Neck Condition (Lymph node enlargement)

What is lymph node enlargement?

-The majority of neck nodes in children are benign
-The majority of neck nodes in adults are malignant
-Neck nodes may be involved secondarily in an infection of any part of the ENT system.

Infective lymphadenopathy
This secondary lymphadenopathy is extremely common in children. An example is jugulo-digastric node enlargement during or following tonsillitis. A single node or a group of nodes may be enlarged. There may be tenderness and symptoms related to the primary infection.

Specific infections presenting with lymph node enlargement (priamary lymphadenopathy) include:
- Glandular fever
- TB
- Toxoplasmosis
- Brucellosis
- Cat- scratch fever
- HIV
The diagnosis in these cases will often be made following the appropriate screening blood test and CXR. FNAC and even excision biopsy may be needed to exclude malignancy

Neck Condition (Neck infections)

Parapharyngeal abscess

This is a deep seated infection of the parapharyngeal space. It often results from a primary infection in the tonsil or is an extension from a parapharyngel abscess (or quinsy). It is more common in children than in adult.

Signs and symptoms

Include pyrexia, neck swelling deep to sternomastoid muscle and a patient who seems unwell. There may be trismus, or a reduced range of neck movements. The tonsil and the lateral pharyngeal wall may be pushed medially. Airway compromise is a late and ominous sign.
If the diagnosis is in doubt, a CT scan will often distinguish between lymphadenitis and an abscess.

Treatment

This will involve a high dose of IV broadspectrum antibiotics (Augmentin), in addition to surgical drainage via a lateral neck approach.

Retropharyngeal abscess

This is a very rare infection of the retropharyngeal space. It is much more common in children and infants than in adults.

Signs and symptoms

An unwell patient, with pyrexia, often with preceding URTI or swallowing difficulty. There may be shortness of breath or stridor, or torticollis-due to prevertebral muscle irritation.

Treatment

A high dose of IV broad spectrum antibiotics (Augmentin). Where necessary the airway will be secured and surgical incision and drainage may be performed via the mouth.

Lugwig's angina

This is a rare infection of the submandibular space, it usually occurs as a result of dental infection. It is more common in adults than in children.

Signs and symptoms

These include pyrexia, drooling, trismus, airway compromise due to backward displacement of the tongue. There may be firm thickening of the tissues of the floor of mouth-best appreciated on bi-manual palpation.

Treatment

High doses of IV broad spectrum antibiotics (Augmentin). Secure the airway (try a naso-pharyngeal airway first since this will often suffice, but were necessary consider a tracheostomy). Surgical incision is often unsatisfying since little pus may drain away.