Head and neck lumps are common diseases, and because of the large number of organs in the head and neck, patients often do not know how to self-judge and diagnose the disease, which can easily overlook the condition and delay the necessary treatment. Roughly speaking, head and neck masses can be divided into three main categories: inflammatory diseases, congenital diseases and tumors. The diagnosis of neck lumps should be based on a combination of disease duration, location and nature of the lump. Generally speaking, lumps that occur within a short period of time (e.g., 7 days) are generally inflammatory, those that have been found for a long time (e.g., 7 years) are mostly congenital, and those of moderate duration (e.g., 7 weeks) are mostly tumors. If the mass is located in the lower anterior neck, thyroid tumor should be considered first, if it is located under the jaw, submandibular gland tumor or lymph nodes should be considered, and if it is located in the area under the ear, parotid origin should be considered. If the mass is single and not painful, benign tumor of neurological origin should be considered first. If they are arranged longitudinally in a bead pattern, the possibility of tuberculosis should be noted. If the mass is painless, multiple, fused, and if accompanied by fever, malignant lymphoma should be considered. If the tumor is located below the ear, with hard texture, poor mobility and more obvious recent enlargement, metastatic tumors of pharyngeal and laryngeal origin should be considered, especially for residents of southeastern region of China, because nasopharyngeal cancer is highly prevalent in the south of China. The following are the characteristics and differentiation of several common neck masses. 1. Thyroid tongue duct cyst: The thyroid gland originates from the endoderm at the bottom of the pharynx during the embryonic stage and moves downward at 15 weeks, eventually staying in front of the trachea, with the isthmus located in front of the 2nd to 4th tracheal ring, and there is a thyroid tongue duct between the thyroid gland and the bottom of the pharynx. If the remnants of thyroid tissue are retained in any part of the downward migration, the thyroglossal duct may continue to exist after birth, resulting in a cystic swelling in the anterior neck, called a thyroglossal duct cyst. The cyst is located in the anterior midline of the neck, mostly near the hyoid bone, and sometimes the cyst grows at the root of the tongue, and a swelling can be seen from the root of the tongue in the oral cavity. When the patient is asked to swallow, the cyst moves up and down with swallowing, and it has high tension and cystic feeling when touched by hand. A thyroid nuclear scan is useful to help me diagnose the thyroid tongue duct cyst and its location. When infection occurs, the thyroglossal conduit becomes enlarged and purulent from time to time, which is acute purulent thyroiditis. 2. Goiter: Goiter is very common, with an incidence of 2% to 6%. The thyroid gland is located in the neck in front of the trachea, covered by the pre-tracheal fascia and fixed to the tracheal ring. When the patient swallows, the thyroid gland moves up and down with the esophagus and trachea, and we can feel the thyroid gland sliding under the examiner’s fingers during the examination. At this point we can use our fingers to feel the size and shape of the thyroid gland. This is a necessary technique for examining the thyroid gland and is a reliable way to distinguish the thyroid gland in the neck from other masses. The normal thyroid is soft and cannot be felt; when an enlargement or tumor occurs, it can be felt. There are many causes of goiter, the most common being simple goiter. Other more common ones include nodular goiter, diffuse toxic goiter (i.e. hyperthyroidism), slow onychitis, primary hypothyroidism combined with goiter, subacute thyroiditis, thyroid cyst, toxic functionally autonomous goiter, and thyroid tumor. 3. Ectopic thyroid gland: Ectopic thyroid gland is formed when the embryonic thyroid gland, in the process of downward migration, may move down excessively, down to the posterior sternum or even the pericardium. Ectopic thyroid can occur in the posterior sternum, submandibular, pericardium, etc. There are even reports of ectopic thyroid occurring in the angle of the jaw or scapula. The ectopic thyroid gland is an abnormal thyroid gland that gradually degenerates with age due to dysplasia and gradually decreases in function, such as elevated thyroid stimulating hormone levels, leading to an enlarged ectopic thyroid gland. At this time, patients often come to the clinic with a lump in the neck, either by themselves or by others. Some doctors do not consider the possibility of ectopic thyroid before surgery and remove the lump without examining the relationship between the lump and the thyroid gland, without performing a thyroid nuclear imaging test, and without giving any explanation to the germ. As a result, the surgery accelerated the onset of hypothyroidism and the patient required lifelong thyroid hormone replacement therapy. Post-operative patients who develop hypothyroidism know to take thyroid hormone for life, and medical disputes often occur as a result. Ectopic thyroids can be shown very specifically by means of thyroid nuclide imaging. Most patients have thyroid tissue in both a normal part of the thyroid gland and in other parts of the body. If we consider the possibility of ectopic thyroid before surgery, a correct diagnosis can be made with radioiodine examination. Supplemental thyroid hormone preparations can make the enlarged thyroid gland smaller and avoid unnecessary surgery. 