GARCIA,

ALYSSA
RACHEL B.
ENT

BASIC ANATOMY OF
THE NECK

LAYERS OF THE NECK

LAYERS OF THE NECK

Skin
Superfi cial fascia
Deep cervical fascia

SKIN

 Loosely attached anteriorly.

Posteriorly, the skin is very thick and adherent
to the underlying structures with numerous
sebaceous glands.
Well supplied with blood vessels, and has
transverse lines.

CERVICAL FASCIA

FUNCTIONS:
o Separates neck into a series of planes and spaces
o Holds visceral structures in place
o Provides gliding surface
2 Major Divisions:
o Superfi cial cervical fascia
o Deep cervical fascia
Superfi cial layer (Investing fascia)
Middle layer (Visceral fascia)
Deep layer (Prevertebral layer)
7

SUPERFICIAL
CERVICAL FASCIA

Cervicocephalic fascia
Encircles the entire neck
BOUNDARIES:
Superior: Zygomastic
process
Inferior: Chest and Axilla
(+) potential space between
SCP and DCP
Rarely involved in serious
infections of the neck
Allows free movement of the
skin and platysma muscle
Serves an excellent cleavage
plane during dissection

10

COMPONENTS OF THE
SUPERFICIAL FASCIA
Structure

Organ/Component

Muscle

Platysma
O: deep fascia from the pectoralis major to the
deltoid muscle
I: lower border of the mandible
A: depresses the mandible

Nerves

Cutaneous branches of the cervical plexus

Veins

External and anterior jugular veins

Lymph Nodes

Lie along the external jugular vein superficial

to SCM
11

DEEP CERVICAL
FASCIA
12

Fascia colli
Lies under the
platysma
Forms sheaths for
the carotid vessels
Has fasciae with
interconnecting
septae, creating
potential spaces
for infection
Encloses the vital
structures
13

THREE LAYERS OF
THE DEEP CERVICAL
FASCIA

14

1.

External or
Investing
or
Enveloping
Layer

2.

Middle or
Pretrachea
l Layer

3.

Internal or
Prevertebr
al Layer
15

EXTERNAL OR INVESTING OR
ENVELOPING LAYER
BOUNDARIES
Superior: Mandible
and Zygoma
Inferior: Clavicle,
Acromion, Spine of
Scapula
Anterior: Hyoid bone
Posterior: Mastoid
process, Superior
nuchal line, Cervical
vertebra
Superiorly outlines
the masticator space
16

Posteriorly forms the

Stylomandibular ligament
band of the cervical fascia
from near the apex of the
styloid process of the
temporal bone to the angle
and posterior border of the
angle of the mandible
found between the Masseter
and Pterygoideus internus
provides a divisionof the
parotid and submandibular
gland and medial pterygoid,
from its deep surface some
fi bers of the Styloglossus
take origin

Components of the External

or Investing layer:
1. 2 muscles
SCM and trapezius
2. 2 salivary glands
- parotid and submandibular glands
3. 2 spaces
- suprasternal space of burns and the
space above the clavicle in the posterior
triangle.
18

MIDDLE OR PRE-TRACHEAL
LAYER
Envelops the:
Pharynx, larynx,
trachea, esophagus
Thyroid &
Parathyroid gland
Buccinator and
constrictor muscles
of the pharynx
Strap muscles

.
19

Attachments of the
Middle or
Pretracheal
layer:
1.

SUPERIOR
- thyrocricoid cartilage,
arising from the inner
surface of the deep fascia
and encloses the SCM.

2.

INFERIOR
- extends into the thorax
and blends with the
pericardium in the middle
mediastinum.
20

 Two Divisions of the Middle or Pretracheal Layer

1.

MUSCULAR PORTION
Continuous with the Superfi cial layer of DCF
Surrounds the infrahyoid (strap) muscles
Strap Muscle: sternohyoid, sternothyroid, thyrohyoid and
omohyoid muscle

.Superiorly: hyoid bone and thyroid cart

.Inferiorly: sternum, clavicle & scapula

21

Two Divisions of the Middle or Pre-tracheal Layer

2. VISCERAL P ORTION
Su rrou nds th e anterior viscera of the neck: thyroid gland,
trachea, esophagus, pharyngeal mu scu lature, buccin ators
muscle
.Antero -superior: hyoid bone and thyroid cartilage
.Postero -su perior: base of the sku ll
.Con tinues inferiorly into the thorax, covering the trachea and
esop hagus blendin g with the fi brous pericardium
.BUCCOPHA RYNGEAL FASC IA
A portion of the visceral dicision on lying posterior to the pharynx
Covering the constrictor muscles and buccinator muscle
Encloses the pharynx

22

INTERNAL OR PREVERTEBRAL
LAYER
Forms a complete ring
Outside: great vessels
Inside: phrenic nerve
- Splits into 2 layers at the
transverse processes:
Pre-vertebral
Alar

It is much thicker than the

pre-tracheal layer.
- covers the prevertebral
muscles longus colli,
longus capitis,
scalenius anterior,
scalenius medius, and
scalenius posterior.

