Cervical swellings
Cervical lymphadenopathy : Causes : Infections ( non- specific , T.B , Syphilis , Glandular fever , Toxoplasmosis , cat scrach fever ) Metastatic tumours : from , head , chest and abdomer . Primary reticulosis : Lymphoma , lymphosarcoma , reticulsarcoma . Sarcoidosis .Branchial cyst :
Remnant of the second branchial cleft , lined by sq. epith . and some tissue . It's symptomatic at adulthood , mainly betw. 15 – 25 years , it's painless swelling in the upper lateral part of the neck . Branchial fistula ( or sinus ) : also remnant of second branchia cleft .Carotid body tumour ( potato tumour ) :
Rare tumour of the chemoreceptor tissue in the carotid body , it is a chemodectoma , it is benign , but may become malignant . ( age 40 – 60 years ) painless upper lateral swelling at the level of hyoid cartilage . Cystic hygroma ( lymphangioma ) Collections of lymphaltic sacs and contain clear lymph . congenital and lie in the subcutaneous tissues at the base of posterior triangle , translucent , flatulent , compressible .Pharyngeal pouch :
is a pulsion diverticulum of the pharynx through a gap of the inferior constrictor muscle . It occurs' at middle and old age , more in men , it may cause caughing and dysphagia . Site : behind the edge of sternomastoid muscle below the level of thyroid cartilage . Sternomastoid Tumours : Ischemic contracture of a segment of the sternomastoid muscle , usually in the middle and lower third of sternomastoid . Neonate or at birth . May cause torticollis .Thyroglassal cyst :
Due to patent portion of thyroglassal duct which begin at the base of the tongue ., occur anywhere between the base of the tongue and thyroid isthmus . Midline swelling moves with protrusion of the tongue . Dermoid cyst : Middeline swelling .Cervical rib :
Rarely visible swelling in the neck but may cause neurological and vascular symptoms . Lipoma : maybe midline or lateral cervical swelling Sab. Cyst : Subcutan swelling . Salivery swelling : Submandibular , sublingual and partotidgl .Goitre : Enlargement of the thyroid gland Benign and malignant . Subclavian artery ancurysm : Pulsalile , in the post . triangle .
Surgical approach to the cervical swellings :
History : Commonest cause is enlarged I.n. and the commonest cause is infection , ask about fever , rigors , malaise dysphagia , caugh … loss of wt . any swelling which maybe secondary to tumors of the skin , nose mauth , pharynx , larynx and the tongue .
Examination :
Site : anterior or posterior triangle , upper part or lower part . - Relation to the muscles , esp. sternomastoid mus . Relation to the trachea , hyoid bone . Size , shape and overlying skin . E.N.T exam and ophthalmologic exam . maybe needed .Investigations :
Simple blood tests graduating to complete blood picture , blood film and ESR . Biochemical tests . X-ray ( cervical and CXR ) . Ultrasound : Super standered and diagnostic for a lot of C. swelling . C.T. Scan and M.R.I , imp in head and neck tumours with secondries . Angiography . Thyroid function tests . F. N. A. C and core biopsy . Incisional and exsional biopsy .Treatment
According to the cause of the cervical swellings . Cervical I.N. , if it is inflammatory treated by treating to cause e.g. tonsillitis , pharngitis , ….T. B. I.N : treating the primary and antitub drugs . Malig . I.N : treating the primary and to deal with secondries . Goitre : May need subtotal or total thyoidectomy . Dermoid cyst , sab. Cyst and lipoma surg . excision . Branchial cyst & fistula excision . Chemodectoma , excised with the assistance of vascular surgeon . Cystic hygroma : require surgical resection . Strenomastoid Tumour and cervical rib or thopaedic surgeon . Thyroglossal cyst should be excised because if inf. And incised may end with fistula formation . Irresistible Tumours may need chemo-radiotherapy .