From the Guidelines
The exception to superficial neck swellings is a deep cervical lymph node enlargement. Superficial neck swellings typically include conditions like sebaceous cysts, lipomas, branchial cysts, thyroglossal cysts, and enlarged superficial lymph nodes. Deep cervical lymph nodes, however, are located beneath the sternocleidomastoid muscle and deep cervical fascia, making them deep structures rather than superficial ones. When enlarged, they may present as a neck mass but are not classified as superficial swellings due to their anatomical location. These deep nodes are part of the deep cervical lymphatic chain and often become enlarged due to infections in the head and neck region, malignancies, or systemic diseases, as noted in the clinical practice guideline for evaluating neck masses in adults 1. Their deep position makes them less visible and palpable compared to superficial swellings, and they typically require imaging studies like ultrasound or CT scans for proper evaluation. Key considerations in evaluating neck masses include the potential for malignancy, with evidence suggesting that a neck mass in an adult should be considered malignant until proven otherwise 1. Therefore, distinguishing between superficial and deep neck swellings is crucial for appropriate diagnosis and management, prioritizing the evaluation of deep cervical lymph node enlargement due to its potential implications for morbidity, mortality, and quality of life. Some common causes of superficial neck swellings, such as sebaceous cysts and lipomas, are generally benign and have a different management approach compared to deep cervical lymph node enlargements. In clinical practice, a thorough physical examination and appropriate diagnostic workup, as outlined in guidelines for evaluating adult neck masses 1, are essential for determining the nature of a neck swelling and guiding further treatment.
From the Research
Superficial Neck Swellings
The following are considered superficial neck swellings:
- Tuberculous lymphadenitis 2
- Reactive/non-specific lymphadenitis 2
- Malignant neoplasms, such as metastatic carcinoma, lymphoma, and thyroid gland carcinoma (Papillary Carcinoma) 2
- Cysts 2
- Benign neoplasms 2
- Sialadenitis 2
Deep Neck Space Abscesses
Deep neck space abscesses are not considered superficial neck swellings, but rather a separate category of neck infections. They can be caused by dental infections, substance abuse, and poor orodental hygiene 3.
Diagnostic Tools
Fine Needle Aspiration Cytology (FNAC) and Fine-needle aspiration biopsy (FNAB) are diagnostic tools used to assess superficial masses and nodules in the neck, including thyroid gland nodules and lymph nodes 2, 4. Ultrasound and colour-power Doppler are also important imaging modalities for the study of the neck, particularly for thyroid gland, parathyroids, and lymph nodes 4.
Exception
Based on the provided studies, deep neck space abscesses, such as peritonsillar abscess, superficial craniocervical infection, and salivary gland infections, are not considered superficial neck swellings, but rather a separate category of neck infections 3.