Benign Neck diseases with explanation of congenital neck masses

1. BENIGN
NECK
DISEASES
Dr.Fatima Shahid
PGT-ENT

2. ANATOMY
• The neck is the transitional
area between the base of
the cranium superiorly and
the clavicles inferiorly.
• The neck joins the head to
the trunk and limbs,
serving as a major conduit
for structures passing
between them.

3. TRAINGLES OF NECK

4. TRAINGLES OF NECK

5. CONTENTS OF TRAINGLE

6. CONTENTS OF TRAINGLE

7. ANATOMIC LANDMARKS

8. SURFACE ANATOMY

9. LYMPH NODES IN NECK

10. CLASSIFICATION ACCORDING TO AGE

11. CLASSIFICATION
• Congenital
• Infectious
• Acquired
• Tumors of parapharygeal space
• Neurogenic Tumors

12. BRANCHIAL CLEFT
• Branchial cleft cysts are
congenital epithelial cysts,
there are 4 theories of origin.
• Common in the 2nd to 3rd
decade of life

13. PATHOPHYSIOLOGY
1.The Brachial apparatus theory
2.The Cervical sinus theory
3.Thymopharyngeal duct theory
4.The inclusion theory

15. CLINICAL FEATURES
• Swelling – upper part of neck, anterior to SCM
• Mass – cystic 70%,solid 30%
• May be painful and increase in size at the time
of infection
• Persistent 80%,intermittent 20%

16. INVESTIGATIONS
IMAGING
• Ultrasonography – Delineate the cystic nature of these
lesions.
• Contrast-enhanced CT scan – shows a cystic and
enhancing mass in the neck. It may aid preoperative
planning and identify compromise of local structures.
• MRI
Fine-needle aspiration – May be helpful to distinguish
branchial cleft cysts from malignant neck masses. – Fine-
needle aspiration and culture may help guide antibiotic
therapy for infected cysts.

18. TREATMENT
Medical
• Antibiotics are required to treat infections /abscesses
related to branchial cleft cysts.
Surgical
• Surgical excision is definitive treatment for branchial
cyst.
• Definitive branchial cleft cyst surgery should not be
attempted during an episode of acute infection or if an
abscess is present.
• Surgical incision and drainage of abscesses is indicated
if present, usually along with concurrent antimicrobial
therapy.

19. BRANCHIAL SINUS & FISTULA
• Congenital Origin, short lined
tracts
• Fistula of first arch: open at
junction of cartolageous and bony
meatus
• Of 2nd arch : Tonsillar fossa
• Of 3rd & 4th arch : Pyriform fossa
and Larynx
• Externally all above open into
SCM.
• Sinuses can open from the line
from tragus to clavicle

20. BRANCHIAL SINUS & FISTULA
• INVESTIGATION :Sinogram
• TREATMENT :Step ladder
excision ,removing the
mouth of the pit in an
ellipse.The High exposure is
best acheieved by vertical
incision anterior to the
ear,curving below the ear
lobe and to the jaw.

21. THYROGLOSSAL CYST
• Thyroglossal duct cysts are the
most common form of
congenital neck cyst.
• TDC is found in between hyoid
bone and the thyroid cartilage
in about 60% of the patients, it
is suprahyoid,supra-sternal
and intra-lingual in about 24%,
13% and 2% respectively

22. PATHOPHYSIOLOGY
The cyst is an epithelial remnant of the thyroglossal tract, which forms as thyroid
descends from tuberculum impar and posterior third of tongue.

23. THYROGLOSSAL CYST

24. CLINICAL FEATURES
• Cystic midline swelling, Mean Age 5 years.
• Sometimes it presents as a draining sinus if it
has burst due to infection or has been
surgically drained.
• Moves with tongue protrusion - it is attached
to the thyroglossal tract which attaches to the
larynx by the peritracheal fascia.
• (Rare) Can cause swallowing or breathing
difficulty in neonates if it is located at the base
of the tongue

25. INVESTIGATIONS
IMAGING
• Ultrasound – unilocular lesions with thin walls
and posterior acoustic enhancement.
• CT scan – CT better evaluates the potential for
thyroglossal duct carcinoma and is thus
preferred in adult patients.

26. INVESTIGATIONS

27. INVESTIGATIONS
• THYROID FUNCTION TEST
• THYROID SCANNING
– To demonstrate any functioning ectopic
thyroid.
– Ectopic thyroid tissue may accompany TGCs in
their location along the line of embryological
thyroid descent

28. TREATMENT
Complete surgical excision
• Including with it the body of hyoid bone and core of
tongue tissue around the tract in the suprahyoid tongue
base to the foramen caecum (Sistrunk’s operation).
• Simple excision of cyst without removal of its tract leads to
recurrence.

29. CYSTIC HYGROMA(LYMPHANGIOMA)
• It is a congenital lesion
usually present within the
first year of life.(post.
Triangle)
• Usually remain unchanged
into adulthood
• Is soft, cystic, multilocular,
partially compressible and
brilliantly transilluminant.
and may present with
pressure effects.

30. CYSTIC HYGROMA(LYMPHANGIOMA)
• CT or MRI may help define
the extent of the neoplasm
• Treatment of
lymphangiomas includes
injection with picibanil or
excision for easily accessible
lesions or those affecting
vital functions

31. HEMANGIOMAS
• Often appear bluish and
are compressible.
• CT or MRI may help
define the extent of the
neoplasm, especially
intrathoracic.

32. HEMANGIOMAS
• Treatment : (depend on site, size and severity)
most often resolve spontaneously within the
first decade.
• surgical treatment is reserved for lesions with
rapid growth involving vital structures, which
fail medical therapy (laser or oral propranolol
in infantile type).

33. SEBACEOUS CYSTS
• These are common masses
occurring often in older
people but can occur at any
age.
• They are slow growing, but
sometimes fluctuant and
painful when infected.
• Diagnosis is made clinically;
the skin overlying the mass is
adherent and a punctum is
often identified.
• Excisional biopsy confirms the
diagnosis

34. THANK YOU !