Midline Swellings of

the Neck

Aetiology• Congenital

• Infectious

• Inflammatory

• Neoplastic

• Inflammatoryo Reactive

lymphadenopathyo Thyroiditis

• Neoplastico Thyroido Parathyroido Pharyngeal/

laryngeal

• Congenitalo Thyroglossal duct

cysto Laryngocoeleo Dermoid cyst

• Infectiouso Ludwig’s Angina

Thyroglossal Duct Cyst

• Moves on protrusion of tongue

• Increases in size during URTI

• Treatment – Sistrunk’s operation

• Fibrous cyst due to persistence of thyroglossal duct

• Cystic midline swelling

• Rounded – 2-3 cm diameter

Laryngocele• Dilatation of laryngeal

saccule

• Extends between thyroid cartilage and ventricle

• Treatment - excision

Ludwig’s Angina• Infection of

submandibular space

• Aetiologyo Dental infections

o Submandibular sialadenitis

o Injuries of oral mucosa

o Fractures of mandible

Clinical Features

Odynophagia with Trismus

Localised infection Spread of infection

Localised to sublingual space

Structures in floor of mouth are

swollen

Tongue pushed up and back

Submental & submaxillary regions

become swollen, tender.

Cellulitis, laryngeal oedema

Tongue pushed up and back

Treatment Complications

• Systemic antibiotics

• Incision & drainageo Intraoral o External

• Tracheostomy

• Spread of infection

• Airway obstruction

• Septicaemia

• Aspiration pneumonia

Sublingual Dermoid Cyst

• Almost always benign.

• Management: Complete surgical removal without spillage of contents.

• Midline swelling

• Does not move on protrusion of tongue

• Contains developmentally mature and well-differentiated tissue.

Reactive Lymphadenopathy

• History of local infection or generalised viral illness.

• Should resolve spontaneously.

• No specific treatment required.

• By far the most common cause of neck swellings.

• Affects all age groups.

• Tender to touch.

Thyroid Swelling

• Most likely due to hyperthyroidism or hypothyroidism.

• Thyroid disease F > M.

• Typically young female patients.

• Moves upwards on swallowing.

• Accompanied by thyroid symptoms.

• FNA may be useful to rule-out more sinister pathology.

• Manage underlying thyroid disorder.

Laryngeal MalignancyGrowth of anterior

commissure and subglottic region

Spreads through cricothyroid membrane

Produces midline swelling

• May invade thyroid cartilage o Perichondritiso Tender on palpation

• Thyroid gland and strap muscles may also be invaded

Treatment

• Radiotherapy• Surgery

o Conservation laryngeal surgery

o Total laryngectomy

• Combined therapy• Endoscopic CO2

laser excision• Organ

preservation

• Depends on o Site of lesiono Extent of lesiono Metastasis

• Nodal• Distant

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