Neckology

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

2. 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

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

4. 颈部三角 颏下三角 颌下三角 颈动脉三角 枕三角 肌三角 锁骨上三角

5. 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

6. 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

7. Neck fascia and fascia space • Fascia space • Fascia space above the hyoid bone • Submandibular space • Parapharyngeal space • Peritonsilla space • Masseter space • Parotid space

8. Space under the hyoid bone • Space cross the hyoid bone • Prevertebral space • Carotid sheath • Postpharyngeal space

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

10. 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 • LevelⅤ：lymph nodes of posterior neck triangle • Level VI：lymph nodes of anterior neck space

11. Neck injury • classification closed injury open injury

12. 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

13. 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

14. Neck injury • diagnosis • History, presentation • X-ray • ＣＴ、ＭＲＩ

15. 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

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

17. 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

18. 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

19. 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

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

21. 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

22. 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

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

24. 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,Ｂultrasonic, CT, isotope examination treatment：surgery

25. thyroglossal cyst or fistula

26. thyroglossal cyst or fistula

27. thyroglossal cyst or fistula

28. angioma

29. angioma

30. Branchial fissure fistula or cyst

31. lymphangioma

32. lymphangioma

33. lymphangioma

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

35. Thank You