Tiêu đề APPROACH TO NECK SWELLING ✅

APPROACH TO NECK SWELLING ANATOMY Midline Anterior Triangle (sup→ lower border mandible, ant→ midline, post→ ant border SCM) Posterior Triangle (ant→ post border SCM, Post→ ant border trapezius, Inf→ clavicle) 1. Submental lymph node 2. Thyroglossal cyst 3. Thyroid nodule in the isthmus 4. Pretracheal (Delphian’s) lymph node 5. Paratracheal lymph node 4. Sublingual dermoid cyst 5. Plunging ranula (retention cyst of the sublingual) 6. Ludwig’s angina 7. Subhyoid bursitis 8. Lipoma in submental region 9. Thymic swelling 1. Lymph node – along anterior border of sternocleidomastoid (levels II, III, IV) 2. Thyroid nodule 3. Submandibular gland mass 4. Branchial cyst + fistula 5. Chemodectoma (carotid body tumour) 6. Carotid aneurysm 7. Pharyngeal pouch 8. Laryngocoele (rare; an air-filled, compressible structure seen in glass-blowers) 9. Soft tissue tumor (hemangioma) 1. Lymph node – level V and supraclavicular lymph node groups 2. Cystic hygroma 3. Cervical rib 4. Brachial plexus neuroma/schwannoma 5. Jugular lymph node 6. Soft tissue tumor *Enlarged lymph nodes→ most common cause lump in neck Infectious inflammatory Reactive viral lymphadenopathy ● Most common cause of cervical lymphadenopathy ● URTI: adenovirus, rhinovirus, enterovirus ● EBV (infectious mononucleosis) ● Resolve spontaneously within 1-2 weeks ● The lymphadenopathy is typically tender and located in the submandibular region or jugular chain Bacterial lymphadenopathy ● Pharynx/skin infection: staph aureus, GABS ● TB:unilateral ● Brucellosis ● Cat-scratch disease Parasitic lymphadenopathy ● Toxoplasma gondii Iman, Nisa, Lissa, Izzaty (21/5/2021)

● Cold abscess ● Plunging Ranula ● Pharyngeal Pouch Solid ● Thyroid swelling ● Salivary gland swelling ● Lymph node swelling ● Bronchiogenic carcinoma ● Sternomastoid tumor Pulsatile ● Aneurysm of carotid artery and subclavian artery ● Carotid body tumour ● LN swelling lying in close proximity to carotid a. ● Primary toxic goiter (may not be pulsatile) ANATOMY Structure: 2 lateral lobes joined by an isthmus that lies in front of the 2nd, 3rd and 4th tracheal rings, anterior to larynx and trachea. Strap muscles of the neck lie superficial to the thyroid gland Nerves and vessels: Superior Thyroid Artery (from external carotid*) Divide the superior thyroid artery close to the gland, to avoid damage to the external branch of the superior laryngeal nerve Inferior Thyroid Artery (from thyrocervical trunk, branch of 1st part of subclavian artery) Divide the inferior thyroid artery far away from the gland to avoid damage to the recurrent laryngeal nerve External Branch of Superior Laryngeal Nerve – supplies the cricothyroid (tense vocal cord) and runs immediately deep to the superior thyroid artery If injured = inability to produce high pitch sounds along with easy voice fatigability (usually monotone voice – range and power of voice affected) – permanent paralysis is rare if nerve has been identified during op. (changes mostly subtle) Recurrent laryngeal nerve – supplies all intrinsic muscles of the larynx (except for the cricothyroid) and runs close to the inferior thyroid artery. The nerve runs behind the pretracheal fascia, hence will not be damaged if the fascia is not breached - If unilateral damage = affected cord lies in the paramedical position (inadequate glottis closure) presents with weak breathy voice, hoarseness - If bilateral damage = acute dyspnoea as a result of the paramedical position of both vocal folds which reduce airway to 2-3mm and which tend to get sucked together on inspiration - The right recurrent laryngeal nerve is more susceptible to damage during thyroidectomy (relative medial location) though a left vocal cord palsy is the most common (long intra-thoracic course, commonly involved in Iman, Nisa, Lissa, Izzaty (21/5/2021)