HEAD & NECK SWELLINGS EXCLUDING GOITRE FAISAL GHANI SIDDIQUI MBBS; FCPS; MCPS-HPE; PGDIP-BIOETHICS PROFESSOR OF SURGERY J 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
MIDLINE SWELLINGS NECK SWELLINGS LATERAL SWELLINGS GENERALIZED SWELLINGS
POSTERIOR TRIANGLE PHARYNGEA L POUCH CYSTIC HYGROMA LATERAL NECK SWELLINGS ANTERIOR TRIANGLE BRANCHIA L CYST CAROTID BODY TUMOUR STERNOMAS TOIDTUMOU R
THYROGLOS SAL CYST GOITRE MIDLINE NECK SWELLINGS
GENERALIZED NECK SWELLINGS
BRANCHIAL CYST
BRANCHIAL CYST -EMBRYOLOGY
BRANCHIAL CYST -EMBRYOLOGY
BRANCHIAL CYST CLINICAL FEATURES Congenital but appears at 20-25 years of age (the fluid accumulates very slowly) Located at junction of upper & middle 3 rd 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 cholesterol crystals
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 POUCH protrusion 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 HYGROMA a 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 sternomastoid muscle 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
TREATMENT Excision along with excision of carotid artery
STERNOMASTOID TUMOUR
STERNOMASTOID TUMOUR - ETIOLOGY TRAUMA 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
THYROGLOSSAL CYST