Neck Masses
  

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A lump or mass in the neck can be from many causes.  Most commonly it is from an infection, such as chronic tonsillitis or an infected tooth.  Other causes include congenital cysts (sacks or fluid) and cancers.  An exact diagnosis may be difficult without a biopsy.  Young children often have lymph nodes in their neck.  Masses are worrisome when they persist, are multiple, are hard or fixed.  Because taking a large sample of tissue from the neck is difficult, your doctor may decide to do a "needle biopsy".  A needle biopsy is performed by inserting a fine needle into the mass and using negative pressure to obtain a few cells for the pathologist to look at.  Unfortunately, this procedure is only about 95% accurate.  An open biopsy, as shown below, is much more accurate, but it is difficult to do and may put various structures at risk.

In the patient shown below, a needle biopsy indicated that the neck mass was from a congenital cyst.  However, upon exploration, infected lymph nodes were found.

neck_operation.jpg (66190 bytes)

View of a Neck Exploration
Mouse-over picture to identify
structures, click on picture to enlarge:
  
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Diagastric Muscle

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Sternocleidomastoid Muscle

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Hypoglossal Nerve (Controls the Tongue)

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Vagus Nerve (Controls the Voice Box)

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Spinal Accessory Nerve (Controls a large Shoulder Muscle)

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Carotid Artery (Supplies Blood to the Brain)

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Internal Jugular Vein (Drains Blood From the Head and Brain)

Shown in the pictures to the right are the CT scan and surgical specimen of a branchial cleft cyst in a 12 year old male.  This is a congenital cyst which is treated with surgical removal.

  

 

   

Thyroid Surgery
 
The picture to the right shows the appearance of the operative field after the thyroid gland is removed.  Note the left recurrent laryngeal nerve.  This nerve runs next to the undersurface of the thyroid and between the trachea and esophagous. The recurrent laryngeal nerve controls the movement of the left true vocal cord.  This nerve can be damaged during surgery, which will result in a weak breathy voice.  
See Vocal Cord Paralysis Video

 Mouse Over Picture to identify nerve. 
Click on picture to enlarge.

Chindo and Chheda reported (Archives of Otolaryngology May 2007) that the incidence of vocal cord paralysis is between 2.09% in monitored patients to 2.96% in unmonitored patients.  There was not a statistical difference between the two groups. 
 

Page last updated 02/07/2008     Copyright  2001, 2002  Kevin Kavanagh All rights reserved,
 
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