The neck is a very important part of the ENT examination. There are various anatomical formations and vital organs here. The most common of these are neck masses. Nearly a hundred lymph nodes are found on both sides of the neck. In addition, in the midline, the thyroid gland is located above the larynx. Swelling of the thyroid gland is seen in the midline of the neck and is called goiter among the people.
Since goiter will be the subject of a separate article, I would like to touch on other neck masses and talk about how to proceed in diagnosis and treatment. When the neck mass is encountered, it is necessary to first look at where it is located and its relationship with the surrounding tissues. If this is a lymph node swelling, the first thing that comes to our mind should be an infection. Lymph circulation follows an anatomical path like blood circulation. When the lymph node swells, it is necessary to look for an infection in the anatomical places behind it where it drains. Most often, swelling of the tonsils, tongue, lip, and an inflammatory condition with the skin cause swelling in the lymph node.
Neck masses have a rule of three:
– If the swelling is present for three days, infection,
– A tumoral formation, if present for 3 months,
– If it has been present for 3 years, the possibility of a congenital pathology should be considered.
Congenital neck masses can be seen on both sides of the neck or in the midline. If it is in the midline, a cyst called a thyroglossal cyst and associated with the wishbone should be considered. It is easily diagnosed with radiological examinations such as ultrasound and its treatment is surgery. Although neck mass is not the most common complaint in our center in Istanbul, it is a disease that should be approached with care as it can be a harbinger of an important disease.
If we think that there is an infection, it is necessary to give the necessary antibiotic immediately and wait for at least a week. If the lesion does not shrink spontaneously, blood tests should be requested and the mass should be examined with ultrasound. The wealth of radiological examinations that have developed in recent years helps the diagnosis a lot, especially in centers such as Turkey.
If a cause cannot be found in all treatments and examinations and the mass is larger than three centimeters, it should be surgically removed. Surgery aids in both diagnosis and treatment.
