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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