General features & management of Common neck lumps are described in this presentation. which are important for Medical students and ENT doctors. Topics discussed in this presentation are Cystic hygroma Hemangioma Branchial cyst Thyroglossal cyst Lipoma Sebaceous cyst Cervical lymphadenopathy Tuberculosis Carotid body tumor Preauricular Cyst/Sinus Lymphoma

1. Dr Saad Shakil
Registrar
ENT – Head & Neck Surgery
Liaquat College of Medicine
& Dentistry
Neck
Masses

2. ANATOMY OF NECK

3. The region of the body that lies
between:
The LOWER BORDER OF THE
MANDIBLE
&
The SUPRASTERNAL NOTCH and
the UPPER BORDER OF CLAVICLE.
NECK

4. Anatomic Landmarks::

5. Anterior
Neck
Triangle
Posterior
Neck
Triangle

7. DIFFERENTIAL DIAGNOSIS

9. MIDLINE NECK SWELLINGS

10. LATERAL NECK SWELLINGS

12. CYSTIC HYGROMA
(LYMPHANGIOMAS)
• It is a congenital lesion usually
present within the first year of life.
(post. Triangle)
• Usually remain unchanged into
adulthood
• Is soft, cystic, multilocular, partially
compressible and brilliantly
transilluminant. and may present
with pressure effects.
• CT or MRI may help define the
extent of the disease
• Treatment:
• Injection with picibanil (sclerosing
agent)
• Excision for easily accessible lesions
or those affecting vital functions.

13. CYSTIC HYGROMA
(LYMPHANGIOMAS)

14. HAEMANGIOMAS
• Often appear bluish and are
compressible.
• CT or MRI may help define the
extent of the neoplasm,
especially intrathoracic.
• Treatment : (depend on site, size
and severity) most often resolve
spontaneously within the first
decade.
• Surgical treatment is reserved
for lesions with rapid growth
involving vital structures, which
fail medical therapy (cs, laser or
oral propranolol in infantile
type).

15. BRANCHIALCLEFT
CYST/SINUS/FISTULA
• Most commonly Reminant of 2nd
branchial cleft.
• Most commonly occur in the
second or third decades!
• Pain +/- (severe throbbing pain)
• Usually presents as a smooth,
fluctuant nontender (tender) ,
nontransluminal mass mobile
forwards and downwards,
underlying the anterior border of
the sternomastoid muscle.
• Branchial fistula or sinus !
• Primary treatment is with control of
infection by antibiotics, followed
by surgical excision.

17. THYROGLOSSAL DUCT CYST
• Common congenital midline neck
mass.
• Sometimes at the lateral edge of the
thyroid cartilage.
• Pain and tenderness +/-
• Can be moved transversally but can
not be moved vertically
• Elevates on protrusion of the
tongue.
• Treatment
• initial control of infection with
antibiotics,
• Surgical excision including the mid-
portion of the body of the hyoid
bone (Sistrunk’s procedure).
• Occasionally, these lesions become
infected and resolve, or persist
following surgery as a thyroglossal

19. 5.
LIPOMA
• Most common benign soft
tissue neoplasm in the neck.
• They are poorly defined, soft
masses usually after the
fourth decade.
• They are usually
asymptomatic, soft to feel
and deep to the
• FNAC or MRI Scan can
confirm the diagnosis.
• Surgery is indicated when the
lump is increasing in size,
cosmesis, or when there is
doubt about the accuracy of
diagnosis.

20. 6.
SEBACEOUS CYSTS
• These are common masses
occurring often in older people
but can occur at any age.
• They are slow growing, but
sometimes fluctuant and
painful when infected.
• Diagnosis is made clinically;
the skin overlying the mass is
adherent and a punctum is
often identified.
• Excisional biopsy confirms the
diagnosis.

21. CERVICAL
LYMPHADENOPATHY
• Acute lymphadenitis
• Tender swelling
• Antibiotic trial, less acute
inflammatory nodes generally
regress in size over 2–6 weeks.
• If the lesion does not respond!
• Biopsy

22. TB CERVICAL
LYMPHADENITIS
• Upper and middle deep cervical LN
• Onset: gradually
• Pain: +/-
• Systemic symptoms unusual in
young (occurs with
• Abscess (painful, increase size, and
skin discoloration
• Mass: indistinct, firm, matted,
fluctuate!
• Temperature: (Cold abscess)
• Invesigations: U/S , CT scan, FNAC,
Biopsy (AFB Smear +
Histopathology)
• Treatment: Antituberculous
Therapy

23. STAGES OF TB
LYMPHADENITIS

24. CAROTID BODY TUMOR
• Rare tumor of chemoreceptors (40-
60 years).
• Slow-growing painless some time
pulsating lump may be bilateral.
• Side to side movement
• Symptoms of transient cerebral
ischemia
• Hard & non tender
• Palpation may induce vasovagal
attack
• Biopsy is contraindicated MRI
angiography is the investigation
of choice.
• Surgical removal is based on
patient factors presenting
symptoms.

25. Lyre Sign
(Splaying of Carotid Vessels)

26. Lyre Sign
(Splaying of Carotid Vessels)

27. PREAURICULAR SINUS/CYST
• Common congenital malformation
• Characterized by a nodule, dent or
dimple located anywhere adjacent to
the external ear.
• Preauricular sinuses and cysts result
from developmental defects of the
first and second pharyngeal arches.
• Treatment:
• Draining the pus occasionally as
it can build up a strong odor
• Antibiotics when infection occurs.
• Surgical excision

28. PREAURICULAR SINUS PREAURICULAR ABSCESS
PRE-AURICULAR SINUS/CYST

29. LYMPHOMAS
• Painless lump, nontender smooth and
discrete
• Slow growing
• Patient Presented with malaise, wt. loss,
pallor.
• Fever, rigor and hepatosplenomegaly
• Mediastinal mass (SVC syndrome)
• Abdomen pressure on IVC may cause
bilateral leg oedma.
• other lymph nodes in the axilla, groin
and abdomen should
• examined
• Treatment: according to stage
(radiosensitive)

30. 2.
METASTATIC LYMPH NODES
• Upper cervical lymph nodes
(upper aerodigestive tract).
• Accessory chain of nodes in the
posterior triangle
(Nasopharyngeal malignancies).
In many cases
• (Occult primary) most common
sites are tonsil, base of tongue,
nasopharynx and pyriform sinus.
• Painless, nontender, and hard
masses
• Work up: Search for primary and
deal with it

32. Thank you