CHAPTER 8 Head, neck and otorhinolaryngology
Scalp swellings
These include sebaceous cysts, lipomas, papillomas, squamous cell and basal cell carcinomas and melanoma (→ Ch. 19). Other swellings of the scalp include those described below.
Swellings in the neck
A convenient classification of these is: superficial, lymph nodes and deep swellings (→ Table 8.1).
TABLE 8.1 Swellings in the neck
Superficial | Sebaceous cyst |
Lipoma | |
Dermoid cyst | |
Abscess | |
Lymph nodes | |
Deep | |
Anterior triangle | |
Posterior triangle | Cervical rib |
Subclavian artery aneurysm | |
Pharyngeal pouch | |
Cystic hygroma |
Superficial
Superficial lumps include sebaceous cysts, lipomas, dermoids and infective lesions, e.g. boils and abscesses. A common site for lipomas is in the midline posteriorly at the level of the collar line (→ Ch. 19).
Lymph nodes
The majority of swellings in the neck, especially in children, are likely to be lymph nodes. The lymph nodes of the head and neck are basically arranged in two circles; an outer superficial one including submental, submandibular, preauricular, and occipital nodes; and an inner one surrounding the trachea and oesophagus and including the paratracheal and retropharyngeal nodes. Both the superficial and deep groups drain into a chain of deep cervical lymph nodes that surround the internal jugular vein. Lymph from there drains into the thoracic duct on the left and into the right lymphatic duct. The causes of cervical lymphadenopathy are shown in Table 8.2.
TABLE 8.2 Causes of cervical lymphadenopathy
Infection | Local lesions on head and neck |
Upper respiratory tract infection | |
Tonsillitis | |
Glandular fever | |
Toxoplasmosis | |
Tuberculosis | |
HIV | |
Cat-scratch disease | |
Malignancy | |
Sarcoidosis |
Deep swellings of the anterior triangle
Swellings that do not move on swallowing
Salivary glands: inflammatory
The parotid gland is included here, although only a part of the gland extends into the neck under normal conditions. In pathological conditions it may present with the swelling largely in the neck. The causes of swellings of the salivary glands are shown in Table 8.3.
TABLE 8.3 Swellings of the salivary glands
Inflammatory and infective | Acute sialadenitis, e.g. mumps parotitis |
Chronic sialadenitis, e.g. calculus, duct stenosis | |
Neoplastic | |
Autoimmune | Mikulicz’s syndrome |
Sjögren’s syndrome |
Salivary glands: tumours
Benign: Pleomorphic adenoma
Differential diagnosis
Parotitis, sebaceous cyst, lipoma, preauricular lymph node, tumour of ramus of mandible.
Benign: Adenolymphoma (Warthin’s tumour)
This is a cystic tumour that contains epithelial and lymphoid elements. It is benign.
Branchial cyst
This is a remnant of the second branchial cleft. It may be associated with a sinus or fistula.
Deep swellings of the posterior triangle
Cervical rib
This may cause neurological or vascular symptoms in the arm (→ Ch. 15). It is often asymptomatic. Occasionally the rib is palpable.
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