NECK MASSES
DR. NADA KHALIL
ASS. PROFESSOR OF SURGERY
MIDLINE SWELLINGS
Median dermoid
Submental lymph node
Thyroglossal cyst
Pretracheal lymph node
Thyroid
LATERAL NECK SWELLINGS
Chemodectoma (carotid body tumor)
Sternomastoid tumor
Branchial cyst
Pharyngeal pouch
Lymph node
Thyroid
Cystic hygroma
BRANCHIAL CYST
• FIVE BRANCHIAL CLEFTS
• 2,3,4 DISAPPEAR, 1
ST
FORMS EXTERNAL AUDITORY MEATUS
• VESTIGIAL REMNANTS OF SECOND BRANCHIAL CLEFT
• SQUAMOUS EPITHELIUM
• THICK , TURBID CHOLESTEROL LADEN FLUID
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BRANCHIAL CYST- CLINICAL PICTURE
• UPPER NECK – EARLY OR, MIDDLE ADULTHOOD
• JUNCTION OF UPPER THIRD AND MIDDLE THIRD OF
ANTERIOR BORDER OF STERNOMASTOID
• FLUCTUANT, SOFT , TRANSILLUMINANT
• INFECTION –RED, TENDER D/D TUBERCULOUS
ABSCESS
• DIAGNOSIS- USG,FNAC
• TREATMENT - EXCISION
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CAROTID BODY TUMOR
• NEUROGENIC TUMOR, HIGH ALTITUDE
• CHRONIC HYPOXIA –CAROTID BODY HYPERPLASIA
• 5
TH
DECADE, 10% - FAMILY HISTORY
• USUALLY BENIGN
• LONG HISTORY, FIRM, RUBBERY, PULSATILE,EMPTIED BUT REFILL
SLOWLY
• BRUIT +, DISPLACE TONSILS MEDIALLY
• INVESTIGATIONS- CAROTID ANGIOGRAM, CAROTID SPLAY, CAROTID
BLUSH, MRI
• ASPIRATION OR BIOPSY IS
CONTRAINDICATED
• RARELY METASTASIZE, SLOW GROWING- SURGERY, NO RADIOTHERAPY
Sternomastoid Tumour
LUDWIG’S ANGINA
• BRAWNY SUBMANDIBULAR SWELLING
• INFLAMMATORY SWELLING OF MOUTH
• CERVICAL AND INTRAORAL – PUTRID
HALITOSIS
• VIRULENT STREPTOCOCCI+ANAEROBIC
• ASSOCIATED WITH CA ORAL CAVITY
• TUNGUE DISPLACED UP – DYSPHAGIA,
AIRWAY OBSTRUCTION
LUDWIG’S ANGINA – CL. COURSE
• CONTROL INFECTION – DO NOT LET CELLULITIS GO INTO THE NECK
BELOW FASCIA TO LARYNX – GLOTTIC OEDEMA
• TREATMENT-IV BROAD SPECTRUM AB, COMBINED WITH
METRONIDAZOLE
• CURVED SUBMENTAL INCISION – DRAIN SUBMENTAL TRIANGLE, CUT
MYELOHYOID
• TRACHEOSTOMY - NEEDED
THYROGLOSSAL CYST
• CONGENITAL- THYROGLOSSAL TRACT
• SITES – SUBHYOID, THYR CARTILAGE, ABOVE HYOID
BONE
• MIDLINE MASS, MOVES WITH TONGUE
PROTRUSION AND SWALLOWING
• ATTACHED TO FORAMEN CAECUM
• INFECTION COMMON- FISTULA
• TRACT + HYOID BONE + CYST – SISTRUNK
OPERATION
CYSTIC HYGROMA-1
• NEONATE, EARLY LIFE –OBSTRUCTED LABOUR
• SWELLING – NECK FACE, PAROTID AREA
• TONGU, FLOOR OF MOUTH
• SOFT, PARTIALLY COMPRESSIBLE,BRILLIANTLY TRANSILLUMINANT
CYSTIC HYGROMA-2
• LESS COMMON SITES- GROIN,AXILLA, MEDISTINUM, CHEEK
• ASPIRATION NEEDED IN GROWING HYGROMAS-CLEAR LYMPH,
MULTILOCULAR
• INFECTION – SPONTANEOUS REGRESSION
• SURGERY, SCLEROTHERAPY REDUCES
Sistrunk operation
PHARYNGEAL POUCH
CERVICAL LYMPHADENOPATHY
