Primary Neck Cancer ‣ Anatomy

In order to fully understand primary neck cancers, it helps to understand the anatomy and function of the structures in the neck. The neck is a complex anatomic region between the head and the body. In the front, the neck extends from the bottom part of the mandible (lower jaw bone) to the bones of the upper chest and shoulders (including the sternum and collar bones). The back of the neck is mostly comprised of muscles, as well as the spine. 

The neck is essentially a passageway for air, food, liquids, blood, and more to travel between the head and the rest of the body, through structures such as blood vessels, nerves, and lymph nodes, as well as the larynx, trachea, and esophagus. 

Important Structures in the Neck

Sternocleidomastoid Muscle
This is the large muscle on either side of the neck. This muscle covers and protects many important deeper structures such as the carotid artery and the jugular vein. This muscle starts at the skull just behind the ear (mastoid bone) and travels down to the sternum (breastbone) and clavicles (collarbones).

Thyroid Gland
The thyroid is located at the midline of the neck, under the skin and a few layers of thin muscles. It sits just in front of and to the side of the upper trachea. It secretes thyroid hormone which is important in regulating many functions of the body. The thyroid gland has a right and left lobe which are connected by an isthmus. Learn more about the thyroid.

Parathyroid Glands
These four glands are located just behind the thyroid gland, two on each side. They are critical in helping to regulate levels of calcium in the blood.

Carotid Sheath
This is an envelope of fascia that envelopes three major structures: the carotid artery, internal jugular vein, and vagus nerve.

Additional Major Arteries & Nerves
Just behind the carotid sheath sits the sympathetic nerve plexus, which helps with blood pressure control and other important functions. There are also other major nerves such as the hypoglossal nerve (which controls tongue movement), the spinal accessory nerve (which controls neck and shoulder movement), and the phrenic nerve that innervates the diaphragm (which facilitates breathing).

Larynx
The larynx is often called the voice box because it houses the vocal cords and is responsible for producing sound during speech. It is part of the throat and is located in the middle of the neck.  The framework of the larynx is formed by the cricoid and thyroid cartilage, as well as, other smaller cartilages. Learn more about the larynx.

Esophagus
The esophagus is the passageway for eating. It is located behind the trachea in the lower neck. Food and liquids travel through this muscular tube which travels from the neck through the chest until it connects to the stomach in the abdomen. 

Trachea
The trachea is the passageway for breathing. It begins just below the cricoid cartilage of the larynx and extends into the chest to eventually split into left and right bronchi which continue to divide in the lungs. The trachea is made up of multiple c-shaped cartilage rings and a posterior muscular wall.

Salivary Glands
The submandibular salivary glands and the tail of the parotid salivary gland are located in the upper part of the neck. Learn more about salivary glands.

Lymph Nodes
There are lymph nodes located throughout the body, and several in the neck. Lymph nodes filter fluid in the body and help to fight infections and cancers. Cancers from a site in the head and neck can drain into lymph nodes and lead to the growth of cancer within the lymph node (called a metastatic lymph node). Learn more about lymph nodes.

Salivary Glands Anatomy | Memorial Sloan Kettering Cancer Center

If you have been diagnosed with salivary gland cancer, knowing a little bit about the salivary glands will help you talk to your doctor about surgery or other aspects of your care.

The salivary glands make saliva and empty it into your mouth through openings called ducts. Saliva helps with swallowing and chewing. It can also help prevent infections from developing in your mouth or throat.

There are two types of salivary glands:

1. the major salivary glands

2. the minor salivary glands

Major Salivary Glands

The major salivary glands are the largest and most important salivary glands. They produce most of the saliva in your mouth.

There are three pairs of major salivary glands: the parotid glands, the submandibular glands, and the sublingual glands.

Parotid Glands

The parotid glands are the largest salivary glands. They are located just in front of the ears. The saliva produced in these glands is secreted into the mouth from a duct near your upper second molar.

Each parotid gland has two parts, or lobes: the superficial lobe and the deep lobe. Between the two lobes is the facial nerve. The facial nerve is important because it controls your ability to close your eyes, raise your eyebrows, and smile.

Other critical structures near the parotid glands include the external carotid artery, which is a major supplier of blood to the head and neck region, and the retromandibular vein, a branch of the jugular vein.

Surgery to treat a parotid gland tumor is called a parotidectomy. It requires great precision because the surgeon has to locate and operate around these important structures.

Learn more about parotidectomy.

Submandibular Glands

About the size of a walnut, the submandibular glands are located below the jaw. The saliva produced in these glands is secreted into the mouth from under the tongue.

Like the parotid glands, the submandibular glands have two parts called the superficial lobe and the deep lobe. Nearby structures include:

• the marginal mandibular nerve, which helps you smile

• the platysma muscle, which helps you move your lower lip

• the lingual nerve, which allows sensation in your tongue

• the hypoglossal nerve, which allows movement in the part of your tongue that helps with speech and swallowing

During treatment, we protect all of these important structures to avoid causing damage.

Learn more about submandibular gland cancer surgery.

Sublingual Glands

The sublingual glands are the smallest of the major salivary glands. These almond-shaped structures are located under the floor of the mouth and below either side of the tongue.

Tumors starting in these glands are particularly rare.

Learn more about surgery for cancers that begin in the sublingual glands.

Minor Salivary Glands

There are hundreds of minor salivary glands throughout the mouth and the aerodigestive tract. Unlike the major salivary glands, these glands are too small to be seen without a microscope. Most are found in the lining of the lips, the tongue, and the roof of the mouth, as well as inside the cheeks, nose, sinuses, and larynx (voice box).

Minor salivary gland tumors are extremely rare. However, they are more likely to be cancerous than benign. Cancers of the minor salivary glands most often begin in the roof of the mouth.

UC San Diego’s Practical Guide to Clinical Medicine

Head and Neck Exam

Lymph Nodes:

The major lymph node groups are located along the anterior
and posterior aspects of the neck and on the underside of the jaw. If the nodes
are quite big, you may be able to see them bulging under the skin, particularly
if the enlargement is asymmetric (i.e. it will be more obvious if one side is
larger then the other). To palpate, use the pads of all four fingertips as these
are the most sensitive parts of your hands. Examine both sides of the head simultaneously,
walking your fingers down the area in question while applying steady, gentle
pressure. The major groups of lymph nodes as well as the structures that they
drain, are listed below. The description of drainage pathways are rough approximations
as there is frequently a fair amount of variability and overlap. Nodes are generally
examined in the following order:

Palpating Anterior Cervical Lymph Nodes

1. Anterior Cervical (both superficial and deep): Nodes that lie both on top of and
   beneath the sternocleidomastoid muscles
   (SCM) on either side of the neck, from the angle of the jaw to the top of the
   clavicle.
   This muscle allows the head to turn to the right and left. The right SCM turns the
   head to the left and vice versa.
   They can be easily identified by asking the patient to turn their head into your
   hand while you provide resistance.
   Drainage: The internal structures of the throat as well as part of the posterior
   pharynx, tonsils, and thyroid gland.

2. Posterior Cervical: Extend in a line posterior to the SCMs but in front of the trapezius,
   from the level of the mastoid bone to the clavicle. Drainage: The skin on the back of the
   head. Also frequently enlarged during upper respiratory infections (e.g. mononucleosis).
3. Tonsillar: Located just below the angle of the mandible. Drainage: The tonsilar and
   posterior pharyngeal regions.
4. Sub-Mandibular: Along the underside of the jaw on either side. Drainage: The structures in
   the floor of the mouth.
5. Sub-Mental: Just below the chin. Drainage: The teeth and intra-oral cavity.
6. Supra-clavicular: In the hollow above the clavicle, just lateral to where it joins the
   sternum. Drainage: Part of the throacic cavity, abdomen.

Lymph nodes of the head and neck

A number of other lymph node groups exist. However, palpation of these areas is limited to those
situations when a problem is identified in that specific region (e.g. the pre-auricular nodes,
located in front of the ears, may become inflamed during infections of the external canal of the
ear).

What are you feeling for? Lymph nodes are part of the immune system. As such, they are most
readily palpable when fighting infections. Infections can either originate from the organs that
they drain or primarily within the lymph node itself, referred to as lymphadenitis. Infected
lymph nodes tend to be:

• Firm, tender, enlarged and warm. Inflammation can spread to the overlying skin, causing it
  to appear reddened.

If an infection remains untreated, the center of the node may become necrotic, resulting in the
accumulation of fluid and debris within the structure. This is known as an abscess and feels a
bit
like a tensely filled balloon or grape (a.k.a. fluctuance). Knowledge of which nodes drain
specific
areas will help you search efficiently. Following infection, lymph nodes occasionally remain
permanently enlarged, though they should be non-tender, small (less the 1 cm), have a rubbery
consistency and none of the characteristics described above or below. It is common, for example,
to
find small, palpable nodes in the submandibular/tonsilar region of otherwise healthy
individuals.
This likely represents sequelae of past pharyngitis or dental infections.

Malignancies may also involve the lymph nodes, either primarily (e.g. lymphoma) or as a site of
metastasis. In either case, these nodes are generally:

• Firm, non-tender, matted (i.e. stuck to each other), fixed (i.e. not freely mobile but
  rather stuck down to
  underlying tissue), and increase in size over time.

The location of the lymph node may help to determine the site of malignancy. Diffuse,
bilateral involvement suggests a systemic malignancy (e.g. lymphoma) while those limited to
a specific anatomic region are more likely associated with a local problem. Enlargement of
nodes located only on the right side of the neck in the anterior cervical chain, for
example, would be consistent with a squamous cell carcinoma, frequently associated with an
intra-oral primary cancer.

Cervical Adenopathy:

Right anterior cervical adenopathy secondary to metastatic cancer.

Cervical Adenopathy:

Massive right side cervical adenopathy secondary to metastatic squamous cell cancer
originating from this patient’s oropharynx.

Diffuse upper airway infections (e.g. mononucleosis), systemic infections (e.g. tuberculosis) and
inflammatory processes (e.g. sarcoidosis) can all cause lymphadenopathy (i. e. lymph node
enlargement). HIV
infection can also cause adenopathy in any region of the body, including head/neck, axilla,
epitrochlear,
inguinal and other areas where there are lymph nodes. In these settings, the findings can be
symmetric or
asymmetric. Historical information as well findings elsewhere in the body are critical to making
these
diagnoses. Furthermore, it may take serial examinations over the course of weeks to determine
whether a node
is truly enlarging, suggestive of malignancy, or responding to therapy/the passage of time and
regressing in
size, as might occur with other inflammatory processes.”

The Ear

External structures: Briefly examine the outer structures, paying particular attention to any
skin
changes suggestive of cancer (e.g basal cell, melanoma, squamous cell), a common asymptomatic
abnormality affecting this sun exposed area. If the patient has pain, try to identify its
precise
location. Infection within the external canal (otitis externa), may cause discharge, and pain
when
the
ear lobe and tragus are manipulated.

Otoscope

Otoscopy: The otoscope allows you to examine the external canal, the structure that connects the
outside world with the middle ear, as well as the ear drum and a few inner ear structures. Proceed
as follows:

1. Put the otoscopic head on your oto-opthalmoscopic. It should easily twist
   into position.
2. Turn on the light source.
3. Place one of the disposable specula on the end of the scope.
4. Grasp the scope so that the handle is either pointed directly downward or
   angled up and towards the patient’s forehead. Either technique is acceptable.
   The scope should be in your right hand if you are examining the right ear.
5. Place the tip of the specula in the opening of the external canal. Do this
   under direct vision (i.e. not while looking through the scope).
6. Gently grasp the top of the left ear with your left hand and pull up and
   backwards. This straightens out the canal, allowing easier passage of the
   scope.
   

   Otoscopic Examination

7. Look through the viewing window with either eye. Slowly
   advance the scope, heading a bit towards the patient’s nose but without
   any up or down angle. Move in small increments. Try not to wiggle the scope
   too much as the external canal is quite sensitive. I find it helpful to
   extend the pinky and fourth fingers of my right hand and place them on the
   side of the patient’s head, which has a stabilizing effect. As you advance,
   pay attention to the appearance of the external canal. In the setting of
   infection, called otitis externa, the walls becomes red, swollen and may
   not accommodate the speculum. In the normal state there should be plenty
   of room. If wax, which appears brownish, irregular and mushy, obscures your
   view, stop and go to the other side. Do not try to extract it until/unless
   you have had specific training in this area! There are pharmacologic means
   of softening wax, which may then be easily irrigated from the canal.
   
