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Neck Masses

A visible or palpable fullness in the neck can be caused by multiple entities. The most common of these is enlargement of lymph nodes in the neck. When lymph node enlargement occurs relatively suddenly, accompanied by tenderness with or without fever or sore throat, an acute infectious problem is usually present, and the odds are excellent that the enlargement will dissipate or resolve once the underlying infectious process has been brought under control with medical therapy. Lymph nodes that enlarge slowly and without any accompanying symptoms require evaluation as well, as these may be a sign of a more serious disease state. Needle aspiration biopsy or surgical removal may be necessary, depending on circumstances.

Neck cysts are fluid filled sacs within the soft tissues. These are generally congenital and of an embryologic origin, but may not manifest themselves for years or even decades after birth. Once a congenital cyst becomes evident, medical therapy will usually reduce the size and tenderness of the mass, but surgical removal is usually necessary. Cysts within the parotid salivary gland or thyroid gland can often be managed medically, with or without needle drainage of fluid from the cyst.

Thyroid nodules are exceedingly common, particularly in women, and are usually benign. Workup will include a thyroid ultrasound (sonogram), and may require a needle aspiration biopsy (generally performed under ultrasound-guidance). Cytology results often dictate whether a patient requires surgery to remove all or a portion of a patient’s thyroid gland, or whether the gland can be followed with repeat ultrasound studies at reasonable intervals. Nodules 4 cm or greater in diameter require surgery regardless of needle biopsy results.  Patients with a history of radiation exposure (from Chernobyl or radiation treatments for enlarged adenoid during the 1950’s, for example) require more aggressive workup and carry a lower threshold for the recommendation of surgery.

Salivary Gland Tumors generally involve the parotid and submandibular glands. The parotid glands are on each side of the face from the cheek bones down to the jaw, with a small tail extending downward into the neck behind and below the angle of the jaw. The submandibular glands are located just below the jaw on each side of the neck. Infection due to dehydration or obstruction is the most common reason for a mass involving these glands to occur, and generally is sudden in onset and accompanied by swelling, pain and tenderness of the entire involved gland. The submandibular glands have the greatest tendency to form stones within the ducts, and these may cause obstruction and swelling of the involved gland. Uncomplicated infections generally respond to antibiotics, hydration, warm compresses and gland massage.  Surgery for chronic or recurrent infection is uncommon, and generally involves the submandibular glands, especially when large stones are present. True tumors are more common in the parotid glands, and are usually benign. Workup will include radiographic studies (ultrasound, CT, and/or MRI), followed by needle aspiration biopsy. True tumors of the salivary gland (both benign and malignant) generally require surgical removal.