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Neck swelling
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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 .