Neck masses

Neck mass

Cervical triangle

Med line neck swelling

a-solid
1-submandibular LN enlargement
2-nodule in the isthmus of thyroid gland
b-cystic lesions
1-dermoid cyst
2-thyroglossal cyst
3-cold abscess
4-subhyoid bursitis
5- laryngocele
6-cystadenoma of the thyroid isthmus

Swelling in digastric triangle

1-LN enlargement in
submandibular
2-submandibular
salivary gland
enlargement
How we differentiate
both?

Swelling in carotid triangle

a-solid
1-upper deep cervical
LN enlargement
2-lat thyroid lobe
enlargement
2-carotid body tumor
b-cystic lesion
1-cold abscess
2-branchial cyst
3-aneurysm of the carotid

Mass of posterior triangle

a-solid
1-LN enlargement
2-neurofibroma from brachial
plexus
3-cervical rib
b-cystic lesion
1-cystic hygroma
2-pharyngeal pouch
3-cold abscess

Dermoid cyst

How it origin
What is it’s histology
Type of Dermoid
DD(ectopic thyroid, thyroglossal cyst , LN)


Thyroglossal cyst
Common sites(beneath the foramen cecum , floor of the mouth, above hyoid, beneath the hyoid on thyroid cartilage, at the level of cricoid cartilage
Definition
Clinical features and complications
Recu infections
Abscess and fistula
Papillary carcinoma
Treatment
Thyroglossal fistula

Structures move up with deglutition

1-thyroid mass
2-subhyoid bursitis
3-pretracheal and prelaryngeal LN
4-thyroglossal cyst

Branchial cyst

Origin
Clinical features
1-age=20-25 y
2-swelling
3-cyst lining by squamous
epithelium so contain cheesy,
toothpaste –like material
4-sternomastoid contraction test
5-aspiration of cyst showed cholesterol crystal
6-LNexamination

Cysts which are positive for cholesterol crystals are

1-cystic hygroma
2-thyroglossal cyst
3-hydrocel
4-dental and dentigerous cyst

DD
1-cold abscess
2-cervical Dermoid cyst
3-carotid body tumor
4-submandibular salivary gland swelling
5-Solitary LN enlargement

Cystic hygroma

Definition
Collection of lymphatic sacs which contain clear colorless lymph
Origin
Congenital and consist of a cluster of lymph channels that failed to connected into the normal lymphatic pathway
Sits
1-post triangle
2-axilla
3-groin
4-mediastinum 5-tongue and buccal mucosa


Cold abscess
Causes
1-TB
2-actinomycosis
3-leprosy
Why it is called cold abscess

Pathology

Stage of inflammation
1-lymphadenitis
2-periadenitis
3-cold abscess

Carotid body tumor(chomodectoma, potato tumor)

1-Originate at carotid body at bifurcation of carotid
2-age 40-70 ys
3-slow growing take ys
4-occasionally press on the carotid sinus produces attack of faintness

DD
1-LN
2-sternomastoid tumor
3-branchial cyst
4-aneurysm of carotid


Sternomastoid tumor
1-3-4wks of childhood
2-hard smooth non-tender
mass adherent to muscle
3-Head point toward the
same affected muscle
and chin to opposite side
(torticollis)
4-Delay in correction may produce facial deformity