OMFS Neck Swelling

1. Neck Swelling
‫اإلتنين‬ ‫يالهوي‬
‫بعض‬ ‫مع‬

2. What Causes Head and Neck Swellings ?
Inflammatory / Infectious conditions.
Cystic lesions, thyroid masses, vascular masses, &
salivary gland masses.
Enlargement of lymph nodes
Benign & Malignant masses.

3. Symptoms Associated with Neck Lumps
 Change in the voice including hoarseness persists for > 2 weeks
 Growth in the mouth
 Swollen tongue
 Blood in the saliva or phlegm
 Swallowing problems

4. History

5. 5 Students & 3 Teachers go for CAMPFIRE
1- Shape 1- Tenderness
2- Size 2- Transillumination
3- Site 3- Temperature
4- Surface
5- Scar
Consistency - Attachment - Mobility - Pulsation -
Fluctuancy - Irreducibility - Regional lymph nodes -
Edge
Physical
Examination

6. • MRI
• C.T SCAN
• PET/CT
Radiographic investigations of Head
and Neck Swelling

7. Fine Needle Aspiration Cytology
Safe
Rapid
Inexpensive
Presurgical Planning
Avoid surgical biopsy

8. What Causes Head and Neck Swellings ?
Cystic lesions, thyroid masses, vascular masses, &
salivary gland masses.
Enlargement of lymph nodes
Inflammatory / Infectious conditions.
Benign & Malignant masses.

12. Inflammatory / Infectious Swelling
Cervical Adenitis secondary to acute URTI, tonsillitis, & EBV .
Chronic inflammatory disease like Tuberculosis, Sarcoidosis, Cat
Scratch disease, Shaving.
These disease processes have to be treated medically.

13. Cystic swelling

14. Dermoid and Epidermoid Cysts
An essential difference between Dermoid cyst and Epidermoid cyst is the
presence of dermal appendages such as sebaceous glands, hair follicles,
& sweat glands
Clinical appearance of Dermoid and Epidermoid cysts of the neck
a midline suprahyoid growing mass
The mass is soft, mobile, and unattached to the overlying skin.
Unlike thyroglossal duct cysts, the Dermoid are not intimately
associated with the hyoid bone and thus do not move on protrusion of the
tongue
On CT scan
the central cavity is usually filled with homogeneous, hypoattenuated fluid material.
Discrete intracystic foci “marbles,” with moderate hyperintensity due to coalescence of
fat into small nodules within a fluid matrix
Surgical Management >> Complete surgical excision

16. Thyroglossal Duct Cyst
The thyroid primordium originates at the level of the foramen cecum at
the junction of the anterior 2/3 & posterior 1/3 of the tongue located in
the midline or slightly paramedian
The cysts usually manifest as an enlarging painless fluctuant mass ranges
from 0.5 to 6 cm in diameter
Approximately 80% of the cysts occur either at or below the level of the
hyoid bone.
Characteristically the lesion moves upward on tongue protrusion, a
reflection of the origin of the duct at the foramen cecum
CT scans >> smooth, well-circumscribed mass anywhere along the
vertical course of the vestigial thyroglossal duct

17. Surgical Management >> Sistrunk procedure involves en bloc excision
of the entire thyroglossal duct tract to the foramen cecum, as well as the
central 1 to 2 cm of the hyoid bone

18. Sistrunk procedure

19. Branchial Cleft Cyst
most commonly located in the submandibular space. However, because
of the anatomic relationship of the second branchial cleft and the cervical
sinus, they can occur anywhere along a line from the oropharyngeal
tonsillar fossa to the supraclavicular region of the neck. These cysts
usually present as painless fluctuant masses in the lateral portion of the
neck adjacent to the anteromedial border of the SCM muscle, at the
mandibular angle
CT scans >> well-circumscribed,
homogeneous, masses surrounded
by a uniformly thin wall
Surgical Management
Complete surgical excision

20. Sebaceous cyst
 Benign, harmless growth that occurs under the skin and tends to be smooth to the
touch.
 Ranging in size, sebaceous cysts are usually found on the scalp, face, neck and
ears.
 They are formed when the release of sebum, a medium-thick fluid produced by
sebaceous glands in the skin, is blocked.
 Unless they become infected and painful or large, sebaceous cysts do not require
medical attention or treatment, and they usually go away on their own.
 If they become infected, the physician may drain the fluid and cells that make up
the cyst wall. Or, if the cyst causes irritation or cosmetic problems, it may be
removed through a simple excision procedure.

21. Ranula presents as a Cystic swelling in the floor of mouth.
 It occurs as a mucous extravasation from sublingual salivary gland.
 Plunging Ranula may extend through the mylohyoid muscles into
the neck.
 Surgical treatment is by removal of the Sublingual gland.

22. Pharyngeal pouch
pocket that forms in the upper part of the esophagus. Food collects in
the pouch instead of going down the esophagus causing difficulty in
swallowing and loss of weight. Some food may regurgitate (comes
back undigested) in the throat and mouth causing coughing and chest
infections.
Etiology
 Upper esophageal sphincter dysfunction.
 When the upper esophageal sphincter doesn’t open all the way, it
puts pressure on an area of the pharynx wall.
 This excess pressure gradually pushes the tissue outward.

23. Clinical picture
• Left side swelling
• Soft, tender
• Pain, dysphagia
• Recurrent respiratory infection
• Halitosis
• Food regurgitation
Diagnosis
Barium swallow, is a special X-ray that highlights the inside of your
mouth, pharynx, and esophagus.

24. Goitre

26. Neoplasms

27. Benign tumors
Pleomorphic adenoma
1- Parotid > submandibular & palatal S.G
2- Painless, firm, slowly growing swelling
3- With Submucosal bluish discoloration
4- Not invade facial n.& no metastasis
5- It’s dump-bell shaped tumor

28. Treatment
Complete excision with a surrounding normal tissue
1- if in Superficial lobe Superficial parotidectomy (lateral
lobectomy)
2- if in superficial and deep lobe Total parotidectomy with
preservation of facial nerve.

29. Warthin’s tumor
• in parotid & minor glands in palate
• slowly growing round painless movable mass
• Bilateral
• If multiple & irregular >>> high recurrence rate
• Superficial parotidectomy

30. Malignant tumors
Malignant pleomorphic adenoma
Primary malignant pleomorphic adenoma
Malignant transformation of benign pleomorphic adenoma

32. Squamous Cell Carcinoma
• 6th most common cancer worldwide
• HNSCC ~ 5% all cancers
• S.C.C most common upper aero digestive tract malignancy
• Smoking
• 50% HNSCC occur in oral cavity
• Management presents considerable functional and aesthetic
problems
• Multidisciplinary approach imperative
 Removal of Primary tumor + cervical nodes
 Surgery / Radiation / Chemotherapy
 Sometimes palliation
 Cervical neck disease reduces survival by 50%