Throat vs Front of Neck Pain
While most of us refer to the front of the neck as the throat, this is often anatomically incorrect. The throat is only one part of the upper respiratory tract and digestive tract. It is also known as the pharynx. It connects the mouth and nasal cavity to the lower airways (larynx and then trachea) as well as to the esophagus (food pipe). A small flap known as the epiglottis ensures that food and fluids do not enter the airways but instead travel down the esophagus.
Therefore throat pain would refer to pharyngeal pain (also known as a sore throat) which is often caused by pharyngitis. When looking at pain at the front of the neck it is important to understand that throat problems is only one possible cause. There are several other conditions that may cause front neck pain which does not involve the pharynx (throat) in any way.
Organs at the Front of the Neck
When assessing pain in any part of the body, it is important to first consider all the organs lying in this area. The vertebrae are bones that lie at the back as part of the spinal column and these organs/structures towards the back (posteriorly) will not be considered. Apart from the mandible (lower jaw bone) on the head and sternum (breastbone) on the chest, there are no other significant bones in the front of the neck, except for the small hyoid bone.
Therefore the most significant organs or structures at the front of the neck include:
- Muscles – Platysma, sternoclediomastoid, supra- and infrahyoid muscles (groups of 4 muscles each).
- Arteries – Common carotid arteries, external internal carotid arteries.
- Veins – External and internal jugular veins.
- Airways – Pharynx, epiglottis, larynx and trachea.
- Glands – Thyroid and parathyroid glands.
- Lymph nodes – anterior (superficial and deep)
There are several small nerves that branch from large cranial nerves which are located at the sides (laterally) and back (posteriorly) of the neck apart from spinal nerves. Disorders of the nerves such as the thyroid, thyroglossal,
glossopharynreal, phrenic and recurrent laryngeal nerves need to be considered as possible causes of neck pain but have not been discussed separately in the causes below.
Causes of Pain in Front of Neck
Some of the more common causes of pain at the front of the neck have been discussed in detail. However, this is not all the causes of front neck pain. It is important that the pain is assessed by a doctor who can then consider other symptoms and possibly conduct diagnostic investigations to reach a final diagnosis. Some of the causes of front neck pain are serious and potentially life-threatening. Early diagnosis and treatment can improve the outcome.
Muscle strain is one of the common causes of front neck pain. It may involve the outermost (superficial muscles) but can also extend to the deeper muscles. A common reason for muscle strain is poor posture and prolonged periods of keeping the neck fixed in one position, like when viewing a screen as is seen in text neck syndrome.
The muscles may also become injured with a blow or following events like a car accident. The sudden forward and backward jerking with impact (whiplash) may also arise with certain contact sports. Tears in the neck muscles are uncommon but can also occur in severe injuries. However, various other neck injuries can also cause pain.
Pain arising from the blood vessels is not common. It may occur with inflammation of the blood vessels (arteritis or phlebitis) or with tears in the blood vessel wall (dissection). Giant cell arteritis is more widely known to affect the arteries supplying the temple of the head but can also involve the carotid artery. The exact cause of this condition is unclear. Pain is more likely to arise in the areas that are being supplied by these arteries as the blood supply to the area is insufficient and may result in tissue injury (ischemia).
Conditions affecting the pharynx (throat), larynx (voice box) and trachea (windpipe) may be responsible for pain in the front of the neck. Inflammation of the airways (pharyngitis, laryngitis and tracheitis) is often due to infections. Another common yet lesser known cause of airway inflammation is due to acid reflux (gastroesophageal reflux disease or GERD). This is known as reflux pharyngitis or reflux laryngitis. Vocal cord lesions (nodules, polyps or cysts) may also cause front neck pain.
Thyroid and Parathyroid Glands
Several thyroid problems and parathyroid conditions may present with pain. This can lead to disturbances in gland function. It is important to note that most causes of hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid) are painless. However, conditions like thyroiditis (thyroid inflammation), some forms of thyroid nodules and thyroid enlargement (goiter) can be painful. Similar conditions may affect the parathyroid gland.
The cervical (neck) lymph nodes may become enlarged for several reasons, with infections being the most common cause. The nodes are an important part of the immune system trapping and destroying infectious agents and abnormal cells in the area. These swollen neck lymph nodes may or may not be painful. Autoimmune conditions and medication (rarely) can also cause enlargement of the neck lymph nodes.
Cancer in the neck region may arise in a number of the organs and structures discussed above. Throat cancer may include cancer of the throat (pharynx) or voice box (larynx). Thyroid cancer is among the more common types of cancer while parathryoid cancer is relatively rare. A lymphoma is cancer of the lymph node. Cancers from elsewhere in the body can spread to the neck region and cause secondary cancer (metastatic cancer).
Other Signs and Symptoms
Pain in the front of the neck is a symptom of some underlying condition. Depending on the cause it may be accompanied by other signs and symptoms which arise as a result of the dysfunction of a specific organ or structure of the front of the neck. These signs and symptoms may include:
- Difficulty swallowing
- Painful swallowing
- Hoarse voice or loss of voice
- Neck stiffness
- Bloody sputum
- Abnormal breathing sounds
When symptoms like bloody sputum is accompanied by unintentional weight loss or persistent fever then this may red flag signs of serious disorders like cancer.
- Neck Pain. MSD Manual