   

   Otitis Externa:

   Swelling due to infection in the external
   canal of the left ear (picture on right) limits the space around
   the Q-Tip. Picture on left is of normal ear for comparison.

   
   

   After moving ahead a few centimeters, you should see the
   tympanic membrane (a.k.a. ear drum). Pay particular attention to:

   
   

   1. The color: When healthy, it has a grayish, translucent appearance.
   2. The structures behind it: The malleous, one of the bones of
      the middle ear, touches the drum. The drum is draped over this
      bone, which is visible through its top half, angled down and backwards.
      The part that is closest to the top of the drum is called the
      lateral process, and is generally most prominent. The tip at the
      bottom-most aspect is the umbo.
   3. The light reflex: Light originating from your scope will be
      reflected off the surface of the drum, making a triangle that
      is visible below the malleous.
      
      
   4. In the setting of infection within the middle ear (known
      as otitis media, the most common pathologic process affecting this area),
      the drum becomes diffusely red and the light reflex is lost. The malleous
      also appears less prominent and you may be able to see a line caused
      by fluid collecting behind the drum. This is called a middle ear effusion
      and can cause the drum to bulge outwards.

   5. There is a valve on your scope that allows the attachment
      of a small, compressible bulb. Place the bulb in the palm of the hand
      which is not holding the scope. With this device, you can squirt small
      puffs of air (known as pneumatic otoscopy) at the tympanic membrane.
      The normal membrane moves, which can be appreciated by the examiner.
      Effusions prevent this from occurring. Ask an experienced examiner to
      demonstrate as this is quite awkward at first and it’s difficult to
      appreciate the movement.

8. Move to the other side of the body and examine the left ear. Hand position is reversed.

Auditory Acuity: If the patient does not complain of hearing loss, this part of the exam is omitted.
A crude assessment can be performed by asking the patient to close their eyes while you place your
fingers a few centimeters from either ear. Rub the finger tips of first one hand and then the other.
Make note of any obvious differences in hearing. Alternatively, you can stand behind the patient and
whisper a few words in first one ear and then the other. Are they able to repeat the phrases back
correctly? Does this seem to be equal on either side? These tests obviously are not very objective.
Precise quantification requires sensitive equipment and is usually done by a trained audiologist.

Detecting Conductive v. Sensorineural Deficits: As with acuity, these tests would only be
performed if the patient complained of hearing loss. Transmission of sound can be broken into
two components:

1. Conduction: The passage of sound from outside to the level of the 8th cranial nerve. This
   includes transmission of sound through the external canal and middle ears.
2. Sensorineural: The transmission of sound through the 8th nerve to the brain.

Hearing loss can occur at either level. To determine which is affected, the following tests are
performed:

Weber: Grasp the 512 Hz tuning fork by its stem and get it to vibrate by either
striking the tines against your hand or by “snapping” the ends between
your thumb and middle finger. Then place the stem towards the back of the patient’s
head, on an imaginary line equidistant from either ear. The bones of the skull
will transmit this sound to the 8th nerve, which should then be appreciated
in both ears equally. Remind the patient that they are trying to detect sound,
not the buzzing vibratory sensation from the fork. If there is a conductive
deficit (e.g. wax in the external canal), the sound will be heard better in
that ear. This is because impaired conduction has prevented any competing sounds
from entering the ear via the normal route. You can create a transient conductive
hearing loss by putting a finger in one ear. Sound transmitted from the tuning
fork will then be heard louder on that side. In the setting of a sensorineural
abnormality (e.g. an acoustic neuroma, a tumor arising from the 8th CN), the
sound will be best heard in the normal ear. If sound is heard better in one
ear it is described as lateralizing to that side. Otherwise, the Weber test
is said to be mid-line.

Weber Test

Rinne: Strike the same tuning fork and place the stem on the mastoid bone, a bony prominence
located
just behind and below the ear. Bone conduction will allow the sound to be transmitted and
appreciated. Instruct the patient to let you know as soon as they can no longer hear the sound.
Then
place the tines of the still vibrating fork right next to, but not touching, the external canal.
They should again be able to hear the sound. This is because, when everything is functioning
normally, transmission of sound through air is always better then through bone. This will not be
the
case if there is a conductive hearing loss (e.g. fluid associated with an infection in the
middle
ear), which causes bone conduction to be greater then or equal to air. If there is a
sensorineural
abnormality (e.g. medication induced toxicity to the 8th CN), air conduction should still be
better
then bone as they will both be equally affected by the deficit.

Rinne Test

The Nose

In the absence of symptoms, this exam is generally omitted. First check to see if the
patient is able to breathe through either nostril effectively. Push on one nostril until it
is occluded and have them inhale. Then repeat on the other side. Air should move equally
well through each nares. To look in the nose, have the patient tilt their head back. Push up
slightly on the tip of the nose with the thumb of your left hand. Place the end of the
speculum (it’s OK to use the same one from the ear exam) into the nares under direct vision.
Now look through the viewing window, noting:

1. The color of the mucosa. It can become quite reddened in the setting of
   infection.
2. The presence of any discharge as well as its color (clear with allergic
   reactions; yellowish with infection).
3. The middle and inferior turbinates, which are shelf-like projections along
   the lateral wall. Any polypoid growths, which may be associated with allergies
   and obstructive symptoms?
4. The other nostril is examined in a similar manner.
5. Loss of smell (anosmia) is a relatively common problem, though often undiagnosed.
   In patients who make mention of this problem, olfaction can be crudely assessed
   using an alcohol pad sniff test as follows:
   1. Ask the patient to close their eyes so that they don’t get any visual
      cues.
   2. Occlude each nostril seqeuentially, making sure that they can move air
      adequately thru both.
   3. Occlude one nostril and then present an unknown item with distinctive aroma,
      asking the patient to inform you when they are able to detect its smell.

   
   A patient should be able to detect the odor of substances with distinctive aromas at a
   distance of 10 cm. Typically coffee, mint or wintergreen oil are used.
   

   Using coffee grounds to assess sense of smell.

Evaluation of Frontal and Maxillary Sinuses

Maxillary and Frontal Sinuses

The head and face contain
a number of sinuses, open cavities that communicate with the upper airway. They
function to warm and cleanse air before it travels down to the lungs. They may
also help to reduce the total weight of the skull. In normal health, these sinuses
cannot be appreciated on examination and cause no symptoms. Inflammatory states,
in particular those caused by allergy or infection, produce symptoms and findings
that may be detected during examination. Symptoms associated with sinusitis
include: nasal congestion, nasal discharge, facial pain, fever, and pain on
palpation of the maxillary teeth. The frontal and maxillary sinuses are the
two that can be indirectly examined. Examination for sinusitis should include
the following:

1. Examination of the nasal mucosa for colored discharge as described above.
   This is due to the fact that the maxillary sinuses drain into the nose via
   a passageway located under the middle turbinate.
2. Directly palpate and percuss the skin overlying the frontal and maxillary
   sinuses. Pain suggests underlying inflammation.
3. Dim the room lights. Place the lighted otoscope directly on the infraorbital
   rim (bone just below the eye). Ask the patient to open their mouth and look
   for light glowing through the mucosa of the upper mouth. In the setting of
   inflammation, the maxillary sinus becomes fluid filled and will not allow
   this transillumination. There are specially designed transilluminators that
   may work better for this task, but are not readily available.
   

   Transillumination of the right maxillary sinus

4. Using a tongue depessor, tap on the teeth which sit in the floor of the
   maxillary sinus. This may cause discomfort if the sinus is inflamed.

The Oro-Pharynx

Exposure and good lighting are critical. Head and Neck specialists have head lamps
that provide excellent illumination and allow them to use both hands to explore
the oral cavity. Most other physicians, however, use an otoscope or flashlight
for illumination. A tongue depressor assists with the exploration. The exam should
be performed in an orderly fashion as follows:

1. Have the patient stick out their tongue so that you can examine the posterior
   pharynx (i.e. the back of the throat). Ask the patient to say “Ah”, which
   elevates the soft palate, giving you a better view. If you are still unable
   to see, place the tongue blade � way back on the tongue and press down while
   the patient again says “Ah,” hopefully improving your view. This causes some
   people to gag, particularly when the blade is pushed onto the more proximal
   aspects of the tongue. It may occasionally be important to determine whether
   the gag reflex is functional (e. g. after a stroke that impairs CNs 9 or 10;
   or to determine if a patient with depressed level of consciousness is able
   to protect their airway from aspiration). This is done by touching a q-tip
   against the posterior pharynx, uvula or tongue. It is not necessary to do
   this during your routine exam as it can be quite noxious!
2. Note that the uvula hangs down from the roof of the mouth, directly in the
   mid-line. With an “Ah,” the uvula rises up. Deviation to one side may be caused
   by CN 9 palsy (the uvula deviates away from the affected side), a tumor or
   an infection.
   

   Cranial Nerve 9 Dysfunction:

   Patient has
   suffered stroke, causing
   loss of function of left CN 9. As a result, uvula is pulled towards the
   normally functioning (ie right) side.

3. The normal pharynx has a dull red color. In the setting of infection, it
   can become quite red, frequently covered with a yellow or white exudate (e.g.
   with Strep. Throat or other types of pharyngitis).
4. The tonsils lie in an alcove created by arches on either side of the mouth.
   The apex of these arches are located lateral to and on a line with the uvula.
   Normal tonsils range from barely apparent to quite prominent. When infected,
   they become red, are frequently covered by whitish/yellow discharge. In the
   setting of a peritonsilar abscess, the tonsils appear asymmetric and the uvula
   may be pushed away from the affected side. When this occurs, the tonsil may
   actually compromise the size of the oral cavity, making breathing quite difficult.

   Left Peritonsilar Abscess.

   Note deveiation of
   uvula towards right.

5. Look carefully along the upper and lower gum lines and at the mucosa in
   general, which can appear quite dry if the patient is dehydrated.
6. Examine the teeth to get a sense of general dentition, as dental health
   has wide implications including:
   • Nutrition (ability to eat)
   • Appearance
     • Self esteem
     • Employability
     • Social acceptance
   • Systemic disease (endocarditis, ? other)
   • Local problems:
   • Profound lack of access to dental care has resulted in MDs assuming
     responsibility for primary Dx and Rx of a number of dental conditions.
   • Dental Anatomy & Exam
     • 16 top teeth, 16 bottom teeth
     • Examine all the teeth and gums, using gloved hands, gauze, tongue
       depressor & lighting if abnormal
     • Make note of: General appearance, any absent teeth, broken teeth
       or obvious cavities; areas of pain, swelling, or infection
     • If abnormal areas are noted, try to precisely define the tooth/teeth
       involved as well as extent of the problem. For example, pain produced
       by tapping on a tooth is commonly caused by a root abscess.

   
   

   NIH
   Tooth
   Site

   
   

   
   
   
   Tooth Abscess: Tooth abscess involving left molar region. Associated
   inflammation of left face can clearly be seen.

7. Have the patient stick their tongue outside their mouth, which allows evaluation
   of CN 12. If there is nerve impairment, the tongue will deviate towards the
   affected side. Any obvious growths or abnormalities? Ask them to flip their
   tongue up so that you can look at the underside. If you see something abnormal,
   grasp the tongue with gauze so that you can get a better look.

   Left CN 12 Dysfunction:

   Stroke has resulted
   in L CN 12 Palsy.
   Tongue therefore deviates to the left.




8. Make note of any growths along the cheeks, hard palate (the roof of the
   mouth between the teeth), soft palate, or anywhere else. In particular, patients
   who smoke or chew tobacco are at risk for oral squamous cell cancer. Any areas
   which are painful or appear abnormal should also be palpated. Put on a pair
   of gloves to better explore these regions. What do they feel like? Are they
   hard? To what extent does a growth involve deeper structures? If the patient
   feels something that you cannot see, try to get someone else to hold the light
   source, freeing both your hands to explore the oral cavity with two tongue
   depressors.
9. The parotid glands are located in either cheek. Infection will cause pain
   and swelling in this area, which can be confirmed on palpation. The ducts
   which drain the parotids enter the mouth in line with the lower molars and
   are readily visible. When infected, you may be able to express pus from the
   ducts by gently palpating the gland.




Right parotid mass.

Note enlargement on right compared with left.

