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Neck Masses:

Benign vs Malignant
Amando Virgilio S. Santos, M.D.; DPBO; FPSO-HNS

n To review the anatomy of the neck

n To discuss how to evaluate a patient with
neck mass
n To discuss most common masses seen in
the neck area

n Mass
n A lump or aggregation of coherent material
n An abnormal growth of tissue resulting from
uncontrolled, progressive multiplication of
cells & serve no physiologic functions

n Synonyms: tumor; neoplasm

n The neck is an exposed area of the body
n It is important to know the basic anatomy
& how to evaluate patients with neck
n Superior:
n Lower margin of the
mandible & superior
nuchal line of the
occipital bone
n Inferior:
n Suprasternal notch &
the upper border of
the clavicle

n Clinical Anatomy 3rd edition

Structures in the Neck
Cross section of the Neck
n Superficial fascia
n Deep Fascia
n Investing
n Pretracheal
n Prevertebral
Triangles of the Neck
n Anterior
n Submental
n Submandibular
n Carotid
n Muscular
n Posterior
n Occipital
n Subclavian
n Lymphatic
n 1/3 of more than 500
lymph nodes in the
body lie above the

n Fisch U: lymphography of the cervical

lymphatic system, Basel, 1968
n History
n Physical examination
n Inspect
n Palpate

n Auscultation/ Transilluminate
n Pertinent questions
n What is the age of the patient?
n Is the mass growing rapidly?
n Is there evidence of infection or inflammation?
n Where in the neck is the mass located?
n Is the mass cystic or solid?
n Is there evidence of infection/malignancy elsewhere
in the head & neck?
n Fundamentals of Otolaryngology 6th ed - Boies
Soft/Cystic Hard/Solid

Movable Fixed

Younger patients Older patients

Slow growing Aggressive/Fast growing

n First consideration - Patients age group
0-15 16-40 40+
Inflammatory Inflammatory Neoplastic
Malignant/ Benign
Congenital/Development Congenital/Development Inflammatory

Neoplastic Neoplastic Congenital/Development

Malignant/ Benign Malignant/ Benign
Traumatic Traumatic Traumatic
n Second consideration
n Location in the neck
n Anterior
n Branchial cleft cyst, Sialadenitis, metastatic
n Posterior
n Lymphangioma, Metastatic
n Midline
n TGDC, Thyroid
n Most common benign masses located in the
neck inflammatory lymphadenopathy
n Trial of antibiotic therapy & observation not to exceed
2 weeks
n Benign tumors are otherwise relatively
uncommon Paragangliomas, Peripheral nerve
neoplasms, lipomas
n Definitive diagnosis requires histopathologic
n Other Diagnostic Tests
n Ultrasound
n CT scan


n Arteriography

n PET scan


n PanEndoscpy
Common Masses
n Thyroglossal Duct
n Formed due to
persistent thyroid
descent tract
n Foramen cecum of
tongue to thyroid gland
n Asymptomatic midline
mass elevates with
swallowing or tongue
n Lymphatic Malformation
n Congenital malformation
resulting from failure of
lymph spaces to connect to
the rest of the lymphatic
n Soft, smooth, non tender
mass that is compressible
& can be transilluminated
n Branchial Cleft Cyst
n Formed from elements
of cervical sinus of His
becoming entrapped
without external &
internal opening
n Non-tender, fluctuant
n Lymphadenophathy
n Reactive lymph nodes
from URTI
n 2 weeks of trial
antibiotic &/or
observation not to
exceed 2 weeks
n TB Adenitis/
n Lymphoma
n Most common
malignancy of head &
neck in children
n Malignant neoplasms
of lymphocytes & their
n Painless cervical mass,
rubbery with
constitutional sxs
n Metastatic
n Look for primary
tumor if present

n Reviewed the anatomy of the neck

n Discussed on how to evaluate patients
with neck mass
n Discussed common neck masses seen in
the neck area
n Otolaryngology Head & Neck Surgery Cummings
n Fundamentals of Otolaryngology Boies
n Clinical Anatomy Snell
n Current Diagnosis & Treatment in Otolaryngology Head & Neck
Surgery - Lalwani
n Clinical Anatomy made ridiculously simple Goldberg
n Otolaryngology Head & Neck Surgery (Clinical reference guide)
Raza Pasha
n Atlas of Clinical Anatomy - Netter