23

ATTACHMENTS OF THE INTERNAL

OR PREVERTEBRAL LAYER:
1.

Superior
- base of the
skull

2.

Inferior
- anterior
longitudinal
ligament of
the vertebral
column.

3.

Posterior
- ligamentum
nuchae

24

2 LAYERS AT THE TRANSVERSE

PROCESSES
Prevertebral Layer
Begins immediately anterior to
vertebral bodies
Superior: skull base
Inferior: coccyx

Posterior wall of the danger

space
Anterior wall of prevertebral
space
Envelops the bodies and deep
muscles of the neck
Extends laterally as the
axillary sheath
Covers the entire spinal
vertebra
infections can aff ect the
spinal vertebra

25

2 LAYERS AT THE TRANSVERSE

PROCESSES
Alar Layer
Between prevertebral and
middle layer
from transverse process on
one side to the contralateral
side
Superior border: skull base
Inferior border: upper
mediastinum at T1-T2
Blends with the visceral fascia
at the level of T2. This seals
inferiorly the (retro)
pharyngeal space

Danger space - space

between the prevertebral
layer and alar layer; from
base of skull to
mediastinum

26

OTHER
COMPONENTS OF
THE DEEP CERVICAL
FASCIA

27

CAROTID SHEATH
- a condensation of the deep cervical fascia which
encloses the following structures:
a.
b.
c.
d.

Common and internal carotid artery,

Internal jugular vein
Vagus nerve
Deep cervical lymph nodes

28

 forms by all 3 layer s of the deep fa scia

anatomically separate from all layers
contains: common carotid a rtery, Internal Jugular Vein and
vagus nerve
travels through pharyngoma xillary spa ce
extends from skull base to thorax

VISCERAL FASCIA
- encloses the pharynx, larynx, trachea and
esophagus

30

POTENTIAL
FASCIAL SPACES

31

1.
a.
b.
2.
a.

M A X I L L A RY S PA C E S
Canine Space
Bu c c a l S p a c e
M A N D I B U L A R S PA C E S
Pr i m a r y
Submental
Sublingual
Submandibular

b. Secondary
Pterygomandibular
Masseteric
Temporal

3.
a.
b.
c.
d.

C E R V I C A L O R D E E P N E C K S PA C E S
Lateral pharyngeal (Pharyngomaxillary) space
Re t ro p h a r y n g e a l ( Re t ro v i s c e r a l ) s p a c e
Danger space
Pre v e r t e b r a l s p a c e

CANINE SPACE
Thin potential space between
Levator anguli oris and levator
labii superioris muscles

SOURCE OF INFECTION :
Infections from Maxillary
canines and bicuspids
Extension from buccal space
Skin infection from nose and
upper lip
MANIFESTATIO NS:

Cheek sweeling and redness

Obliteration of the nasolabial fold
Edema of upper and lower eye lid
Tenderness and severe pain
secondary to infraorbital nerve
edema and infl ammation

MAXILLARY SPACES
C A N I N E S PA C E S
Between the anterior surface of the maxilla and the levator labii superioris
Infection involving maxillary canine tooth
Swelling on lateral are of the nose

B U C C A L S PA C E
Between the buccinators muscle and the skin and superfi cial fascia

Contents: Buccal fat pad, stensens duct, facial artery

Borders
Anterior-Corner of the mouth
Posterior-Masseter muscle
Superior Maxilla
Inferior Mandible
Superfi cial -subcutaneous tissue
Deep-Buccinator muscle

Source of Infection

Infection from the upper and

lower premolars and molars

34

BUCCAL SPACE

Signs and
symptoms

Cheek swelling (Below

Zygomatic arch and above
inferior border of Mandible)
Redness anterior to the
masseter muscle
Can spread through
subcutaneous tissues into the
periorbital space
and past the inferior border of
the mandible to the
subcutaneous tissues lying
superfi cial to the
submandibular space.

