Journal Reading

LITERATURE READING

NEOPLASM OF THE NECK

Tita Puspitasari
Supervisor :
DR. dr. Agung Dinasti Permana, M.Kes., Sp.T.H.T.K.L (K), FICS

Department of Otorhinolaryngology, Head and Neck Surgery

Hasan Sadikin General Hospital – Padjajaran University
Bandung
2020
 Neck Anatomy
The neck/ is the part of the body  that connects the head with the torso.
Anterior : Bottom part of the mandible (lower jaw) to the bones of the
upper chest and shoulder.
The content of the neck is grouped into 4 neck spaces/compartments.
• Vertebral :  Cervical vertebrae and muscles (bound the neck triangle)
• Visceral : Contains glands (thyroid, parathyroid, and thymus),
the larynx, pharynx and trachea.
• Paired vascular compartmen: paired carotid sheats (vagus nerve,
common carotid artery, IJV
Besides the listed structures, the neck contains cervical lymph node.
 Lump in The Neck

• Benign : Congenital abnormalities, pathological disorders (cysts,

inflammation, infections and neoplasms that cover all neck structures).
• Malignant : Mucosa upper aerodigestive tract oral cavity, pharynx,
larynx, salivary glands , thyroid, parathyroid.
• Most common : SCC and papillary thyroid cancer.

Shah P. Jatin, Patel G. Snehal, Singh Bhuvanesh, Wong J. Richard. Thyroid and Parathyroid Glands. Jatin Shah’s Head And Neck Surgery And Oncology. Fifth
Edition. 2020. 12:489-490
Shah P. Jatin, Patel G. Snehal, Singh Bhuvanesh, Wong J. Richard. Thyroid and Parathyroid Glands. Jatin Shah’s Head And Neck Surgery And Oncology. Fifth
Edition. 2020. 12:489-490
 Benign Lymph Node
Branchial Cyst
• Obliteration disorder results in a brankial cleft. End of 4th
week of embryo life.
• Can appear as an infected cystic mass or fistula.
• 20% of neck mass in children.
• Small, can enlarge enough to cause difficulty swallowing and
breathing.
• 95% of the second gap. 75% of cysts, aged 40 years between
10 and.
• No gender predilection has been reported.
• The second type of branchial cleft:

• A small lump or fluctuating lateral mass of the neck adjacent to the

anteromedial border of the sternocleidomastoid muscle in the angle of
the lower jaw (usually only on one side of the neck, rarely on both sides,
does not cause pain, unless infected). There are also other symptoms:
hoarseness (associated with cranial nerve palsy IX, X, and XII), protrusions
on the pharynx.
• Palsy of nerves IX, X, XI, XII or very rarely occurs in benign tumors or
cysts, and usually shows direct infiltration of local malignancies or
metastatic lymph nodes.
Benign Lymph Node
Branchial Cyst
Branchial Cleft Cyst. 2015 Radiology key.
• Thyroglossal duct
cyst (TGDC) : Most
common midline
congenital
malformation of
the neck.
• Incomplete
involution of the
thyroglossal duct,
which connects
the base of tongue
to the thyroid
Thyroglossal duct cyst excision
The Sistrunk procedure
 Malignant Lymph Nodes, Epidemiology

• SCC of the skin : 2-10%

• Salivary gland cancer : SCC, pleomorphic adenoma,
adenocarsinoma, dan salivary ductal 25-40%.
• Well differentiated thyroid carsinoma : 10-15%.
• SCC of upper aerodigestive track 10-78%.
• Servical adenopathy : ↓ Survival 50%.

Shah P. Jatin, Patel G. Snehal, Singh Bhuvanesh, Wong J. Richard. Thyroid and Parathyroid Glands. Jatin Shah’s Head And Neck Surgery And Oncology. Fifth
Edition. 2020. 12:489-490
 Predisposition Factors
• Tobacco, alcohol : Upper aerodigestive tract cancers 2-3x,
• both smoke and alkohol : 20-30x,
• HPV : Oropharyngeal carcinomas,
• EBV : Nasopharyngeal cancer,
• Genetic predisposition : Fanconi anemia,
• Immune-compromised patients : HIV, chronic immunosuppressive
treatment after organ transplantation,
• Exposure to ionizing radiation : Thyroid gland and salivary glands,
• Occupational exposures (wood dust, polycyclic hydrocarbons, and
asbestos),
• Gastroesophageal reflux
 Neck Lymp Nodes

Ron Mitzner, Classification Neck Dissection. 2018. Medscape

 Neck Dissection
• Neck dissection : the fibrofatty contents of the neck are removed for the
treatment of cervical lymphatic metastases.
• RND: lymph nodes levels I-V and lymph + nodes surround the tail parotid
gland, the spinal accessory nerve, the internal jugular vein, and the
sternocleidomastoid muscle.
• Advanced neck disease, recurrent after chemoradiation, or gross
extracapsular spread to the spinal accessory nerve, sternomastoid muscle,
and the internal jugular vein.
• ERND : additional lymph node/nonlymphatic structures relative.
Retropharyngeal lymph nodes, the hypoglossal nerve, prevertebral
musculature, or the carotid artery

Ron Mitzner, Classification Neck Dissection. 2018. Medscape

MRND : levels I-V, preservation of 1 or more of the
following 3 nonlymphatic structures: the spinal
accessory nerve, the internal jugular vein, and the
sternomastoid muscle
 SND : one or more lymph node groups are preserved.
N0-N1 disease.
• Oral cavity cancer : I-III
• Oropharyngeal, hypopharyngeal, and laryngeal
cancer : II-IV
• Thyroid gland, hypopharynx, cervical trachea,
cervical esophagus, and subglottic larynx : VI
• Cutaneous malignancies : II-V, postauricular,
suboccipital, posterolateral neck dissection. Arise in
the preauricular, anterior scalp, or temporal region
(II, III, Va, parotid, facial, external jugular nodes).

Ron Mitzner, Classification Neck Dissection. 2018. Medscape

 Oropharyngeal,
Oral cavity cancer : I-III
hypopharyngeal, and laryngeal
cancer : II-IV
Thyroid gland, hypopharynx, Thyroid gland, hypopharynx,
cervical trachea, cervical cervical trachea, cervical
esophagus, and subglottic larynx : esophagus, and subglottic larynx :
VI/Anterior ND VI/Anterior ND
Neck Dissection Incission
 Summary
• Lump in the neck : Benign or Malignant
• Obliteration disorder results in a brankial cleft can appear as an
infected cystic mass or fistula.
• Thyroglossal duct cyst : Benign most common : The Sistrunk
procedure.
• Malignant : SCC of the skin, Salivary gland cancer, pleomorphic
adenoma. adenocarsinoma, salivary ductal 25-40%, well
differentiated thyroid carsinoma, SCC of upper aerodigestive track.
• Predisposition factors : Tobacco, alcohol, EBV, HPV.
• Neck dissection : the fibrofatty contents of the neck are removed
for the treatment of cervical lymphatic metastases
Thank you