The neck contains a dense arrangement of bone, muscle, cartilage, and soft tissue. Noticing a depression or indentation in this region is common. These indents can represent normal anatomical landmarks, acquired changes related to lifestyle, or signs of an underlying medical condition. Understanding the specific structures in the neck helps distinguish between a natural variation and a change that warrants professional attention.
Anatomical Structures That Mimic Indents
The most frequent reason for noticing a neck indent is observing a naturally recessed part of the skeletal structure. The most prominent example is the suprasternal notch, or jugular notch, a large dip located centrally at the base of the throat. This depression sits above the manubrium (upper breastbone) and between the collarbones (clavicles). The notch serves as an important reference point for internal structures like the trachea and major blood vessels.
The junction where large neck muscles meet the collarbones can also create noticeable depressions. The sternocleidomastoid (SCM) muscle runs from behind the ear to the collarbone and breastbone. The triangular space between its two lower heads (sternal and clavicular) is known as the lesser supraclavicular fossa, which forms a natural surface depression.
Contours around the laryngeal prominence, or Adam’s apple, can also produce depressions. The cartilage and muscles surrounding the larynx create shadows, particularly when the head is tilted or when swallowing.
Acquired Indentations
Indentations can develop over time due to external forces, repetitive strain, or changes in soft tissue composition. “Tech neck” is a common example, caused by prolonged forward-head posture while looking at screens. This chronic tilt strains neck muscles, leading to soft tissue changes that create horizontal creases or indents in the skin and fat pads.
Repetitive pressure during sleep can cause temporary depressions in the subcutaneous fat. Sleeping consistently on one side compresses adipose tissue, leading to a localized depression that resolves slowly. Localized lipodystrophy, characterized by fat loss from a small area, also manifests as a dent or crater.
This fat loss is often drug-induced, occurring at sites of repeated medication injection, such as insulin or steroids. Additionally, scar tissue from a healed injury, minor surgery, or a resolved deep acne cyst can result in a depressed area where underlying tissue has retracted or fibrosed.
Indents as Symptoms of Underlying Conditions
While many indents are benign, some depressions signal medically significant issues. Congenital cysts and masses, though usually lumps, can appear as a dimple or pit, especially if small or connected to a deeper structure via a sinus tract. Branchial cleft cysts, developmental anomalies, occasionally present as a small skin pit or opening along the side of the neck.
The loss of muscle bulk, known as muscular atrophy, causes a visible indentation where the muscle should be prominent. Atrophy of the sternocleidomastoid (SCM) muscle, for example, can lead to a noticeable depression. This often occurs as a complication following neck dissection surgery for head and neck cancers, typically due to nerve or blood supply damage during the procedure.
Post-surgical changes following procedures like a thyroidectomy or lymph node removal can also leave a depression due to tissue removal or internal scar adhesions. In rare instances, a skeletal abnormality may alter the neck’s contour, making the overlying soft tissue appear sunken. A cervical rib, an extra rib growing from the lowest neck bone, can distort the anatomy enough to create an apparent indentation.
Guidance on Professional Consultation
If a neck indentation is new, changing, or accompanied by other symptoms, seek a professional medical evaluation. Any indent that appears suddenly, grows rapidly, or feels hard and fixed should be examined by a healthcare provider. Indentations that are painful, tender, warm, or red may indicate an underlying infection or inflammation.
Other signs that warrant prompt consultation include difficulty swallowing, a persistent change in voice, or unexplained fever. A medical professional can use imaging, such as ultrasound or computed tomography (CT) scans, to determine if the depression is a harmless soft tissue change or related to a deeper structure like a cyst, atrophied muscle, or skeletal variation.