MANDIBULAR SPACE
PRIMARY SPACE
Ludwigs angina
S U B M E N TA L
Between anterior bellies of Digastric muscles
and between the mylohyoid muscle and skin
Infection spread from roots of mandibular
incisors

S U B L IN G UA L
Between the oral mucosa and the mylohyoid
muscle
No swelling outside; Tongue pushed upwards

SUBMANDIBULAR
Between the mylohyoid muscle and the skin
and superfi cial fascia
(+) swelling

MANDIBULAR SPACE
SUBLINGUAL AND SUBMANDIBULAR
Exit on the medial aspect of the
mandible and have an open posterior
boundary
Involuntary lingual perforation of
infection from the mandibular molars
SUBLINGUAL SPACE INFECTION
Small extraoral swelling but much
intraoral swelling of the fl oor of the mouth
Bilateral = able to elevate tongue

SUBMANDIBULAR SPACE
Can communicate freely with secondary space
Swelling at inferior lateral border of mandible to
digastric area and hyoid bone
Can see the swelling outside
Chin appears grossly swollen
Firm, erythematous swelling

MYLOHYOID LINE
Factor that determines the sublingual or
submandibular involvement is the relationship
between the area of the infection and location of the
mylohyoid muscless attachment
If apex of teen is SUPERIOR to the mylohyoid muscle
attachment (premolars, 1st molar) sublingual
space is involved
If INFERIOR (3rd molar) submandibular space is
involved
Mylohoid diaphragm of the mouth

LUDWIGS ANGINA
In f ectio n of al l three o f the p rim ar y m an dib ul ar
sp a ces
As descr ibed in 19 36 dur ing the p rean ti bi oti c a rea
Ra pid ga ngrenou s b il atera ll y sprea din g cel lu li ti s of
the pri ma ry m a ndi bul ar sp aces
CLI NICAL FEATU R ES:
Severe swelling
Elevation and displacement of tongue
Tense hard bilateral induration of submandibular region,
superior to hyoid bone
Trismus
Drooling of Saliva
Inability to swallow
Infection progresses at
an alarming speed to
cause airway obstruction
Often leads to death

39

SECONDARY SPACE
M a s ti c ato r S p a c e
Become infected by secondary spread of infection from other anterior spaces

M A SS ET ER I C S PA C E

Between lateral aspect of mandible and masseter muscle

Involved in buccal space infection
Posteroinferior face swelling with mild to moderate trismus
Diff erentiate from parotid swellings because submasseteric infections
obscure earlobe from frontal view whereas parotid swellings elevate it.

S i g n s a n d S y m p t om s

Swelling of the face

Severe trismus
Dysphagia
Swelling of the retromolar triangle area

TEMPORAL SPACE
Posterior and superior to the masseteric and pterygomandibular
spaces

BOUNDARIES:
Lateral temporalis fascia
Medial skull

Involved in serious overwhelming

infection
Swelling over temporal area (temporalis
muscle and soft tissues ) and trismus
CLINICAL FEATURES:

Severe Pain
Jaw deviates to the aff ected side
TRISMUS
Swelling of the temporal area
Tenderness over the condyle

PTERYGOMANDIBULAR
SPACE
Lies between medial
aspect of mandible and
pterygomandibular muscle
Involved by infection
spread from sublingual
and submandibular spaces
and from soft tissue
infection from 3rd molar
Little or no swelling
evident on intraoral or
extraoral exam but has
signifi cant trismus

LATERAL PHARYNGEAL SPACE

(PHARYNGOMAXILLARY)
Cone sh ape d sp ace with its base at the base of the s kull, pe trous
portion of the te mpor al b on e and its ap ex at the hyoid bone
Conte nts: styloid proce ss divides this space into 2 compartme nts
P RE ST YLO ID CO MPARTME N T muscular (ante rior to s tyloid
proce ss )

Fat
LN
Internal maxillary artery
Inferior alveolar, lingual auriculotemporal nerve

P O S TS T YLO ID CO MPART ME N T ne urovascu lar (poste rior to

styloid p roce ss)

Carotid artery
IJV
Sympathetic chain
CN IX, X, XI, XII

Involved in infections from tonsils, pharynx,

mandibular, 3rd molar, petrous portion of
temporal nose and pharynx
Manifests as:
Medial displacement of lateral pharyngeal wall and
tonsils
Parotid edema
Retromandibular neck fullness
Dysphagia

