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HEAD & NECK SWELLINGS

EXCLUDING GOITRE

FAISAL GHANI SIDDIQUIMBBS; FCPS; MCPS-HPE; PGDIP-BIOETHICS

PROFESSOR OF SURGERYJ I N N A H S I N D H M E D I C A L U N I V E R S I T Y

NECK SWELLINGS

MIDLINE SWELLINGS

LATERAL SWELLINGS

GENERALIZEDSWELLINGS

PHARYNGEAL POUCH

CYSTIC HYGROMA

BRANCHIAL CYST

CAROTID BODY

TUMOUR

POSTERIOR TRIANGLE

ANTERIOR TRIANGLE

STERNOMASTOIDTUMOU

RLATERAL NECK SWELLINGS

THYROGLOSSAL CYST

GOITRE

MIDLINE NECK SWELLINGS

GENERALIZED NECK SWELLINGS

BRANCHIAL CYST

BRANCHIAL CYST -EMBRYOLOGY

BRANCHIAL CYST -EMBRYOLOGY

BRANCHIAL CYST –CLINICAL FEATURES•Congenital but appears at 20-25years of age (the fluid accumulates very slowly)

• Located at junction of upper & middle 3rd of anterior border of sternomastoid muscle

• Smooth, soft & fluctuant• Non-transilluminant

BRANCHIAL CYST -PATHOLOGY• Lined by squamous epithelium

with sebaceous glands• Filled with thick, turbid, cheesy

material containing cholesterolcrystals

BRANCHIAL CYST -DIAGNOSIS• Essentially clinical • Ultrasound shows a cystic

mass • Needle aspiration reveals

clear-to-turbid fluid rich in cholesterol crystals

BRANCHIAL CYST –COMPLICATIONS

• Recurrent infection• Branchial sinus• Branchiogenic carcinoma

BRANCHIAL CYST –TREATMENT

• Excision through a transverse incision

PHARYNGEAL POUCH

PHARYNGEAL POUCHprotrusion of pharyngeal mucosa through a

weak area in the posterior pharyngeal wall called ‘Killian’s dehiscence’

PHARYNGEAL POUCH –CLINICAL FEATURES• Dysphagia• Regurgitation of undigested food• Swelling

• behind the sternomastoid muscle at the level of thyroid cartilage

• increases on deglutition• smooth; ill-defined; reduces with gurgling

sounds on pressure

• Recurrent chest infections

PHARYNGEAL POUCH -INVESTIGATIONS• Barium swallow: outlines the pouch• Flexible endoscopy: shows opening of

the pouch

PHARYNGEAL POUCH –TREATMENT

• Excision of pouch and cricopharyngeal myotomy• Endoscopic division of wall between the pouch

and cricopharyngeal muscle to widen neck of the pouch to allow free drainage of contents into esophagus

CYSTIC HYGROMA

CYSTIC HYGROMAa developmental malformation (hamartoma) of the lymphatic system

resulting from failure of jugular sac to join the main lymphatic system

CYSTIC HYGROMA –CLINICAL PRESENTATION

• Presents at birth or in early infancy

• May cause obstructed labour due to large size

CYSTIC HYGROMA –CLINICAL PRESENTATION• Situated in lower part of

posterior triangle of the neck• Soft, cystic, partially

compressible• Brilliantly trans-illuminant

CYSTIC HYGROMA -COMPLICATIONS• Secondary infection• Respiratory obstruction due to

rapid increase in size

CYSTIC HYGROMA - TREATMENT

Excision of all cysts with preservation of normal neurovascular structures

CAROTID BODY TUMOUR

CAROTID BODY TUMOUR• Tumour arising from

chemoreceptor cells

• Higher incidence seen in people living at high altitudes; chronic hypoxia leading to hyperplasia

CAROTID BODY TUMOUR –CLINICAL FEATURES• Lump under the anterior

border of sternomastoidmuscle

• Firm• Can be moved side to side

but not above downwards• Pulsatile• Audible bruit

CAROTID BODY TUMOUR -INVESTIGATIONS• Duplex ultrasound• Carotid angiogram:

• splaying of carotid bifurcation • blush of tumour

TREATMENTExcision along with excision of carotid artery

STERNOMASTOIDTUMOUR

STERNOMASTOID TUMOUR -ETIOLOGYTRAUMA TO STERNOMASTOID

MUSCLE AT BIRTH

HEMATOMA FORMATION CAUSING SWELLING

FIBROSIS LEADING TO MUSCLE SHORTENING

STERNOMASTOID TUMOUR – CLINICAL FEATURES

• Presents shortly after birth

• Swelling small & hard; palpable in the body of the sternomastoid muscle

• Muscle stretched and chin deviated to the opposite side

STERNOMASTOID TUMOUR – TREATMENT

• Physiotherapy to stretch sternomastoid muscle; spontaneous resolution with no long-term effects

• Surgical release of the contracture

LYMPHADENOPATHY

GOITRE

THYROGLOSSALCYST