#12139 - Neck Lumps - ENT

Neck lumps

80:20 rule

• Paediatric neck lumps

  • 20% malignanct

  • 80% benign

• Adult neck lumps

  • 80% malignant

  • 20% benign

20:40 rule

• Age < 20 years

  • Inflammatory neck nodes e.g due to tonsillitis

  • Congenital lesions e.g thyroglossal cyst, branchial cyst

  • Lymphoma

• Age 20-40 years

  • Salivary gland pathology (calculi, infection, tumour)

  • Thyroid pathology (tumour, thyroiditis, goiter)

  • Chronic infection (TB, HIV)

• Age > 40 years

  • Primary/secondary malignant disease

Paediatric neck lumps

• Mainly benign (80:20)

• Commonly anterior to sternocleidomastoid i.e in anterior triangle

• Isolated neck lump in posterior triangle has increase risk of being malignant

Thyroglossal cyst

• Commonest midline mass in children

• Formed from a persistent thyroglossal duct

  • Embryological remnant as thyroid descends, remains connected to tongue via thyroglossal duct. Normally atrophie and closes before birth)

• Fibrous cyst arises at any point along route of duct

  • Most commonly below hyoid bone

• Moves on swallowing or sticking out tounge

• Usually asymptomatic, apart from presence of lump

• If it becomes infected – pain and swelling persist

Management: USS – check they have a thyroid as cyst can be only thyroid tissue + excision

Dermoid cyst

• Usually present as submental swellings in the midline

• Are dermal remnants occurring along lines of fusion in the embryo

• Lined by epidermis + may contain hair, teeth and debris

• Don’t move on swallowing/tongue protrusion

Management: excision

Lymphadenopathy

• Lateral neck lumps commonly caused by enlarged infective nodes

• Tender if infected

• Multiple, palpable non-tender nodes = normal in children

• Commonest infection = viral URTI

• Resolution of infected nodes is rapid as primary infection settles

Mumps

• Parotid gland enlargement due to mumps virus is common

• Usually bilateral

• Child has malaise and pyrexia

• Rare cases complicated by orchitis + encephalitis

Management: symptomatic relief

Branchial arch cysts

• Arise from embryonic remnants of branchial arches

• Presents as smooth swelling, usually in front of sternocleidomastoid at junction of upper and middle 1/3rds

• Cyst may enlarge during URTI then persist

• May be tender in acute stage

• O/E usually fluctuant, doesn’t transluminate, doesn’t move on swallowing, no lymphadenopathy

Management: excision

Adult Neck Lumps

Thyroid masses

Commonest midline neck lump in adults

• Range from simple goiter to neoplasia

• Presenting symptoms

  • Usually painless midline neck lump M

  • Moves on swallowing

  • +/- Dysphonia

  • +/- Respiratory distress (compression of airway)

  • +/- Dysphagia...