The Thyroid Exam

Prior to palpation, look at the thyroid region. If the gland is quite enlarged, you may
actually notice it protruding underneath the skin. To find the thyroid gland, first locate
the thyroid cartilage (a.k.a the Adams Apple), which is a mid-line bulge towards the top of
the anterior surface of the neck. It’s particularly prominent in thin males, sits atop the
tracheal rings, and can be seen best when the patient tilts their head backwards. Deviation
to one side or the other is usually associated with intra-thoracic pathology. For example,
air trapped in one pleural space (known as a pneumothorax) can generate enough pressure so
that it collapses the lung on that side, causing mediastinal structures, along with the
trachea, to be pushed towards the opposite chest. This deviation may be visible on
inspection and can be accentuated by gently placing your finger in the top of the thyroid
cartilage and noting its position relative to the midline. The thyroid gland lies
approximately 2-3 cm below the thyroid cartilage, on either side of the tracheal rings,
which may or may not be apparent on visual inspection. If you’re unsure, give the patient a
glass of water and have them swallow as you watch this region. Thyroid tissue, along with
all of the adjacent structures, will move up and down with swallowing. The normal thyroid is
not visible, so it’s not worth going through this swallowing exercise if you don’t see
anything on gross inspection.

Location of the Thyroid

Palpation: The thyroid can be examined while you stand in front of or behind the
patient. Exam from behind the patient is described below:

1. Stand behind the patient and place the middle three fingers of either hand
   along the mid-line of the neck, just below the chin. Gently walk them down
   until you reach the top of the thyroid cartilage, the first firm structure
   with which you come into contact. Use gentle pressure, otherwise this can
   be uncomfortable. Make sure that you tell your patients what you’re doing
   so they know you’re not trying to choke them! The cartilage has a small notch
   in its top and is approximately 1.5-2 cm in length. As you cannot actually
   see the area that you’re examining, it may be helpful to practice in front
   of a mirror. You can also try to identify and feel the structures from the
   front while looking at the area in question before performing the exam from
   behind.
2. Walk down the thyroid cartilage with your fingers until you come to the
   horizontal groove which separates it from the cricoid cartilage (the first
   tracheal ring). You should be able to feel a small indentation (it barely
   accepts the tip of your finger) between these 2 structures, directly in the
   mid-line. This is the crico-thyroid membrane, the site for emergent tracheal
   access in the event of upper airway obstruction.
3. Continue walking down until you reach the next well defined tracheal ring.
   Now slide the three fingers of both hands to either side of the rings. The
   thyroid gland extends from this point downwards for approximately 2-3 cm along
   each side. The two main lobes are connected by a small isthmus that reaches
   across mid-line and is almost never palpable. Apply very gentle pressure when
   you palpate as the normal thyroid tissue is not very prominent and easily
   compressible. If you’re unsure or wish confirmation, have the patient drink
   water as you palpate. The gland should slide beneath your fingers while it
   moves upward along with the cartilagenous rings. It takes a very soft, experienced
   touch in order to actually feel this structure, so don’t be disappointed if
   you can’t identify anything.
   

   Thyroid Examination

4. Pay attention to several things as you try to identify the thyroid: If enlarged
   (and this is a subjective sense that you will develop after many exams), is
   it symmetrically so? Unilateral vs. bilateral? Are there discrete nodules
   within either lobe? If the gland feels firm, is it attached to the adjacent
   structures (i.e. fixed to underlying tissue.. consistent with malignancy)
   or freely mobile (i.e. moves up and down with swallowing)? If there is concern
   re: malignancy, a careful lymph node exam (described above) is important as
   this is the most common site of spread.

How to check your Lymph Nodes

Introduction

You have been diagnosed with a skin cancer that on occasions can spread into the lymphatic system. That is why, as part of your examination, your nodes are examined by your doctor or specialist nurse at your follow-up appointments. The lymph nodes examined depend on the location of your skin cancer, eg: if your skin cancer was on your leg then the lymph nodes in your inguinal area (groin) will be felt or if on your face then the nodes in your head and neck would be examined. The aim is to detect any enlargement of the lymph nodes and undertake investigations at an early stage. Some people express a wish to check their own lymph nodes between clinic appointments. This is why you have been given this information. Your doctor or nurse will show you how and which lymph nodes to check. 

The Lymphatic System

This system consists of lymphatic vessels and tissue. Lymph is a fluid that contains proteins and waste materials, which is collected from around the cells in the body, eventually draining into larger vessels.   

Lymphatic vessels

One way of describing this is to imagine a river that starts as a small stream, which then weaves its way between the cells and small blood vessels of the body’s connective tissue.  On its journey more tissue and waste material is collected. The fluid (lymph) that accumulates firstly drains into larger lymph vessels, then into ducts in the neck, before emptying into the blood stream. 

Lymphatic tissue

Lymph nodes are small oval clumps of lymphatic tissue found at intervals along the vessels. They are grouped like “beads on a string” both deep in the body and near the surface (see previous diagram). These lymph nodes filter out harmful organisms and cells from the lymphatic fluid before it is returned to the blood stream. Lymph nodes can only be felt in the areas listed: 

• head and neck 
• arms 
• axilla (armpits) 
• inguinal area (groin)
• back of knees 

Usually lymph nodes are not enlarged and thus not able to be felt, but if you have previously had an infection (such as tonsillitis) you may have noticed and felt lymph nodes becoming enlarged, painful and tender.  Lymph nodes can also become enlarged due to cancer cells lodging in them. Checking your lymph nodes once a month is sufficient and this can be done at the same time as you check your skin for any changing moles. Checking them more often may result indifficulty noticing any change. 

Do not panic if you feel a lymph node as it may well be due to an infection, but if it has not gone away in a week contact your doctor or specialist nurse. 

 

How to Check Lymph Nodes in the Head and Neck

• With your fingertips, in a gentle circular motion feel the lymph nodes shown. 
• Start with the nodes in front of the ear (1) then follow in order finishing just above the collar bone (10)
• Always check your nodes in this order. 
• Check both sides for comparison. If you have an enlarged lymph node it may feel like a swelling the size of a pea, sometimes they can be larger. 

When feeling the nodes in your neck (marked 8): 

• Tilt your head towards the side you are examining, this helps to relax the muscle. 
• Now press your fingers under the muscle. 

When checking the lymph nodes above the collar bone: 

• Hunch your shoulders and bring your elbows forward to relax the skin. 
• Now feel above the collar bone (marked 10).

How to Check Lymph Nodes in the Armpit

Diagram how to check the lymph nodes in your armpitRemove all clothing down to the waist to get easy access to the armpits. 

• Sit in a comfortable position.
• Check each armpit in turn.

To check the left side, lift your arm slightly then place the fingers of your right hand high into the armpit and then lower your arm.

• Feel in the central area of the armpit.

Now move your fingers firmly against the chest wall as follows: 

• Along the front border of the armpit.  
• Along the back border of the armpit. 
• Feel along the inner border of the arm. 
• Now check the other armpit.

How to Check Lymph Nodes in the Groin

Diagram of the lymph nodes in the groinThere are two areas to look for inguinal (groin) nodes:

• Feel the horizontal chain of nodes in the right groin just below the ligament (see above diagram).
• Feel the vertical chain along the upper thigh (see above diagram).
• Check the lymph nodes in the other groin.

Conclusion 

The purpose of this information is to help you understand why you have your nodes checked at your follow-up appointments. It explains which lymph nodes you need to check and how to undertake this procedure yourself. The aim is to ensure that if in the unlikely case there is spread of your skin cancer to the lymph nodes, it is detected and reported to your doctor or nurse straight away rather than waiting until your next clinic appointment.

Lymphatic Drainage of the Head and Neck

The lymphatic system functions to drain tissue fluid, plasma proteins and other cellular debris back into the blood stream, and is also involved in immune defence. Once this collection of substances enters the lymphatic vessels, it is known as lymph. Lymph is subsequently filtered by lymph nodes and directed into the venous system.

This article will explore the anatomy of lymphatic drainage throughout the head and neck, and how this is relevant clinically. We will also look at Waldeyer’s ring, the collection of lymphatic tissue surrounding the superior pharynx.

---

Lymphatic Vessels

The lymphatic vessels of the head and neck can be divided into two major groups; superficial vessels and deep vessels.

Superficial Vessels

The superficial vessels drain lymph from the scalp, face and neck into the superficial ring of lymph nodes at the junction of the neck and head.

Deep Vessels

The deep lymphatic vessels of the head and neck arise from the deep cervical lymph nodes. They converge to form the left and right jugular lymphatic trunks:

• Left jugular lymphatic trunk – combines with the thoracic duct at the root of the neck. This empties into the venous system via the left subclavian vein.

• Right jugular lymphatic trunk – forms the right lymphatic duct at the root of the neck. This empties into the venous system via the right subclavian vein.

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Lymph Nodes

The lymph nodes of the head and neck can be divided into two groups; a superficial ring of lymph nodes, and a vertical group of deep lymph nodes.

Superficial Lymph Nodes

The superficial lymph nodes of the head and neck receive lymph from the scalp, face and neck. They are arranged in a ring shape; extending from underneath the chin, to the posterior aspect of the head. They ultimately drain into the deep lymph nodes.

• Occipital: There are usually between 1-3 occipital lymph nodes. They are located in the back of the head at the lateral border of the trapezius muscle and collect lymph from the occipital area of the scalp.

• Mastoid: There are usually 2 mastoid lymph nodes, which are also called the post-auricular lymph nodes. They are located posterior to the ear and lie on the insertion of the sternocleidomastoid muscle into the mastoid process. They collect lymph from the posterior neck, upper ear and the back of the external auditory meatus (the ear canal).

• Pre-auricular: There are usually between 1-3 pre-auricular lymph nodes. They are located anterior to the auricle of the ear, and collect lymph from the superficial areas of the face and temporal region.

• Parotid: The parotid lymph nodes are a small group of nodes located superficially to the parotid gland. They collect lymph from the nose, the nasal cavity, the external acoustic meatus, the tympanic cavity and the lateral borders of the orbit. There are also parotid lymph nodes deep to the parotid gland that drain the nasal cavities and the nasopharynx.

• Submental: These lymph nodes are located superficially to the mylohoid muscle. They collect lymph from the central lower lip, the floor of the mouth and the apex of the tongue.

• Submandibular: There are usually between 3-6 submandibular nodes. They are located below the mandible in the submandibular triangle and collect lymph from the cheeks, the lateral aspects of the nose, upper lip, lateral parts of the lower lip, gums and the anterior tongue. They also receive lymph from the submental and facial lymph nodes.

• Facial: This group comprises the maxillary/infraorbital, buccinator and supramandibular lymph nodes. They collect lymph from the mucous membranes of the nose and cheek, eyelids and conjunctiva.

• Superficial Cervical: The superficial cervical lymph nodes can be divided into the superficial anterior cervical nodes and the posterior lateral superficial cervical lymph nodes. The anterior nodes lie close to the anterior jugular vein and collect lymph from the superficial surfaces of the anterior neck. The posterior lateral nodes lie close to the external jugular vein and collect lymph from superficial surfaces of the neck.

Fig 1 – The superficial and deep lymph nodes of the head and neck.

Deep Lymph Nodes

The deep (cervical) lymph nodes receive all of the lymph from the head and neck –  either directly or indirectly via the superficial lymph nodes. They are organised into a vertical chain, located within close proximity to the internal jugular vein within the carotid sheath. The efferent vessels from the deep cervical lymph nodes converge to form the jugular lymphatic trunks.

The nodes can be divided into superior and inferior deep cervical lymph nodes. They are numerous in number, but include the prelaryngeal, pretracheal, paratracheal, retropharyngeal, infrahyoid, jugulodigastric (tonsilar), jugulo-omohyoid and supraclavicular nodes.

[start-clinical]

Clinical Relevance: Virchow’s Node

Virchow’s node is a supraclavicular node, located in the left supraclavicular fossa (located immediately superior to the clavicle). It receives lymph drainage from the abdominal cavity.

The finding of an enlarged Virchow’s node is referred to as Troisier’s sign – and indicates of the presence of cancer in the abdomen, specifically gastric cancer, that has spread through the lymph vessels.

[end-clinical]

Waldeyer’s Ring

Waldeyer’s tonsillar ring refers to the collection of lymphatic tissue surrounding the superior pharynx. This lymphatic tissue responds to pathogens that may be ingested or inhaled. The tonsils that make up the ring are as follows:

• Lingual tonsil – located on the posterior base of the tongue to form the antero-inferior part of the ring.

