It is advisable to see an ENT doctor if you have noticed a swelling in the neck for a few weeks. These swellings may be painful or painless, persistent despite antibiotics, and maybe associated with ear, nose and throat symptoms.
Head and Neck Conditions
Head and Neck Procedures
Book an Appointment
At Adult and Child ENT Specialists, We are committed on providing Effective, Personalised & Holistic Care for all patients.
Head and Neck Conditions
Enlarged neck nodes
Enlarged neck nodes usually occur from an upper respiratory tract infection (virus or bacteria). Do not be alarmed if you notice or felt multiple/single, unilateral or bilateral painful neck swellings which started after your fever, cough or flu. They are often reactionary and most will self-resolve or disappear with a course of oral antibiotics. Suspicious neck nodes which requires further evaluation typically are firm/hard, painless, persistent for more than a month or growing in size.
A full head and neck examination with nasal endoscopy is performed to rule out primary causes in the head and neck. Fine needle aspiration cytology can be performed at bedside to sample a palpable node. Imaging such as ultrasound neck or CT neck may be ordered for further evaluation of the node. Removal of the node (excision biopsy) maybe required for histology and to rule out cancer (eg.lymphoma) in certain cases.
Neck abscess
Neck abscess is a collection of pus which has formed in spaces between structures of the neck or in your neck muscles (intramuscular abscess). Risk factors include diabetes, immunocompromised states or a complication from throat or dental infections. Neck abscess is a medical emergency as complications such as airway compromise, mediastinitis (inflammation of tissues in the chest), carotid artery rupture and jugular vein thrombosis can occur if left untreated. Management commonly includes CT neck with contrast (diagnosis, extension of abscess), intravenous antibiotics and surgical drainage.
Thyroid nodules
You may have a thyroid nodule if you observe that your neck swelling elevates on swallowing. An ultrasound of the thyroid gland, thyroid hormone test is required to characterise the nodule and to ascertain if your thyroid hormone level is in the normal range. A fine needle aspiration cytology (FNAC) is performed if your thyroid nodule is suspicious on ultrasound findings (TI-RADs classification). Thyroidectomy will be discussed with you after obtaining your FNAC results (Bethesda classification).
Salivary gland swelling
The three major salivary glands that supply saliva to your oral cavity are the parotid, submandibular and sublingual glands. These glands are situated at the corner of your jaw, below your jawline and under your tongue (floor of mouth) respectively. Infections (virus or bacterial), a blocked duct or stone may cause these glands to swell painfully. Treatment commonly includes oral antibiotics, pain-killers, hydration and dental/oral hygiene. Imaging and surgical management is required if your swelling is persistent or complications such as abscess collection occur.
A painless salivary swelling requires a full head and neck examination with nasal endoscopy, further imaging with CT/MRI and FNAC. Majority of these salivary gland lesions will require surgical removal.
Head and Neck Procedures
Fine needle aspiration cytology (FNAC)
FNAC is a bedside diagnostic procedure whereby a fine bore needle attached to a syringe is used to draw out cells or fluid from your neck swelling. These aspirates are sent to the lab for cytology. The procedure can be performed free-hand or with ultrasound guidance.
Excision biopsy
This procedure involves surgical removal of enlarged lymph nodes in entirety. You may have undergone prior tests such as imaging scans or FNAC. This procedure aids in diagnosis. There will be an scar in the neck and surgery can be performed under local or general anesthesia. Suture removal used to close the incision is commonly performed one week post-procedure in clinic.
Incision and drainage of neck abscess
This procedure is required when pus has accumulated in the deep neck spaces in your neck (deep neck space abscess) or in the muscles of your neck (intramuscular abscess); and oral/intravenous antibiotics did not help with improving the infection. The size and location of the abscess is first delineated on CT neck with contrast. Under general anaesthesia, Dr Soon will make an incision on the neck which will allow access to the pus cavity. The pus is drained, sent for culture and abscess wall sent for histology. The cavity is washed and left open for daily cleansing and debridement (removal of unhealthy tissue). Secondary suture (to close the wound) will be performed at a later date when the wound is clean.
Thyroidectomy
Thyroidectomy is a procedure performed to remove half (hemithyroidectomy) or all of your thyroid (total thyroidectomy). It is performed for diagnostic reasons if FNAC is inconclusive, or as therapy for thyroid cancer, or for a goitre (growing) causing compressive symptoms. It is performed under general anesthesia, and through a horizontal neck crease incision. A neck drain is left in the neck post-surgery and removed after 2-3 days depending on the drainage amount. Patients can opt to stay for a night and go home with the drain, or to stay inpatient till the drain is removed. Dr Soon will see you in a week to remove your sutures, and to discuss your histology results.
Parotidectomy
Parotidectomy is a procedure performed to remove all (total parotidectomy) or part of your parotid gland (superficial parotidectomy) under general anesthesia. It is indicated when you have a lesion in your parotid gland. Facial nerve monitoring is commonly used during surgery. A neck drain is left post-surgery and removed typically 2-3 days post-surgery depending on the drainage amount. Patients can choose to stay for a night, and thereafter home with drain or to stay inpatient till the drain is removed.
Excision Submandibular Gland
This procedure is performed to remove your submandibular gland through a horizontal skin crease incision below your jawline, under general anaesthesia. Indications for this procedure include a suspicious lesion proven on prior FNAC or imaging, a submandibular lymph node or a stone lodged in the gland. A neck drain is left post-surgery and removed typically 2-3 days post-surgery depending on the drainage amount. Patients can choose to stay for a night, and thereafter home with drain or to stay inpatient till the drain is removed.
Marsupialisation and Intraoral Removal of Salivary Stone
Salivary stones typically form in the duct of your submandibular gland or in the submandibular gland. These calcified stones (calculi) less commonly form in the parotid gland and rarely in the sublingual gland. If the stone is lodged in your submandibular duct, near the opening, it can be retrieved easily through an intra-oral approach by making a slit along the dilated duct, removing the stone and suturing the edges of the slit outwards (marsupialisation) allowing saliva to drain freely.
