Understanding the basic evaluation of the neck mass is essential in determining when a mass is insignificant or significant, and potentially malignant. Beginning with an understanding of neck anatomy, a thorough history and physical exam, this basic evaluation can become straightforward and well directed.
Most neck masses are secondary to enlargement of lymph nodes. Palpable masses of the thyroid are also relatively common. Less common masses arise from the major salivary glands or have congenital origins. It is uncommon to see neck masses arising from bone, cartilage, muscle, vasculature, or nerves of the head and neck.
The Sternocleidomastoid muscle defines the anterior and posterior triangle of the neck. The laryngo-tracheal complex defines the central neck. The majority of the parotid gland is located within the neck rather than in the lateral face and the submandibular gland is located below and just anterior to the angle of the mandible. The lymph nodes of the neck are described in six basic levels: level 1 (submandibular and submental), levels 2, 3, and 4 (high, mid, and low jugular chain), level 5 (posterior triangle) and level 6 (central neck).