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Head and Neck sinuses and masses - Coggle Diagram
Head and Neck sinuses and masses
Etiology
Infection
Trauma
Neoplasm
Benign
Hemangiomas
Lymphangiomas
Cystic hygromas
Malignant
Neuroblastoma
Lymphoma
Rhabdomyosarcoma
Congenital
Embryonic origin
Congenital cysts and sinuses result from embryonic structures that failed to mature o persisted in an aberrant fashion
Thryoglossal duct cyst
Preauricular pits and sinuses
Branchial cleft anomalies
Dermoid cysts
Median cervical clefts
Thyroglossal duct cyst
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Most common lesion of the midline
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Preschool children
Preop prep
TFT to r/o median ectopic thryoid 10-45%
Ectopic thyroid
90% located @
Excision of thyroglossal duct cyst
Avoid complications
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Transverse incision
Dissect the cyst cephalad to hyoid bone
Base of the tract ligated with absorbable suture
Wide excision
No need to approximate hyoid
Anesthesiologist finger @ base of the tongue
2 identify cephalad extent of dissection
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US
MR
Gammagram
Foramen cecum
Site of thyroid diverticulum development
Structure develops caudal to the central tuberculum impar (Pharingeal bud that leads to formation of the tongue)
Thyroid irrigation & drainage
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Innervation
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Ganglion
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Passed through hyoid bone
Location:
60% Adjacent to hyoid bone
24% Suprahyoid
13% Infrahyoid
8% Intralingual
Location: Anywhere along migratory course of thyroglossal tract if it fails to be obliterated
Failure of complete migration:
LINGUAL THYROID
Beneath the foramen cecum @ base of the tongue
Presentation:
Painless mass in the midline
PE: Smooth, soft and non-tender
Palpate the lesion while child sticks out his/her tongue.
Cyst moves cephalad when tongue protrudes
Infection 1/3
Mouth flora
Draining sinus 1/4
Location:
Adjacent to hyoid 66%
Suprahyoid 24%
Infrahyoid 13%
8% Intralingual
Treatment
Ethanol ablation
Recurrence 33-56%
Sclerotherapy
Marsupialization
Excision
Differential dx.
Dermoid cyst
Branchial arch cysts
Lipoma
Thyroid nodules
Pyramidal lobe hypertrophy
Midline adenopathy
Cartilagenous remnants
Remnants of the branchial arch and cleft
Midline fusion abnormalities
Complete resection
=
avoids recurrence
Remnants of embryonic Branchial apparatus
Cyst
Remnants of sinuses s external opening.
Appear later in childhood
Squamous epithelium
Sinuses
Persistence of the eternal opening only
Fistula
Persistence of the branchial groove c breakdown of the branchial membrane
End of fistula, # of syllables in the word
1
2
3
Pyriform
Tonsil
Ear
Congenital
Present at birth
Presentation
Drainge along SCM
Diagnosis
US
1st. study
CT
MRI
Barium esophagogram
3rd. and 4th
Fistulogram
1st cleft anomalies
Mandible
Complications
+Salivary fistulas
+EAC stenosis
+Facial palsy
+Hearing loss
Type I
Duplications of the membranous external auditory canal
Medial to the concha often extending into the postauricular crease and ending at the osseous- cartilagenous jct of the EAC
Squamous epithelium
Ectoderm
Lateral to the facial nerve
Swelling near the ear
Type II
Duplications of both the membranous and cartilagenous EAC c tract opening in the parotid gland and the neck below the angle of the mandible extending toward the inferior part of the EAC
Mesoderm and Ectoderm
Medial to the facial nerve
2nd cleft anomalies
2nd arch
Hyoid bone
Superior body
2nd pouch
Tonsillar
Supratonsillar fossa
Complications
Recurrence 3-22%
Vocal chord paralysis
Hematoma
Seroma
3rd. cleft anomalies
Inferior Parathyroid
Thymus
Ascends posterior to the carotid artery
4th cleft anomalies
Superior parathyroid
Ultimobranchial body
Found in the L side
Lower portion of the anterior neck
Complications
Recurrence
Salivary fistulas
Sinuses frequent on the R side
Bilateral 10% cases
Tonsillectomy
Not recommended
Does not increase recurrance risk
Presentation
SCM
Anywhere along the SCM tract
Sx. BranquiOtoRenal
Mayor Criteria
MInor Criteria
Ear anomalies
Facial asymmetry
Preauricular pits
