Swelling of the neck occurs with infectious, endocrine, allergic, otolaryngological, dental diseases, traumatic injuries, and some somatic pathologies. It can be acute, chronic, unilateral or bilateral, localized or widespread. Sometimes it is combined with pain, local hyperemia, hyperthermia, fever, symptoms of intoxication. The cause of the swelling is established using the data of the survey, external examination, ultrasound, radiography, otolaryngological techniques, laboratory tests. Rest is recommended until the diagnosis is made.
Why does the neck swell
Traumatic injuries
Soft tissue bruises are accompanied by moderate local edema, pain, aggravated during neck movements. The swelling disappears within a few days. Subluxation of the cervical vertebra is the result of a sharp turn of the head, more often detected in children. Asymmetric swelling of the back of the neck is complemented by a forced position of the head, pain, muscle tension. In fractures, local swelling is determined in the projection of the spinous process of the damaged vertebra.
In victims with injuries of the larynx, external edema is usually insignificant. Severe swelling may be the result of severe complications: internal bleeding into soft tissues, subcutaneous emphysema that occurs against the background of a rupture or penetrating injury to the larynx. Difficulties in breathing, aphonia, pain syndrome are noted. Possible hemoptysis, asphyxia.
With uncomplicated foreign bodies of the larynx, the symptom is absent. Against the background of inflammation in the area where the foreign object is located, swelling of varying severity occurs, combined with pain, hyperthermia, and symptoms of intoxication. A life-threatening condition is the perforation of the larynx with a sharp foreign body with the development of subcutaneous emphysema.
Diseases of the lymphatic system
Neck swelling is often associated with inflammation of the regional lymph nodes. The following diseases can become the cause of lymphadenitis:
- Purulent lesions of soft tissues : infected wounds, boils, carbuncles, abscesses, phlegmon of the face, head and neck.
- Dental problems : caries, pulpitis, flux, stomatitis, purulent parotitis, maxillary abscess, abscesses of the tongue, oral cavity, osteomyelitis of the jaw.
- ENT pathologies : tonsillitis, chronic tonsillitis, paratonsillar, parapharyngeal, intratonsillar abscesses, otitis media, pharyngitis, laryngitis.
- Children's infectious diseases : diphtheria, scarlet fever, mumps.
- Dangerous infections : plague, anthrax.
In children with chronic skin diseases, lymphadenitis of the cervical, submandibular, and occipital lymph nodes occurs with the development of Kaposi's herpetiform eczema. An increase in lymph nodes also becomes a consequence of the lymphogenous spread of malignant tumors: cancer of the tongue, lower and upper jaws, larynx, pharynx, nose, paranasal sinuses.
Neck swelling due to thyroiditis
Endocrine pathologies
The most pronounced diffuse swelling of the neck is observed with myxedema. Not only the neck swells, but also the face, in severe cases, swelling spreads throughout the body. Distinctive features are the absence of redness, blanching, pits when pressing on the skin, shortness of breath, lethargy, lethargy, increased sensitivity to cold. The change in the anterior surface of the neck is determined in all forms of goiter:
- Diffuse euthyroid goiter. The general condition is not changed, weakness, headaches are sometimes observed. In mild cases, swelling is noticeable only when feeling, tilting the head back, in severe cases it reaches the degree of a pronounced cosmetic defect.
- Diffuse toxic goiter. The developed symptomatology of a thyrotoxicosis is found out. The thyroid gland is evenly enlarged, the degree of swelling does not always correlate with the severity of the manifestations of the disease.
- Nodular goiter. The function of the gland is often preserved, some patients show signs of hypo- or hyperthyroidism. The swelling of the neck is uneven, one side is larger than the other.
In acute thyroiditis, swelling is combined with soreness, local hyperthermia, and hyperthermia. The onset of the purulent form of thyroiditis is marked by increased pain, severe fever, and lymphadenitis. In patients with subacute thyroiditis, the body temperature is subfebrile, swelling is noted, moderate pain in the projection of the thyroid gland, in half of the cases symptoms of thyrotoxicosis are detected. Chronic thyroiditis develops gradually. The affected area is bumpy, painless.
