The Neck

Published on 02/03/2015 by admin

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Last modified 02/03/2015

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Chapter 7 The Neck

A. Neck Features And Swellings

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.

image

Figure 7-1 Anterior and posterior triangles of the neck.

(From Seidel HM, Ball JB, Benedict GW: Mosby’s Guide to Physical Examination, 3rd ed. St. Louis, Mosby, 1995.)

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).

Table 7-1 Neck Masses

Anterior triangle
Midline
image Mostly thyroidal—goiter/nodule(s)
image Thyroglossal (duct) cyst
image Thyroglossal fistula
image Dermoid (cyst)
Lateral aspect
image Branchial cleft cyst
image Branchial fistula
image Branchial hygroma
image Cystic hygroma
image Laryngocele
image Masseter muscle hypertrophy
Posterior triangle
Neoplastic
image Lymphomas
image Metastatic
image Neurogenic
image Paragangliomas/glomus tumors
image Miscellaneous (ectopic salivary)
Inflammatory: localized
image Tuberculous lymphadenitis (scrofula)
image Bacterial lymphadenitis (abscess)
image Suppurated branchial or thyroglossal cyst
Inflammatory: diffuse
image 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.

image

Figure 7-2 Surface projections of several neck masses.

(From Seidel HM, Ball JB, Benedict GW: Mosby’s Guide to Physical Examination, 3rd ed. St. Louis, Mosby, 1995.)

16 What is a dermoid (cyst)?

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