• INFLAMMATORY –REACTIVE HYPERPLASIA
• INFECTIVE –
VIRAL-INF MONONUCLEOSIS, HIV
BACTERIAL-STREP, STAPH, ACTINOMYCOSIS, TUBERCULAR
PROTOZOA – TOXOPLASMOSIS
• NEOPLASTIC –LYMPHOMA, SEC, OCCULT
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CERVICAL LYMPHADENITIS
• 300/800 LN IN THE NECK
• INFECTION- ORAL, NASAL,PHARYNX, LARYNX, EAR, SCALP,FACE
ACUTE LYMPHADENITIS
• ENLARGED, TENDER, FEVER, MALAISE
• TONSILLITIS, DENTAL INFECTION/ABSCESS
• ANTIBIOTICS- DRAINAGE
CHRONIC LYMPHADENITIS
• CHRONIC, PAINLESS-TB, CA, LYMPHOMA, HIV
• EXCLUDE PRIMARY LESION –H & N
• FNAC
TUBERCULAR LYMPHADENITIS
• CHILDREN, YOUNG ADULTS
• DEEP CERVICAL NODES – MATTING
• BOVINE, HUMAN TB BACILLI –TONSIL
• PRIMARY FOCUS – LUNG
• CASEATED NODES – COLD ABSCESS- COLLAR STUD ABSCESS-
CHEESY MATERIAL – EXCISION- ATT X 6-8 MON
GOITER – ENLARGEMENT OF
THYROID
• SOLITARY NODULE, NODULAR GOITER, DIFFUSE HYPERPLASTIC
• INV – EUTHYROID PT. FIRM NODULE, NODULAR OR SMOOTH THYROID
• PAIN, SUDDEN INCREASE – BLEEDING
• TRACHEAL OBSTRUCTION- AIRWAY
THYROID FUNCTION TESTS
• T3, T4 , TSH
• ISOTOPE SCANNING
• THYROID AUTUANTIBODIES
• OTHER – FNAC, USG, CT/ MRI SCAN
• INDIRECT LARYNGOSCOPY, TRUCUT BIOPSY
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COMPLICATIONS
• SECONDARY THYROTOXICOSIS-30%
• CARCINOMA –FOLLICULAR
• TREATMENT- IODIED SALT, SURGERY, SUPRESSSING DOSE OF
THYROXIN
• SOLITARY NODULE – TFT, AB, ISOTOPE SCAN, USG, FNAC, CT/MR
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THYROTOXICOSIS
• DIFFUSE TOXIC GOITER
• TOXIC NODULAR GOITER
• TOXIC NODULE
THYROTOXICOSIS-CLINICAL
FEATURES
• TIREDNESS, EMOTIONAL LABILITY, HEAT INTOLERANCE, WT LOSS,
GOOD APETITE
• PALPITATIONS, MOIST PALMS,EXOPHTHALMOS, LIDRETRACTION,
AGITATION, BRUIT AND GOITER
• SIGNS –EYE,PRETIBIAL MYXEDEMA
• INV- TFT
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TREATMENT
• ANTITHYROID DRUGS, SURGERY, RADIOIODINE
TUMORS OF THYROID
• BENIGN – ADENOMA –FOLLICULAR
• MALIGNANT- PAPILLARY 60%, FOLLICULAR 20%, ANAPLASTIC 10%
• MEDULARRY CA – 5%, MALIGNANT LYMPHOMA-5%
DIAGNOSIS THYROID CA
• CLINICAL
• FNAC
• LOW RISK - < 40 YRS, MEN,<50 WOMEN, NO METASTASIS, <5CM
TUMOR, OLD, INTRA CAPSULAR
• HIGH RISK – DISTANT METS, OLD, EXTRATHYROID SPREAD, > 5CM
TUMOR
CARCINOMA THYROID-TREATMENT
• SURGERY
• THYROXIN, RADIOIODINE METS
• MEASURE – THYROGLOBULIN- FU AND TO DETECT METS
SECONDARIES- PRIMARY H & N
• NASOPHARYNX,TONSIL,TONGUE,PYRIFORM FOSSA, SUPRAGLOTTIC
LARYNX
• FNAC, CT SCAN, MRI
• SURGERY –EN BLOC LN DISSECTION
• ND- CLASSIC, MODIFIED N, SELECTIVE
• RADIOTHERAPY, CHEMOTHERAPY
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THANKS