Midline swellings of the neck

Dhingra

1. Midline Swellings of the Neck

2. Aetiology Congenital Infectious Inflammatory Neoplastic

3. Inflammatory Reactive lymphadenopathy Thyroiditis Neoplastic Thyroid Parathyroid Pharyngeal/laryngeal Congenital Thyroglossal duct cyst Laryngocoele Dermoid cyst Infectious Ludwig’s Angina

4. Thyroglossal Duct Cyst Moves on protrusion of tongue Increases in size during URTI Treatment – Sistrunk’s operation Fibrous cyst due to persistence of thyroglossal duct Cystic midline swelling Rounded – 2-3 cm diameter

5. Laryngocele Dilatation of laryngeal saccule Extends between thyroid cartilage and ventricle Treatment - excision

6. Ludwig’s Angina Infection of submandibular space Aetiology Dental infections Submandibular sialadenitis Injuries of oral mucosa Fractures of mandible

7. Clinical Features Odynophagia with Trismus Localised infection Spread of infection

8. Treatment Complications Systemic antibiotics Incision & drainage Intraoral External Tracheostomy Spread of infection Airway obstruction Septicaemia Aspiration pneumonia

9. Sublingual Dermoid Cyst Almost always benign. Management : Complete surgical removal without spillage of contents. Midline swelling Does not move on protrusion of tongue Contains developmentally mature and well-differentiated tissue.

10. Reactive Lymphadenopathy History of local infection or generalised viral illness . Should resolve spontaneously . No specific treatment required. By far the most common cause of neck swellings . Affects all age groups . Tender to touch.

11. Thyroid Swelling Most likely due to hyperthyroidism or hypothyroidism . Thyroid disease F > M . Typically young female patients.

12. Moves upwards on swallowing . Accompanied by thyroid symptoms. FNA may be useful to rule-out more sinister pathology. Manage underlying thyroid disorder.

13. Laryngeal Malignancy

14. May invade thyroid cartilage Perichondritis Tender on palpation Thyroid gland and strap muscles may also be invaded

15. Treatment Radiotherapy Surgery Conservation laryngeal surgery Total laryngectomy Combined therapy Endoscopic CO 2 laser excision Organ preservation Depends on Site of lesion Extent of lesion Metastasis Nodal Distant

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