Midline Neck Swellings: Causes, Diagnosis, and Treatment

Midline Neck Swellings: Causes, Diagnosis, and Treatment

Write short note on swelling midline of neck.
Or
Write briefly on midline swellings of neck.

Answer. The midline swellings of neck are:

• Ludwig’s angina
• Enlarged sub-mental lymph node
• Sub-lingual dermoid cyst
• Thyroglossal cyst
• Sub-hyoid bursitis
• Goiter of thyroid, isthmus and pyramidal lobe
• Enlarged lymphnode and lipoma insubsternal space of burns
• Retrosternal goiter
• Thymic swelling
• Bony swelling arising from the manubrium sterni.

“What Are Midline Neck Swellings And Their Causes”

Swelling midline of neck ludwig’s angina

• This is an inflammatory edema of the flor of the mouth. It spreads to the submandibular region and sub-mental region.
• Tense, tender, browny edematous swelling in the submental region with putrid halitosis is characteristic of this condition.

Enlarged Submental Lymph Nodes

The three important causes ofenlargement:

1. Tuberculosis: Mattd submental nodes, fim in consistency,with enlarged upper deep cervical lymph nodes, with or without evening rise of temperature are suggestive of tuberculosis.

2. Non-Hodgkin’s lymphoma can present with sub-mental nodes along with other lymph nodes in the horizontal group of nodes such as submandibular, upper deep cervical, pre-auricular, post-auricular and occipital lymph nodes (external Waldeyer’s ring). Nodes are firm or rubbery, discrete without matting.

“Best Ways To Understand Midline Neck Swelling Diagnosis”

3. Secondaries in the submental lymph nodes can arise from carcinoma of the tip of the tongue, flor of the mouth,central portion of the lower lip.
The nodes are hard in consistency and sometimes, fied.

Sublingual dermoid Cyst

• Sublingual dermoid Cyst is a type of sequestration dermoid cyst which occurs due to sequestration of the surface ectoderm at the site of fusion of the two mandibular arches. Hence, such a cyst occurs in the midline, in the flor of the mouth.
• When they arise from 2nd branchial cleft, they are found lateral to the midline. Hence, lateral variety.

“The Role Of Sistrunk Procedure In Treating Thyroglossal Cysts”

Subhyoid Bursitis

• Accumulation of inflammatory flid in the subhyoid bursa results in a swelling and is described as sub hyoid bursitis.
• Bursa is located below the hyoid bone and in front of the thyrohyoid membrane.
• Subhyoid Bursitis is swelling in front of neck in midline below hyoid bone.
• Swelling moves up with deglutition and is tender.

“Importance Of Early Diagnosis For Midline Neck Swellings”

Thyroglossal Cyst

• Thyroglossal Cyst arises from thyroglossal tract or duct which extends from foramen cecum at base of tongue to isthumus of thyroid.
• Thyroglossal Cyst is common in females and is painless midline swelling.
  Swelling is deviated to left side.
• Thyroglossal cyst exhibits three types of mobilities, i.e.

1. It moves upwards with deglutition
2. Cyst moves with protrusion of tongue
3. Swelling move sideways but not vertically as it is tethered by the thyroglossal duct.

Enlarged Isthmus Of Thyroid Gland

Almostall the diseases ofthe thyroid gland result in enlargement of the isthmus. However, a solitary nodule and cysts can occur in relation to isthmus.

The swelling moves with deglutition.

However, it does not move on protrusion of the tongue.

“Risk Factors For Developing Midline Neck Swellings”

Pretracheal and Prelaryngeal lymph nodes

These lymph nodes produce nodular swelling in the midline.

One or two discrete nodes are palpable. They can enlarge due to following conditions:

• Acute laryngitis: The nodes are tender, soft.
• Papillary carcinoma ofthyroid: The nodes are fim without mattng, with or without evidence of thyroid nodule.
• Carcinoma ofthe larynx: The nodes are hard in consistency.

“Early Signs Of Complications With Midline Neck Swellings”

Thymic Swelling

• Thymic Swelling is caused by an aneurysm of innominate or subclavian artery.
• Thymic Swelling is a pulsatile swelling.

lipoma in Suprasternal Space of Burns

• It is soft and lobular.
• Edge of lipoma slips under the palpating figer.