The nerve to the lower lip muscles (marginal mandibular) lies just below the jaw-line and is at risk from an incision in this location. Generally the main nerves at risk are the small nerve to the muscles of the lower lip, the nerve to the trapezius (shoulder muscle), and the nerve that supplies touch sensation to the ear. The likelihood of a significant unplanned injury is very small but will be discussed with you. Nerve damage may lead to an area of numbness and even a weakness of a muscle. Infection and a small haematoma can also occur but are rare. There is the possibility of damage to nerves in the area which Dr McIvor will discuss with you. The liklihood of complications is very small for this surgery. Is it a safe operation and what are the side effects?ĭr McIvor has done thousands of neck operations. What will happen when I get back to the ward? What do I do on the day of surgery and what shall I bring to hospital? What must I do in the week before surgery? When and where will the operation be done? Removal may need to be delayed if the cyst is acutely inflamed because of the risk of creating a branchial fistula. Care must be taken not to damage the carotid vessels and internal jugular vein which usually lie deep to the swelling. On examination, it is usually fluctuant but does not transilluminate. The cyst may enlarge during an upper respiratory tract infection and then persist. It is most common in young adults where it presents as a smooth swelling in front of the anterior border of the sternomastoid at the junction of its upper and middle thirds. It arises from embryonic remnants of the second branchial cleft in the neck. A fistula is a tract connecting the gut to the skin. A sinus refers to a tract with or without a cyst that communicates to either the gut or skin. A cyst refers to a mucosa or epithelium lined structure with no external or visceral openings. The word branchial comes from the Greek, "bragchia," meaning gills.
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Some will have a past history of skin cancers. These patients may be heavy smokers and may experience throat or ear discomfort, voice change or swallowing difficulty. Lateral neck nodes in adults may be metastases from the throat. Any nodes that persist for more than 3 weeks in the absence of a diagnosis should be investigated. Lymphomatous nodes can have similar symptoms of fever, night sweats, weight loss, and tenderness.
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Serology for glandular fever or toxoplasmosis may be positive. Inflammatory nodes are generally associated with systemic symptoms such as tenderness, fever, malaise, sore throat. Any lumps that are persisting or growing over a few weeks or months must be investigated for malignancy. Most inflammatory lumps will begin to resolve within 3 weeks. parotid or thyroid cancers can be quiescent for years before taking on a more aggressive course. Generally lumps that have been present for years are benign but not necessarily so e.g. However multiple non-tender nodes can be due to malignancy either primarily of lymph nodes (lymphoma) or secondarily by spread from a cancer of the head and neck (nodal metastasis). Multiple lumps are generally lymph nodes and the most common cause is inflammation e.g. glandular fever, toxoplasmosis. Most thyroid lumps are benign but still require investigation as some are cancers. Lower neck - in front of or deep to the neck muscles – often represent thyroid abnormalities and will elevate with swallowing. Other possibilities include nerve tumours, carotid body tumours. Any persisting lateral neck lump in an adult must be treated with suspicion for malignancy. In adolescents and young adults a branchial cyst may come up almost over night and present as a firm swelling in the upper neck. Lateral neck – usually are enlarged lymph nodes. In Polynesian patients in particular, a cystic swelling may be due to a plunging ranula which is due to chronic leakage of mucus from the sublingual gland (under the tongue) into the neck. As with parotid lumps, lymph nodes involved by skin cancer occur increasingly with age. Under the body of the mandible – usually related to abnormalities of the submandibular gland such as blocked gland, infection, tumour. Most are benign parotid tumours but lymph nodes involved by skin cancer occur increasingly with age. In the lower neck they may represent thyroid abnormalities and will elevate with swallowing.Īngle of jaw – most of these are parotid lumps.
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Under the chin they may represent dermoid cysts, thyroglossal cysts (especially around the hyoid). present at birth at least in vestigial form. Midline lumps – these are often congenital i.e. Single lateral neck lumps in an adult over 40 must be considered cancerous until proven otherwise. The vast majority of lumps in children and young adults will be either inflammatory or congenital. The important concepts in understanding neck lumps are