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Indications For Surgery

Drainage

Swelling

Infection

Special Investigations

Thyroid Scan

Ultrasound Scan

Thyroxin Levels

Remnants Of Embryonic Branchial Apparatus

Fibromatosis Colli

Second Pouch

Cysts

Sinuses

Fistulas

30% of congenital neck masses

Indications For Surgery

AKA sternomastoid tumour of infancy

Associated congenital hip dislocation

Enlargement of the mass

Infection

Third Pouch

First Branchial Cleft Fistula

First Branchial Arch

Cleft lip and palate

Abnormal shape of the external ear

Malformation of the internal ossicles

First Branchial Cleft

Microtia

Aural atresia

Indications For Surgery

Work Classification

Type 1:

1st branchial groove

No cartilage or adnexal tissue

Swellings near the ear

Type 2:

Associated with parotid gland

Contain skin and adnexal structures

Swellings inf. to angle of mandible or ant. to sternocleidomastoid

Clinical Presentation

THIRD ARCH

Draining pit or fistula in anterior triangle

Infected tract

Mass in anterior triangle

Second And Third Branchial Cleft Fistulae

Midline

Below hyoid

Smooth

Soft

Non Tender

No movement on tongue protrusion

Hypothyroidism

Fourth Branchial Pouch Sinus

Neonatal neck mass

Recurrent deep neck infection

Indications For Surgery

Sinus diagnosed on barium swallow or sinogram

Recurrent deep neck infections or suppurative thyroiditis

FOURTH ARCH

Pre Auricular Pit or Fistula

SECOND ARCH

Thyroglossal Duct Cyst

Embryology

Indications For Surgery

Thyroid diverticulum develops from foramen cecum and descends in the neck.

Hyoid bone develops from second branchial arch

Thyroglossal duct may pass in front of, behind or through the hyoid.

First Pouch

Failed resolution

Enlargement

Pain

Infection

Respiratory distress

Special Investigations

CT

MRI

Contrasted CT

FBC

X-match

Fourth Pouch

EMBRYOLOGY OF THE BRANCHIAL APPARATUS

Cystic Hygroma/Lymphangioma

SIXTH ARCH

FIRST ARCH

50% are present at birth

80% are present by 3 years of age

Boys = Girls

Classified by Landing and Farber:

Lymphangioma simplex

Cavernous lymphangioma

Cystic hygroma / Cystic lymphangioma

Congenital Malformations Of The Neck

1. Thyroglossal Duct Cyst

2. Cystic Hygroma/Lymphangioma

3. Remnants Of Embryonic Branchial

Apparatus

4. Fibromatosis Colli

5. Pre-Auricular Pit/Fistula

BIBLIOGRAPHY

Sixth Pouch

1. Ashcraft's Paediatric Surgery, fifth edition

2. Byron's Paediatric Otorynolaryngology

3. Google image search

4. www.wikipedia.com

5. Gray's Atlas of Anatomy

CONGENITAL MALFORMATIONS OF THE NECK

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