NECK MASSES 241 the anterior border of the sternomastoid muscle. It is cystic and quite lobile in all directions. If the fluid is aspirated it will be found to contain lolesterol crystals. Cysts in this position have their internal opening just shind the posterior pillar of the fauces. On occasion they may occur in the pper third of the sternomastoid muscle and mimic a parotid swelling by ashing the tail of the parotid outwards. These cysts represent remnants from te first branchial cleft and open internally at the junction of the bony and Fig. 123. Thyroglossal cyst. r—ifc - . Fig. 124. Branchial cyst. artilaginous external auditory meatus. As well as presenting as a mass t(Ney lay also cause a discharging ear. Cervical ribs, if large, may simulate a stony hard lymph node in the art of the posterior triangle. The fact that they are the only structures re stony hard in that area is helpful in the diagnosis. Laryngocele is dealt with in Chapter 36 (p. 176). It is a remnant QJ rimitive air sac and presents at the side of the neck over the thyro] aembrane. It may be easily inflated and emptied of air, and it shoj haracteristic radiographic appearance. Sometimes the mouth of t; ecomes blocked, infection supervenes and the presentation is that yocele. . Tuberculosis. This classically affects the lymph nodes in the Drmerly it was not uncommon for the glands to involve the skin and t discharging sinus. Nowadays this is rare because such enlarged neck re usually dealt with at a much earlier stage. Tuberculosis commonly lands in the deep jugular chain around the carotid bulb and he glands in the posterior fossa are aifected. As the glands enlarge o become intimately associated with the walls of the major blood his makes excision difficult. While many cases have associated pi uberculosis, the neck glands may be the only manifestation of the The treatment is to excise one or two glands for biopsy, and to treat tfeefbafter vith the appropriate chemotherapy.