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When Should I See A Neck Lump Specialist?

All lumps in the neck must have a diagnosis! A specialist review at our One Stop Neck Lump Clinic at 86 Mauranui Clinic in Epsom, Auckland will allow a diagnosis and management plan in the earliest possible time. Call Auckland 09 6311948 for or click on this link for an urgent appointment

Neck Lumps occur at different ages and in different areas of the neck and these factors can help lead to an early diagnosis. In younger adults and children lumps in the neck are usually either inflammatory or congenital in origin whereas in older adults a much higher index of suspicion for cancer must be maintained. The neck is divided into several regions: 1. Anterior neck; 2. Lateral neck; 3. Posterior neck; 4. Angle of the jaw; 5. Submandibular region. The anterior  neck is divided at the level of the hyoid bone into a. suprahyoid and b. infra hyoid regions. The lateral neck is further divided into a. The carotid sheath and b. The posterior triangle.

Posterior Neck Lumps

The posterior neck contains very few structures of importance and skin cancer metastasising to occipital and post auricular lymph nodes are the only significant malignancies that present in this region. Other lumps include lipomas and benign lymph node swellings.

Anterior Neck Lumps

Infrahyoid masses will be mostly thyroid in origin see Thyroid Surgery. Nearly all thyroglossal duct cysts are below the hyoid, slightly left of midline, and seen in young people. Pretracheal nodes that are caused by metastatic laryngeal or thyroid tumours can also present in this region . Suprahyoid masses may be thyroglossal but are more likely to be submental lymph nodes involved by inflammation or malignancy from the skin or oral cavity, particularly the floor of mouth. Dermoids are rare developmental inclusion cysts that form in the midline during embryonic development but often do not manifest until later in life. Thyroid tissue can arrest anywhere along the thyroglossal tract and can present in the submental region.

Lateral Neck Lumps

Lateral neck masses are more complex. They most commonly present in the carotid sheath in association with the carotid artery or jugular vein but they can also appear in the posterior triangle.
Solid lesions in the lateral neck are either nodal (inflammatory or metastatic malignancy) or they are rare tumours like carotid body tumours, neurogenic tumours associated with many of the nerves in the neck or rarely they can be malignant sarcomas of the deep neck tissues. Cystic lesions may be congenital branchial cleft cysts or lymphatic/vascular malformations. However they may also be cystic malignant nodes. These are notoriously difficult to diagnose and needle biopsies are often non- diagnostic.
Cystic nodal metastases are frequently confused with benign branchial cleft cysts and a careful history of upper aerodigestive tract symptoms is important to elicit.particularly in the era of HPV related Oropharyngeal cancer. Thyroid cancers may also appear as cystic lymph nodes in the lateral neck
Lesions in the skin and subcutaneous tissues are usually benign but skin cancers and melanoma can occur as cutaneous nodules.
Nodal lesions in the posterior triangle and supraclavicular area are less common. Metastases to this area either come from skin lesions in the posterior scalp or  from nasopharyngeal carcinoma, most frequently seen in Asian patients. Typically TB can affect lymph nodes in this area. Atypical TB in children tends to affect level I nodes in the submandibular area.

Submandibular Neck Lumps

Lumps in the submandibular area are usually related to the submandibular gland. Obstruction of the duct by stones or sludge typically presents as painful swelling associated with eating or even with the thought of food. The swelling will generally resolve over a period unless an ascending infection develops. Sometimes the stone can be felt in the duct in the floor of the mouth. Massaging the gland rather than producing a good flow of clear saliva often produces a small amount of turbid saliva or none at all. Submandibular salivary tumours present as painless progressive swellings. About 50% are malignant. See Salivary Gland Surgery.

Lymph node metastases to this area are either from lip or anterior facial skin cancers or from tumours on the oral tongue, floor of mouth or buccal mucosa.

Lumps at the Angle of the Jaw

Parotid swellings, that occur in the preauricular area, in the tail (which is often difficult to separate from the upper neck) or in the deep lobe, are usually neoplasms. Most tumours are benign but NZ has a high incidence of metastatic skin cancer to nodes in the parotid and our most common parotid malignancy is metastatic SCC. See Salivary Gland Surgery
Congenital cysts can occur in this region and they originate from the first branchial arch.

