Swellings of the Laryngeal/Pharyngeal Region

The larynx is located in the midline of the anterior part of the neck at the level of the cervical vertebrae C3–C6. It extends vertically from the tip of the epiglottis to the inferior border of the cricoid cartilage (at the level of C6) where it is continuous with the trachea, forming the laryngotracheal junction at the same horizontal level as the pharyngoesophageal junction. The pharynx is a centrally located posterior elongated chamber in the neck extending from the clivus superiorly to the pharyngoesophageal junction inferiorly, at the level of the lower border of the cricoid cartilage. From above downwards, the pharynx lies successively behind the nasal cavity (nasopharynx), the oral cavity (oropharynx), and the larynx (laryngopharynx). This chapter discusses the pathology, etiology, clinical presentation, complications, investigations (workup), diagnosis, differential diagnosis, management, and prognosis of midline neck swellings that may occur in the laryngeal/pharyngeal region, namely pre-laryngeal (Delphian) lymph node, laryngeal tumors (with particular emphasis on malignant laryngeal neoplasms, mainly squamous cell carcinoma and adenoid cystic carcinoma of the larynx), bursa in front of Adam’s apple, chondritis of thyroid cartilage (pyogenic chondritis—tuberculous chondritis), retropharyngeal abscess (pyogenic—tuberculous), and laryngocele.