• Palatine tonsils – located on each side between the palatoglossal and palatopharyngeal arches. These are the common ‘tonsils’ that can be seen within the oral cavity. They form the lateral part of the ring.

• Tubal tonsils – these are located where each Eustachian tube opens into the nasopharynx and form the lateral part of the ring.

• Pharyngeal tonsil –  also called the nasopharyngeal/adenoid tonsil, located in the roof of the nasopharynx, behind the uvulva and forms the postero-superior part of the ring.

[start-clinical]

Clinical Relevance: Inflamed Palatine Tonsils (Tonsillitis)

The palatine tonsils can become inflamed due to a viral or bacterial infection. In such a case, they appear red and enlarged, and are accompanied by enlarged jugulo-digastric lymph nodes.

Chronic infection of the palatine tonsils can be treated with their removal, a tonsillectomy. When performing a tonsillectomy, there may be bleeding primarily from the external palatine vein and secondarily from the tonsilar branch of the facial artery.

If an infection spreads to the peritonsillar tissue, it can cause abscess formation. This can cause deviation of the uvula, known as quinsy. A quinsy is a medical emergency, as it can potentially cause obstruction of the pharynx. It is treated with draining of the abscess and antibiotics.

Fig 2 – Quinsy – inflammation of the peritonsillar tissue. Note also how the uvula has deviated to the right as a result of the inflammation.

[end-clinical]

Lymphatics of the Brain

It was thought that lymphatics were absent from the brain until in 2015, scientists located lymphatic vessels in the brains of mice and subsequently humans. Work is underway to determine and describe the lymphatic vessels involved.

Anatomy Of The Parotid & Submandibular Glands & Ducts

The major salivary glands, three pairs in total, are found in and around your mouth and throat. The major salivary glands are the parotid, submandibular, and sublingual glands. The parotid glands are located in front and beneath the ear. A duct, called Stensen’s duct, drains saliva from the parotid gland into the mouth, at the area of the upper cheeks. The submandibular glands are found on both sides, just under and deep to the jaw, towards the back of the mouth. This gland produces roughly 70% of the saliva in our mouth. The submandibular duct, called Warhtin’s duct, enter the floor of the mouth under the the front of the tongue. Sublingual glands, meanwhile, reside beneath the tongue, and supply saliva to the floor of the mouth as well. There are many (between 600 to 1,000) tiny glands called minor salivary glands. These glands are 1-2 mm in diameter and coat all the mucousal surfaces or lining of our mouth and throat.

Parotid Surgery Animation

Purpose of salivary gland

Together, the salivary glands produce saliva, which help moisten our mouth, soften the food we chew, initiate digestion, protect the teeth from decay, and help keep the mouth clean by washing away germs. The flow of saliva is stimulated by the presence of food in the mouth, or even the sight and smell of food.

What is the parotid gland?

The parotid glands produce a type of saliva that is “serous” which means it’s more watery and thin. It is has the protein Amylase that helps begin the process of starch digestion. While we are not eating, the parotid glands each contribute to 10% of saliva in the mouth, but when stimulated by eating the saliva each parotid gland produces accounts for 25% of the saliva in the mouth.

Types of cells

There are many different types of cells that make up the small little parts of the gland that produce saliva and secrete it (you can see these different cell types on the diagram). Because of the variety of cell types, there are many different types of tumors and cancers that can develop in the parotid gland. Additionally, because there are several lymph nodes inside the parotid gland, at times skin cancers over the temple, scalp and cheek areas can spread to this area; additionally, lymphomas can occur in these lymph nodes.

The salivary glands are constantly working, and can be affected by many medical conditions, medications, and even not drinking enough water. Infections and inflammation of the gland can cause it to swell up and become painful. Obstruction of the ducts, which can happen because of salivary stones or narrowing of the duct from infection, can cause the saliva to back up into the gland and lead to it to swelling up as well.

If you would like to know more about the salivary glands, schedule a consultation with parotid surgeon Dr. Larian today by calling (888) 687-6118.

Next, learn about parotid & facial nerve anatomy.

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Frequently Asked Questions about Parotid Surgery:

At the Center for Advanced Parotid Surgery, our team of medical professionals specializes in performing minimally invasive parotidectomy with a focus on facial nerve preservation and facial reconstruction. Here we’ve put together the most common questions we get from patients.

How Should I Prepare for Surgery?

• Ensure all your questions are answered. Write them down when you think of them.
• You should have a clear idea of exactly what surgery is planned, what will be done, the risks, all your options and what the expected benefits are.
• You should also have a clear expectation of results that is in alignment with the doctor’s expectations as well.
• You should tell your surgeon what medications and supplements (including herbal and OTC medications like ibuprofen) you are currently taking.
• Ensure that you have stopped taking any medication or supplement that our surgeon asks within the proper timeframe.
• If you are not already leading a healthy life, it is best to start doing so several weeks before the surgery, not just before. Be active, eat healthy and quit smoking (if you smoke).

How Long Will I Be Hospitalized?

It really depends upon exactly what was done during the surgery. In most cases, a brief hospital stay of four days or less may be required.

Can a Facelift Be Performed at the Same Time as a Parotid?

In many cases, yes. In fact, it is often safer to do the surgeries concurrently because the parotid surgical procedure carefully traces the facial nerve and positions it safely. Doing a facelift at the same time lowers the chance of accidentally damaging this nerve at a later time because of its shifted position.
Depending on the size of the tumor removed, there may be excess skin on one side of the face that will need to be tightened. To maintain facial symmetry, the other side of the face may also need tightening. So a facelift at this time may be an ideal choice. Dr. Larian and his team will advice you if a facelift is an option for you.

How long does Parotid surgery take?

Most parotidectomies take between 3 and 4 hours.

Do Benign Parotid Tumors Need to Be Removed?

The most common approach to dealing with parotid tumors, even benign ones, is to surgically remove them. These tumors can grow to abnormal sizes that can disfigure the face. More importantly, even a benign parotid tumor can become cancerous if left alone to grow.

Do salivary gland stones go away on their own?

There are a number of non-surgical procedures that often help the stones go away without surgery. If that doesn’t work and the salivary gland is completely blocked and swelling, surgery is the next best step.

How long does it take for a Parotidectomy to heal?

You can plan on one to two weeks for initial incision healing and about six weeks for complete incision healing. Scar creams are advised for use to hasten healing and should be used for the first six weeks. Incisions may continue to change in form for up to two years after surgery, but most scars are hidden behind the jawline and ear and not readily noticeable.







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Neck Anatomy: Muscles, glands, organs

Neck anatomy: want to learn more about it?

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Author:
Jana Vasković
•

Reviewer:
Nicola McLaren MSc

Last reviewed: February 25, 2021

Reading time: 8 minutes

Every adolescent has heard at least once “don’t forget your head somewhere!” from their parents. Well, luckily, we have necks that attach our heads to our trunks, so joke’s on them for saying that.

Besides wearing necklaces and spraying perfume, the neck has other functions as well. For instance, it supports the position of the head and enables us to turn our head towards stimuli. So when you hear Bohemian rhapsody, you can turn your head towards that bar and maybe decide to go in and have some fun.

This page will discuss the anatomy of the neck.

Key facts about neck anatomy

Compartments	Vertebral (1), visceral (1), vascular compartments (2)
Triangles	Anterior: submandibular, submental, muscular and carotid triangles Posterior: Occipital and omoclavicular
Muscles	Suprahyoid: Stylohyoid, digastric, mylohyoid, geniohyoid muscles Infrahyoid: Omohyoid, sternothyroid, thyrohyoid, sternothyroid muscles
Larynx	9 cartilages: Thyroid (1), epiglottic (1), cricoid (1), arytenoid (2), corniculate (2), cuneiform (2) cartilages
Thyroid gland	Consists of left and right lobes connected by a central isthmus, produces thyroxine and triiodothyronine
Hyoid bone	Consists of a central body with paired greater and lessor horns

Neck spaces

The content of the neck is grouped into 4 neck spaces, called the compartments.

Protection of the parts of the neck and its mobility are ensured by the vertebrae and muscles of the neck. If you want to find out more about the neck compartments and their content, we got you covered with these quizzes and articles!

Triangles of the neck

You may be shocked that we’re mentioning triangles here, as you probably didn’t enroll in anatomy because you love maths. But don’t worry, these triangles are not hard to remember and they are very important for understanding neck anatomy. The neck triangles are actually spaces bordered by the neck muscles. There are two main triangles; the anterior, and the posterior, triangles of the neck.

The anterior triangle of the neck is made by the anterior border of the sternocleidomastoid muscle, the inferior border of the mandible and the midline of the neck. This triangle can be further divided into the submandibular triangle, submental triangle, muscular triangle and carotid triangle.

Similarly, the posterior triangle is bounded by the posterior border of the sternocleidomastoid muscle, the anterior border of the trapezius muscle and the middle third of the clavicle. It can be subdivided into the occipital triangle and the omoclavicular triangle.

Triangles of the neck

Anterior triangle	Superiorly – inferior border of mandible Medially – midline of neck Laterally – anterior border of sternocleidomastoid muscle Content: pharynx, larynx, glands, common carotid, internal carotid and external carotid arteries, internal jugular vein, facial, glossopharyngeal, vagus, hypoglossal nerves
Submandibular triangle	Superiorly – inferior border of mandible Laterally – anterior belly of digastric muscle Medially – posterior belly of digastric muscle
Submental triangle	Inferiorly – hyoid bone Laterally – anterior belly of digastric muscle Medially – midline of neck
Muscular (Omotracheal) triangle	Superiorly – hyoid bone Laterally – superior belly of omohyoid and anterior border of sternocleidomastoid Medially – midline of neck
Carotid triangle	Anteroinferiorly – superior belly of omohyoid muscle Superiorly – stylohyoid and posterior belly of digastric muscles Posteriorly – anterior border of sternocleidomastoid muscle
Posterior triangle	Anteriorly – posterior edge of sternocleidomastoid muscle Posteriorly – anterior edge of trapezius muscle Inferiorly – middle one-third of clavicle Content: external jugular vein, subclavian artery, accessory nerve, cervical plexus, trunks of the brachial plexus
Occipital triangle	Anteriorly – posterior edge of sternocleidomastoid muscle Posteriorly – anterior edge of trapezius muscle Inferiorly – superior belly of omohyoid muscle
Omoclavicular (subclavian/ supraclavicular) triangle	Superiorly – inferior belly of omohyoid muscle Anteriorly –  posterior edge of sternocleidomastoid muscle Posteriorly – anterior edge of trapezius muscle

Check out these learning materials to master the triangles of the neck!

Neck muscles

The muscles of the neck are a hot topic within anatomy circles. They are usually described within the triangles; so there are the muscles of the anterior triangle, and the muscles of the posterior triangle. Furthermore, the anterior triangle muscles are grouped depending on their position to the hyoid bone; as the suprahyoid and infrahyoid muscles.

The posterior triangle is continuous with the upper limb. It contains the following muscles: sternocleidomastoid, trapezius, splenius capitis, levator scapulae, omohyoid, as well as the anterior, middle and posterior scalene muscles.

Larynx anatomy

As we know, the respiratory system is divided into upper and lower parts. Well, the larynx is the beginning of the lower airway. Below, it continues as the trachea, while above it is continuous with the pharynx.

The main larynx function is to conduct air to the trachea; it also acts to prevent food from entering the trachea too. This is possible because the larynx has a flap on its upper part called the epiglottis that is closed during swallowing and open during breathing. The larynx also holds the structures of the ‘voice box’, which consists of nine cartilages: three unpaired (thyroid, epiglottic and cricoid cartilages) and three paired (arytenoid, corniculate and cuneiform cartilages), articulating via the joints of the larynx.

To learn everything about the larynx go through these learning materials:

Once you’re familiar with the anatomy of the larynx, you can check out this interesting clinical case of lithium battery ingestion.

Thyroid gland anatomy

The thyroid gland is a butterfly shaped endocrine gland placed anteriorly to the thyroid cartilage of the larynx. Basic thyroid anatomy describes the gland as having two lobes; left and right (like the wings of the butterfly). The lobes are connected by an isthmus (the body of the butterfly).

