Head & Neck Lumps Oxford

A lipoma is a lump which arises from the fatty cells under the skin. It is sometimes known as a fatty lump, which isn’t uncommon for people to have within their body. They predominantly occur in the upper back, shoulders and abdomen, however they are sometimes seen in the head and neck region, where they account for approximately 15% of all lipomas. The diagnosis can usually be confirmed by scan, however occasionally a needle biopsy may be required.

Whilst the majority of lipomas can be observed without any further treatment, they may need surgical removal if there is uncertainty regarding the diagnosis, concerns on examination, a size which is greater than 10cm, rapid growth , associated pain, a deep seated location or concern cosmetically. Occasionally if they are large, there may be a concern that they can turn cancerous. Treatment of lipomas involves surgery. It may be possible to undertake this under local or general anaesthetic, depending on your specialist.

These type of lumps are present from birth (congenital), however may only present later in adult life. They are the most common congenital cause of a neck lump. Branchial cleft cysts do not often cause symptoms, but may become tender, enlarged, or inflamed with possible abscess formation during episodes of upper respiratory tract infections. Patients can present with purulent drainage to skin or throat from spontaneous rupture of branchial cleft cyst abscess. The most concerning symptoms include problems with swallowing and breathing.

One of the difficulties with branchial cysts is that they can be difficult to differentiate from a cancerous neck lump, as they can share similar characteristics. It’s important for your specialist to ensure that the cyst is not a malignancy. Investigations which are usually considered include a scan and a needle biopsy. If diagnosis is still unclear, then occasionally further detailed tests may be necessary. Due to the congenital nature of the cyst, it is important your surgeon ensures that the cyst has no deeper connection with the underlying structures within your neck. These may include the structures within your ear such as the nerve supplying the face or the hearing mechanisms and can also sometimes communicate with the structures deep within your throat.

Once the diagnosis has been confirmed, then there is an option to manage this without surgery and simply observe it. If the lump is causing problems, due to repeated infections, or there are concerns about the appearance cosmetically, then they can be removed surgically.

There is typically no urgency, after the diagnosis is confirmed; clinicians can defer surgery, whilst allowing any acute infection to settle. When a cyst becomes acutely infected, presenting with a painful neck lump with a temperature, then antibiotics and possible (drainage with a needle) aspiration are generally preferable. Recurrence rates are generally low (<5%), however if there has been previous surgery or infection, they can be as high as 20%. There is small risk to various nerves travelling within the neck, which may include the nerve to the face, tongue and shoulder. It is important your specialist talks to you about this.

This is a cyst that usually occurs in the front of the neck. It develops in the tissue that is sometimes left behind when your thyroid gland is developing at birth. It is usually painless, soft and round. It may move when you swallow or poke your tongue out. If the cysts become infected, then it may become painful and tender. It may leak pus like fluid. If it becomes more swollen it can occasionally interfere with your swallowing or breathing.

If they become acutely infected, it may require antibiotics and drainage of the pus. Once the acute infection has settled and things are less inflamed, surgery to remove the whole cyst can be considered. A scan is usually undertaken to confirm the diagnosis and exclude the rare possibility that this is a thyroid gland in the wrong place. Whilst there may be an option to simply observe it, if you are having problems, then your specialist is likely to advise removal of the lump.

Your surgeon will talk to you about what the surgery involves. If they are not removed adequately, then the recurrence rate can be high. Removal should normally incorporate the mid portion of the hyoid bone which sits behind the cyst. The hyoid bone is a small horseshoe shaped bone that sits underneath the tongue. The tract of the cyst may travel close to the hyoid bone. Removing this bone as part of the operation, reduces the chance of recurrence. The operation to remove a thyroglossal cyst is called a Sistrunk operation.  This is normally undertaken under general anaesthesia, with a 1-2 night stay in hospital.

There are a number of large (major) salivary glands within your neck. These include the submandibular glands, which sit under your jaw bone and the parotid glands which sit on the side of the face.

Submandibular Gland

These may become enlarged due to inflammation, infection or tumours which may be benign (non-cancerous) or malignant (cancerous). Occasionally stones can develop within the gland or duct and cause problems. 

If the lump fails to resolve and a diagnosis of malignancy has been excluded, there may be an option to observe this, or potentially consider surgical removal.

The submandibular gland sits next to important nerves within the upper neck, which supply the movement of your lower face, tongue as well as sensation to the tongue. It is important your surgeon talks to you about the risks involved and what they can do to minimise this.

Parotid Gland

This large salivary gland sits on the side of the face. This can be affected by benign lumps. The commonest lump is the Pleomorphic adenoma. This occurs in approximately 80% of individuals.

Whilst benign there is a small risk that this can turn into a cancer over time. The risk is small and in the region of 1.5% at 5 years and approximately 5% at 15years. Your specialist will investigate this further with a scan and needle biopsy.

Surgery on the parotid gland carries a risk to the nerve supplying the movement of the face. This is highly specialised surgery. It is important your surgeon is able to carefully identify the nerve. There are a number of ways which the facial nerve can be identified during surgery and carefully dissected away from the tumour. This may include the use of facial nerve monitors, finding the nerve as it travels within the bottom of the skull or other anatomical techniques.

The author has undertaken several hundred parotid operations. His risk of facial nerve injury are in the region of 2-3% as a temporary risk. That is a temporary weakness of the lower branches of the face which recover completely back to normal over weeks to months.

His risk of permanent weakness is 0%. Surgery is performed under general anaesthesia and usually includes a 1-2 night stay in hospital. A drain is normally kept in overnight and removed the following day.

The thyroid gland is like a bow-tie and is located in the lower part of the neck, below the voicebox (larynx) and above the collarbones.

A thyroid nodule is a lump in or on the thyroid gland. Thyroid nodules are detected in about 6 percent of women and 1-2 percent of men; they occur 10 times as often in older individuals, but are usually not diagnosed. Any time a lump is discovered in thyroid tissue, the possibility of cancer must be considered. More than 95 percent of thyroid nodules are benign (non-cancerous), but tests are needed to determine if a nodule is cancerous.These tests include a scan and needle biopsy.

Mr Silva works closely with the thyroid endocrine surgeons, Radu Mihai and Shad Khan’ who undertake this type of surgery. On occasion they will work together depending on the complexity of the case.

If you have any concerns or you wish to seek an opinion, please contact us here.