RETROPHARYNGEAL SPACE
Before Danger Space
B e t w e e n s ku l l b a s e t o t h e s u p e r i o r m e d i a s t i n u m , t r a ch e a l b i f u rca t i o n ( T 4 )
Re f e r s t o l y m p h n o d e c o n t a i n i n g s p a c e t h a t l i e s a n t e r i o r t o a l a r f a s c i a
and posterior to pharynx and esophagus
I n v o l v e d i n i n f e c t i o n f ro m t h e n o s e s i n u s e s , a d e n o i d s , n a s o p h a r y n x a n d
d i re c t s p re a d f ro m l a t e r a l p h a r y n g e a l p s a c e
G re a t e s t n u m b e r o f re t ro p h a r y n g e a l l y m p h n o d e s f o u n d i n ch i l d re n < 4y / o
h i g h e r i n c i d e n c e o f re t ro p h a r y n g e a l a b s c e s s
I n a d u l t s r a re l y i n v o l v e d , u s u a l l y s e c o n d a r y t o t r a u m a

Clinical Manifestations:

Odynophygia and dysphagia

Drooling and diffi culty in
expelling secretions
Cervical rigidity neck is
held rigid and tilted toward
the uninvolved side
hot-potato voice
Unilateral bulging of
posterior pharyngeal wall

PREVERTEBRAL SPACE
From skull base to coccyx
Anterior: prevertebral fascia
Posterior: vertebral bodies
Lateral transverse process of vertebrae
Contains dense areolar tissue
Infection most often due to direct extension from TB in
the cervical vertebra
CLINICAL MANIFESTATION:
Midline abscess: to diff erentiate from retropharyngeal abscess
which is usually unilateral
Cold abscess: posterior to the pharynx
Chonically ill patients
Low grade fever

PREVERTEBRAL SPACE
Refers to the potential for rapid spread through the
loose areolar tissue of this space and may involve the
posterior mediastinum to the level of the diaphragm
BOUNDARIES:

Superior: base of skull

Inferior: diaphragm
Anterior: alar fascia
Posterior: prevertebral fascia

Clinical manifestation of infection of this space is

same as primary space infection and severe sepsis
should mediastinal involvement ensue

NECK MASSES

48

 Physiologic
Goiter in pregnancy, etc.
part of normal process or growing up

Congenital
Hemangioma, etc.
Present ever since the patient was born

Infectious
Neoplastic
Primary or metastatic
Benign or malignant

H emangioma most common in children, most common

congenital mass
Lymphoma malignan t tumor primary in th e neck
Multiple n eck masses metastatic
Eld erly with large n eck mass most probably neoplastic

EVALUATION OF NECK
MASSES
Time course progression
Malignant rate is fast
Benign rate is slow

Associated symptoms
Voice, swallowing, pain, epistaxis, etc.
Hoarseness, bleeding, etc.

Personal habits
Tobacco, alcohol

Past history
Trauma, irradiation, surgery

Dictum
an undiagnosed neck mass on an elderly is considered
malignant until proven otherwise

FINE NEEDLE BIOPSY

Current standard of care

Small gauge needle

Requires-proper collection
Slide preparation
Skilled cytopathologist sometimes diffi cult to interpret

A very good diagnostic

test

BENIGN NECK
MASSES

53

BRANCHIAL CLEFT CYSTS

Arise from the failure of the
pharyngobrachial ducts to
obliterate during fetal
development
Appears as a tender,
infl ammatory mass located
at the anterior border of the
sternocleidomastoid muscle.
FIRST BRANCHIAL CLEFT
ANOMALIES:
Make up less than 1% of all
bronchogenic anomalies and
usually appears on the face or
near the auricle.
There are two types of fi rst
bronchial anomalies, type 1
and type 2.

 SECOND BRANCHIAL CLEFT ANOMALIES

Most common of three types
Present discrete rounded masses below the angle of the
mandible and at the anterior border of the sternocleidomastoid
muscle.

THIRD BRANCHIAL CLEFT ANOMALIES

Third branchial cleft cysts present anterior to the
sternocleidomastoid muscle and lower in the neck than either
fi rst or second branchial anomalies
Third branchial cysts are deep to the third arch derivatives and
superfi cial to fourth arch derivatives.
These anomalies end in the pharynx at the thyrogyoid
membrane or pyriform sinus.

