1. Congenital Disorder

2. Although present at birth masses may not become clinically apparent until childhood or even adulthood

3. Congenital neck mass Branchial system Thyroid gland Dermoid Teratoid
vascular

4. Important criteria Age of presentation Location of the mass
Associated symptom

5. Thyroglossal duct cyst
The most common congenital neck mass
M=F
Majority before age 12

6. Thyroid gland descent begin in the third week & complete by the eight week
As it descent it is intimately associated with the hyoid bone which is in the process of fusing in the midline

7. It is the failure of thyroglossal duct to involute that causes thyroglossal duct cysts

8. The majority of the cysts present at or below the level of the hyoid bone in the midline of the neck

9. Thyroid arrest ( ectopic thyroid )
Lingual thyroid
As far as superior mediastinum

10. Thyroglossal duct cyst ( physical examination )
Smooth , nontender
Rise with swallowing
Cyst infection :
acute ↑ in size
skin erythema
tenderness
spontaneous drainage

11. connection with the pharynx :
polymicrobial infection
oral pathogen

12. Determination of the location of normal thyroid tissue is essential prior to the excision of any suspected cyst or ectopic thyroid .
US is the preferred mode of imaging
In uncooperate child or dense cyst thyroid scan should be considered

13. Treatment preop. Antibiotic for infected cyst Sistrunk excision
Rarely papillary adenoarcinoma

14. Reccurence 10% in Sistrunk Failure of hyoid removal
Failure of remove section of tongue
Rupture of the cyst
Resurgery

15. Teratoma & dermoid are true developmental neoplasm
Arises from pluripotent cells at anatomic sites where they are not normally found

16. Dermoid cyst Consist ectoderm & mesoderm
Lined by epidermis and contain hair follicle & sebsceous glands
Smooth nontender mass in submental region
Surgical removal

17. teratoma Three germ layers
Disorganized teratoid cyst → true teratoma ( epignathi )
Cervical region
Firm & mobile
Cystic and solid composition
Surgical removal

18. Branchial arch anomaly
Present at birth , clinically apparent at childhood
Develop during third to 7th embryonic week
Six pairs arches,four paired groove externally,four paired pouch internally

19. First arch Meckel‘s cartilage Maxilla, malleus , incus , mandible
Sphenomandibular ligament
Mylohyoid , ant. Belly of digastric, tensor tympani , TVP , masseter , temporalis , medial & lateral pterygoids
Trigeminal nerve
Maxillary artery

20. Second arch Reichert's cartilage
Upper body of hyoid bone lesser cornu , stylohyoid ligament , styloid process , stapes
Muscle of facial expression , platysma , stylohyoid, post. Belly of digastric , stapedius muscle
Facial nerve
Stapedial artery

21. Third arch Greater cornu & lesser portion of hyoid bone
Stylopharyngeous , super and middle constrictor of the pharynx
Glossopharyngeal nerve
Part of the internal carotid artery

22. Fourth arch Thyroid cartilage Cricothyroid muscle vagus nerve
arch of the aorta

23. Sixth arch Cricoid and arytenoid cartilage
Corniform & corniculate cartilage
RLN
Inferior constrictor muscle
Ductus arteriosus

24. Pharyngeal pouch First pouch : form ET & middle ear cleft
Second pouch : palatine tonsil
Third pouch : inf parathyroid gland & thymic duct
Fourth pouch : sup parathyroid gland
Sixth pouch : ultimobranchial body

25. Pharyngeal groove First groove : external auditory meatus
The remaining grooves are obliterated by the caudal overgrowth of the second branchial arch

26. A cyst is a collection of fluid in an epithelium – lined sac

27. Groove cyst : line with squamous epithelium
Pouch cyst : line with respiratory epithelium
Sinus tract : from epithelial surface to the deeper tissue
Fistula : a tract between skin to the pharynx or larynx internally

28. Branchial cleft anomaly
At birth or shortly there after
Small opening along the anterior border of SCM
Mocoid discharge with URI
A complete fistula is uncommon with most ending before the pharynx is reached
Cyst is more common than fistula or sinuses

29. Cont. Majority arises from second branchial cleft
Usual course is recurrent infection
Early surgical excision
Recurrent cases : preopertive fistulogram

30. First branchial cleft anomaly
Uncommon
First category :
absent external auditory canal
Second category :
Type I : Duplication of membranous EAC
Type II : Duplication of membranous & bony EAC
At angle of mandible
Fistulous tract at bony & membranous junction

31. Drainage may occur from EAC by palpation of angle or preauricular mass

32. Preauricular sinus
Malformation of six hillocks that form the auricle .
Excision

33. Second branchial cleft anomalies
Most common anomaly
Opening : lower half of the neck
Anterior border of SCM
Internal opening : If present is in the tonsillar fossa
Surgical removal

34. First branchial sinuses open anterior to the SCM , above the hyoid bone
Second branchial sinuses open anterior to the SCM below the thyroid .

35. The tract runs between the internal & external carotid arteries and passes lateral to the IX & XII and continues inferior to the posterior belly of the digastric , opening into the tonsillar fossa

36. If the fistula opens into the tonsillar fossa , the tonsil should be removed to obtain complete exposure .

37. Third branchial cleft cyst
Very rare Courses posterior and lateral to the ICA and CN XII , terminate its course at the level of the piriform sinus

38. Lymphangiomas
Abnormal lymphatic development along the jugular lymphatic sac
50% present by 1year
90% preent by age 2
Occurs in the sixth week of emberyonic development .
Thin-walled endothelial-lined cysts infiltrating into the surrounding tissue

39. Lymphangioma simplex
Thin-walled lymphatic channel

40. Cavernous lymphangioma
Large lymphatic channel

41. Cystic hygroma
Large lymphatic dilatation

42. The lesion present most often in the posterior cervical triangle of the neck and are soft , nontender poorly defined mass that transilluminate

43. Surgical excision is the treatment of choice .
The timing is dependent on the surgeon philosophy .
Early excision for possibility of infection , rapid growth , and potential airway compromise .
Waiting until 3-4 years of age because of involution and technical ease of operation

44. Hemangiomas The most common tumor of infancy
Majority was recognized by the age of 6 months of age .
Defective embryonic development of the peripheral vessel .
Arrested development at the endothelial stage gives rise to these subcutaneous vascular mass

45. Type of hemangiomas
Capillary
Cavernous
Juvenile

46. Soft
Compressible
Nonpulsatile bluish mass
Involvement :
parotid
Neck
Tongue
Skin

47. Rapid growth in neonatal period
Involution at 5 years : 50%
Involution at 7years : 70%

48. Lesions that not involve critical structure are usually observed

49. Imaging CT scanning outline the lesion Angiography : diagnosis
embolization

50. Symptomatic lesion :
corticosteroid
interferon-α2a

51. Surgical excision Critical area Spontaneous bleeding
Recurrent infection
consumption coagulopathy

52. Fibromatosis colli Congenital tumor of SCM
Often detected 2-3 weeks after birth
Firm nontender
Involved with the underlying muscle
Torticollis
Difficult vaginal delivery and traction on the H&N

53. Usually resolved by 18 months
US is diagnostic
Physical therapy prevent long term difficulty
Permanent lesion : surgery