Neck Swellings (184-198)

Question 1

Name differential diagnoses for a swelling in the midline of the neck;

Answer 1

Midline- Thyroglossal cyst, dermoid cyst, ectopic thyroid, ludwigs angina, thyroid or parathyroid neoplasm.

Any triangle/part in neck - Abscess, lipoma, lymphadenopathy, lymphoma.

Question 2

How would you distinguish a thyroglossal cyst from a thyroid swelling?;

Answer 2

Thyroglossal cysts move on protrusion/movements of the tongue - Classically elevates (unlike thyroid swelling)

Thyroid swellings & thyroglossal cysts may both move with swallowing.

Thyroid gland originates from the base of the tongue (foramen caecum), descends via the thyroglossal duct.
If duct doesnt obliterate (remains patent) thyroglossal cysts occur. Creating cavities that may fill with fluid and being prone to infection)

Question 3

Name four differential diagnoses for a swelling in the anterior triangle of the neck;

Answer 3

Branchial cyst, parotitis, carotid body tumour, salivary gland tumour

Question 4

Name four differential diagnoses for a swelling in the posterior triangle of the neck;

Answer 4

Tuberculosis, cystic hygroma, pancoast tumour, cervical rib

Question 5

Name two features associated with a cervical rib;

Answer 5

Compressive symptoms, palpable swelling

Question 6

Name two features associated with a subclavian steal syndrome;

Answer 6

(Stenosis localated proximal to the origin of the vertebral artery). Syncope and light headedness.

Question 7

Describe four signs and symptoms associated with a Pancoast tumour;

Answer 7

Cancompress on the brachial plexus - producing upper limb paraesthesia or weakness.
Can compress on cervical sympathetic chain resulting in Horner’s syndrome, which present with ptosis, meisosi and facial anhidrosis.
Can compress reccurent layngeal nerve - presents with hoarse voice.
Can compress SVC - dilated facial & upper limb veins plus respiratory comprimise.

Question 8

Name the sensory nerves that arise from the cervical plexus;

Answer 8

C1-C4

Question 9

Name the main motor nerve that arises from the cervical plexus and what this nerve supplies;

Answer 9

Ansa Cervicalis (C1-C3) - supplies strap (infrahyoid) muscles, except geniohyoid (supplied by C1 nerve root)

Question 10

What is the nerve supply to the strap muscles in the neck?;

Answer 10

Ansa Cervicalis (C1-C3) except geniohyoid (supplied by C1 nerve root)

Question 11

What is the nerve supply to the digastric muscles?;

Answer 11

Anterior belly- Inferior alveolar nerve (branch of the mandibular nerve CN V3).

Posterior belly- Digastric nerve (branch of facial nerve CN VII)

Question 12

Where is the stellate ganglion located?;

Answer 12

C7 vertebra

(a collection of sympathetic nerves found anterior to the neck of the first rib)

Question 13

What are the indications for performing a carotid endarterectomy?;

Answer 13

Symptotic carotid stenosis 50-79% (e.g. TIA in past six months). Severe stenosis 80-99% even if asymptomatic.

Question 14

What structures are at risk of injury during a carotid endarterectomy?;

Answer 14

Nerves
- Vagus (CN X) branches - superior and laryngeal recurrent laryngeal nerves,
-Glossopharyngeal (CN IX),
- Hypoglossal (CN XI),
- Mandibular branch of facial,
- pre-auricular

Question 15

What structures are at risk of injury when performing a submandibular gland surgery?;

Answer 15

Marginal Mandibular branch of facial nerve, lingual or hypoglossal nerve.