The main function of the thyroid gland is the production of two hormones that take part in the many metabolic processes of the body. These hormones are called thyroxine (T4) and triiodothyronine (T3). Check out our study units to expand your knowledge and quiz yourself about the thyroid gland’s structure and function!

Conclude the topic with our article about the disorders of the thyroid gland.

Hyoid bone

Have you heard about the one bone in the body that isn’t attached to any other bones, well this is it – the hyoid bone. You can easily find and palpate the hyoid just superior to the thyroid cartilage. The body of the hyoid bone projects anteriorly (like the base of the letter U), whereas the greater horns project posteriorly from the body (the two arms of the U). 

Think you know the bones of the body? Test yourself!

The bone is superiorly attached to the floor of the oral cavity, inferior to the larynx and posterior to the pharynx. So, to talk about the hyoid bone function, its primary function is to support and be an anchor point for the many muscles and soft tissues of the neck.

Go through the following learning materials to learn more about the hyoid bone in a fun and engaging way! We also prepared a custom quiz on the neck anatomy. Check it out and learn more about bones, muscles, arteries, veins, and nerves of the neck.

Neck anatomy: want to learn more about it?

Our engaging videos, interactive quizzes, in-depth articles and HD atlas are here to get you top results faster.

What do you prefer to learn with?

“I would honestly say that Kenhub cut my study time in half.”
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Read more.
Kim Bengochea, Regis University, Denver

90,000 causes, symptoms, diagnosis and treatment

Lymph nodes in the human body act as a biological and mechanical filter. The lymph collects harmful substances and bacteria, which are then destroyed by the lymph nodes. There are about 500 of them in the body. Cancer of the lymph nodes is a fairly rare disease, which occupies 4% of all types of oncology. It develops in the form of an independent pathology or with the spread of metastases from a tumor of another localization.

Classification of lymph node cancer

If there is any inflammatory or infectious process in the body, the lymph nodes react to it with an increase, and sometimes even soreness. If this condition does not go away for a long time, then this is a reason to consult a doctor, since it is important to detect pathology at an early stage.

Lymph node cancer can develop in one of two forms:

• Hodgkin’s lymphoma (lymphogranulomatosis).The most common variant of the development of cancer of the lymph nodes, occurs in 1/3 of cases of detection of such oncology in both adults and children. Hodgkin’s lymphoma is considered a more favorable form in terms of healing. Even at the 4th stage of the disease, the survival rate is 65%;
• Non-Hodgkin’s lymphoma. This is a more serious form of lymph node cancer, occurring in 2/3 of cases. The disease progresses rapidly, metastases appear early and spread throughout the body.

Causes and risk factors

Lymph node cancer has several age peaks, in which the disease is diagnosed more often. This is the period from 15 to 30 years, and people over 50 are also at risk. It is during this time that the risk of developing lymphoma is higher. The exact causes of the onset of the disease are unknown. Doctors cite only risk factors that increase the likelihood of developing lymphoma:

• long-term interaction with harmful substances;
• HIV infection and other types of immunodeficiency;
• smoking and alcohol abuse;
• radiation exposure;
• living in an unfavorable environment;
• pregnancy over the age of 35;
• Epstein-Bar virus
• genetic inheritance.

Stages

Different types of lymphomas can have different degrees of spread throughout the body. With this in mind, there are 4 stages of lymph node cancer.

• First. Only one area is affected, cancer of the lymph nodes develops in the armpit, in the neck, etc.
• Second. The tumor process already spreads to 2 or more groups of lymph nodes.
• Third. In addition to the lymph nodes, the diaphragm and one organ outside the lymphatic system are affected.
• Fourth. At the last stage, tissues outside the lymphatic system are affected, and in several parts of the body at once. The disease invades vital organs, so treatment becomes less effective.

Types of lymph node cancer

In addition to the division according to the type of lymphoma, lymph node cancer is classified according to the location of the lesion. According to this criterion, oncology of different types of lymph nodes is distinguished:

• axillary;

90,013 cervical;

90,013 pulmonary;

90,013 ileum;

• supraclavicular;
• inguinal.

In percentage terms, cancer of the lymph nodes most often occurs in the groove area (35%), then on the neck (31%) and armpits (28%). Other localizations of oncology account for 6%. The most favorable prognosis is observed for cancer of the nodes in the groin, armpits and under the jaw.

Symptoms and signs of lymph node cancer

Lymph node cancer can manifest itself in different ways depending on the form of the disease that develops in the patient. With lymphogranulomatosis, the following symptoms are observed:

• Strong enlargement of the lymph nodes above the collarbone and in the neck;
• enlargement of the mediastinal nodes with a specific cough, shortness of breath and swelling of the veins in the neck;
• Painful sensations in the lumbar region, most often manifested at night.

The disease causes different symptoms when a specific group of lymph nodes is affected. If the pathology develops in an acute form, then the patient immediately experiences an increased degree of sweating and a sharp increase in body temperature. There is also a lot of weight loss, which progresses over time. With the development of the disease, more characteristic symptoms of lymph node cancer appear:

• febrile condition;
• severe itching of the skin;
• weakness;
• lesions of a red or dark shade on the skin;
• diarrhea, tendency to belch;
• Frequent migraines, dizziness;
• Soreness in the epigastrium and umbilicus.

When to see a doctor

Cancer of the lymph nodes requires timely detection at the earliest stage, since the prognosis of recovery depends on this. In the presence of risk factors or symptoms of the disease, you should immediately consult a doctor for appropriate diagnostic measures. In the case of oncology of the lymphatic system, the patient needs the help of an oncologist. In our oncology center “Sofia” on the 2nd Tverskoy-Yamskiy lane. house 10 employs the best specialists who specialize in the diagnosis and treatment of various types of oncology.

Diagnosis of cancer of nodes in the oncology center

If lymph node cancer is suspected, the doctor begins with a general examination to detect characteristic signs of the disease. It is very important to answer all the questions of a specialist, since any complaints and manifestations, as well as previous illnesses, can give the doctor the necessary information base to prescribe a successful treatment in the future.

An important stage of the examination is palpation of the lymph nodes, which makes it possible to identify their enlargement and soreness.Also, the Sofia Cancer Center practices all modern diagnostic methods that allow to identify the disease with 100% accuracy. The patient may be assigned:

• scintigraphy;
• PET / CT;
• magnetic resonance imaging;
• lymphography;
• blood test for onokmarkers;
• vacuum aspiration biopsy of neoplasm tissues;
• SPECT (single photon emission computed tomography).

Treatment of lymph node cancer

The treatment regimen for lymphoma depends on many factors: the location of the tumor, its spread throughout the body, size and presence of metastases in other tissues and organs. The best results are obtained with an integrated approach that combines several methods of treatment.

Chemotherapy

Lymph node metastases in cancer require mandatory chemotherapy. It is considered a versatile treatment and is used alone or in combination with other methods.The essence of chemotherapy is the intravenous administration of special anticancer drugs that destroy cancer cells. Such drugs also act on healthy tissues, which leads to the appearance of side effects, but when metastases spread, this is the only way of treatment.

Surgery

Treatment of lymph node cancer with a surgical method consists in their complete removal. This method is also considered to be quite effective, since it minimizes the risk of recurrence of the disease.Surgery for lymph node cancer is performed with resection of several regional-type nodes, which is necessary to reduce the likelihood of recurrent oncology.

Cervical, submandibular, inguinal and axillary lymph nodes are removed under local anesthesia, and deeper ones under general anesthesia. The excised parts can be used for histology and correct diagnosis.

Radiation therapy

The use of radiation therapy is recommended in conjunction with surgical treatment.This method allows you to destroy cancer cells that may have remained after surgery. Also, radiation therapy is used at an early stage in preparation for surgery to reduce the size of the tumor.

Bone marrow transplant

Today, another new method is used in the treatment of lymph node cancer – donor bone marrow transplantation. This operation allows for very optimistic predictions, especially at an early stage of the disease.

Treatment projections

The prognosis for cancer of the lymph nodes is quite favorable. With this disease, treatment is extremely successful in 70-83% of cases in which there is a 5-year survival rate. The number of relapses is 30-35%. More often, the disease recurs in men, which is explained by more difficult working conditions and bad habits. In general, the prognosis depends on how early the disease was diagnosed and treatment started. The age of the patient is of no less importance.

How to make an appointment with a specialist at the Sofia Cancer Center

To get a consultation with a specialist in our cancer center, you need to use any convenient way to register. Fill out the online form on the website by entering all the required data, or call us at the contact number +7 (495) 775-73-60.

Oncology center “Sofia” is open for you not only on weekdays, but also on weekends, so you can choose a convenient appointment time. We are located on the 2nd Tverskoy-Yamskiy lane, 10, not far from the metro stations Tverskaya, Novoslobodskaya, Chekhovskaya, Belorusskaya and Mayakovskaya.Take care of your health and see a doctor in time, without waiting for the deterioration of the condition.

Head and Neck Cancer – Prevention, Stages, Symptoms and Treatments

Introduction

Cancer begins when healthy cells change and grow uncontrollably, forming a mass called a tumor. The tumor can be cancerous or benign. Cancer is malignant, meaning it can grow and spread to other parts of the body. A benign tumor can grow but not spread to other tissues.

Head and neck cancer

Head and neck cancer is a term used to describe a number of different cancers that develop in or around the throat, larynx, nose, sinuses and mouth.

The majority of head and neck cancers are squamous cell carcinomas. This type of oncology begins in the cells of the epithelium, which makes up a thin layer of superficial tissue. Directly below the epithelium, in some areas of the head and neck, there is a layer of moist tissue called the mucosa.If cancer is found only in the squamous layer, it is called carcinoma in situ. If the cancer has grown outside of this cell layer and moved into deeper tissues, it is called invasive squamous cell carcinoma.

If head and neck cancer begins in the salivary glands, the tumor is usually classified as adenocarcinoma, adenoid cystic carcinoma, or mucoepidermoid carcinoma.

Types of head and neck cancer

There are 5 main types of head and neck cancer, each named for the part of the body where it is found.

• Laryngeal cancer and hypopharyngeal cancer . The larynx is an integral part of the vocal apparatus. This tubular organ on the neck is designed for breathing, speaking, and swallowing. It is located at the top of the windpipe, or trachea. The hypopharynx (esophagus) is the lower part of the throat surrounded by the larynx.
• Cancer of the nasal cavity and paranasal sinuses . The nasal cavity is the space behind the nose where air enters the throat. The paranasal sinuses are air-filled areas that surround the nasal cavity.
• Nasopharyngeal cancer. The nasopharynx is an air cavity in the upper part of the pharynx behind the nose.
• Oral and oropharyngeal cancer . The oral cavity includes the mouth and tongue. The oropharynx includes the middle of the throat, from the tonsils to the tip of the vocal apparatus.
• Salivary gland cancer . The salivary gland produces saliva. Saliva is the liquid that is secreted in the mouth to keep it moist and contains enzymes that break down food.

Other types of cancer can also be localized in the head and neck area, but their diagnosis and treatment are very different.

Risk factors and prevention of head oncology

A risk factor is anything that increases the likelihood of developing oncology in humans. Although risk factors often influence the development of cancer, most of them do not directly cause it. Some people with multiple risk factors may never develop cancer, while others with no known risk factors may. Knowing your risk factors and discussing them with your doctor can help you make more informed lifestyle and health care choices.

There are 2 substances that significantly increase the risk of head and neck cancer:

• Tobacco. Tobacco use means: smoking cigarettes, cigars or pipes; chewing or snuff. It is the most significant risk factor for head and neck cancer.
• Alcohol. Alcohol abuse increases the risk of developing malignant neoplasms. …

Drinking alcohol and tobacco together increases this risk even more.

Factors that may increase your risk of head and neck cancer include:

• Prolonged sun exposure. This is especially true for lip cancers and scalp and neck cancers.
• Human papillomavirus (HPV). Sex with a person with HPV is the most common route of HPV infection. There are different types of HPV called strains.
• Epstein-Barr Virus (EBV). Exposure to EBV (the virus that causes mononucleosis or “mono”) plays a significant role in the development of nasopharyngeal cancer.
• Pos. Men are 2-3 times more likely to develop head and neck cancer. However, the incidence of head and neck cancer in women has been on the rise for several decades.
• Age . People over the age of 45 are more at risk of cancer.
• Poor oral and dental hygiene .
• Environmental or Occupational Inhalants .Inhalation of various chemical compounds (paints and varnishes, asbestos) can increase the risk of developing a dangerous disease.
• Marijuana use .
• Incorrect power supply. A diet low in vitamins A and B increases risks.
• Gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux disease (LERD) . Reflux is associated with tumor growth in a given area.
• Weakened immune system .
• Exposure to radioactive radiation. Directly related to the development of the oncological process.
• History of head and neck cancer. People who have had head and neck cancer once have a higher chance of developing another cancer in the future.

