Neck lumps Flashcards
What are the borders of the anterior neck triangle?
Superior = inferior border of the mandible
Lateral - anterior border of SCM
Medial - sagittal down the midline
List the subdivisions of the anterior neck triangle
- Carotid triangle
- Submental triangle
- Submandibular triangle
- Muscular triangle
What are the borders of the carotid triangle?
Superior - posterior belly of digastric
Lateral - medial border of SCM
Inferior - superior belly of omohyoid
What are the major components of the carotid triangle?
- Common carotid artery (it bifurcates here)
- Internal jugular vein
- Hypoglossal and vagus nerves
What are the borders of the submental triangle?
(Found under the chin)
Inferior - hyoid bone
Medial - midline
Lateral - anterior belly of digastric
What are the main components of the submental triangle?
Submental lymph nodes
What are the borders of the submandibular triangle?
Superior - body of mandible
Anterior - anterior belly of digastric
Posterior border - posterior belly of digastric
What are the main components of the submandibular triangle
- Submandibular gland and lymph nodes
- Facial artery and vein passes through
What are the borders of the muscular triangle?
Superior - hyoid bone
Medial - midline of the neck
Superolateral - superior belly of omohyoid
Inferolateral - inferior portion of SCM
What are the main components of the muscular triangle?
- Muscles and organs including: infrahyoid muscles, pharynx, thyroid and parathyroid gland
What are the borders of the posterior neck triangle?
Anterior - posterior border of SCM
Posterior - anterior border of trapezius
Inferior - middle 1/3 of the clavicle
What are the subdivisions of the posterior neck triangle?
- Occipital triangle
- Subclavian triangle
What structure splits up the posterior neck triangle into the subdivisions?
The omohyoid muscle (specifically the inferior belly)
Which posterior neck triangle is larger and positioned superiorly?
Occipital triangle
What are the muscular components of the posterior neck triangle?
- Omohyoid muscle
- Splenius cpitus
- Levator scapule
- Scalanes (anterior, middle and posterior)
What are the vascular components of the posterior neck triangle?
- External jugular vein
- Subclavian vein
- Transverse cervical and supracapsular
What are the nervous components of the posterior neck triangle?
- Accessory nerve
- Cervical plexus (phrenic plexus)
- Branchial plexus
What is the role of the lymphatic system
Drainage of tissue fluid, plasma proteins and cellular debris, along with immune functioning
What are the divisions of the lymphatic system
- Superficial vessels
- Deep vessels
What is the function of the superficial lymphatic vessels?
Drainage from the scalp, face and neck to pass it on to deep lymphatic vessels
What are the divisions of the deep lymphatic vessels?
Left jugular lymphatic trunk
Right jugular lymphatic trunk
Where do the deep lymphatic vessels direct lymph to?
The associated subclavian vein (left and right depending on the jugular lymphatic trunk)
List the superficial lymph nodes
Occipital Mastoid Preauricular Parotid Submental Submandibular Facial Superficial cervical
What is the function of the deep lymph nodes?
- Recieve all the lymph from the head and neck either directly or via the superficial lymph nodes
Differential diagnosis for a superficial neck lump located at any aspect of the neck
- Skin abscess
- Lipoma
- Dermoid cyst
Differential diagnosis for a midline lump
- Thyroglossal cyst
- Thyroid swelling (goitre)
- Submental lymph nodes
- Sublingual dermoid cyst
Differential diagnosis for a lump in the anterior triangle
- Lymphadenopathy affecting submandibular nodes (infection, neoplasm)
- Submandibular gland pathology
- Tail of parotid gland swelling
- Branchial and lymphoepithalial cysts
- Thyroid lobe swelling
Differential diagnosis for a lump in the posterior triangle
- Lymphadenopathy - due to infections or neoplasms (primary or secondary)
- Carotid body tumour
- Lipoma
- Subclavian artery aneurysm
- Pharyngeal pouch
List bacterial infectious aetiology for cervical lymphadenopathy
- Dental abscess, cellulitis, periodontitis or pericoronitis
- Tonsil, face or scalp infections
- TB or syphilis
- Cat scratch disease
List viral infectious aetiology for cervical lymphadenopathy
Herpetic stomatitis
Infectious mononucleosis
HIV
List neoplastic aetiology for cervical lymphadenopathy
- Primary neoplasms - hodgkins and non hodgkins lymphoma or leukemia, skin neoplasms
- Secondary - carcinoma (oral, salivary gland, thyroid), malignant melanoma, metastases from gastric of abdominal cancer
Important history on examination for neck lumps
- History of systemic illness or infectious disease e.g. HIV or syphillis
- History of animal scratch
- Signs of systemic symptoms - fever, sweats, anaemia
- Signs of nasal, sinus or nasopharyngeal symptoms
- History of drugs (phenytoin)
- Onset and changes to the lump over time
Special ix for neck lumps
- Blood
- CXR
- Serology
- FNA
- Ultrasound (thyroid)
- Biopsy
- Others:: matoux test, thyroid function and ACE and calcium levels
Important signs upon inspection of a neck lump
- Changes to voice - weak, hoarse
- SOB or stridor
- Scars on the neck - previous surgery
- Obvious neck massess
What type of neck lymps will rise on swallowing?
Thyroid mass
Thyroglossal cyst
What type of neck lumps will move on protrusion of the tongue?
Thyroglossal cyst
What are the things we look for when assessing and presenting a neck lump?
- Size
- Site
- Shape
- Skin (overlying)
- Texture
- Temperature
- Mobility
- Fluctuant
- Pulsatility
- Ausculation
