Types Of Neck Swellings | Triangles of the Neck

Swelling of Neck

Few more weeks to go and the weather is making things worse.

People having fun with the weights.

It was a nice long drive.

Okay,this post won't be useful for general readers.This is for medical students and doctors.Even for my self as a reference.


Swellings in the neck
Swellings in the neck are caused by innumerable pathological lesion arising from the anatomical structure lying within.

I'm going to classify them in two category;according to structures and nature and location.

Skin and superficial fascia
Sebaceous cyst
Lipoma
Fibroma

Lymphatics
Cystic hygroma
Solitary lymphatic cyst

Lymph nodes
Inflammatory
Neoplastic
Reticulosis


Blood vessels
Aneurysm
Hemangioma
Carotid body tumour

Nerve tissue
Neurofibroma

Thyroid gland 
Inflammatory
Neoplastic
Autoimmune disease

Pharynx
Pharyngeal pouch

Larynx
Laryngocele

Branchial arch remnant
Brachial cyst

Thyroglossal duct remnant
Thyroglossal cyst

Salivary Gland
Inflammatory
Neoplastic
Autoimmune disease

Most of the neck swellings can often be diagnosed from the history and physical signs alone.
The most common swelling in the neck are of lymph node origin and the most likely causes of lymphadenopathy are infection and metastatic spread of cancer.

Lymph nodes -85%
Goiters-8%
Others-7%

Lymph nodes are recognised by the physical sign more easily when multiple then when solitary. Solitary lymph node swelling is a great diagnostic challenge.

Goiters are swelling of the thyroid gland .They are distinguished from other lump in the neck by the fact that they move on swallowing.

Triangle of The Neck and Surgical Anatomy

Anatomically ,the swellings of the neck can be classified into 2 groups.  Situated in the midline and lateral.
The anterolateral part of the neck is conventionally divided into an anterior and posterior triangle by the sternomastoid muscle.By pressing the jaw laterally against the resistance of one's hand the sternomastoid become taut.
This muscle helps to define two triangles.The anterior triangle is bounded by the midline from chin to manubrium, posteriorly by the anterior border of the sternomastoid and above by  the lower border of the mandible.It can be subdivided by the digastric muscle and the omohyoid muscle into the to suprahyoid submental carotid and   muscular triangles.

The posterior triangle is bounded anteriorly by the posterior border of the sternomastoid, posteriorly by the anterior border of the trapezius and below by the middle third of the clavicle.For clinical evaluation,the swellings in the neck can be grouped in one of these easily definable triangles.

Classification

Cystic swellings
1.Ranula
2.Cervical dermoid
3.Subhyoid bursal cyst
4.Thyroglossal cyst
5.Cyst in relation to isthmus of thyroid gland.
6.Cold abscess in space of burns
7. Aneurysm of artery

Solid swellings
1.Lymph node swellings.
*Submental
*Pre-laryngeal
*Pre-tracheal

2.Thyroid gland swelling (moves up with swallowing)
*Diffuse swelling
*Solitary nodule
*Multinodular

3.Bony growth arising from the manubrium.

4.Rarely persistent thymus

5.Rarely ectopic thyroid

All the midline swelling are included within the anterior triangle.

Lateral Swellings- Cystic and solid
For better clinical assessment, lateral swellings can be grouped according to their location within any of the three triangles of the neck:
(a)sub- mandibular triangle
(b) carotid triangle
(c) posterior triangle

Submandibular Triangle
Cystic swellings
1.Plunging ranula
2.Lateral variety of sublingual dermoid
3.Retention cyst of salivary gland.

Solid swellings
1.Submandibular salivary gland
*Tumor
*Sialitis
*Sialolithiasis
*Sjogren's syndrome
2.Lymph node swelling

Carotid Triangle
Cystic swellings
1.Branchial cyst
2.Abscess in lymph node glands
3.Carotid aneurysm
4.Cystadenoma of lateral lobe of thyroid
5.Laryngocele

Solid Swellings
1.Carotid body tumour
2.Lymph node swelling
3.Solid swelling of lateral lobe of thyroid
4.Sternomastoid tumour
5.Bronchiogenic carcinoma

Posterior Triangle
Cystic Swellings
1.Cystic hygroma
2.Solitary lymphatic cyst
3.Abscess in lymph node
4.Pharyngeal pouch
5.Subclavian aneurysm

Solid swellings
1.Lymph node swelling
2.Cervical rib

Swellings anywhere in the neck
1.Sebaceous cyst
2.Lipoma
3.Fibroma
4.Neurofibroma
5.Haemangioma

Hope it helps.

This might be useful as well.