Dhingra

1. Midline
Swellings of the
Neck

2. Aetiology
• Congenital
• Infectious
• Inflammatory
• Neoplastic

3. • Inflammatory
o Reactive
lymphadenopathy
o Thyroiditis
• Neoplastic
o Thyroid
o Parathyroid
o Pharyngeal/larynge
al
• Congenital
o Thyroglossal duct
cyst
o Laryngocoele
o Dermoid cyst
• Infectious
o Ludwig’s Angina

4. Thyroglossal Duct Cyst
• Moves on protrusion of
tongue
• Increases in size during
URTI
• Treatment – Sistrunk’s
operation
• Fibrous cyst due to
persistence of
thyroglossal duct
• Cystic midline swelling
• Rounded – 2-3 cm
diameter

6. Laryngocele
• Dilatation of laryngeal
saccule
• Extends between
thyroid cartilage and
ventricle
• Treatment - excision

7. Ludwig’s Angina
• Infection of
submandibular
space
• Aetiology
o Dental infections
o Submandibular
sialadenitis
o Injuries of oral mucosa
o Fractures of mandible

8. Clinical Features
Odynophagia with Trismus
Localised infection Spread of infection
Localised to sublingual
space
Structures in floor of
mouth are swollen
Tongue pushed up and
back
Submental & submaxillary
regions become swollen, tender.
Cellulitis, laryngeal oedema
Tongue pushed up and back

9. Treatment Complications
• Systemic antibiotics
• Incision & drainage
o Intraoral
o External
• Tracheostomy
• Spread of infection
• Airway obstruction
• Septicaemia
• Aspiration
pneumonia

10. Sublingual Dermoid Cyst
• Almost always benign.
• Management:
Complete surgical
removal without
spillage of contents.
• Midline swelling
• Does not move on
protrusion of tongue
• Contains
developmentally
mature and well-differentiated
tissue.

11. Reactive
Lymphadenopathy
• History of local infection
or generalised viral
illness.
• Should resolve
spontaneously.
• No specific treatment
required.
• By far the most
common cause of
neck swellings.
• Affects all age groups.
• Tender to touch.

13. Thyroid Swelling
• Most likely due to
hyperthyroidism or
hypothyroidism.
• Thyroid disease F > M.
• Typically young female
patients.

14. • Moves upwards on
swallowing.
• Accompanied by
thyroid symptoms.
• FNA may be useful to
rule-out more sinister
pathology.
• Manage underlying
thyroid disorder.

15. Laryngeal Malignancy
Growth of anterior commissure
and subglottic region
Spreads through cricothyroid
membrane
Produces midline swelling

16. • May invade thyroid
cartilage
o Perichondritis
o Tender on palpation
• Thyroid gland and
strap muscles may
also be invaded

17. Treatment
• Radiotherapy
• Surgery
o Conservation
laryngeal surgery
o Total laryngectomy
• Combined therapy
• Endoscopic CO2
laser excision
• Organ
preservation
• Depends on
o Site of lesion
o Extent of lesion
o Metastasis
• Nodal
• Distant

18. Thank you