Prevention

Tobacco cessation is essential to prevention.

• Refusal to use alcohol and marijuana.
• Regular use of sunscreen, including lip balm with sufficient sun protection factor (SPF)
• Reducing the risk of contracting HPV through HPV vaccination or by limiting the number of sexual partners.Using a condom during intercourse may not completely protect against HPV.
• Maintaining proper dental care. Poorly fitted dentures can trap carcinogens from tobacco and alcohol. Dentures should be removed every night, cleaned and rinsed thoroughly every day.

Follow-up and follow-up

Treatment for people diagnosed with cancer does not end once active therapy is complete.The attending physician will continue to check to see if the cancer has recurred, monitor any possible side effects, and monitor your overall health. This is called follow-up. It consists of regular medical examinations and tests.

Relapse control

One of the goals of follow-up is to control relapse, that is, relapse of the disease. Cancer recurs because small clumps of malignant cells may remain in the body.Over time, these cells can grow until they appear on test results or cause symptoms. During follow-up, your healthcare provider may provide you with personal information about your risk of recurrence. Your doctor will ask specific questions about your health. Blood tests or imaging tests may be required as part of regular follow-up. Follow-up recommendations depend on several factors, including the type and stage of head and neck cancer initially diagnosed and the treatment given.The doctor will also advise on what signs and symptoms to control.

Control of long-term and delayed side effects

Treatment of malignant tumors is accompanied by various side effects. Long-term effects persist after a period of therapy. Delayed side effects can develop months or even years later. Long-term and delayed effects can include physical and emotional changes.

Talk with your doctor about the risk of these side effects, depending on the type of cancer, your individual treatment plan, and your overall health.If your treatment is known to have some delayed effects, you may need to have certain additional tests. For example, if you have received radiation therapy, your doctor will recommend that you donate blood regularly to check your thyroid function. Your doctor may refer you to a specialist for delayed effects.

Rehabilitation is an essential part of follow-up after head and neck cancer treatment. Patients may be given physical therapy to maintain motor function and level of movement, and speech and swallowing therapy to restore skills such as speaking and eating.Proper assessment and treatment can often prevent long-term speech and swallowing problems. Some patients may need to learn new ways of eating or other ways of preparing food.

People may look different, feel tired, and may not be able to speak or eat as they used to. Many people experience depression. Support groups help patients cope with post-treatment changes.

Maintaining Your Own Medical Records

You and your doctor will work together to develop an individual follow-up plan.Be sure to discuss any concerns you have about your own future physical or emotional health.

Stages

Staging is the determination of where the cancer is located, whether it has spread, and where, and its effect on other parts of the body.

Doctors use diagnostic tests to determine the stage of cancer; they may need information based on tissue samples obtained during surgery, so staging may continue until all analyzes are performed.Staging information helps the clinician determine which treatment is best and predict the possibility of recovery.

TNM Tumor Classification System

One way of staging a cancer is with the TNM system. Doctors use the results of diagnostic tests and scans to get answers to the following questions:

• Tumor (T): its size and location?
• Lymph nodes (N): the extent to which the process has spread to the lymph nodes?
• Metastasis (M): The prevalence of cancer to other parts of the body?

The results are pooled to determine the stage of cancer for each patient.The stage provides a general way of describing cancer so that clinicians can collaboratively plan optimal treatment.

Head and Neck Cancer: Symptoms and Signs

Patients with head and neck cancer often experience the following symptoms or signs. Sometimes, patients with head and neck cancer do not see any of the following changes. Or, the symptom may be caused by a non-cancer disease.

• Non-healing inflammation or wound
• Red or white spot in the mouth
• Lump, lump or mass in the head or neck area, painful or painless
• Long-term sore throat
• Putrid breath that cannot be explained hygiene
• Hoarseness or hoarseness of voice
• Frequent nosebleeds and / or unusual discharge from the nose
• Difficulty breathing (including nasal)
• Double eyes
• Numbness in the neck or weakness in the occipital region
• Pain or difficulty with chewing, swallowing even small pieces of food
• Pain in the jaw
• Bloody discharge in saliva or phlegm, mucus that is released into the mouth from the respiratory tract
• Loose teeth
• Dentures that no longer fit
• Unexplained weight loss
• Fatigue
• Ear pain or infection

If you are concerned about any of the above, you should contact a specialist. Your doctor will ask, among other things, how long and how often you have been experiencing the symptom (s). This conversation will help in making the correct diagnosis.

Once cancer is diagnosed, symptom relief remains an important part of cancer care. This can be called palliative or supportive care. It often begins shortly after diagnosis and continues throughout treatment.

Methods of treatment of head and neck oncology

The standards of medical care for head and neck oncology are the best of modern methods of treatment.Doctors recommend considering clinical trials as one of the treatment options. Clinical trials are testing a new approach to treatment. Experts want to know if the new treatment is safe, effective. Clinical research is an option for treatment and cancer care at all stages of cancer.

Oncology Team

Head and neck cancer specialists usually form an interdisciplinary team to treat each patient. The structure includes the following specialties:

• Chemotherapist: Treatment with drugs, including chemotherapy, immunotherapy and targeted therapy.
• Radiologist-Oncologist: specializes in radiation therapy.
• Oncologist: Treatment by surgery.
• Reconstructive / Plastic Surgeon: Reconstruction of damage caused by tumor treatment
• Orthopedic dentist : Reconstruction of tissues in the oral cavity.
• Otolaryngologist : restoration of tissues of the ear, throat, nose.
• Dentist-Oncologist : Experience in treating patients with head and neck cancer.
• Cancer Nurse: specializes in caring for cancer patients.
• Physiotherapist : restoration of physical activity, physical strength.
• Speech therapist : restoration of speech and swallowing skills after the performed manipulations.
• Audiologist: Treatment and control of hearing problems.
• Psychologist / Psychiatrist : Deals with the emotional, psychological and behavioral needs of the cancer patient and the patient’s family.
• Social worker . provides advice to patients, family members and support groups.
• Certified Nutritionist : Helps people understand how to eat and what to eat for their specific condition.

A patient may need to be seen by several specialists before a treatment plan is fully developed.

Treatment overview

Many head and neck cancers are curable, especially if detected early.Eliminating cancer is the primary goal of treatment, but maintaining the function of nearby nerves, organs, and tissues is equally important. When planning treatment, doctors consider how the treatment can affect a person’s quality of life.

The main therapy options are surgical, radiation, targeted, chemotherapy. Surgery or radiation therapy alone or in combination can be part of a treatment plan.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, potential side effects, personal preference, and overall health.

Surgery

The goal of surgery is to remove a cancerous tumor and a portion of healthy tissue during an operation. For head and neck cancer, the following surgeries are used:

• Laser surgeries. This method can be used to treat a tumor at an early stage, especially if it has been found in the larynx.
• Delete . This is an operation to remove a cancerous tumor and some of the surrounding healthy tissue known as an edge.
• Lymphadenectomy or cervical dissection . If the doctor suspects that the cancer has spread, he or she may remove the lymph nodes in the neck. This can be done at the same time as removing the tumor.
• Reconstructive (plastic) surgery . If cancer surgery requires removal of an important area of ​​tissue, such as removal of the jaw, skin, pharynx, or tongue, reconstructive or plastic surgery may be required to replace the missing tissue.This operation helps to restore a person’s appearance and the functionality of individual organs. A speech therapist is required to re-teach the patient to swallow and communicate using the latest techniques.

Based on the location, size, type of cancer, the treatment process will take place in stages with several operations. If it is impossible to completely eliminate the tumor, additional procedures are recommended. If cancer cells remain after surgery, other types of oncological care (radio-, chemotherapy) are prescribed in combined or isolated form.

Side effects of surgery

Adverse consequences of the operation depend on the method and place of its implementation. Patients should discuss all the nuances of the side effects of the therapy with their doctor. The most common negative consequences of operations in the head and neck area are problems with the speech apparatus and the swallowing process, hearing loss. Removal of lymph nodes is accompanied by stiffness in the shoulders. In addition, lymphostasis may occur. After a total laryngectomy, which involves removing the larynx, people may have decreased thyroid function, which needs to be controlled, for example, by taking thyroid hormone medications.

Another likely side effect is laryngeal edema, which makes breathing difficult. In this case, a temporary channel for normal breathing (tracheostomy) is made in the trachea by the instrument.

Some patients experience facial disfigurement after surgery. Reconstructive surgery may be recommended to initiate or maintain important bodily functions (eg, repairing a tracheostomy defect). Patients should meet with various members of the medical team to make joint treatment decisions and understand the healing process.Programs that help patients adapt to changes in their appearance can come in handy both before and after surgery.

Radiation therapy

Radiation therapy (radiotherapy) is the use of ionizing radiation for the treatment of malignant neoplasms. The treatment regimen contains several cycles of procedures carried out at specific time intervals. Radiotherapy can be prescribed both separately and in conjunction with surgery.

External beam therapy is the most optimal option.It implies the effect on the tumor of radiation emanating from the apparatus located outside the body. A special type of external external beam radiation therapy is intensity modulated radiation therapy (IMRT). It uses advanced technology to precisely direct the radiation beams to the neoplasm. IMRT significantly reduces the likelihood of damage to healthy areas, minimizing possible negative consequences.

Proton therapy is a type of external external beam therapy using protons.Modern medicine practically does not use proton therapy.

Brachytherapy – contact method of radiotherapy using implants. According to the method of application, it can be manual and automated.

Before starting treatment, the patient should visit a dentist-oncologist to solve the problem of caries, since radiotherapy can aggravate the carious process. You will also need the recommendations of a speech therapist for a further recovery period.

Other unpleasant consequences of radiotherapy can be redness, swelling of the skin area in contact with radiation, loss of appetite, stomatitis (ulcers on the inner surface of the cheeks).Patients complain of dry mouth, bone aches, fatigue. Most of the symptoms disappear shortly after the end of the course of treatment. If the lymph nodes are damaged during treatment, soft tissue edema (lymphoma) may occur.

Radiation therapy can cause hypothyroidism, in which the thyroid gland (located in the neck) slows down the production of hormones responsible for alertness and activity. In this case, the endocrinologist prescribes hormone replacement drugs. If radiation therapy is given to the neck area, thyroid function should be monitored periodically.

Drug therapy

Systemic therapy is the use of drugs to eliminate the oncological process. These drugs are injected into the bloodstream to eliminate cancer cells. The systemic treatment regimen is drawn up by a chemotherapist.

Common systemic treatments are placing an intravenous (IV) catheter into a vein or swallowing (oral) the drug.

The following types of drug therapy are used for head and neck cancer:

• Chemotherapy
• Targeted therapy
• Immunotherapy The drug therapy regimen (number of drugs) depends on the form and severity of the oncological process.

Chemotherapy

The use of drugs that prevent the development and division of tumor cells is called chemotherapy.

The chemotherapy regimen is similar to radiotherapy: several stages in a certain amount of time. The number of drugs taken is individual and depends on many factors.

Negative consequences are also highly individual. First of all, there are depressive conditions, hair loss, nausea and vomiting.

Targeted therapy

Each tumor has its own characteristics, targets.A type of oncological treatment based on the destruction of target molecules (specific genes) and enzymes that feed the vital activity of malignant cells. Targeted (targeted) therapy prevents the death of normal cells and tissues by affecting only targeted molecules.

To select the necessary drug, the doctor conducts an analysis to determine the protein fractions, neoplasm genes. EGFR Inhibitors . For head and neck cancer, treatment may be directed at a specific tumor protein called the epidermal growth factor receptor (EGFR).Researchers have found that drugs that block EGFR help stop or slow the growth of certain types of head and neck cancers.

Agnostic anticancer therapy. Larotrectinib (Vitrakvi) is a certified targeted therapy drug that focuses on altered NTRK genes. Larotrectinib is relevant for the elimination of metastases, which, for various reasons, cannot be removed by surgery.

