Clinicopathological Study of Midline Swelling of the Neck in Rajendra Institute of Medical Sciences, Ranchi
Authors/Creators
- 1. Junior Resident, Department of ENT, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- 2. Senior Resident, Department of ENT, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
- 3. Senior Resident, Department of ENT, Medinirai Medical College and Hospital, Palamu, Jharkhand, India
- 4. Associate Professor, Department of ENT, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
Description
Background: Neck swelling is a very common presentation among patients that we encounter in our day to day life. This is present in wide range of age groups and have multiple differential diagnosis. Therefore this produces a need for the surgeons to properly understand the embryology and anatomy and the various causes in different age groups to reach to apt diagnosis and appropriate management algorithm. Method: A prospective study was conducted in otorhinolaryngology department of Rajendra Institute of Medical Sciences, Ranchi over a period of 18 months from April 2021 to September 2022. A total of 60 patients with midline swelling, who gave consent were evaluated and studied. Result: In our study 60 patients were studied. Thyroid swelling is the most common midline swelling (65%) found in our study followed by Ludwig’s angina (20%), thyroglossal cyst (10%) and dermoid cyst (5%). Wide range of age group from 6 years to 70 years presented with midline neck swelling. The midline swelling were of variety of origin from being congenital or acquired , inflammatory or non-inflammatory, benign or malignant. Patients were evaluated to reach a diagnosis. In our study FNAC could not diagnose the papillary and follicular variant of thyroid swelling which was confirmed on postoperative histopathological examination thus showing poor accuracy. Conclusion: Among the midline benign neck swellings, thyroid swelling was found to be the commonest. Thyroid swellings occur more commonly in the females than males. Though FNAC is the most readily available tool for diagnosis but it is not definite for thyroid swelling since aspirate could be taken from the benign site and malignancy could be missed. USG guided FNAC is more effective and safe option. However clinically suspicious malignant cases should be followed up. Treatment of benign neck swelling is surgical excision while in acute case Ludwig’s angina, incision and drainage followed by higher antibiotics coverage is effective.
Abstract (English)
Background: Neck swelling is a very common presentation among patients that we encounter in our day to day life. This is present in wide range of age groups and have multiple differential diagnosis. Therefore this produces a need for the surgeons to properly understand the embryology and anatomy and the various causes in different age groups to reach to apt diagnosis and appropriate management algorithm. Method: A prospective study was conducted in otorhinolaryngology department of Rajendra Institute of Medical Sciences, Ranchi over a period of 18 months from April 2021 to September 2022. A total of 60 patients with midline swelling, who gave consent were evaluated and studied. Result: In our study 60 patients were studied. Thyroid swelling is the most common midline swelling (65%) found in our study followed by Ludwig’s angina (20%), thyroglossal cyst (10%) and dermoid cyst (5%). Wide range of age group from 6 years to 70 years presented with midline neck swelling. The midline swelling were of variety of origin from being congenital or acquired , inflammatory or non-inflammatory, benign or malignant. Patients were evaluated to reach a diagnosis. In our study FNAC could not diagnose the papillary and follicular variant of thyroid swelling which was confirmed on postoperative histopathological examination thus showing poor accuracy. Conclusion: Among the midline benign neck swellings, thyroid swelling was found to be the commonest. Thyroid swellings occur more commonly in the females than males. Though FNAC is the most readily available tool for diagnosis but it is not definite for thyroid swelling since aspirate could be taken from the benign site and malignancy could be missed. USG guided FNAC is more effective and safe option. However clinically suspicious malignant cases should be followed up. Treatment of benign neck swelling is surgical excision while in acute case Ludwig’s angina, incision and drainage followed by higher antibiotics coverage is effective.
