Neck Lumps

Understanding Neck Anatomy:

The neck is a structure that connects the head to the remaining body. It is the pathway through which major nerves and blood vessels from the brain to the lower body and vice versa traverse. It encompasses muscles, thyroid and parathyroid glands, cartilages, part of the spinal cord and vertebra, lymph nodes, trachea (windpipe), esophagus (food pipe), epiglottis, hyoid bone, larynx, pharynx, etc. Let us get slightly into the neck anatomy for a better understanding of neck swellings.

Our neck is divided into,

Anterior Triangle.

• Submandibular triangle.

• Submental triangle.

• Muscular triangle.

• Carotid triangle.

Posterior Triangle.

These triangles are actually triangular spaces bordered by the neck muscles. Based on their location, they are named anterior (front) or posterior (back). For example, the upper or superior part of the anterior triangle is bordered by the lower border of the mandible, the midline of the neck borders the medial side, and the lateral part of the triangle is bordered by the anterior (or front) portion of the sternocleidomastoid muscle.

Apart from bordering, they also encompass vital structures like common, internal, and external carotid arteries, cranial nerves, larynx, and pharynx.

Neck muscles are classified and named with relation to the hyoid bone.

• Infrahyoid muscles (below the hyoid bone).

• Suprahyoid muscles (above the hyoid bone).

Apart from these muscles, there are also:

• Sternocleidomastoid.

• Trapezius.

• Splenius capitis.

• Levator scapulae.

• Scalene.

• Omohyoid.

Do Neck Lumps Cause a Concern?

Although most neck lumps do not cause any threat and occur due to seasonal infection-induced lymph node enlargement, there are possibilities of more serious causes for swelling in the neck due to abnormalities in the underlying vital structures. Hence any swelling or lump of the neck must not be ignored unless or until a less serious cause is confirmed. Such neck swellings are of great concern because lumps of serious origin necessitate removal as their treatment, which becomes quite challenging due to the risk of vital structures passing through, in, and around the lumps getting injured.

Why Do Neck Lumps Occur?

Neck lumps occur due to diverse reasons. The more common and less serious neck lumps are due to swelling of the lymph nodes of the neck caused by a local throat infection, common cold, other viral infections like herpes simplex, infectious mononucleosis, rubella, etc., which regresses with the treatment of infection. Developmental anomalies also cause neck swelling to occur at birth or with aging. Cysts and tumors arising from the neck structures also cause neck swelling. These tumors can either be benign or malignant (cancerous). Habits like smoking predispose to throat cancer.

What Are the Types of Neck Swellings?

Neck swellings or lumps can be categorized based on their cause, which include the following:

Swollen lymph nodes due to

• Bacterial infection.

• Viral infection.

• Allergies.

• Cancer.

• Thyroid problems.

Salivary gland disorders like,

• Mumps.

• Salivary gland tumor.

• Salivary gland cyst.

• Salivary gland infection.

• Salivary gland stones.

Thyroid gland disorders like,

• Thyroid gland swelling.

• Goiter.

• Tumors of the thyroid gland.

• Thyroid nodules.

Developmental disorders like,

• Branchial cyst.

• Cystic hygroma.

• Thyroglossal cyst.

• Dermoid cysts.

Infectious conditions like,

• Cold abscess.

• Ludwig’s angina.

1. Carotid body tumor.

2. Laryngocele.

3. Throat cancer.

How Does My Doctor Diagnose the Neck Lump?

If you notice any neck lump, do not ignore it. Reach out to a physician. Your doctor might ask you some questions regarding the duration of the swelling, its rate of growth, whether you have pain or not, associated symptoms, etc. After that, they will palpate or touch your neck lump to check for its consistency, temperature, and movement. Sometimes they may transilluminate the swelling, ask you to swallow and check its movement with deglutition (swelling), and order you some basic blood investigation tests, barium swallow examination, X-rays, arteriography, etc.

Let us look into a few neck swellings to understand their origin, significance, and management in detail below.

a) Swollen Lymph Nodes:

• This is the most common cause of neck lumps, and these are not quite serious. It is the natural mechanism of the body to react to infections.