Maxillofacial pathology
The cause of swelling is often diseases of the salivary glands, soft tissues. Swelling is observed in the following pathological conditions:
- Sialadenitis. The parotid salivary gland suffers more often, unilateral painful swelling is located on the border of the neck and lower jaw, next to the earlobe. The submandibular salivary glands, which are localized in the submandibular triangle of the neck, are less commonly affected.
- Purulent parotitis. With purulent inflammation, the swelling spreads to the neck, cheek, submandibular region from the side of the lesion. There is a pronounced deformation. Pain, general hyperthermia, severe weakness, weakness are noted.
- Salivary gland abscess. Along with the parotid, other salivary glands may suffer. In 50% of cases, inflammation captures the paired organ. The area of swelling corresponds to the location of the affected gland. There is a sharp pain, febrile body temperature, pronounced intoxication syndrome.
- Periorbital abscess. It is formed as a complication of tonsillitis, furunculosis, infected skin abrasions, oral mucosa. One-sided swelling is revealed in the zone of the submandibular triangle. When an abscess ruptures, swelling spreads down the neck.
- Phlegmon of the neck. It is provoked by odontogenic or tonsilogenic infection, foreign bodies of the laryngopharynx. Edema appears on one side, grows rapidly, diffusely covers a significant part of the neck. The skin over the area of swelling is red, hot, tense. The general condition is severe.
Diseases of the ENT organs
Swelling of the neck in otolaryngological diseases is more often due to lymphadenitis. Diseases accompanied by swelling of the neck, not associated with an increase in lymph nodes, include:
- Chondroperichondritis of the larynx. A limited area of swelling is located in front in the lower or middle third of the neck. It is combined with chills, weakness, hyperthermia, pain, aggravated by talking, coughing, swallowing.
- Neck cyst. The tumor-like formation is localized along the lateral or anterior surface, and is more clearly contoured when the head is turned in the opposite direction. In the absence of inflammation, it is asymptomatic. When infected, the skin turns red, the cyst enlarges, becomes painful, and the swelling extends beyond the affected area.
- Abdominal abscess. Swelling of the neck behind the angle of the lower jaw, sore throat, respiratory disorders, aggravated in an upright position, a pronounced violation of the general condition, hyperthermia are found.
- Lemierre's syndrome. Postanginal anaerobic sepsis is manifested by swelling of the lower part of the lateral surface of the neck (in the projection of the jugular vein), pain, progressive deterioration of the condition up to impaired consciousness and speech, the development of pneumonia, arthritis, and osteomyelitis.
- Angina Ludwig. The disease is characterized by a rapid onset and severe course with fever, intoxication, severe sore throat, diffuse swelling of the soft tissues of the neck. On palpation, the tissues are painful, dense, "woody".
Allergy
With angioedema, swelling of the neck, face, lips, eyelids, auricles, limbs, and genital area is observed. The edema is painless, accompanied by a feeling of tension and fullness, pallor of the skin. It is provoked by contact with allergens: drugs, food, insect venom. Sometimes it occurs due to pseudo-allergy. In addition, severe swelling of the face, neck, feet, hands is found in the edematous type of allergy to salicylates.
infectious diseases
The most common infectious cause of neck swelling is mumps. Swelling is detected in the area of the salivary glands, often bilateral, sometimes asymmetrical. Due to the increase in the upper sections of the neck, the face becomes pear-shaped. Severe swelling of the anterior neck is detected in the toxic form of diphtheria. Grade 1 is characterized by swelling reaching the middle of the neck, Grade 2 - to the collarbones, Grade 3 - spreading to the face, chest, back, back of the neck.
In patients with typhus, redness, swelling of the face and neck is supplemented by an injection of the conjunctiva, the appearance of a thick rash on the trunk and extremities, hepatosplenomegaly, oliguria, neurological disorders, severe intoxication.
Neoplasms
Local swelling of the neck may be due to the development of neoplasia, which include:
- lipomas, fibromas;
- cancer of the pharynx and larynx;
- thyroid tumors.
Benign neoplasms are limited, painless swellings that do not increase or increase very slowly in size. Malignant neoplasias progress rapidly, cause an increase in lymph nodes, germinate neighboring organs, are accompanied by respiratory and swallowing disorders, voice changes.
Other reasons
The list of other causes of neck swelling includes a number of diseases of various etiologies:
- Rheumatology, orthopedics : cervical myositis, Shulman's disease, scleroderma, dermatomyositis.