Files
IJPCR,Vol14,Issue12,Article101.pdf
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Additional details
Dates
- Accepted
-
2022-12-10
Software
- Repository URL
- https://impactfactor.org/PDF/IJPCR/14/IJPCR,Vol14,Issue12,Article101.pdf
- Development Status
- Active
References
- 1. Tariq Ahmad, Mohammad Naeem, Siddique Ahmad, Ambreen Samad, Amir Nasir. Fine Needle Aspiration Cytology (FNAC) And Neck Swellings In The Surgical Outpatient. J Ayub Med Coll Abbottabad 2008; 20(3):30-32. 2. Skandalaki's Surgical Anatomy by John E. Skandalaki, Gene L. Colborn, Thomas A. Weidman, Roger S. Foster Jr., Andrew N. Kingsnorth, Lee J. Skandalakis, Panajiotis N. Skandalakis, Petros S. Mirilas, Pacini F, Schlumberger M, Dralle H, Elisei R, Smit JW, Wiersinga A. European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol. 2006;154:787-803. 3. Orell Sr, Sterrett GF, Whitaker D. Fine needle aspiration cytology. 5th edition, New Delhi: Elsevier Health Sciences; 2012. 4. Afridi S, Malik K, Wahed I. Role of fine needle aspiration biopsy andcytology in breast lumps. J College of Physicians and Surgeons Pakistan. 1995; 5:75-7. 5. Lee Mcgregor's synopsis of Surgical Anatomy 9th Edition by A. Lee McGregor 7. Fakir M A, Bhuyan M. Ludwig's Angina: a study of 50 cases. Ban J Otorhinolaryngol 2008;14(2):51- 6. 6. Sharma V. Ludwig's angina evaluation of its medical treatment in 47 cases. J Col Med Sci Nep. 2011;7(3):1-5. 7. Turkyilmaz Z, Karabulut R, Bayazit YA, Sonmez K, Koybasioglu A, Yilmaz M et al. Congenital neck masses in children and their embryologic and clinical feature. BENT. 2008;4(1):7-18. 8. Mahmud S, Haque R, Mamun AA, et al. Factors influencing Ludwig's Angina. Bangladesh Journal of Otorhinolaryngology. 2014;20(1):5–7. 9. Fakir MAY, Bhuyan MAH, Uddin MM, et al. Ludwig's Angina: a study of 50 cases. Bangladesh Journal of Otorhinolaryngology. 2008; 14(2):51- 56. 10. Kao J-K, Yang S-C. Ludwig's angina in children. Journal of Acute Medicine. 2011;1(1):23– 26. 11. Buckley MF, O'Connor K. Ludwig's angina in a 76-year-old man. Emergency medicine journal: EMJ. 2009; 26(9):679–680. 12. Huang TT, Liu TC. Deep neck infection: analysis of 185 cases. Head Neck. 2004;26(10):854-60. 13. Russel RCG, Williams NS, Bulstrode CJK. In: Bailey and Love's short practice of surgery, 24th edn. Arnold, London 2004;710-86. 14. Hanif MA, Alauddin M. The incidence of tubercular cervical lymphadenitis. Bangladesh J of Otolaryngology 1997; 3(2): 42-46. 15. Siddique A, Mahmud CM, Razee KAA, Ahmed CN. Presentation of cervical lymphadenopathy to the surgeons. Journal of Surgical Sciences 2005, 9(2):54-57. 16. Watkison JC, Gaze MN, Wilson J. A. Benign neck disease. In: Stell and Maran's Head neck surgery, 4th edn Butteworth- Heinemann, Oxford 2000; 181-182. 17. Patel S, Gattani VJ, Nitnaware AZ. Clinicopathological study of thyroid swelling and its management. Int J Otorhinolaryngol Head Neck Surg. 2020;6:727-31. 18. Keshri SP, Kumar S, Thakur S. Clinico-Pathological Study of Solitary Thyroid Nodule with Special Reference to Fine Needle Aspiration Cytology. Int J Sci Res. 2017;6(2):78 9-94. 19. Gupta M, Gupta S, Gupta VB. Correlation of fine needle aspiration cytology with histopathology in the diagnosis of solitary thyroid nodule. J Thyroid Res. 2010;379051. 20. Samir G, Nibedita SS, Kumar PR, Rajlaxmi P, Swarupjit G. A Clinicopathological Study of Solitary Thyroid Nodule. J Pharm Biomed Sci. 2015;5(03):233-7. 21. Chetan VR, Veeresalingam B, Kumar MK, Durbesula PT, Rao PS. A study on the clinical manifestations and the incidence of benign and malignant tumors in a solitary thyroid nodule. Int J Res Med Sci. 2013;1(4):429-34. 22. Pyar K. P., Hla S. A., Lwin K. T. Y., Aung Z. N. H., Myat K., Maung L. M., Hein Y. M., Aung L. H., Thant M. M., Maung M. M., Zaw M. H., Mg Y. H., Maung N. L., Win T., Mg K. T., Phone S. S., Ya K. Z., Kyaw A. P., Aung Z. P., Kyaw M. T., Min S., Moe T. A., Oo K. M., & Ko M. K. Clinical and laboratory predictors for acquiring COVID-19 infections in patients on maintenance hemodialysis in 5th wave of epidemic in Myanmar. Journal of Medical Research and Health Sciences. 2022; 5(12): 2345–2354.