Chapter 22: Benign Neck Mass Flashcards
Superior boundary of neck
- Lower border of the mandible
- Mastoid tips
- Superior nuchal line
Inferior border of the neck
- Suprasternal notch
- Clavicles
- Horizontal line through the spinous process of the 7th cervical vertebra
Divides each side of the neck into 2 triangles
Sternocleidomastoid
Most masses appear in the…
Anterior cervical triangle
The more likely the neck is malignant
The older the patient
Preferred method of diagnosing a neck mass when immediate excision is not indicated
FNAB
Vestigial remnants of the fetal branchial apparatus from which all neck structures are derived
Branchial cleft cysts
Early development there are
5 branchial arches
4 grooves
Rapid growth of the 1st and 2nd arches and the epipericardial ridge submerges the 3rd and 4th branchial arches and the 2nd, 3rd and 4th branchial clefts into a large cavity known as the…
Cervical sinus of His
Future SCM muscle
Epipericardial ridge
Usually present as a bulge or sinus tract opening along the anterior border of the SCM muscle
Most branchial clefts cysts (develop from 2nd, 3rd and 4th arches)
Presents between ages 20 and 30 as a smooth, painless, slowly enlarging mass in the lateral neck
Branchial cleft cyst
Treatment of branchial cleft cyst
Complete surgical removal of the cyst and tract
First seen as a ventral midline diverticulum of the floor of the pharynx just caudal to the junction of the 1st and 2nd branchial arches at the site known as the foramen cecum
Thyroid gland
Midline cysts found anywhere between the base of the tongue and superior border of the thyroid gland
Thyroglossal duct cyst
Midline cyst that elevates with swallowing
Thyroglossal duct cyst
Treatment of thyroglossal duct cysts
Complete excision of both the cyst and the entire thyroglossal duct tract up to the foramen cecum at the base of the tongue
Sistrunk procedure
Removal of the central portion of the hyoid bone to ensure complete removal of the tract
A lymphangioma that arises from vestigial lymph channels in the neck
Cystic hygroma
Present as a relatively simple thin-walled cyst in the floor of the mouth or may involve all the tissues from the floor of the mouth down to the mediastinum
Cystic hygroma
- 80% of the time there is only a painless cyst in the posterior cervical triangle or in the supraclavicular area
- Present by the age of 2
- Tx: complete surgical excision (if regression fails to occur)
Cystic hygroma
Last step in the work-up of a neck mass
Biopsy
Tender neck nodes…
Infectious
Painless neck nodes…
Metastatic disease