Immunotherapy

An obligatory stage of treatment designed to increase the body’s natural resistance, strengthen the immune system.Substances produced by immune cells or produced in laboratory conditions are used.

Pembrolizumab (Keytruda) and nivolumab (Opdivo) are the latest effective immunotherapy for the treatment of recurrent or metastatic squamous cell carcinoma of the head and neck. Pembrolizumab can be given alone if the tumor expresses a certain amount of the PD-L1 protein. Alternatively, it can be used in combination with chemotherapy regardless of the level of PD-L1 expressed by the tumor.Nivolumab can be used if the cancer has continued to grow or spread during treatment with platinum-based chemotherapy.

Different types of immunotherapy can provoke different negative consequences. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes.

Physical, psychological and social consequences of oncology

Patients receiving cancer care inevitably face physical, psychological stress, as well as social consequences.Supportive therapy (also called palliative therapy) controls all of these factors.

Supportive therapy is very diverse, meaning drug treatment, changes in nutrition, psychological relief.

Metastatic head and neck cancer

If the process spreads outside the affected organ, doctors call it metastatic cancer. In this case, it is important to consult a physician experienced in treating such cases.Doctors have different views on the optimal standard treatment plan. Clinical trials can also be considered as a treatment option.

A treatment plan for metastatic cancer can combine all of the above treatment methods of oncology.

Remission and the possibility of recovery

Remission is a condition in which there are no malignant cells in the body and the corresponding symptoms are absent. Remission is also called “no evidence of disease”.

Remission can be temporary or permanent.

If the disease returns after the initial cycle of therapy, it is called recurrent cancer. The disease may recur at the same site (local recurrence), nearby (regional recurrence), or elsewhere (distant recurrence). In such a case, it is necessary to conduct a series of fresh tests in order to understand the complete picture of the general state of health.

If treatment fails

Head and neck cancer, unfortunately, is not always curable.This type of event is called progressive or terminal cancer.

Such a diagnosis is a great stress for the patient and his relatives. Therefore, it is so important to talk frankly with the medical care team, explaining your feelings, anxiety. Special training and experience help the medical team provide support to patients and their families. It is extremely important to provide a person with physical comfort, freedom from pain and psycho-emotional assistance.

Lump in the throat – the causes of the appearance, with what diseases it occurs, diagnosis and treatment methods

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-medication.In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For a diagnosis and correct treatment, you should contact your doctor.

The feeling of a lump in the throat is not uncommon. Many have experienced this painless but uncomfortable condition at least once in their lives. In the medical literature, it is referred to as the pharyngeal ball. In most cases, this symptom is not associated with serious diseases, however, the exact answer can be obtained only after consulting a specialist, because there are a number of diseases that can be accompanied by a sensation of a foreign body in the throat.

Varieties

There is no generally accepted classification. It all depends on the cause of the condition.

Possible causes of a lump in the throat

Patients with a complaint of a lump in the throat can be divided into two groups: in some, this condition occurs due to neuropsychiatric disorders, while in others the reason lies in somatic, that is, those related directly to internal organs, diseases.

Often, a feeling of a lump in the throat appears in people who are easily excitable, sensitive to stress and emotional upheaval. A lump in the throat has long been described by doctors as a symptom of a neurotic disorder that occurs more often in young women. However, at present, this condition occurs with the same frequency in people of both sexes.

If the feeling of a lump in the throat is constant and persists for several weeks, then first of all it is necessary to exclude oncopathology. It can be a malignant or benign process in the larynx, esophagus or other organs of the neck, causing compression of the surrounding tissue.Particular attention should be paid if the patient complains of pain in the neck or when swallowing, increased fatigue, loss of appetite and body weight.

Infectious and inflammatory diseases of the ENT organs can also cause the pharyngeal ball.

Very often the appearance of a feeling of a coma in the throat is associated with diseases of the gastrointestinal tract.

It is necessary to find out if the patient has symptoms such as heartburn, cough, sour belching, stomach pain and feeling of heaviness after eating.

The sensation of a foreign body in the throat can be caused by a pathology of the thyroid gland. An increase in the volume of the gland is more often associated with a lack of iodine in food or with autoimmune damage (autoimmune thyroiditis).

Sometimes the reason for the sensation of a coma in the throat is a decrease or even complete cessation of salivation.

This condition can occur in patients with diabetes mellitus, in women in menopause, with systemic autoimmune diseases.

An enlarged lymph node in the neck can also lead to discomfort and a feeling of a lump in the throat.

Difficulty swallowing can sometimes occur due to osteochondrosis of the cervical spine. In this case, a person may be disturbed by headache, dizziness, pain in the neck, back, stiffness of movements.

Do not forget about the possible role of traumatic effects on tissues. Endoscopic examinations and even eating rough food can make your throat feel uncomfortable.

The feeling of a lump in the throat is mainly accompanied by:

1. Diseases of the ENT organs (tonsillitis, tonsillitis, epiglottitis, pharyngitis).
2. Diseases of the thyroid gland (endemic goiter, diffuse toxic goiter, autoimmune thyroiditis).
3. Neoplasms in the neck.
4. Osteochondrosis of the cervical spine.
5. Gastroesophageal reflux disease (GERD).
6. Dyskinesia of the esophagus.
7. Heterotopia of the gastric mucosa.
8. Diseases of the endocrine system (diabetes mellitus, hormonal disorders).
9. Systemic autoimmune diseases (scleroderma, Sjogren’s syndrome).
10. Psychological factors, stress.

Which doctors should you contact

If you have complaints about a lump in your throat, it is advisable to contact first of all
a general practitioner who, after examination, will be able to refer the patient to a specialist with a narrow profile, such as:

Diagnostics

To clarify the diagnosis, the doctor may prescribe the following types of examination:

1. Gastroscopy (esophagogastroduodenoscopy, EGDS) with suspected gastroesophageal disease and esophageal dyskinesia.
2. Ultrasound of the thyroid gland, blood test for thyroid hormones.

Pharyngitis: signs, symptoms, treatment – MedCom

Causes of the development of the disease

A natural process for humans is nasal breathing. The nasal passages are designed so that the inhaled air comes in with a slight delay. During these pauses, it is warmed up, filtered and in this form is supplied to the body. When the nose is stuffy and breathing occurs through the mouth, the risk of pharyngitis increases – because the air does not pass through the “filters” and enters through the mouth with bacteria, viruses, dust, etc.An unnatural process makes the pharynx dry out, it becomes a favorable environment for the development of pathogenic flora.

The second common cause of pharyngitis is a runny nose against the background of ARVI. In this case, the focus of inflammation is in the throat, developing gradually. Frequent treatment of the nasal passages with vasoconstrictive drops negatively affects the condition of the pharynx, which also causes the development of the disease.

Called among other reasons:

• vitamin deficiency and malnutrition;
• bad habits;

90,013 injuries;

• individual features in the structure of the nasopharynx;
• long-term antibiotic treatment;
• chemical fumes;
• ingestion of allergens.

Often, pharyngitis is promoted by past diseases, for example, diabetes mellitus, dental caries, heart, renal failure, sinusitis, sinusitis and others.

Stages and symptoms of the disease

The symptoms of pharyngitis are often confused with the common manifestations of SARS and tonsillitis. The patient begins self-treatment, which turns out to be ineffective and leads to complications.

Specialists distinguish four stages of the disease, each of which has its own visible signs and symptoms:

1. Catarrhal – accompanied by coughing and sore throat.
2. Granular – there is a tickling sensation in the throat. Small bumps on the throat mucosa increase in size.
3. Purulent – the bumps are inflamed, there is swelling, purulent plaque and ulcers.
4. Atrophic – leads to atrophy of the throat tissues, swallowing functions are almost impossible.

At the first sign of illness, do not hesitate. See your doctor for help as soon as possible. Pharyngitis can be acute or chronic.The first type has the following symptoms:

• sore and dry throat;

90,013 shrunken voice;

• increase in body temperature;
• enlarged lymph nodes.

There is a sensation of a foreign object in the throat, there are problems with swallowing, general ailments, as in viral diseases (headache, aches, fever). Another sign is that mucous accumulations are felt in the throat, which cannot be gotten rid of.

In chronic pharyngitis, patients complain of dry and sore throat, dry cough, strong purulent discharge, constant desire to swallow a lump, and cough up are often observed. Often such urge is accompanied by an emetic urge. The cough is worse in the morning and is accompanied by nausea. Another symptom is swelling and sore throat, which is worse when swallowing.

Diagnostics and treatment

A specialized otolaryngologist (ENT) is engaged in the diagnosis and treatment of pharyngitis.A number of laboratory tests are used to make a diagnosis (blood tests, throat swab, and others). Based on the results of analyzes and examination of the patient, a treatment regimen for pharyngitis is selected.

The choice of therapy also depends on the age of the patient. When treating children, the methods differ significantly. Mandatory recommendations include plenty of warm drinks, ventilation and wet cleaning in the room. Inhalations and sprays – only with the permission of a doctor and under the supervision of adults. The same careful approach to procedures is required for pregnant women.Taking medication can become dangerous for a child, so a sparing scheme is drawn up by a specialized specialist.

The choice of the course depends on the causes and pathogens of the disease. Among the effective methods of treating pharyngitis are called:

1. Drug treatment – antibiotics, antiviral, anti-inflammatory drugs.
2. Complexes of vitamins and minerals.
3. Physiotherapy (electrophoresis, UHF, inhalation).

In some cases, instrumental intervention is required to treat acute pharyngitis.

General recommendations for the treatment of pharyngitis of various origins include: abundant warm drink, diet, rejection of bad habits. Treatment may include lozenges, lozenges, aerosols, and oil.

Folk remedies have also proven themselves well in the treatment of pharyngitis. This can be herbal rinses, foot baths, soda inhalations. So that treatment with folk methods does not cause complications, remember: the doctor must give the appointment.

Complications of the disease

It is necessary to treat pharyngitis in a timely manner and in compliance with all instructions.It would seem that a harmless disease can cause serious consequences for the body.

Depending on the nature of the pathogen, pharyngitis gives different complications. These include:

1. Decreased immunity and, as a consequence, increased sensitivity to viral diseases.
2. Inflammation of the lymph nodes and salivary glands.
3. Inflammatory processes in the middle ear and auditory tube, leading to hearing loss.
4. Tracheitis and chronic bronchitis.

With untreated pharyngitis there is always a chance that it will become chronic.

Preventive measures

For prevention purposes, experts recommend adhering to the following recommendations. Lead a healthy lifestyle, avoiding tobacco, alcohol and overly spicy foods. Walk more in the fresh air and do not forget about physical education. Do not inhale harmful vapors and vapors, cold air and breathe correctly through your nose.

Timely treatment of the respiratory system will also reduce the risk of developing pharyngitis of any nature.Simple rules of hygiene will help to resist diseases of bacterial origin: regular toothbrush change, gargling, treatment of dental caries.

90,000 Enlarged lymph nodes. Do you need an oncologist or a therapist?

Every third appeal to an oncologist on social networks or on portals of remote counseling is formulated something like this: “please help me, I have enlarged lymph nodes.”

As a rule, young people write, usually from 18 to 25 years old, and I do not remember a case when in the end it turned out that the situation required treatment by an oncologist.Most often, an increase in lymph nodes was caused by a sore tooth, throat, conjunctivitis, and so on.

It is clear that fear and fear for your health in such cases make you immediately run to the oncologist.

However, is it that simple, and is it worth rolling your eyes about any handling of an enlarged l / node?

My personal statistics show that if a person comes for a full-time consultation, he is already one of those few whose situation was not limited to the banal “it got sick and passed”.

Let’s take a closer look at how the lymphatic system works and understand the nature of enlarged lymph nodes.

Fact No. 1

Lymph nodes are an integral part of our body.

In total, there are about several hundred of them and they are usually located along the lymphatic vessels, which usually run along the large venous vessels.

Lymphatic vessels drain lymph (interstitial fluid) and “filter” it through the lymph nodes, where an army of lymphocytes is ready to deal with almost any infection.

Fact No. 2

Lymphatic vessels are not something abstract.

It is worth crossing or bandaging them, for example, during surgery on the axillary lymph nodes for breast cancer, and lymphostasis is most likely to develop – swelling of the limb, which, again, will most likely not go away.

The most visible to us from the point of view of inspection – the so-called peripheral lymph nodes (cervical, supraclavicular, axillary and inguinal) can increase, and in most cases these are manifestations of reactive lymphadenopathy – an inflammatory reaction that indicates the fight against infection.

