INTRODUCTION

Discrete swellings in the neck are often due to lymph node enlargement (cervical lymphadenopathy) but may occasionally be caused by disorders in:

More diffuse swelling of the neck may be caused by obesity or:

The location of a lump or swelling in the neck will often give a good indication of the tissue of origin, and the age of the patient may also help suggest the most likely diagnoses (Box 6.1). The duration of the lesion is also relevant: one that has been present since an early age is likely to be of congenital origin, while a lump appearing in later life and persisting may be malignant.

Although a wide range of diseases may present with lesions in the neck (Fig. 6.1), the most common complaint is of swelling and/or pain in the cervical lymph nodes (Box 6.2, Algorithm 6.1). This chapter concentrates on these. Over a quarter of the lymph nodes in the body are connected with lymph nodes situated in the head and the neck. The tonsil is lymphoid tissue located between the pillars of the fauces, and there is similar material in the posterior third of the tongue (lingual tonsil) and the posterior wall of the pharynx (adenoids). These three areas form a ring of lymphoid tissue around the oropharynx (Waldeyer ring). It is not surprising then, that many diseases of the lymphoid tissue present primarily in the head and neck.

The dental surgeon can often detect serious disease through neck node examination. Tenderness, consistency and mobility should be documented. Both anterior and posterior cervical nodes should be examined as well as other nodes, liver and spleen if systemic disease is a possibility. Generalized lymphadenopathy with or without enlargement of other lymphoid tissue such as liver and spleen (hepatosplenomegaly) suggests a systemic cause.

CLINICAL FEATURES

The patient may be aware that they have lymphadenopathy, usually termed ‘glands in the neck’. The main complaint with respect to cervical lymph nodes is usually of swelling. Tenderness may have drawn the patient’s attention to their presence. The history should include: date of onset of symptoms; details of any swelling, such as duration and character; and any details of pain experienced, such as duration, character, radiation, aggravating and relieving factors, and associated phenomena.

Lymph nodes that are tender and mobile may be inflammatory (lymphadenitis). Lymph nodes swollen from acute infections are usually tender, soft and discrete, while chronic infections give firm lymph nodes. In the systemic infective disorders the nodes are usually firm, discrete, tender and mobile.