Young children often have lymph nodes in their upper neck and cause concern
to the parents. These may be caused from tonsillar infections.
Hallmarks of a
(non-cancerous) process are that the mass is bilateral (both sides), soft,
mobile and is not increasing in size. Over 90% of children have lymph
nodes in this area and not all can be biopsied. However, if they
become hard, fixed and multiple, biopsy to rule out a cancer may be
In adults, neck masses are commonly caused by an infection, such as chronic tonsillitis
or an infected tooth. Other causes include congenital cysts (sacs of
fluid) and cancers. An exact diagnosis may be difficult without a
Masses in the posterior neck are often lymph nodes along the spinal
accessory nerve. Open biopsy in this area must be done with extreme
caution because of risk to injuring this nerve and paralyzing the trapezius
muscle. This is a large muscle which raises the arm above the
Masses in the lower neck are very worrisome,
especially if just off midline. A mass in this area may represent
lymph nodes involved with cancer which has metastasis from the lungs or
abdomen. This is a common presentation of lung cancer.
are worrisome when they persist, are multiple, or are hard and fixed. Because
taking a large sample of tissue from the neck requires surgery, 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 important 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.
View of a Neck
picture to identify
structures, click on picture to enlarge:
Nerve (Controls the Tongue)
(Controls the Voice Box)
Nerve (Controls a large Shoulder Muscle)
(Supplies Blood to the Brain)
Vein (Drains Blood From the Head and Brain)