 

If you have concern regarding a neck lump call our One Stop Neck Lump Clinic on Auckland 09 6311948

 

 

John has just returned from the ASOHNS ASM in Brisbane where he was involved as an invited speaker. John spoke in a plenary session on the use of energy devices in thyroid surgery. The talk included a review of a personal series of thyroidectomies. John has performed over 50 thyroidectomy procedures per year since 2002 and over 100 per year  since 2004 with a total number of over 1800. John then presented some complex thyroid cancer cases to a panel of experts. The meeting was a great success with over 500 registrants and a high quality program.

Dr John Chaplin is currently returning from Kaohsiung Taiwan where he attended the 3rd meeting of the APTS. The meeting was was supported by the Taiwanese Head and Neck Cancer Surgery Society. There were over 700 participants from all over the world and John presented an invited lecture on the use of Harmonic scalpel in thyroid surgery. The talks covered all aspects of thyroid cancer, thyroid nodules, goitre  surgery and included multidisciplinary management of locally advanced, poorly differentiated and anaplastic thyroid cancer and also  management of papillary micro carcinoma. It was culturally interesting with surgeons and specialists from a diverse range of regional and international nations in attendance. The APTS is now affiliated with the American  Head and Neck Surgery Society (AHNS) Endocrine Surgery Group and this has given great endorsement to the APTS.

Dr John Chaplin helped convene a thyroid cancer workshop at Auckland City Hospital on 22 Nov this year. Dr Bryan McIver, Endocrine Oncologist, from Moffitt Cancer Center in Tampa, Florida USA was guest speaker. The meeting was attended by thyroid surgeons and endocrinologists from around the North Island. The first part of the meeting involved case presentations to Dr McIver who discussed the various scenarios and the treatment recommendations based on the latest ATA guidelines with input and questions from the audience. Dr McIver then spoke on risk assessment of thyroid cancer, the use of radio iodine in differentiated thyroid cancer and poorly differentiated and anaplastic thyroid cancer. There were also talks on thyroid surgery, bleeding, IONM, vocal fold rehabilitation and  medullary thyroid cancer. An academic dinner followed the meeting where Dr McIver then spoke on assessment of thyroid nodules particularly with respect to Molecular testing of FNA biopsy samples. He attended the thyroid cancer endocrine MDM on Friday where further thyroid malignancy case discussions were followed by a talk on the use of external beam radiation therapy in thyroid cancer.

Thyroid Cancer One Day Meeting

 Wed 21st November 2018

Clinical Education Centre

Level 5

Auckland City Hospital

Academic programme

 Morning session  – Thyroid Cancer MDM   8am – 12.45pm

0800  registration/ meet & greet

 0815        Multidisciplinary Case discussions with Dr Bryan McIver

10.15       Morning tea

10.45       Multidisciplinary Case discussions with Dr Bryan McIver

12.45 -1.15  lunch

 Afternoon session  – Scientific Programme   1.15pm -17.30pm

 13.15       Prevalence of thyroid cancer in NZ              Dr Geoff Braatvedt

13.30     Risk stratification of thyroid nodules

– with audience polling                                 Dr Bruno Carvalho

14.00       Shorter operative times, less bleeding           Dr John Chaplin

14.15       Avoiding hypoparathyroidism                           Dr Nick McIvor

14.30       Nerve monitoring                                             Dr John Chaplin     

14.45       Risk stratification for recurrence… ?RAI         Dr Bryan McIver

 

15.15       Afternoon tea

 

15.45       Management of laryngeal nerve injury             Dr David Vokes

16.00       Management of RAI-refractory thyroid ca Dr Bryan McIver

16.30       Anaplastic carcinoma                                             Dr Nick McIvor

16.45       Management of Medullary Thyroid Cancer in NZ   Dr Joey Siu

 

17.00       General discussion with comments by Dr Bryan McIver

17.30       Close

 

Our customer Doug has shared his unique story about undergoing one of the first Transoral Robotic Surgery (TORS) procedures in New Zealand. We are proud to have been there for Doug, providing peace of mind that the cost of the new technology procedure was taken care of so that he and his family could focus on what matters most, getting Doug well again.

Our customer Doug has shared his unique story about undergoing one of the first Transoral Robotic Surgery (TORS) procedures in New Zealand. We are proud to have been there for Doug, providing peace of mind that the cost of the new technology procedure was taken care of so that he and his family could focus […]

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