neck lumps 1 comp

8/13/2019 Neck Lumps 1 Comp

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CONSIDERATIONS

&NECK LUMPS IN

PAEDIATRIC AGE GROUP


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GENERAL CONSIDERATIONS

A neck swelling should be carefullyevaluated by History, thorough clinicalexamination, imaging, endoscopy andfinally biopsy. Never resort to biopsy as afirst step.


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GENERAL CONSIDERATIONSCONTD.Age - 80 : 20 Rule to differentiate between

benign and malignant disease

Paediatric age group - 80% neck masses are benign


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Adult age group

80 % of neck masses are malignant


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Adult - Metastatic disease from structures

below clavicle may occur

Lung

Breast Stomach

Pancreas

Kidney Prostate

Uterus


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Clinical History & Examination Contd.

PRESENCE OF PAIN

SPECIFIC SYMPTOMS OF HEAD & NECK

MALIGNANCY

Dysphagia Pharyngo oesophagus

Dysphonia Larynx and Hypopharynx


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REFERRED OTALGIA POOR PROGNOSIS

WEIGHT LOSS

MALAISE LYMPHOMA & TUBERCULOSIS

NOCTURNAL FEVER AND PRURITIS

LYMPHOMA


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THOROUGH EXAMINATION OF

ENT and Head & NeckLumps in abdomen, Liver, Spleen and Axilla

POSITION OF LUMP IN RELATION TO TRIANGLES OFTHE NECK - FOR EXAMPLE

Thyroid Mid lineN.P.C Posterior triangleG.I malignancy Supraclavicular lump

MULTIPLE LUMPS LYMPH NODESPULSATILE LUMP WITH BRUIT CAROTID BODY

TUMORS


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INVESTIGATIONS

Haematological examination

Chest X ray & other relavent radiological studies

Endoscopy

F.N.A.C

Biopsy As the last step Preferably under G.A

after endoscopic examination of upper aero -

digestive tract


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NECK LUMPS

PAEDIATRIC CONDITIONS(Below 20 yrs of age)

Majority of the lumps are located anterior tosternomastoid.

An isolated lump in the posterior triangle islikely to be malignancy


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NECK SWELLINGS IN PAEDIATRIC AGE GROUP

MIDLINE NECK SWELLINGS LATERAL NECK SWELLINGS


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MID LINE NECK SWELLINGS

COMMON

Thyroglossal cyst

Dermoid cyst

Midline lymphnodes


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THYROGLOSSAL CYST

Commonest midline cystic swelling

Thyroglossal duct passes from foramen caecum atthe base of the tongue to isthmus of thyroid gland

The tract may pass behind, infront or through thebody of the hyoid bone

The duct usually disappears. A portion of the ductmay remain patent. Cystic dilatation of this portiondue to retained secretions is thyroglossal cyst.


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CLINICAL FEATURES

Even though congenital , presents at a later age usually5 yrs age

Midline cystic swelling at the thyrohyoid level

Swelling freely mobile in all directions

The swelling moves upwards on deglutition and onprotruding the tongue

Painful due to infection

Thyroglossal fistula occurs due to bursting of infectedcyst or incision or incomplete removal of the cyst

Carcinomatous changes can occur


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TREATMENT

Sistrunks operation- complete excision of thetract along with the body of the hyoid bone


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DERMOID CYST7% of dermoids occur in Head & Neck

Always in the midline of the neck


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Epidermoid cyst Most common

- Lined by squamous epithelium

containing cheesy material

- No adnexial structures

True dermoid Lined by squamous epithelium

- Contains skin appendages Hairfollicles, sebacious, and sweat glands

- Congenital, acquired (Implantation)


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Teratoid cyst - Rare. Contains elements of

ectoderm, endoderm andmesoderm

Solid or cystic, painless midline mass between

submental region and suprasternal notch

Treatment - Local excision


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OTHER MIDLINE SWELLINGS

Lymphnodes Inflammatory

- Tuberculous

- Neoplasia

Thyroid swelling


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INFECTIVE CAUSES

INFLAMMATORY CONDITIONS

Enlarged, infected lymphnodes of the neck arethe commonest cause for lateral neck lumps in

children

Some times tender

Primary areas of infection - oral cavity,oropharynx, nasopharynx and scalp


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Viral origin

Enlarged, Tender, Often bilateral parotid

swellings , extremely common

Constitutional symptoms- Malaise, pyrexia

Complications (orchitis, encephalitis) are rare

Treatment - Symptomatic

MUMPS


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TUBERCULOUS CERVICAL LYMPHADENITIS

Very common

Involves upper deep cervical and posterior triangle lymph nodes

Long standing lymphadenitis

Matting of lymphnodes due to periadenitis

Caseation Abscess formation Sinus

Diagnosis Blood examination, Mantoux, X-ray chest, F.N.A.C,Biopsy conclusive

Treatment A.T.T.


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CONGENITAL CAUSES

BRANCHIAL CYST

17% OF ALL PAEDIATRIC CERVICAL MASSES

Theories of Origin

Branchial apparatus theory-remnants of pharyngeal pouches

or branchial clefts, or a fusion of these two elements

Cervical sinus theoryCervical sinus of His formed by secondarch growing down to fuse with the fifth

Thyropharyngeal duct theory- cysts are remnants or original

connection between thymus and third branchial pouch

The inclusion theory- cysts are epithelial inclusions inlymphnodes acceptable theory


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CLINICAL FEATURES

Age Second or third decade

Painless smooth cystic swelling freely mobile

Site Junction of upper third and lower two thirds of theanterior border of sternomastoid

Sometimes higher, mimic parotid swelling, pushing parotid

Presence of cholesterol crystals in the fluid aspirated fromthe cyst

Cyst has internal opening behind posterior tonsillar pillarsor between bony & cartilaginous parts of external auditorymeatus

Treatment - excision


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Seen in the posterior triangle of the neck

Typically enlarges during crying and valsalva

manoeuvere

Brilliantly Transilluminant, walls thin, partiallycompressible


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The Hygroma may extend into face,mediastinum and axilla

May encroach on to air way (stridor), Brachialplexus (pain)

Sudden increase in size due to haemorrhage or

infection could be fatal


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Treatment

Excision - surgery difficult due to swelling extending

between nerves & blood vessels

Injection of sclerosing agents tried


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CHEMODECTOMA(Carotid body tumor, Potato tumor, Nonchromaffin

Paraganglioma)

Origin Chemoreceptor tissues around thecarotid bulb at the bifurcation of commoncarotid artery

Slow growing, firm, pulsatile mass understernomastoid at the level of bifurcation ofcarotids. Swelling mobile side to side and notvertically

Diagnosis C.T. & Carotid angiography

Treatment Surgical excision


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NEOPLASIAS

Primary- very common in paediatric age

group , usually lymphomas

Secondary metastatic nodesusually dueto nasopharyngeal carcinoma


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Lymphomas Usually of the Hodgkins variety

- Unilateral isolated lump in the neck

- Diagnosis by histopathological exam.

- Treatment Radiotherapy &

Chemotherapy


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PEDIATRIC NECK SWELLINGS

PEARLS OF WISDOM

80% are benign located in the anterior triangle

20% are malignant situated in the posterior triangle

Commonest midline lumpin children is thyroglossal cyst. Itmoves on swallowing and with protrusion of tongue

Commonest multiple lateral neck lumpsin children iscervical lymphadenopathy secondary to infection

Common, isolated lateral neck lumpin children is thebranchial cyst


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