Neck abnormalities

Question 1

Causes of short neck

Answer 1

1. Turner’s Syndrome
2. Gorgylism
3. Klippel- Feil Syndrome (Developmental anomaly of upper cervical vertebral column; with reduced number or fusion of them); Neck: vertebral fusion, cervical spina bifida, webbing and limited movement;
   Association: Torticollis, Hemivertebrae, fused rib; Neurodefect - moebius syndrome, syringomyelia, deafness, micrognathia, cleft palate, congenital heart disease
4. Spondyloepiphyseal dysplasia

Question 2

Steps in examination of Short Neck

Answer 2

1. Note range of movement and any associated deformity like webbing, scar, low, M-shape hairline
2. Note the height of patient and if there is facial dysmorphism
3. Examine the limbs - short and deformed, limited flexion in gargoylism, increase carrying angle in Turner’s syndrome
4. Spine examination - Abnormality and Sprengel shoulder (Congenital elevation of the scapula)
5. Chest - Shield-like and widely spaced nipples, sign of COA
6. Abdomen - hepatosplenomegaly

Question 3

Causes of lateral neck masses

Answer 3

1. Cervical LNs - viral (URI, Infectious Mononucleosis), Pyogenic, TB, Toxo, Kawasaki’s disease, tumor - Lymphoma, Leukaemia, secondary tumor
2. Cystic Hygroma
3. Branchial cyst
4. Sternomastoid tumor

Question 4

Steps in examination of neck masses

Answer 4

1. Local examination - rmb to transluminate
2. Look for infection or tumor in drainage areas: Throat, ears and scalp
3. Other LN enlargement
4. Hepatosplenomegaly

Question 5

Causes of wry neck or torticollis or head tilting

Answer 5

1. Muscular (sternomastoid tumor, myositis ossificans)
2. Vertebral (Subluxation of atlanto-axial joint with URI;
   Rheumatoid arthritis; Klippel- Feil syndrome; Scoliosis)
3. Soft tissue (cervical lymphadenitis; tonsillar abcess)
4. Eye (4th nerve palsy)
5. Ear (Vestibular disturbance)
6. Brain (Posterior fossa tumor causing cerebellar damage)
7. Drug induced dystonia (Phenothiazine, Metoclopramide)

Question 6

Causes of webbing of neck

Answer 6

1. Turner’s syndrome
2. Noonan’s syndrome
3. Escobak syndrome - Camptodactyly and Syndactyly)

Remark: Redundant skin fold at neck: Down’s; Patau’s; Klippel Feil syndrome

Question 7

Brown Syndrome

Answer 7

Adduction of eye - Cannot elevate the eye so that eye becomes deviated (downwards) due to shortened superior oblique tendon/ adhesion between tendon and its sheath due to inflammation

Question 8

Duane Syndrome

Answer 8

Defect in abduction with retraction of eyeball - adduction of affected eye - vertical /oblique movement of eyeball + narrowing of palpebral fissure;
Due to abnormal rectus muscle innervation or fibrosis of rectus muscle