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Midline and Anterior Triangle Lumps (Thyroglossal Cyst (Viva (Differential…
Midline and Anterior Triangle Lumps
Thyroglossal Cyst
Presentation
Young pt.
Fluctuant midline neck lump
Usually subhyoid
Protrusion of tongue → elevation
Swallowing → elevation
May see opening of a thyroglossal
sinus
Following removal there will be a
transverse incision just above the
thyroid cartilage.
Pathology
Persistence of any part of the thyroglossal duct
which marks the developmental descent of the
thyroid from the foramen caecum
Ectopic thyroid tissue can be found anywhere
along this path of descent.
Cysts may contain thyroid tissue which can
undergo malignant change → papillary Ca
Viva
Differential
Thyroid nodule and masses
Dermoid / epidermal cysts
Subhyoid bursa
Epidemiology
Rare
M=F
40% in 1st decade
Complications
Infection
Sinus formation
Development of Ca
Recurrence post-op
Tx
Sistrunk’s Operation
Inject patent tract w/ dye at start
Excise cyst and patent tract
Need to central portion of hyoid
as tract runs through it.
Branchial Cyst
Pathology
Failed fusion of 2nd and 3rd branchial arches
Lined by squamous epithelium
Contain “glary” fluid w/ cholesterol crystals
Presentation
Young pt.
Ant. margin of SCM at junction of
upper and middle thirds
Firm, fluctuant ovoid swelling
Opaque on transillumination
May be opening from branchial sinus
Complications
Infection
Sinus formation
Recurrence post-op
Tx
Surgical Excision
Bonney’s blue dye can be
injected into fistula to allow more
accurate excision
May be difficult due to proximity
of carotids
Medical
Sclerotherapy is an option
Chemodectoma
Pathology
Very rare
Tumour of the paraganglion cells of the carotid
bodies: measure pH and PaO2 and PaCO2
Located @ the carotid bifurcation
Mostly benign (5% malignant)
Presentation
Ant. triangle @ the angle of the jaw
Pulsatile
Moves laterally but not vertically
Pressure can → syncope
May be bilateral
Ix
Duplex US
Angiography: splaying
CT / MRI
Mx
Surgical Excision
Ultrasonic surgical dissection
Radiotherapy
Large tumours
Unfit for surgery