- 75% of lateral neck masses in patients over 40 years are caused by malignant tumours.
- In the absence of overt signs of infection, a lateral neck mass is metastatic squamous cell carcinoma or lymphoma until proved otherwise.
- The primary tumour can be detected in 50% of patients by clinical examination alone and in a further 10-15% by panendoscopy of the upper aerodigestive tract.
- Fine needle aspiration biopsy is an accurate, sensitive, inexpensive, and rapid technique that can be performed in the clinic.
- Excisional and incisional biopsy of cervical metastases results in a 2-3 times increased incidence of local treatment failure when compared with fine needle aspiration cytology.
- Excisional biopsy of parotid tumours risks damage to the facial nerve and seeding of the wound, and recurrence may develop up to 20 years after the first attempt at resection.
Differential diagnoses of lateral neck masses
- Developmental: branchial cyst, haemangioma, laryngocoele
- Skin and subcutaneous tissues: sebaceous cyst, lipoma
- Lymph nodes:
Viral: Epstein-Barr virus, HIV
Bacterial: staphylococcus, tuberculosis, cat scratch, brucella
Protozoa: toxoplasma, leishmaniasis
Fungal: histoplasmosis, blastomycosis, coccidiomycosis
Granulomatous: sarcoid, foreign body reaction
Neoplastic: lymphoma, metastasis
- Carotid sheath: aneurysm, carotid body tumour, vagal or sympathetic neuroma
- Salivary gland (parotid or submandibular)
Infective: sialadenitis, sialolithiasis
Autoimmune: Sjögren's syndrome
Miscellaneous: AIDS related disease
Source: Management of lateral neck masses in adults Michael Gleeson, Amanda Herbert, and Aurelia Richards BMJ 2000;320 1521-1524