 TREATMENT FOR ALL TYPES OF FBCA

Initial control of the infection followed by surgical excision
of the cyst and tract.
Incision and drainage procedures should be avoided; BUT
Needle aspiration and decompression

THYROGLOSSAL DUCT CYST

Present as midline mass of the anterior
neck
May be asymptomatic and appear only
when they become infected
Make up approximately one third of all
congenital neck masses.
Their location may be variable at times,
with some cysts presenting more
laterally or as law as the level of the
thyroid gland
A pathognomonic sign on physical
examination is vertical motion of the
mass with swallowing and tongue
protrusion

T RE AT MEN T
The Sistrunk operation is the standard
method of thyroglossal duct cyst excision
The cyst is excised with a cuff of tissue,
including the center portion of the hyoid
bone.

LARYNGOCELES
An abnormal dilation or herniation of the
saccule of the larynx.
Presents with hoarseness, cough, dyspnea,
dysphagia, a foreign body sensation or
any combination of these symptoms

T H RE E T Y P ES
a. In t ern a l
Within the limits of the thyroid cartilage

b. E xt ern a l
Extends beyond the thyroid cartilage and
protrudes through the thyrohyoid membrane

c. Co m b in ed
TRE ATM E NT
If asymptomatic, the management of
laryngoceles consists of:
Laryngoscopic decompression for small
lesions
Surgical excision through an external
approach for larger lesions or laser
endoscopy

PLUNGING RANULAS
Slow-growing, painless,
submental masses
Arise from the sublingual
gland
Defi ned as plunging when
they extend through the
mylohyoid muscle into the
neck
Mucoceles or retention cysts
of the fl oor of the mouth

Treatment
Excision of the mass in
continuity with the sublingual
gland.

LYMPHANGIOMAS
C o n g e n i ta l m a l f o rm a t i o n s o f th e
l y m p h a ti c c h a n n el s
Fa i l u re o f th e l y m p h s p a c es to
c o n n e c t to th e re m a i n i n g l y m p h a ti c
s y s te m
T h e m a s s i s u s u a l l y s o ft, d o u g h y ,
s m o o t h , n o n - te n d e r a n d
c o m p re s s i b l e .
t r a n s i l l u m i n a t es
T R E AT M E N T
Surgical excision is the mainstay of
therapy
Infi ltratice nature
Debulking improves cosmetic appearance
and symptomatic relief while preserving
critical normal anatomic structures

HEMANGIOMAS
M a l f o rm a t i o n o f v a s c u l a r t i s s u e .
C l a s s i fi e d a s c a p i l l a r y , c a v e rn o u s o r j u v e n i l e
U s u a l l y p re s e n t i n t h e fi r s t f e w m o n t h s o f l i f e , g ro w
r a p i d l y d u r i n g t h e fi r s t y e a r , a n d b e g i n t o s l o w l y
involute at 18 to 24 months
In 90% involution occurs without the need for any
therapy
P re s e n t s a s a re d o r b l u i s h s o ft m a s s t h a t i s
c o m p re s s i b l e a n d i n c re a s e s i n s i z e w i t h s t r a i n i n g o r
crying
C T s c a n s , M R I o r b o t h a re v a l u a b l y u s e d f o r d i a g n o s i s
MANAGEMENT
Managed conservatively
Intervention is indicated if the lesion is causing
any of the following symptoms:

A irway c om prom ise

Skin ulce ration
Dy sphagia
Thro mbo c ytopenia
Cardiac f ailure

Systemic corticosteroids or surgical laser excision

TERATOMAS
Ter a to m a s of t he h ea d a nd the nec k
m a ke up a pprox im a t el y 3 .5 % of a ll
t er a t om a s
O r i gin i s from pl ur ipote nti a l ce ll s
T he y c on ta in e le m e n ts f ro m a l l
t hree ge rm l a y er s
Firm nec k m a sses not ed a t bir t h or
w it hin t h e fi r st y ea r of li fe
Ter a to m a s u sua ll y pre sent a s fi rm
ne ck m a sses a n d a re m ost
c om m o nl y n ote d a t bir t h o r w it hi n
t he fi r st ye a r of li fe .
La rge ter a tom a s c a n c a use
respir a tor y co m prom ise or
dy spha gia
T he m o st su cc e ssf ul t rea tm e nt
m e thod is su rgic a l exc i si on

DERMOID CYSTS
Dermoid cysts arise from
epithelium that has been
entrapped in deeper tissue
either during embryogenesis
or by traumatic implantation.
Contain a variety of tissues
from all three germ layers
Most often form along lines of
embryologic fusion
Typically present as midline,
non-tender, mobile neck
masses in the submental
region
Surgical excision is the
mainstay of treatment

