Lateral Neck Swellings

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Lateral Neck Swelling

Fig. 5.24 Branchial cyst (a, arrow; b). This has a consistent site, is smooth, and, if there is no secondary infection, nontender. It lies between the upper one-third and lower two-thirds of the anterior border of the sternomastoid, and is deep to and partly concealed by this muscle (c). It can be large by the time it presents. When excised, the deep surface is found to be closely related to the internal jugular vein.

A metastatic lymph node from the thyroid, upper respiratory tract (e.g., nasopharynx) or postcricoid region, and swellings of neurogenous origin (chemodectomas, neurofibromas, neuroblastomas) are among the important differential diagnoses of a lateral neck swelling. The ubiquitous lipoma is also not uncommon in the neck, and in children the cystic hygroma is to be remembered. Hodgkin's disease also frequently presents with an enlarged cervical lymph node.

Cranial Nerve Test

Fig. 5.26 Test for accessory cranial nerve (XI) function. The sternomastoid muscle is supplied by the accessory nerve. If the patient is asked to press the forehead against the examiner's hand (a), the sternal attachments of the muscle stand out (b, arrow). When cranial nerve X is inactive, the sternal head on the side of the lesion remains flat (c, arrow). Bull, Color Atlas of ENT Diagnosis © 2003 Thieme All rights reserved. Usage subject to terms and conditions of license.

Fig. 5.25 Laryngocele. This is an unusual neck swelling that the patient can inflate with the Valsalva maneuver. It is an enlargement of the laryngeal saccule into the neck between hyoid and thyroid cartilage. It tends to occur in musicians who play wind instruments, or in glass blowers. Infection may develop in laryngoceles (a pyolaryngocele), and presents as an acute neck swelling often with hoarseness and stridor.

Fig. 5.26 Test for accessory cranial nerve (XI) function. The sternomastoid muscle is supplied by the accessory nerve. If the patient is asked to press the forehead against the examiner's hand (a), the sternal attachments of the muscle stand out (b, arrow). When cranial nerve X is inactive, the sternal head on the side of the lesion remains flat (c, arrow). Bull, Color Atlas of ENT Diagnosis © 2003 Thieme All rights reserved. Usage subject to terms and conditions of license.

Sympathetic Trunk

Fig. 5.27 Horner's syndrome. Pressure on the sympathetic nerve trunk in the neck, particularly by malignant disease, causes changes in the eye. Ptosis, with a small pupil, is apparent in the patient's left eye; this is also associated with an enophthalmos and a lack of sweating. With a cervical swelling, examination should exclude Horner's syndrome.

Fig. 5.27 Horner's syndrome. Pressure on the sympathetic nerve trunk in the neck, particularly by malignant disease, causes changes in the eye. Ptosis, with a small pupil, is apparent in the patient's left eye; this is also associated with an enophthalmos and a lack of sweating. With a cervical swelling, examination should exclude Horner's syndrome.

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