- Cardiology, pulmonology : exudative pericarditis, pleurisy, mediastinitis, superior vena cava syndrome.
- Dermatology : furunculosis, bullous dermatitis.
- Neurology : Melkersson-Rosenthal syndrome.
- Nephrology : membranous glomerulonephritis.
- Emergencies : cytokine storm.
Diagnostics
General practitioners are involved in establishing the cause of neck swelling. According to indications, patients are referred to otolaryngologists, endocrinologists, maxillofacial surgeons, and other specialists. The examination includes objective, instrumental, laboratory methods. The following diagnostic procedures are carried out:
- Interrogation, general inspection . A basic study that allows you to establish a preliminary diagnosis, draw up a plan for further examination. It involves the study of symptoms, anamnesis of the disease, an assessment of external changes.
- Sonography . Ultrasound of the neck is informative when studying the state of organs and soft tissues, it allows you to identify tumors, areas of inflammation, determine the localization, boundaries of pathological processes. An ultrasound of the thyroid gland is prescribed if an endocrine cause of neck swelling is suspected. Ultrasound of the lymph nodes is recommended for lymphadenitis, cancerous tumors.
- Radiography . To exclude subluxations, fractures of the vertebrae, an X-ray of C1 or the cervical spine is prescribed. With symptoms of damage to the ENT organs, an x-ray of the larynx is performed.
- Other Imaging Techniques . CT, MRI of the neck are performed to detail the information obtained during sonography or radiography, make it possible to clarify the localization, volume, nature of the pathological process.
- Radioisotope scintigraphy. Effective in the study of the thyroid gland, visualizes the nodes, confirms the presence of diffuse changes.
- Endoscopic examination of the throat. Direct and indirect laryngoscopy, microlaryngoscopy, fibrolaryngoscopy are prescribed for lesions of the larynx. According to the indications during the study, a biopsy is performed.
- Laboratory tests . Depending on the existing symptoms, general and biochemical blood tests, a study of the level of thyroid hormones and antibodies to them, a microbiological analysis of swabs, punctures, blood samples, and a cytological or histological examination of the biopsy can be performed.
Palpation of the neck
Treatment
Help at the prehospital stage
In case of traumatic injuries, the neck must be fixed with a cotton-gauze collar. In other cases, it is recommended to provide the neck with functional rest, not to self-medicate, since swelling occurs with a variety of diseases that require different approaches to therapy. With intense pain, the use of painkillers is allowed. It is impossible to warm the neck - this can increase inflammatory and other pathological processes.
Conservative therapy
The scheme of conservative treatment includes a protective regimen, etiopathogenetic and symptomatic drug therapy, physiotherapy. The following drugs are used:
- NSAIDs . They are used in the form of tablets, injections, local remedies. They have analgesic and anti-inflammatory effects.
- Antibiotics . Broad-spectrum drugs are prescribed, after receiving the results of sowing, the drugs are replaced, taking into account the sensitivity of the pathogen. With extensive purulent processes, combinations of two drugs are recommended.
- Antithyroid drugs . Hyperthyroidism is considered as an indication for the use of medications. Hypothyroidism is treated with replacement therapy.
- Antihistamines . Necessary for swelling of the neck due to allergic reactions.
After the elimination of acute phenomena, UHF, laser therapy, electrophoresis with novocaine, anti-inflammatory drugs are used. Patients with cancer undergo chemotherapy, radiation therapy.
Surgery
For acute pain, blockades with local anesthetics are performed. Taking into account the nature of the pathology, the following operations are performed:
- Traumatic injuries : transoral fixation, application of the Halo apparatus, PST of neck wounds, tracheostomy, chordectomy, larynx resection, laryngopexy, removal of foreign bodies of the larynx, reconstructive interventions.
- Maxillofacial pathologies : parotidectomy, opening of abscesses and phlegmon of the neck, bougienage of the excretory duct of the salivary gland.
- Endocrine diseases : node enucleation, subtotal resection of the thyroid gland, hemithyroidectomy.
- Otolaryngological diseases : removal of the median or lateral cyst of the neck, opening of the pharyngeal abscess.
- Tumors : excision of lipomas and fibroids of the neck, removal of the thyroid gland, radioiodine therapy for thyroid cancer, laryngectomy, laryngopharyngectomy, hemilaryngectomy, installation of a voice prosthesis, Crile, Vanach operations.