Chapter 7 The Neck
A. Neck Features And Swellings
(1) Generalities
The neck is an important crossroad of anatomic structures and organ systems, the most important of which is the thyroid (discussed in Chapter 8).
7 What are the anterior and posterior triangles of the neck?
They are important regions of the lateral neck, separated from each other by the sternocleidomastoid muscles (SCMs) (Fig. 7-1). These can be easily located through inspection and palpation, especially if tensed against resistance. The remaining borders of the posterior triangle are the anterior margin of the trapezius and the upper margin of the clavicle, whereas the remaining borders of the anterior triangle are the mandible and midline.
8 What are the contents of the cervical triangles?
In the anterior triangle, one can often palpate the jugulodigastric node. Other nodes are instead undetectable, unless enlarged by infection, inflammation, or malignancy. The anterior triangles also may harbor important embryologic remnants, such as thyroglossal duct/cysts, branchial cysts, and dermoids.
In the posterior triangle, there are many undetectable nodes that can become enlarged after a pharyngitis or a viral upper respiratory illness (URI).
The subclavian artery may be felt pulsating at the base of the neck, just above the clavicle.
The transverse process of the atlas may be palpated high in the neck, between the mandibular angle and mastoid process. It may be misinterpreted as a cervical mass.
The pulsatile common carotid artery (and its prominent bifurcation) is usually felt more laterally, along the SCM.
9 Which swellings may be encountered during inspection of the neck?
Many. Classification and origin depend on location (posterior or anterior triangle; and for the latter, midline or lateral aspect) and nature (inflammatory or neoplastic) (Table 7-1).
Anterior triangle |
Midline |
Mostly thyroidal—goiter/nodule(s) |
Thyroglossal (duct) cyst |
Thyroglossal fistula |
Dermoid (cyst) |
Lateral aspect |
Branchial cleft cyst |
Branchial fistula |
Branchial hygroma |
Cystic hygroma |
Laryngocele |
Masseter muscle hypertrophy |
Posterior triangle |
Neoplastic |
Lymphomas |
Metastatic |
Neurogenic |
Paragangliomas/glomus tumors |
Miscellaneous (ectopic salivary) |
Inflammatory: localized |
Tuberculous lymphadenitis (scrofula) |
Bacterial lymphadenitis (abscess) |
Suppurated branchial or thyroglossal cyst |
Inflammatory: diffuse |
Ludwig’s angina |
(2) Swellings of the Anterior Triangle (Midline)
10 What is the origin of midline swellings of the anterior cervical triangle?
They are mostly thyroidal (goiters or nodules). Less commonly, they represent remnants of embryonic structures, such as dermoids or thyroglossal duct cysts (Fig. 7-2). Since only thyroid and laryngeal structures ascend with deglutition, nonthyroidal masses can be easily identified by asking the patient to swallow.
12 Do thyroglossal cysts transilluminate?
No—which is counterintuitive, considering their cystic nature.
13 How common is a thyroglossal cyst?
Quite common. In fact, of all congenital neck masses, 75% are thyroglossal duct cysts.
14 What accounts for the other 25% of congenital neck masses?
Branchial cleft cysts, typically located more laterally, just between the SCM and hyoid.