• Such a defense mechanism causes lymph nodes near the infection site to swell.

• Upper respiratory infections like the common cold, streptococcal throat infections, pharyngitis, etc., are common causes of neck swelling.

• Rare causes include lymph node swelling due to cancer of the mouth, neck, and throat. At times, advanced cancer from other parts of the body might get metastasized or spread to the neck lymph nodes and cause neck swelling.

• In most cases, elimination of the infection regresses the neck swelling.

b) Cancer:

• Cancer of the throat, mouth, and neck can itself cause neck lumps.

• Smoking and alcoholism increase the risk of throat or oropharyngeal cancers.

• Human papillomavirus infection, a sexually transmitted infection, increases the risk of mouth and throat cancer.

• Lung and breast cancer, thyroid cancer also cause neck swellings.

• A lump caused due to cancer already indicates the advanced stage of the disease. Chemotherapy and radiotherapy are choices to prolong the survival rate.

• In the case of thyroid cancer, either partial or total excision of the thyroid gland along with chemotherapy, radiotherapy, and radioactive iodine treatment might be the treatment choice based on the extent of tumor spread.

c) Goiter:

• It is the benign enlargement of the thyroid gland due to decreased thyroid hormone production. It is a midline neck swelling.

• This can be genetically acquired. Endemic goiter due to natural food and water iodine deficiency, enzyme deficiency, excessive consumption of goitrogenic foods like cabbage, turnip, cauliflower, etc., or impaired thyroid gland are some causes.

• Goiter can also occur during pregnancy and puberty.

• Females are commonly affected.

• Visible neck swelling that moves with swallowing is a common symptom.

• Big goiters exert pressure on the food and windpipe and cause pain with swallowing.

• Opting for iodized salts, iodine therapy, and Thyroxine administration helps reduce neck swelling.

• If the gland fails to respond to the above treatment, the swelling is too big and exerting pressure on the nearby structures, or for cosmetic purposes, partial removal of the gland followed by Thyroxine supplementation is advised.

d) Ludwig’s Angina:

• It is a life-threatening condition.

• It is a bacterial infection of the spaces within the floor of the mouth.

• This results due to untreated or ignored lower teeth infection that spreads underneath leading to cellulitis.

• Symptoms include pain in the floor of the mouth, difficulty swallowing, neck swelling, tongue being pushed to the palate, fever, etc.

• As the infection gets vigorous, it leads to the swelling of the neck leading to airway compromise, which is potentially life-threatening.

• In such a case, tracheostomy (opening through the neck) is performed to maintain the airway.

• Drainage of the fluids and intravenous antibiotics are used in its management.

e) Salivary Gland Disorders:

• Submandibular salivary stones cause a blockage in the salivary ducts, thereby causing accumulation of the saliva.

• Salivary gland infection or tumors can lead to the swelling of the salivary gland resulting in lymph node enlargement of the neck or the spread of cancer to the neck.

• Removal of the salivary gland or part of the gland with the cyst or tumor is the treatment of choice, followed by radiation therapy for aggressive tumors.

f) Cystic Hygroma:

• It is a lateral neck swelling occurring in the early infancy period due to developmental anomaly.

• In cystic hygroma, a neck lump or cystic swelling is seen in the lower third of the neck that contains clear lymph inside.

• It is round in shape and soft in consistency.

• Removal of the cyst is its only treatment.

g) Cold Abscess:

• Apart from tuberculosis, leprosy, actinomycosis, and gumma degeneration are also causes of cold abscess in the neck.

• It is a cystic lateral neck swelling.

• Though it is an abscess (collection of pus), it lacks the feature of heat usually exhibited by an abscess. Hence it is known as a cold abscess.

• It may occur secondary to tuberculous lymphadenitis or cervical spine tuberculosis and may present with neck pain initially.

• Small cold abscess resolves with antitubercular medications. Larger cysts might require aspiration of the cystic contents.

Conclusion:

Whether your neck swelling is of short or long origin, painful or painless, constant or increasing in size, accompanied with or without other symptoms, do not ignore and wait for the right moment. Right away, consult an ENT (ear, nose, and throat) specialist to rule out serious conditions.