LYMPHADENOPATHY
A chronic, abnormal
enlargement of the
lympnodes, usually
associated with disease.
Reactive viral adenopathy
HIV associated infl ammatory
disorder
General persistent
Bacterial disease
Granulomatous disease

REACTIVE VIRAL
LYMPHADENOPATHY
Most common cause of viral cervical adenopathy in
children
Usually associated with symptoms of an underlying
upper respiratory tract infection
Adenovirus, rhinovirus, and enterovirus
Tend to regress in 1 to 2 weeks

HIV ASSOCIATED
INFLAMMATORY DISORDER
Present in 12-45% of patient with HIV
Idiopathic follicular hyperplasia is the most common
cause of adenopathy
Mycobacterium tuberculosis, Pneumocystis carinii,
lymphoma, and Kaposi sarcoma should also be
considered
Treatment of the underlying HIV infection

PERSISTENT GENERALIZED
LYMPHADENOPATHY
Generalized lymphadenopathy without an identifi able
infectious or neoplastic cause
The neck is the most common site

BACTERIAL LYMPHADENOPATHY
Frequently caused by Staphylococcus aureus and
group A B-Streptococcus
Usually develop in the submandibular or
jugulodigastric region
Often accompanied by sore throat, skin lesions, and
symptoms of upper respiratory tract infection
Empirical antibiotic is the fi rst line of management

ACTINOMYCOSIS
50% to 96% of cases of
actinomycosis aff ect the
head and neck region
Painless, fl uctuant, neck
mass in the submandibular
or upper digastric regions
The diagnosis is made by
clinical suspicion and
biopsy; it is confi rmed
histologically by the
presence of granulomas
with sulfur granules
Penicillin is the treatment of
choice

TUBERCULOSIS
More common in adults than
in children
Causative agent is M
tuberculosis
Lymphadenopathy tends to be
more diff use and bilateral
Tuberculin skin tests are
strongly positive
Scrofula (cervical
tuberculosis)

KAWASAKI DISEASE
An a cute multisys tem
va s culitis in child ren
Pres ent w ith ac ute nonp urulent c ervical
ly mpha denopathy ;
ery thema, ed ema and
d es q ua mation of the
ha nds and feet;
p olymorp hous ex anthema;
conjunctiv al injection; and
ery thema of the lip s and
ora l ca vity
Ea r ly id entifi cation and
trea tment w ith as pirin and
g lob ulin are imp erative in
a voiding serious cardiac
complications

THYROID MASSES
Manifest in the
anterior compartment
of the neck
Ultrasound, thyroid
scans, and thyroid
function tests
FNAB provides the
most diagnostic
information in the
evaluation of a
thyroid mass. The
treatment is based on
histologic fi ndings

LIPOMAS
Most common benign soft tissue neoplasm
Arise from the subcutaneous tissue
Present as painle ss, smooth, encapsulated, round masse s
15-20% of all lipomas occur in the he ad and neck
Most of these neoplasms are solitary lesions
Tre ated with excision
Recurrences are ve ry rare

NEUROFIBROMAS
Not encapsulated
The nerves tend to traverse the
tumors and are integral to them
Solitary neurofi bromas are very rare
Multiple neurofi bromas are common,
especially in patient with Von
Recklinghausen disease
The treatment of both neurilemomas
and neurofi bromas consists of simple
surgical resection
The function of the aff ected nerve can
typically be preserved with
neurilemomas unless the neoplasms
are intimately involved with some
cranial nerves
These tumors rarely recur and
malignant transformation is
exceedingly rare

MALIGNANT
NECK MASSES

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BASAL CELL CARCINOMA

Most common tumor in Head
and Neck
Most common skin carcinoma
Solitary, slow growing
25% of all human carcinomas
Fair-skinned individuals
History of sun exposure
85% occur in face o Lips, top
of eyebrows, eyeball, dorsum
of the nose, tip of the nose
(most common)
70 years median age - Rarely
metastasize - Very
radiosensitive

SQUAMOUS CELL
CARCINOMA
90% of all head and neck
malignancies
More aggressive
CONTRIBUTING FACTORS:
Smoking, alcoholism, poor oral
hygiene, chronic trauma, virus
(EBV) chronic infection, radiation
Ulcerative, necrotic o Foulsmelling *basal cell not foul
smelling

Adenosquamous CA , Parotid
Radical neck dissection

Squamous cell CA
Abbe-estlander fl ap o Full
thickness incision
Lower lip rotated upwards
Fish mouth deformity

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