An approach to neck masses

• The neck is the transitional area between the

base of the cranium superiorly and the clavicles
inferiorly.
• The neck joins the head to the trunk and limbs,
serving as a major conduit for structures passing
between them.
• The neck is traditionally divided into the central
and the lateral necks, with the lateral neck
further subdivided into anterior and posterior
triangles
Contents of Anterior triangle
Lymph Nodes
Patient presented with neck lump,
swelling or mass, what is your work
up?
• HISTORY:
– Age
• Children – benign
• Adults -- neoplastic
• Location
– Midline swelling
Lateral swelling
 Duration

Transient post
Bilateral parotid
Congenital Inflammatory Metastatic prandial salivary
swelling
gland swelling

Present at birth, Short history, Mumps in

Acute, Resolves
Enlarge rapidly Progressive Duct stenosis children, Sialosis
within 6 weeks
during URTI enlargement in adults
Family Social
History History

TB Contact
Smoking Alcohol Travel Hx
contact Hx
Examination

General Physical Examination

Head and Neck examination

• Post nasal space
• Oral cavity
• Posterior 3rd of tongue
• Tonsil
• Larynx
• Pharynx
• thyroid
Position, size and
character of node

Hard and fixed – SCC

Soft and rubbery -

lymphoma

Pulsatile – carotid
body tumor

Mobile node in only

one direction – vagal
schwanomma

Supraclavicular node –
metastatic spread from
chest/breast/GIT
Features raise suspicion of malignancy:
• 1. voice change,
• 2. odynophagia,
• 3. dysphagia,
• 4. haemoptysis
• 5. previous radiation, especially with thyroid
tumours.
• 6. oral lesions, recent trauma, globus sensation,
• 7. referred ear pain, muffled or decreased
hearing
• 8. constitutional symptoms (e.g. night sweats,
anorexia, weight loss),
• 9. unilateral nasal discharge or epistaxis,
• 10. family history of cancer and previous
tumours
Investigations
CBC

ESR

Viral serology

Montaoux Test

CXR

Ultrasound

FNAC

CT/MRI

Excisional Biopsy