OtoRhinoLaryngology Portal

The Leading Online Gallery of Otolaryngology and Head & Neck Surgery Specialty

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Neck Muscles Anatomy - Posterior Triangle, Prevertebral and Lateral Muscles

Neck Lump

The probable aetiologies of a neck lump in this area includes lymph nodes enlargement, branchial cyst, and parotid mass.  CT-scan and FNAC are usually carried out prior to its surgical intervention.

Swelling caused by benign parotid tumour.

Swelling caused by submandibular lymphangioma.


 Secondary infection of sub-vermilion border skin (arrow) which had occured upon traumatic shaving.  Submental lymphadenitis (ellipse) is visible and palpable as a tender swelling on the ipsilateral submental region.

Submental swelling and induration secondary to suppurative lymphadenitis.

 Kikuchi disease (histologically-confirmed) presenting with painful submental (arrow) and upper cervical lymphadenopathy.

Transillumination in Cystic Neck Swelling

Transillumination of cystic neck swelling caused by lymphangioma.  

[C- chin, M- mastoid tip, S- suprasternal notch]


CT-scan of neck in sagittal and axial plane showing a left-sided submandibular lymphangioma which was successfully removed surgically.

Thyroglossal Cyst

Thyroglossal cyst in a 9 year old child. 


A similar swelling in an adult with differentials including midline lymphadenophathy, lipoma and dermoid cyst.

Throglossal Cyst (In An Adult)


A well-defined central upper neck swelling.


Positive transillumination test.


 Markings after skin preparation and draping done intraoperatively.  [1 - midline at symphysis menti, 2 - hyoid bone level, 3 - skin crease incision line for exposure, 4 - superior thyroid notch, 5 - cricoid cartilage level, 6 - suprasternal notch]


 The cyst prior to delivery.

 The 'bed' of the cyst (*).  [T - thyroid cartilage.dot - central point of the superior thyroid notch, 1 - symphysis menti, 5 - cricoid cartilage level]

 Preoperative endolaryngeal view during phonation showing supraglottic narrowing (+) involving right false cord, petiole area, and diffuse bulge of right aryepiglottic fold.  [PF - pyriform fossa, PPW - posterior pharyngeal wall towards hypopharynx] 

 Preoperative endolaryngeal view during at rest showing supraglottic narrowing (+) involving right false cord, petiole area, and diffuse bulge of right aryepiglottic fold.  [PF - pyriform fossa, PPW - posterior pharyngeal wall towards hypopharynx]


Postoperative endolaryngeal view during phonation (A) and at rest (B) 24 hours after surgery showing dramatic improvement of supraglottic narrowinng.  Clinically, laryngeal innervations appeared intact and the patient's voice retured to normal.  NB: credit of this image to Dr. Tan Teck Soon.

Branchial Cyst

CT-scan slice in coronal view.  [(+) - cyst]


CT-scan slice in axial view.  [(+) - cyst]


Swelling caused by right branchial cyst (+).


 The typical location of the swelling (oval).

 The cyst in view (+).  The sternomastoid muscle being retracted laterally.


White dashed line - surface marking of sternomastoid muscle.

Thyroid Isthmus Mass

Thyroid isthmus mass(circle). Yellow dots- sternal ends of clavicles.

Thyroid Gland Movements Upon Swallowing

Thyroid swelling characteristically

moves up upon swallowing.



Diffuse goitre at rest.



Diffuse goitre upon swallowing.


Left-sided goitre (+) made more prominent upon swallowing

Central goitre moves up upon swallowing.



Video of thyroid movement upon swallowing.

Grave's Opthalmopathy

Significant proptosis and conjunctival chemosis

The Recurent Laryngeal Nerve after Thyroidectomy

Figure shows right recurrent laryngeal nerve running alongside of tracheal wall.

Right recurrent laryngeal nerve (arrow) running in an angular course towards its destination behind the cricothyroid joint.  [T-trachea, RL-right thyroid lobe, LL-thyroid lobe]

Left recurrent laryngeal nerve (arrow) running in a more vertical course towards its destination behind the cricothyroid joint.  [S-superior, R-right, L-left, T-trachea, SH-sternohyoid muscle, SM-sternomastoid muscle,

C-cicothyroid muscle]

Healed thyroidectomy scar (arrows).


 Watch total thyroidectomy video @ YouTube

Watch another video of thyroidectomy @ YouTube

The Recurent Laryngeal Nerve Anatomical Relations During Total Laryngectomy


  H- head, T- thorax, S- sternomastoid, CA- common carotid artery, T- trachea,

E- oesophagus, TH- thyroid gland, arrow- recurrent laryngeal nerve.

An example of EMG endotracheal tube used for intraoperative recurrent laryngeal nerve monitoring in thyroid and parathyroid surgery.



The above endotracheal tube in place. 


Read more at Otolaryngology Houston



Total Thyroidectomy Specimen


Figure shows a large excised total thyroidectomy specimen in anatomical position.  The typical bosselated appearance of multinodular goitre is shown.




An intraoperative view of a huge multinodular goitre which had caused extrinsic compression of the oesophagus resulting in dysphagia.  [R - right, L - left, ct - right cricothyroid muscle]

Retrosternal Goitre: CT-scan

Retrosternal Goitre with Tracheal Deviation

Retrosternal goitre with mediastinal extension causing extrinsic compression and deviation of trachea to right (dashed red line). 

Ectopic Thyroid in The Throat (Tongue Base)


Thyroid Cyst: CT-scan

 CT-scan axial view.

 CT-scan coronal view.

 CT-scan sagittal view.


A well-defined high attenuation lesion in upper pole of right thyroid lobe with possibilities of haemorrhagic cyst or infected cyst.

Thyroid Surgery & Its Complications

The Carotid Body Tumour

Superficial Cervical Lymphadenopathy

Tuberculous Cervical "Cold" Abscess

 Diagnostic aspiration of formed "cold abscess".  The fluid was sent for direct AFB smear, TB PCR and standard culture and sensitivity test.  TB PCR was found positive from the aspirated abscess.


 Close-up view of the fluid aspirated.


 Necrotic right supraclavicular lymphadenopathy (same patient) with dried scab (dotted circle). 

Mantoux Test

This is a diagnostic test of Tuberculosis. 


More Info: Wikipedia


Watch video of Mantoux Test and Reading the PPD @ YouTube




Induration of forearm skin 72 hours after Mantoux test. 

 Positive Mantoux test (45 mm) in a patient presented with cervical lymphadenopathy of 3 weeks duration.

 An acute induration surrounding BCG scar in a child with Kawasaki disease.

Pulmonary Tuberculosis Presenting with Haemoptysis


Laryngeal evidence of haemoptysis in a patient with pulmonary tuberculosis.