Neckology The Otolaryngology Faculty of Shanghai Jiao Tong University School of Medicine Xiang Mingliang

Anatomy of neck Neck border Upper ： mandibular rim, mandibular angle, mastoidale, supraoccipital line lower ： suprasternal notch, sternoclavicular joint, collar bone, line between acromion and 7th cervical vertebrae

Anatomy of neck Neck sector Posterior region ： nucha Anter-lateral region ： neck anterior region lateral region

颈部三角 颏下三角 颌下三角 颈动脉三角 肌三角 锁骨上三角 枕三角

Organs in neck middle ： thyroid gland, larynx, trachea, hypopharynx, neck segment of esophagus, strap muscles lateral ： Cervical sheath Sternocleidomastoid muscle Omohyoid muscle Posterior group of encephalic nerves Submaxillary gland

Neck fascia and fascia space Superficial fascia ： under the subcutaneous, wrap total neck up Deep fascia ： –Superficial layer ： wrap sternocleidomastoid muscle and cucullaris –Middle layer ： visceral fascia –Deep layer ： prevertebral fascia

Neck fascia and fascia space Fascia space –Fascia space above the hyoid bone Submandibular space Parapharyngeal space Peritonsilla space Masseter space Parotid space

–Space under the hyoid bone –Space cross the hyoid bone Prevertebral space Carotid sheath Postpharyngeal space

Strata of neck derma platysma Strap muscles Thyroid gland Larynx and trachea hypopharynx neck segment of esophagus prevertebral fascia

Lymph nodes in neck （ １９９１ ） Level I ： submental triangle, submaxillary triangle Level II ： upper group of jugular lymph nodes Level Ⅲ： middle group of jugular lymph nodes Level Ⅳ： lower group of jugular lymph nodes Level Ⅴ： lymph nodes of posterior neck triangle Level VI ： lymph nodes of anterior neck space

Neck injury classification closed injury open injury

Neck injury cause mechanical ： Direct violence from surrounding ： force characteristic ： blunt 、 sharp 、 blast wave 、 stranglehold wound characteristic ： traffic accident 、 industrial accident 、 accident damage 、 suicide 、 war injury Violence from inner ： anesthesia intubation 、 take foreign body 、 nasal feeding intubation 、 injury of foreign body physical ： burn injury chemical ： corrosive injury 、 poison gas injury

Neck injury Clinic presentation Early stage ： soft tissue injury ： pain, odynophagia, bleeding ， dyspnea, hoarseness cartilage injury ： dyspnea, odynophagia, hemoptysis, hoarseness ； cartilage mark disappearness, fricative, abnormal move of larynx, aerocele Middle stage ： bleeding, infection Late stage ： larynx or trachea stenosis, fistula

Neck injury diagnosis –History, presentation –X-ray – ＣＴ、ＭＲＩ

Neck injury treatment Early stage ABCrules Open respiratory tract （ Air way ） hemostasia （ Bleeding ） antishock （ Circulation ） Repair of larynx and trachea Wound suturation Prevention of infection or tetanus

Neck injury Middle stage ： Prevention of secondary bleeding antiinfection Late stage Repair or reconstruction

Differential diagnosis of neck lump classification inflammation ： acute, chronic ； specific, nonspecific trauma ： hematoma 、 false aneurysm neoplasm ： benign or malignancy ： more in benign malignant ： primary, metastasis ； deformity ： angioma 、 cyst

Differential diagnosis of neck lump General law Duration ： 7d inflammation ， 7M neoplasm ， 7y deformity propery ： 80%malignant in neoplasm 80% metastasis in malignancy 80% head and neck source in metastasis site ： metastasis in left supraclavicularis from left chest or abdomen, in right from right chest

Differential diagnosis of neck lump Common tumor middle ： thyroid tumor, thyroglossal cyst sternocleidomastoid muscle region ： metastasis, neural tumor, branchial cyst, adenitis, carotid body tumor Submaxillary triangle ： neoplasm of submaxillary gland, adenitis Postmaxillary region ： neoplasm 、 neural tumor Posterior region of neck ： adenitis, metastasis

Differential diagnosis of neck lump Assistant examination B ultrasound CT MRI DSA puncture Pathological examination ： cell 、 tissue

Differential diagnosis of neck lump inflammation ： short duration ， local pain, haphalagesia ， change in size ， antiinfection operative Benign tumor ： grow slowly, no pain, mestexture ， smooth face Primary malignance ： progressive growth, short duration, rough face, hard texture, poor activity

Differential diagnosis of neck lump metastasis ： most in sternocleidomastoid muscle region ， progressive growth ， poor activity 。 Symptoms of primary lesion Deformity: long duration ， slowly growth ， cyst feeling evident ， can get liquids from the lump

treatment of neck lump inflammation ： anti-infection Benign tumor ： surgery Primary malignancy ： chemotherapy or radiotherapy ， surgery metastasis ： radiotherapy, neck dissection deformity ： surgery trauma ： surgery

Deformity of neck thyroglossal cyst or fistula: thyroglossal dust irregression during embryo Classification of fistula ： complete—outer fistulous inlet 、 inner fistulous inlet uncomplete—outer fistulous inlet Middle line of neck diagnosis ： cyst or fistula in the middle of neck, Ｂ ultrasonic, CT, isotope examination treatment ： surgery

thyroglossal cyst or fistula

angioma

Branchial fissure fistula or cyst Outer inlet Inner inlet the first sternocleido mastoid muscle region Ear cannel The second sternocleido mastoid muscle region Tonsil pouch The third sternocleido mastoid muscle region Priform fossa

lymphangioma

Malignancy in neck metastasis Primary lesion NPC （６０％－８０％） Tonsil malignancy Hypopharyngeal cancer Laryngeal cancer Thyroid cancer Malignancy of sinus Malignancy of mouth

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