Fact No. 3

Most often, cervical and submandibular l / nodes are inflamed, because in the facial region of the skull there are many open mucous membranes and related infections.

Sore throat, carious or decayed teeth, ear and ocular bacterial and viral infections are the most common causes of cervical lymphadenopathy. Axillary and inguinal l / nodes react by the same principle.

Therefore, if the lymph node is worried, first of all you need to go to the therapist, dentist, ENT doctor.

In case of an incomprehensible genesis of lymphadenopathy, the doctor will prescribe an ultrasound scan, and in the process of this study, attention will be directed mainly not to the size of the l / node, but to its shape and differentiation of the structure.

Fact No. 4

It is impossible to understand the nature of the swollen lymph nodes by WTSAP or during a telemedicine consultation.

Enlargement of the lymph node even up to 1.5-2 cm in the absence of differentiation disorders.

Fact No. 5

Lymph nodes enlarge in cancer, because cancer cells enter the lymphatic vessels draining a certain area, which then settle in the “filters” (lymph nodes) in the form of metastases and begin to grow there.

Such lymph nodes do not shrink after the treatment of infectious diseases, but only enlarge, merging with other lymph nodes into conglomerates, going beyond the l / node and fixing it in the surrounding tissues. Such lymph nodes are rarely painful, they are dense, very dense.

Often with oncological diseases the lymph nodes are affected by a “chain”, well defined by palpation. In lymphomas, conglomerates are often visible from the side. Of course, with such manifestations, one must go to an oncologist and hematologist.

A biopsy will be performed for suspicious nodules for no other reason. This is either a puncture with a needle with a sampling of material, or an operation to completely remove the lymph node for histological examination.

Let’s summarize

Most cases of swollen lymph nodes are associated with inflammation. An ultrasound scan allows you to assess the structure of the lymph node and helps the doctor decide whether a biopsy is necessary.

And the most important thing is that before you go to an oncologist with an enlarged lymph node, you need to contact at least a therapist who will conduct an examination and try to exclude commonplace things.

Don’t get sick!

You can read Ruslan Absalyamov’s Instagram here.

90,000 The whole truth about caries

Caries is, first of all, a bacterial infection of the oral cavity, leading first to the destruction of tooth enamel, and later to the loss of teeth. It is this infection that then leads to the development of pulpitis, periodontitis, periodontitis, and tooth loss.

Dental health has a significant impact on the general condition of the body.An unhealed tooth can cause many unexpected diseases.

We rarely think that healthy teeth are not only a beautiful smile, the ability to chew food freely and not suffer from pain, but also vigor, energy, optimism, efficiency … After all, teeth are connected through the nervous and circulatory systems with almost everyone internal organs, so even banal caries can lead to unexpected consequences. For example, there is a known case when a patient told a dentist during treatment that he was very worried about eczema, which he believed to be caused by occupational stress.However, after the removal of the decayed tooth, the eczema stopped by itself …

Is it a coincidence? Hardly. Doctors are of the following opinion: in the presence of untreated caries, microbes, in particular streptococci and staphylococci, gradually enter the bloodstream and affect various organs and systems. First of all, a sick tooth can provoke visual and hearing impairment, skin reactions, hair loss or inflammation of the endocrine glands, and even the development of rheumatism, renal or heart failure.

Very often, after a visit to the dentist, conjunctivitis is also cured. So, profuse unexplained lacrimation is often caused by inflammation of the upper canine, also called the “eye tooth”.

It should be remembered that microbes accumulated in a diseased gum or tooth can penetrate the body over a fairly long distance through the blood. The worst possible complication (and fortunately one of the rarest) is Osler’s endocarditis, an extremely dangerous heart disease. In 50 percent of its root cause are bad teeth.Streptococcus enters the heart through the blood and affects its inner layer (endocardium).

All these facts allow us to conclude that in addition to the aesthetic appearance, there are many much more important reasons for taking care of the health of your teeth.

Several reasons for visiting a dentist-therapist.

1. The appearance of an unpleasant odor from the mouth.

Possible causes: the deposition of soft dental plaque on the teeth with insufficient oral hygiene, food retention in the interdental spaces, which indicates a possible inflammation of the gums or the presence of carious cavities.

2. Occurrence of pain when biting.

This may be the first symptom of periodontitis – an inflammatory process in the bone tissue surrounding the tooth root.

3. Changes in the color of the filled teeth.

This indicates a possible tooth decay under the filling, even if it was placed very recently.

4. Appearance of reactions to temperature stimuli (cold or hot food and drinks).

This may be a sign of the appearance of a carious cavity or exposure of the necks of the teeth, which in any case requires intervention.

5. Toothache.

The most common reason for visiting the dentist. Toothache is a sign that inflammation of the dental pulp (pulpitis) has developed as a result of untreated caries.

6. Edema appeared on the gums.

A swelling appeared on the gum, the tooth hurts when biting. One of the reasons may be a cyst formed at the root of the tooth. Its occurrence is usually associated with tooth inflammation or trauma. The cyst needs urgent treatment.

7. Diseases of ENT organs often occur.

If you often suffer from diseases of the throat, nose, ears, then you should definitely contact your dentist. The reason may lie in an inflamed tooth, the infection from which spreads along the mucous membrane and enters the nasopharynx.

8. You are preparing for a planned operation, planning a pregnancy.

In such situations, it is necessary to sanitize the oral cavity to prevent infectious complications.

9. Prevention of diseases of the oral cavity.

Even if you think that your teeth are healthy, you should visit the dentist’s office 2 times a year.This contributes to the detection of diseases of the oral cavity in the early stages, their timely treatment and prevention. Also, do not forget that early treatment is not only less painful, less likely to lead to complications, allows you to preserve your own teeth for a long time and do without prosthetics, but it also costs much less than the treatment of neglected cases, with pronounced signs of inflammation (pain, swelling, temperature).

The author of the article, M. S. Karpenko

Throat cancer

About throat cancer

Throat cancer is not a defined medical condition,
a term often used to refer to any type of cancer that occurs in
back of the mouth, upper alimentary tube (pharynx), and vocal apparatus
(larynx).There are several different types of throat cancer and each case
the patient is individual. The two most common types of throat cancer are:

●
Laryngeal cancer

●
Pharyngeal cancer

Cancer of the larynx refers to cancer that forms in the tissues
larynx (in the vocal apparatus). The larynx is the part of the throat, between the base of the tongue and
trachea, and consists of three main parts:

●
Supra-lingual: upper part
larynx above the vocal cords, including the epiglottis

●
Glottis:
the middle part of the larynx, where the vocal cords are located

●
Subopharyngeal
space: the lower part of the larynx between the vocal cords and the trachea

Pharyngeal cancer forms in the pharynx, a hollow tube that
passes from behind the nose to the top of the trachea, and is classified into three types:

●
Nasopharyngeal cancer: Forms in the upper part of the throat behind
nosed

●
Oropharyngeal cancer: Forms in the middle of the throat, behind
mouth.

●
Hypopharyngeal cancer:
forms in the lower part of the throat, just above the larynx, or in the vocal
apparatus.

RISK FACTORS

In addition to the risk factors associated with all types of head and neck cancer, genetic abnormalities and poor diet can also play a role in increasing the chances of developing cancer.

PREVALENCE

Nearly 300,000 new cases of cancer of the larynx and pharynx were
diagnosed worldwide in 2012, making it the 13th most common
diagnosed cancer in men.The incidence of throat cancer is significant
varies from country to country; however, it is almost universally more common in
men than women. This reflects differences in exposure to risk factors that
can cause throat cancer. Throat cancer is more common in people over 55.
although younger patients may also develop tumors at these sites.

Manifestations

Since the larynx and the uppermost parts of the digestive tract are adjacent to each other, the manifestations noted by patients with the occurrence of cancer in any of these localizations are quite similar.The most common of them are a persistent change in the timbre of the voice (hoarseness and roughness of the voice persist for more than 3 weeks) or difficulty swallowing (earlier there is a problem with swallowing solid food, and only then the ability to swallow liquids is impaired). Other possible manifestations:

• Sore throat;
• Persistent ear pain (especially if it is noted on only one side).
• Noisy or labored breathing.
• Unplanned weight loss.
• Hemoptysis.
• The appearance of swelling in the neck.

Diagnostics

Cancers of the larynx and pharynx are difficult to access, so a more detailed examination with endoscopy under general anesthesia may be required. Many of the manifestations described above are also possible in individuals with medical conditions other than cancer. However, it is important that anyone with persistent complaints is examined by a head and neck cancer specialist. As a rule, such a specialist will take a detailed history and examine the mouth, throat and neck in the clinic.

The diagnosis of cancer of the larynx and the uppermost digestive tract is difficult, as a detailed examination with endoscopy under general anesthesia may be required. During endoscopy, biopsies of any suspicious areas may be done to confirm the diagnosis. To determine the size and length of tumor foci, as well as to clarify the involvement of the cervical lymph nodes in the pathological process, ultrasound examination (ultrasound), computed tomography (CT) and magnetic resonance imaging (MRI) of the neck and throat can be performed.There are no blood tests available to diagnose cancer of the larynx or hypopharynx, but they can be done as part of a more detailed general examination prior to local anesthesia.

No blood tests are available to diagnose cancer of the larynx or pharynx
, but they can be performed as part of a more general assessment prior to
for general anesthesia.

Treatment

The ability to treat any tumor depends on a number of different factors, including its size, location, type and involvement of adjacent structures.In this regard, there are no differences between cancer of the larynx and pharynx, and therefore any treatment should be selected on an individual basis.

In principle, it is possible to treat early stages of laryngeal tumors either by surgery or by radiation therapy. For slightly larger tumors of the larynx or laryngopharynx, a combination of chemotherapy and radiation therapy is often used, while in the most common stages, surgical resection is mainly performed.

The tumor of each individual person is characterized by certain biological differences that affect the characteristics of the development of cancer.”Biological therapy” refers to treatments that take into account similar characteristics of the tumor, which leads to the arrest of tumor growth and division of malignant cells.

Less commonly, newer treatments such as photodynamic therapy, proton therapy, and drugs that target tumors at the molecular level are being used, but these treatments are increasingly being studied in clinical trials for head and neck cancer.

Throat cancer FAQ

What are the stages of throat cancer?

As with all types of cancer, groups or stages are distinguished, mainly depending on the prevalence of the disease and the aggressiveness of the type of tumor.There are stages from I (small tumors in the early stages, still resembling the tissue from which they originate; they are also referred to as “highly differentiated”) to IV (larger and more common tumors that no longer resemble healthy tissue – “poorly differentiated”) …

Is laryngeal / pharyngeal cancer spreading?

Unfortunately, if cancer is not detected at an early stage, malignant cells can spread from their primary location in the larynx or pharynx to lymph nodes in the neck, and then even to the lungs and liver.After the spread of cancer, its treatment becomes more difficult, which is why it is necessary to detect such diseases as early as possible.

If I have laryngeal surgery, will my speech be saved?

Small tumors of the vocal cords can be removed without compromising the integrity of the larynx itself. In such a case, the timbre of the voice may change (it may become coarser or hoarse), but usually this is not a problem.If the tumor is larger, the larynx may need to be removed completely (this is called a laryngectomy). However, even in such situations, there are ways to restore the voice through the use of special valves or electronic devices. However, it should be noted that the voice will be very different from the usual one, and it is not possible to guarantee a favorable outcome.

Will you be able to swallow normally?

Both surgery and chemoradiotherapy may interfere with your ability to safely swallow food / liquids.The reason may lie in the loss of normal function of the swallowing mechanism, and after chemoradiotherapy, the problem is often associated with insufficient production of saliva, which leads to a dry throat. During treatment, it may be necessary to use a tube passed through the nose into the stomach cavity to replenish fluids and administer nutritional mixtures.

Is there a cure for throat cancer?

Yes. With the exception of those cases when the malignant tumor has become very large and penetrates into the surrounding structures, in connection with which it cannot be removed, or it has spread to distant parts of the body, the task of the measures being taken is to cure this disease.Unfortunately, even smaller tumors, after complete removal, may later recur, or, with continued exposure to known risk factors, a new cancer may develop.

If throat cancer has already developed, is there any point in quitting smoking?

Yes. Continued smoking will reduce the effectiveness of any treatment given and may complicate recovery.