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Neck swellingsNeck swellings
ByBy
Prof.Dr. Mohamed WardaProf.Dr. Mohamed Warda
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Neck swellingsNeck swellings
Midline swellingsMidline swellings
Lateral SwellingsLateral Swellings
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A neck mass is very commonA neck mass is very commonA variety of clinical condiitons areA variety of clinical condiitons are
assoc a e w a mass n eassoc a e w a mass n eneckneck
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Midline neck swellingsMidline neck swellings
Sublingual dermoid cystSublingual dermoid cyst Dermoid cystDermoid cyst
..
Throglossal cystThroglossal cyst
Thyroid nodule in the isthmusThyroid nodule in the isthmus
Subhyoid bursaSubhyoid bursa Thymic cystThymic cyst
LaryngocoeleLaryngocoele
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Lateral neck swellingsLateral neck swellings
Solid SwellingsSolid Swellings
Anterior triangleAnterior triangle Posterior trianglePosterior triangle
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Lymph nodesLymph nodes
Parotid swellingParotid swelling
Submandibular SwSubmandibular Sw
Cervical ribCervical rib
Lymph nodesLymph nodes
Thyroid glandThyroid gland
Sternomastoid trSternomastoid tr
Carotid body trCarotid body tr
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Thyroid cystThyroid cyst
Plun in ranulaPlun in ranula
Cystic hygromaCystic hygroma
Branchial cystBranchial cyst
LaryngoceleLaryngocele
abcessabcess
LaryngoceleLaryngocele
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Enlarged lymph nodesEnlarged lymph nodes
InfectionInfection
-- non specificnon specific
-- specificspecific
MalignantMalignant
11ry lymphomary lymphoma
22ry metastasisry metastasis
. .. .
SyphilisSyphilis
ToxoplasmosisToxoplasmosis
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FIGUREFIGURE 22.. Lymph node groups with the most likely sites ofLymph node groups with the most likely sites ofthe primary lesion.the primary lesion.
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EtiologyEtiology
CongenitalCongenital
raumaticraumatic
InflammatoryInflammatory
NeoplasticNeoplastic
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CongenitalCongenital
Pediatric age groupPediatric age group
Benign: thyroglossal duct cyst,branchialBenign: thyroglossal duct cyst,branchialcleft cyst, cystic hygroma, hemangiomacleft cyst, cystic hygroma, hemangioma
,, Lateral: inflammatory or hyperplastic LNLateral: inflammatory or hyperplastic LN
Maligant is rare: lymphoma thyroid ca orMaligant is rare: lymphoma thyroid ca or
other soft tissue tumorother soft tissue tumor
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Thyroglossal duct cystThyroglossal duct cyst
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Thyroglossal duct cysts are remnants of theembryonic thyroglossal duct that may occuranywhere from the base of the tongue to thethyroid gland. The majority, however, are found
a e eve o e yro yo mem rane, un erthe deep cervical fascia. hey are midline or just
off the midline, and move up and down upon
swallowing
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A dermoid cyst is a pocket or cavity under thekin h n in i n rm ll r n in
Dermoid cystDermoid cyst
the outer layers of the skin. The pocket formsa mass that is sometimes visible at birth or inearly infancy but often is not seen until lateryears. Dermoid cysts are usually found on thehead or neck, and sometimes on the face.
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A dermoid cyst is a congenital defect (present
from birth) that occurs during embryonicdevelopment when the skin layers do notro erl row to ether. A dermoid c st is lined
with epithelium, which contains tissues and cellsnormally present in skin layers, including hairfollicles, sebaceous (skin oil), and sweat glands.
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Branchial cystBranchial cyst
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BRANCHIAL CLEFT CYSTS are congenitalcysts, that arise in the lateral aspect of the neck
when the second branchial cleft fails to closeduring embryonic development. At about thefourth week of embryonic life, 4 branchial (or
p aryngea c e ts eve op etween r gesknown as the branchial (or pharyngeal) arches.These arches and clefts contribute to theformation of various structures of the head andneck.
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Branchial cleft cysts are the most commonof congenital neck masses. They are
bilateral in about 2-3% of thecases. Usually, they do not appear at
,life. If they get infected, they may form adeep neck abscess or a draining fistula.
The treatment of branchial cleft cysts issurgical excision.
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Cystic hygromaCystic hygroma
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are)lymphangiomasCystic hygromas (
multiloculated cystic structures that arebenign in nature. They form as the result ofbudding lymphatics and, thus, may occur
anywhere in the body, although they are mostfrequently encountered in the neck (75%)and axilla (20%).
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Often the tongue, base of tongue,
supraglottic larynx and mediastinum areinvolved, causing severe respiratory
. .
Surgery is the treatment of choice
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TraumaticTraumatic
Rarely produce a solitary massRarely produce a solitary mass
Hematoma, sternomastoid tumor AVMHematoma, sternomastoid tumor AVM
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InflammationInflammation
Sign of inflammation and tendernessSign of inflammation and tenderness
, ,, ,toxoplasomosis, cattoxoplasomosis, cat--scratch fever,scratch fever,
Hyperplastic lymphadenopathy in AIDSHyperplastic lymphadenopathy in AIDS
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NeoplasticNeoplastic
Benign: Lipoma , neurofibroma, CarotidBenign: Lipoma , neurofibroma, Carotidbody tumor, neurogenic tumor adenomabody tumor, neurogenic tumor adenoma
of thyroid and parathyroid.of thyroid and parathyroid. Malignant: primary or metastaticMalignant: primary or metastatic
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An asymptomatic solitary neck mass in theAn asymptomatic solitary neck mass in the
lateral aspect of the neck in an adultlateral aspect of the neck in an adultshould be considered a metastatic lymphshould be considered a metastatic lymph
..
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DiagnosisDiagnosis HistoryHistory
Physical examinationPhysical examination X ray & ultrasoundX ray & ultrasound
Fine neddle aspiration or biopsy: sensitivity ,Fine neddle aspiration or biopsy: sensitivity ,lymphoma is difficultlymphoma is difficult
Excional biopsy : small or movableExcional biopsy : small or movable
Incisional biopsy : large , multiple unresectable.Incisional biopsy : large , multiple unresectable.
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Open biopsy , it is best performed in theOpen biopsy , it is best performed in the
operating roomoperating room To proceed with definite surgicalTo proceed with definite surgical
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Thank youThank you