Evaluation and Management of Pediatric Neck masses文档文档.pptVIP

Third Branchial Cleft Cysts Patients present with recurrent infections of the lower lateral neck Masses low in the anterior neck, more often on the left side Sinus tract starting at the piriform fossa, through the thyrohyoid membrane, tracking under CN XII and carotid, but anterior to CN X Often track through the upper pole of the thyroid * Fourth Branchial Cleft Cysts May have opening located near the apex of the pyriform sinus, fistula or sinus tract that travels between the superior and inferior laryngeal nerves, or an external opening along the anterior border of the sternocleidomastoid muscle in the lower neck. Very rare, first reported by Sanborn in 1972 * Thyroglossal Duct Cyst Most common congenital midline mass Elevates with tongue protrusion Commonly at the level of the hyoid Ectopic thyroid tissue vs. thyroglossal duct cyst Ultrasound Radioisotope scan * Cervical Thymic Cysts Commonly in the lower neck, but anywhere from the pyriform sinus to the chest Failure of involution of the cervical thymopharyngeal ducts. Firm, mobile masses found in the lower aspects of the neck. CXR, CT scan * Dermoid Cysts Tissue from all three germinal layers Sweat and sebaceous glands Midline mass that does not elevate with tongue protrusion Misdiagnosed as thyroglossal duct cysts Total surgical excision to prevent recurrence * Teratoma All three germ cell layers, but foreign to the site of presentation Mature vs. immature Rarely present after the first year of life 20% associated maternal polyhydramnios Unlike adult teratomas, they rarely demonstrate malignant degeneration. Surgical excision. * Laryngoceles Enlarged laryngeal saccule Classified as internal, external, or both Internal Confined to larynx, involves FC and AE fold Hoarseness/ respiratory distress vs. neck mass External and Combined Laryngoceles Compressible, lateral neck mass that distends with increases in intralaryngeal pressures Through the thyrohyoid membrane at the entrance of the Superior Laryngeal Nerv