Lumps in the head and neck
Investigation and treatment of benign lumps and swellings of the neck, jaw and salivary glands, from a Consultant who manages head and neck pathology every week in his NHS practice.
A lump in the neck deserves a proper look
Most lumps in the head and neck are benign: an enlarged lymph node after an infection, a cyst, a swollen salivary gland, a lipoma. But a lump that persists for more than two or three weeks should always be examined by a specialist, because the small number that are not benign are far easier to treat when found early. The purpose of a consultation is to find out what the lump is, promptly, and then treat it if it needs treating.
Chris investigates and treats:
- Salivary gland swellings: blocked ducts, salivary stones, recurrent infections and benign salivary gland tumours
- Neck lumps and enlarged lymph nodes
- Cysts of the neck, including branchial and thyroglossal cysts
- Lipomas and other soft-tissue lumps
- Swellings of the jaw and cheek
Investigation
After examining you, Chris will usually arrange an ultrasound scan of the neck, often with a fine-needle sample taken at the same time, which gives a diagnosis for most lumps without the need for surgery. Some lumps need a CT or MRI scan. Both private hospitals have imaging departments on site, and results are usually back within a week.
Treatment
Many lumps need no treatment once they have been diagnosed, only reassurance. Where removal is recommended, it ranges from a short procedure under local anaesthetic for a small lipoma or cyst to a day-case or overnight operation under general anaesthetic for a salivary gland. Chris performs removal of the submandibular gland and parotid gland surgery for benign disease, operations that need particular care because of the facial nerve and other structures nearby. He will explain the risks that apply to your operation specifically, and what to expect afterwards.
Do I definitely need treatment?
Not necessarily. Chris will first establish whether treatment is needed at all and whether there are reasonable alternatives to surgery. He may recommend leaving things alone when:
- a lump is a reactive lymph node after an infection, which will settle on its own and can be checked again in a few weeks
- an ultrasound and needle sample show a harmless lump that is not growing and not troubling you
- a salivary gland problem is caused by a stone or blockage that can be treated without removing the gland
What does the next week look like?
A typical recovery. Yours will be discussed with you individually before you decide to go ahead.
- That evening
- For a small lump under local anaesthetic, mild discomfort and a dressing. For salivary gland surgery, an overnight stay with a small drain in the neck.
- Day one
- A stiff neck and a numb patch of skin near the wound are normal. The drain, if you had one, usually comes out before you go home.
- Days 2 to 3
- Swelling and bruising in the neck at their most noticeable. Keep your head up when resting; it helps.
- By one week
- Stitches or clips out. Back to light activity. Numbness around the wound can take weeks to months to fade.
- Practicalities
- Driving
- Same day for a minor lump. About a week after neck surgery, once you can turn your head comfortably.
- Work
- Next day for a minor lump. 1 to 2 weeks after salivary gland surgery.
- Eating
- Normal after a minor lump. Soft food for a few days after gland surgery; it can be uncomfortable to chew at first.
Chris's view
"Nine neck lumps in ten are nothing serious, but I never assume which nine. An ultrasound and a needle sample give most people a clear answer within a week, and that's worth having."
Mr Christopher VinallWhen should I get advice?
Arrange an assessment for any lump in the neck that has been there for more than three weeks, swelling under the jaw or in front of the ear (particularly when eating), repeated salivary gland infections, or a lump found on a scan done for another reason.