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Full text of "Diseases Of The Nose Throat And Ear"

CHAPTER 45
NECK MASSES

In the changing pattern of the specialty it is essential that every otolaryngo-
logist should be familiar with the diagnosis and management of masses in the
neck. It is also desirable that general practitioners should have some insight
of what is a fairly common complaint.

In this chapter a description will be given of the main causes of neck masses
and of the management of the patient who presents with such a complaint.

CAUSES OF NECK MASSES

1. Skin and Associated Structures. The most frequent skin lump is a sebaceous
cyst and the diagnostic feature here is the presence of a punctum. Neuro-
fibromas are usually multiple flat raised areas which may be associated with
cafe au lait spots and occasionally with acoustic neuromas. Lipomas can occur
anywhere in the neck, but usually present as a supraclavicular fat pad. In the
presence of enlarged glands the skin should be searched for melanomas or
infected scratches (as in cat scratch fever) or boils. Some fungous infections
affect the skin and subcutaneous tissue of the cervicofacial region, the
commonest being actinomycosis^ tularaemia^ orf and blastomycosis*

2. Thyroid Masses. This is the commonest group of neck swellings seen in a
general hospital, and the simple goitre with or without hyperthyroidism is
most frequently found. A painful hard swollen thyroid, often accompanied by
a fever, is suggestive of thyroiditis and in this group is included Hashimoto's
disease. A. solitary thyroid nodule should always be regarded with suspicion
because it might be a simple adenoma, a papillary carcinoma, a follicular
carcinoma or a medullary carcinoma. A squamous carcinoma or a reticulosis of
the thyroid gland presents as a painless swelling and causes tracheal com-
pression or recurrent laryngeal nerve paralysis,

3. Infected Lymph Nodes. These are the most frequent swellings encountered
in general practice. Of these, the eufargQdjugulodigastric node seen in children
with tonsillitis is the commonest, and this in turn drains into the deep jugular
chain to cause further lymphadenopathy. Infected skin lesions such as cat
scratch fever and other more simple infections may also cause enlargement of
cervical glands. Enlarged lymph nodes in the posterior triangle usually occur
in the adult population, and the commonest causes are infectious mono-
nucleosis, toxoplasmosis, brucellosis and cytomegalovirus. This group may
also produce some lymphadenopathy in the deep jugular chain. Para-
pharyngeal abscesses may arise from either dental or tonsillar sources.

4. Salivary Gland Diseases. These may be included in neck swellings, as the
submandibular gland lies entirely within the neck, and the tail of the parotid,

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