4, gill slit cysts: gill slit cysts are located in the anterior cervical triangle, along the anterior border of the sternocleidomastoid muscle, mostly in the upper cervical submandibular region, and are sexy to the touch. Because of the rich lymphatic tissue of the cyst wall and the interconnection with the lymphatic tissue of the pharynx, when infection occurs in the pharynx or oral cavity, the gill slit cyst also increases in size with the occurrence of infection, and the pain and pressure pain is obvious, and even causes fever. 5, cervical lymph node enlargement: cervical lymph node enlargement for infection or tumor metastasis is common. Infections in the oral cavity and pharynx often cause swollen and painful submandibular lymph nodes, which are sometimes large and sometimes small, and the swollen lymph nodes are not obvious, but pain and pressure are obvious. Lymphatic tuberculosis mostly occurs in the submandibular, posterior anterior border of sternocleidomastoid muscle and supraclavicular. Most patients have toxic symptoms of tuberculosis such as malaise, low fever, night sweats, and emaciation. Generally, they do not adhere to the surrounding tissues, can slide freely when pushed, and are painless when pressed. Later, they can form cold abscesses, fistulas and ulcers. At this time, the lymph nodes are found to be adherent to the surrounding tissues. There is a certain pattern of cancer cell metastasis via lymphatic fluid. The lymph nodes in front of the sternocleidomastoid muscle, including the submandibular triangle and the paracervical area, are commonly found in the metastases of thyroid, oral cavity, nose and throat. Metastatic cancer in the posterior cervical triangle behind the sternocleidomastoid muscle is less common, and occasionally seen in tuberculous lymph node enlargement and malignant lymphoma. The supraclavicular region is the most frequent site of metastatic cancer. Metastatic cancer from the gastrointestinal tract on the left side and metastatic cancer from the lung on the right side are most common. Breast cancer mostly occurs in the ipsilateral axillary and neck lymph node enlargement. The local characteristics of metastatic lymph nodes are fixed mass, hard texture, fast growth and adhesion to surrounding tissues. 6.Hemangioma: spongy and trapezoid hemangioma. They are purple-red and dark red, soft in texture and vary in size and shape, and shrink after pressure is applied and return to their original shape immediately after decompression. 7.Cystic hydatid tumor: mostly congenital, located in the supraclavicular fossa and posterior cervical triangle, slow growing, not adherent to the skin, but can be adherent to the subcutaneous tissue, cystic, translucent, visible with a flashlight. 8.Dermatoglyphic cyst: mostly located in the sub-chin triangle, single round, not adherent to the skin, adherent to the deep subcutaneous tissue. Parotid tumors: Parotid tumors include benign tumors, mixed tumors of the parotid gland and malignant tumors. Parotid tumors are located between the earlobe and the angle of the lower jaw. 10.Neurofibroma or nerve sheath tumor: It is a kind of benign tumor of nerve tissue, mostly from sympathetic nerve and vagus nerve, with slow growth. It is tough in texture, painless when pressed, mostly located in the anterior cervical triangle, parapharynx and supraclavicular region, and has no adhesion with skin-colored surrounding tissues. 11.Carotid body aneurysm: Carotid body is a kind of chemoreceptor. Carotid body aneurysms are slow growing, mostly located at the anterior border of the sternocleidomastoid muscle of the carotid triangle below the angle of the jaw, and are single round or oval masses, which resemble hard rubber when touched and can be moved left and right, but with limited up and down movement, and sometimes vascular pulsation can be felt and vascular exhaustion murmurs can be heard. For the prevention of neck lumps, the following points should be noted 1. 1. Self-examination and touching of the neck, especially both sides of the neck area, if there is any suspicion, go to the hospital for examination as soon as possible for early detection; 2. We can also use various means such as blood biochemistry, national bacteria culture, B-ultrasound, CT and MRI (magnetic resonance imaging), thyroid fine needle aspiration cytology, endoscopy (rhinoscopy, laryngoscopy, bronchoscopy, gastroscopy, etc.), X-ray, biopsy, cell smear, etc. to help us determine the nature.