The Submandibular Triangle The Submandibular Triangle

Carotid triangleCarotid triangle

Boundaries:

Sternomastoid muscle posteriorly .

Posterior belly of digastric superiorly.

Superior belly of omohyoid antero - inferior .

Boundaries of Carotid TriangleBoundaries of Carotid Triangle

Carotid triangleCarotid triangle

• Vein of the carotid triangle

Vein of the carotid triangle                                                     

The muscular triangleThe muscular triangle

Boundaries:

Mid line of neck .

Superior belly of omohyoid superiorly .

Sternomastoid muscle posteriorly .

Boundaries of Carotid TriangleBoundaries of Carotid Triangle

Content of anterior triangles:Content of anterior triangles:

The thyroid gland.

The submandibular gland.

The carotid sheath.

The deep cervical group of lymph nodes.

The supra and infrahyoid groups of muscles.

Posterior triangle

Boundaries of Posterior Boundaries of Posterior TriangleTriangle

Anterior :- sternomastoid .

Posterior :- trapezius .

Inferior :- middle third of clavicle .

The posterior triangle is subdivided by posterior belly of omohyoid in to :-

large occipital triangle

Small supraclavicular triangle

Boundaries of Carotid TriangleBoundaries of Carotid Triangle

CYSTCYST

Means a swelling consisting of a collection of fluid in a sac which is lined by epithelium or endothelium

FISTULAFISTULA

Is an abnormal communication between two epithelial surface

SINUSSINUS

Is a blind track lined with granulations leading from an epithelial surface in to the surrounding tissues .

ULCER ULCER

Is a discontinuity of an epithelial surface.

Tumour Tumour

Is a new growth of tissue (mass) which can refer to an inflammatory or neoplastic growth .

A neoplastic mass is an uncontrolled proliferation of a clon of cells without useful function

Diagnosis Diagnosis

Depends on :

Age of patient .

Clinical course.

Site.

Solid or cystic.

Midline swellingMidline swelling

Solid swelling : Submental lymph node enlargement. Nodule in isthmus.

Cystic swelling : Thyroglossal cyst. Dermoid cyst. Laryngocoele. Cyst of thyroid. Cold abscess.

Submandibular triangle Submandibular triangle swellingswelling

Enlarged Submandibular lymph node:

Multiple

Rolled over the edge of mandible

Not felt in the floor of mouth

Enlarged Submandibular salivary gland

Swelling in the carotid triangleSwelling in the carotid triangle Solid :

Deep cervical L.Node.

Enlarge lateral lobe of thyroid gland.

Carotid body tuomour.

Cystic:

Cold abscess.

Brancheal cyst.

Swelling in the posterior triangle Swelling in the posterior triangle Solid :

L.Node enlargement .

Neurofibroma.

Cervical rib.

Cystic:

Cystic hygroma.

Cold abscess.

Pneumatocele.

OthersOthers Swelling of skin & subcutaneous

tissues:

As lipoma .

Sebaceous cyst .

haemangioma.

Carotid body tuomourCarotid body tuomour

Rare .

Slow growing malignant tuomour.

Arise from the chemoreceptor at the bifurcation of carotid artey.

Usually occur at middle age .

Usually smooth but may be lobular.

Move side to side but not vertically.

Exhibit transmitted pulsation from underlying carotid artery.

Thyroglossal duct cyst

The thyroglossal duct cystThe thyroglossal duct cyst

It is a remnant of the diverticulum formed by migration of thyroid tissue from foramen cecum at the base of the tongue through the hyoid bone to its final position around the tracheal cartilage .

The thyroglossal duct cystThe thyroglossal duct cyst

Failure of subsequent closure and obliteration of this tract predisposes to thyroglossal cyst formation.

Is a rare but occasional cause of a benign neck mass.

Almost always in the midline.

site: 20% are suprahyoid. 15% occur at the hyoid . 65% are infrahyoid.

Present by the age of 10 in 50% of cases. but may be found in the older population as well.

No sex predominance .

Racial predominance in whites.

size: It measure about 0.5-5cm in diameter, and

gradually ↑ in size.

It is painful if increase in size or became infected

Asymptomatic

Hot , red & tender if infection present.

Consistency:

Firm to hard

Movement:

Upward by deglutition, & protrusion

of the tongue.

Diagnosis is usually made clinically.

Thyroglossal fistula Thyroglossal fistula

Are almost always the result of infection with spontaneous or surgical drainage.

It can drain internally , externally or both.

Discharge of mucus & recurrent attack of inflamation is the clinical finding.

Treatment Treatment

Before thyroglossal duct cysts are excised, it is important to demonstrate that normally functioning thyroid tissue is in its usual location.

Thyroid scans and thyroid function studies are ordered preoperatively.

Treatment Treatment

Total surgical excision (sistrunk procedure) including:- The cyst and sinus to the base of the tongue. Whole fistula. Middle third of hyoid bone.

Neck fistulaNeck fistula

Cystic hygromaCystic hygroma

• Also called (cavernous lymphangioma) .

• It occurs due to sequestration of a portion of a jugular lymph sac from lymphatic systems .

• It occupies the lower third of the neck and as it enlarges it pass upwards towards the ear.

Cystic hygromaCystic hygroma

Usually it manifests itself during early

infancy.

occasionally it is present at birth .

Exceptionally it is so larges as to obstruct

labour.

Lymphatic drainage

Lymphatic drainage of head and neck are particularly important when locating and working up a "neck mass" or possible malignancy.

Lymphatic drainage:Lymphatic drainage:

Superficial nodes: Are few nodes lies superficial to the deep fascia :1. The anterior cervical node along the anterior jugular vein.

2. The superficial cervical nodes along the external jugular vein.

Deep nodes: 1. Vertical chain.

2. Circular chain.

Vertical chain Deep nodes

Is closely related to internal jugular vein.

Types of vertical chains:

1. Superior deep cervical (jugulo-digastric nodes ).

2. Inferior deep cervical (jugulo-omohyoid nodes ).

3. Few nodes in the root of the neck called supraclavicular nodes (virchow’s nodes ), (Troisier’s sign).

Circular chainCircular chain Submental nodes . Submandibular nodes . Buccal or facial nodes . Preauricular (parotid ) nodes . Posterior auricular nodes . Occipital nodes . Retropharyngeal , pretracheal nodes .