Question
QUESTION: Hi,
In may of this year I had a lymph node biopsy done on a deep lymph node in the anterior neck triangle. The biopsy was benign and reactive. Recently when I feel around on my neck where the scar is on the right side of my neck it feels very lumpy. I have asked my ent who did the surgery and he believes its just scar tissue and nothing which would require a follow up ct. Today I was pushing on the area of the scar  when I turn my head and neck the other direction and push on that area it feels like something hard like a bone is poking the opposite (left) side of my neck. I tried to push on the same area on the other side of my neck and I don't feel that feeling of something poking me in the neck. Also when i push on the area of te scar indont feel the hard think poking me. I only feel it when i push on the scar ans turn my head at the same time. I assume this has to do with the surgery and the scar tissue. I am just concerned what feels like its poking me an why it doesn't feel the same on the other side. I have asked the ent a few different times that i still feel the lump sensation in my neck, exactly what I was feeling before they did the ct and figured out I had several swollen lymph nodes the largest being 2 cm. the lump nodes were deep, none of the doctors could feel them from the outside. I could feel it inside my neck. Should I be concerned about this? When I push on the scar area and feel something hard poking me on the opposite side? Thanks.

ANSWER: Hi Kim,

Even if I were to say there is nothing to be concerned about, you would still be concerned. That's the way it is. If you feel concerned, it is justified. Like you said, the doctors could not feel it, but you could. However, I can say that you probably should listen to your ENT, at least for a little while. Scar tissue can be an issue after surgery and may be so for quite a while - maybe up to a year or even more. It is difficult to discern exactly what your are feeling, perhaps part of the cartilage. The more sensitive you become to palpation, the more you will notice. I'm not sure if it was a simple biopsy or if they removed all of the nodes indicated on CT. It will take a while for things to settle. If the area on the opposite side of your neck is painful upon palpation, it may be a little more concerning, however, structures in that area can be sensitive. Pushing and rotating will tend to bring structures out like articulations and cartilage. These things are not always completely symmetrical as one would think.

If it was just a sample for biopsy, things may not change that much, however, removal of node(s) would be more significant and would produce more scar tissue. If there are nodes remaining, if you are pushing them to the opposite side, it would tend to extend the area further. It is difficult to discern, however, the scar is significant in size.

Bottom line, if you are that concerned, either insist on a post-op CT scan and make sure the doctor takes note of your concern and places it in his/her office notes, perhaps write a certified letter expressing your concerns - this would be difficult to ignore, or get a second opinion.

I hope everything is OK and it is just scar tissue, which is most likely the case.

All the best and thanks for asking; although not my area of expertise, I hope this helps somewhat or gives you some direction.

Dr. Steve

---------- FOLLOW-UP ----------

QUESTION: Thank you for your input. There were quit a few nodes which showed up on the ct scan being enlarged but the largest one was on the right side close to 2 cm.  He removed two nodes which were embedded. The incision was not suppose to be that large. The reason that the nodes weren't able to be felt from the outside is bc they were so deeply embedded inside my neck. My main concern now is when I push on the scar while I turn my neck the opposite direction it feels painful like something is poking me. I almost think when I push on the scar it's pushing the hyoid bone into my neck. I can feel the bone in that area. I guess what I am asking is would that be possible? I don't feel it when I just push in on it it's only when i push and turn at the same time. Other than that I am not having any pain. Sometimes the incision is still a little tender when it gets bumped by my one year old. I figured I would give it a little more time then ask again for a follow up ct. There were also some swollen nodes on the opposite side that weren't removed so I was curious to see of thoses were still swollen. Every now and again I feel a lump but its mainly when I turn my head so I am assuming its scar tissue. I keep telling myself not to be to worried bc the biopsy was benign so that means its nothing serious going on. Do you think i am safe to think that whatever I feel which is poking me has to be related to the scar and incision even though the poking feeling is on the opposite side of my neck? It's almost like the scar tissue is pressing on the cartilage which is pressing onto the hyoid bone. Is this all connected and possible? Thanks for your time.

Answer
Thank you for your input.

You are welcome Kim. Please excuse my lack of expertise in this matter.

There were quit a few nodes which showed up on the ct scan being enlarged but the largest one was on the right side close to 2 cm.  He removed two nodes which were embedded.

I assume he removed the 2cm and another of the larger ones on the right side.

The incision was not suppose to be that large.

I can only assume it is because of the depth of the enlarged nodes.

The reason that the nodes weren't able to be felt from the outside is bc they were so deeply embedded inside my neck.

I understand that only you were able to feel them by palpation. Not sure if they were, in themselves, painful; however, swollen lymph nodes typically are.

My main concern now is when I push on the scar while I turn my neck the opposite direction it feels painful like something is poking me. I almost think when I push on the scar it's pushing the hyoid bone into my neck. I can feel the bone in that area. I guess what I am asking is would that be possible?

You are saying, when you press into the area of surgery and rotate your head to the left, you feel a painful prominence in the neck, opposite of the surgical area.

Is the feeling on the skin or does it feel deeper? Is the pain only when you, after pressing in the right side and turning left, press on the left side where the prominence is?

I almost think when I push on the scar it's pushing the hyoid bone into my neck. I can feel the bone in that area. I guess what I am asking is would that be possible?

It is possible that scar tissue can have that effect, however, you are very sensitive in that area. It could be muscles that are recovering and have scar tissue. Again, we are not perfectly symmetrical, and it could be that one side is slightly larger. It could be that you have other lymph nodes that may be enlarged on the left side. Because you had surgery on the right side, and the scar was larger because he had to go deeper than planned, there may have been a significant area of tissue removal - try comparing with less pressure on the right side than the left to, perhaps get a more balanced comparison.

You should also be able to look in the mirror with your head straight and place you index finger in the depression of the larynx, and this should be directly under your chin. If you then flex your head - bend your head down, you should feel the hyoid bone slide under your finger and you can follow that up to get a general idea of center, however, the hyoid will not have a similar depression. The hyoid spreads directly out to the side on either side, and you can follow them out using your index finger and thumb to get an idea of symmetry. Because there are muscle attachments, one side may be more tender, especially the deeper out to the sides you get. Just be soft, you can discern more with a lighter touch.

Sometimes the incision is still a little tender when it gets bumped by my one year old. I figured I would give it a little more time then ask again for a follow up ct. There were also some swollen nodes on the opposite side that weren't removed so I was curious to see of those were still swollen.

Maybe try wearing a soft collar to help keep the area warm and protect it for a while when you need. I am a big fan of follow up exams, and a CT would certainly be most welcome regarding condition and any future consequences or planning. Considering your history; fortunately benign - I assume by "reactive", it means they are enlarging, and your anxiety regarding what you are experiencing, a follow up CT would be nice.       

Every now and again I feel a lump but its mainly when I turn my head so I am assuming its scar tissue. I keep telling myself not to be to worried bc the biopsy was benign so that means its nothing serious going on.

Yes, it is very good there is no malignancy, however, if by reactive it means growing, the concern would be pressure on any sensitive structures should on significantly enlarge, and your doctor should be able to determine this.

Do you think i am safe to think that whatever I feel which is poking me has to be related to the scar and incision even though the poking feeling is on the opposite side of my neck?

No. I would rather have examination findings which correlate with imaging studies.

It's almost like the scar tissue is pressing on the cartilage which is pressing onto the hyoid bone. Is this all connected and possible?

Well, scar tissue would tend to restrict motion as it is not as resilient as normal tissue. Pressing seems to suggest force and I'm not sure scar tissue would do that.

Kind regards,

Dr. Steve