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Surgery

Neck Surgery

The neck:
The structure sufficiently strong enough to anchor the head, mobile enough to move it in several directions. It represents one of the most complex anatomical regions intimately linked with the head anatomy. It is an important element for fashion accessories and jewelry display. It provides writers and movie directors a source of inspirations to enrich their story lines.
Welcome to faces, your medical and surgical guide to the head and neck!
The neck contains the cervical spine, the trachea, the larynx, the esophagus, around 300 lymph nodes, muscles, nerves, connective, tissue and skin. For this reason, the pathology of the neck is very wide ranging. The diagnostic workup is heavily supported on imaging tests. Many neck lumps need a fine needle biopsy before planning a treatment strategy. Presenting all neck pathologists would be too ambitious, so in this video I decided to present you some of my representative cases of benign neck masses.
The first case belongs to a woman with a slow growing mass, at the left side of her neck, distorting its contour.
She was also complaining from a slight limitation in moving up her left shoulder. It was a lipoma, a benign tumor of fat cells. In this particular case it was compressing the accessory nerve on its way to supply the trapezius muscle, explaining the shoulder movement limitation. After removal, the neck regained its normal curvature, preserving the nerve and its function.
This is also a lipoma located at the anterior part of the neck. Imaging and cytology help to differentiate it from thyroglossal cyst. I invite you to watch the salivary glands video with more details on salivary gland tumors and the anatomy of the facial nerve.
This mass is a submandibular gland tumor. When performing the removal of the submandibular tumor, it is important to take into account not only the facial nerve, but also the lingual nerve.
This lump looks similar to the latter, but in this case it is a branchial cleft cyst. These are congenital abnormalities, meaning it’s a condition present at birth. Despite it is a congenital defect, most cysts turn into symptomatic lumps only in late childhood or early adulthood.
At the same side, this young woman had nothing but a slight discomfort over the past months. Despite no evident mass at inspection, the clinical examination and then CT scan and cytology pointed toward what after surgery was confirmed to be a branchial cleft cyst. The mass was removed from a delicate position with important structures to preserve:
1) The hypoglossal nerve, that supplies the tongue muscles.
2) The accessory nerve, for trapezius and sternocleidomastoid muscle.
3) Major neck vessels.
This woman had discomfort at her right side of the neck, in particular when rotating her head. Imaging exams revealed a paraganglioma: a neuroendocrine tumor, located at the carotid bifurcation. It was removed and nowadays she has no symptoms. However genetic tests showed an hereditary mutation, which means there is a risk of having other paragangliomas. Therefore she’s under lifelong follow-up.
So, you have seen how rich is the neck anatomy, some pathologies of the neck and also an opportunity to have an idea how skin scars look at different stages of healing, though it is important to remember that scaring depends on many factors, a topic for another video maybe!
I hope you like the video.
See you soon.
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  • Rua Bernardo Lima 29 A, 1150 - 075 Lisboa
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  • Av. Sanches de Miranda 30, 7006-805 - Évora
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