HEAD & NECK SWELLINGS

Size: px

Start display at page:

Download "HEAD & NECK SWELLINGS"

Winifred Beasley
5 years ago
Views:

1 HEAD & NECK SWELLINGS EXCLUDING GOITRE FAISAL GHANI SIDDIQUI MBBS; FCPS; MCPS-HPE; PGDIP-BIOETHICS PROFESSOR OF SURGERY J I N N A H S I N D H M E D I C A L U N I V E R S I T Y

3 MIDLINE SWELLINGS NECK SWELLINGS LATERAL SWELLINGS GENERALIZED SWELLINGS

4 POSTERIOR TRIANGLE PHARYNGEA L POUCH CYSTIC HYGROMA LATERAL NECK SWELLINGS ANTERIOR TRIANGLE BRANCHIA L CYST CAROTID BODY TUMOUR STERNOMAS TOIDTUMOU R

5 THYROGLOS SAL CYST GOITRE MIDLINE NECK SWELLINGS

6 GENERALIZED NECK SWELLINGS

7 BRANCHIAL CYST

8 BRANCHIAL CYST -EMBRYOLOGY

9 BRANCHIAL CYST -EMBRYOLOGY

BRANCHIAL CYST CLINICAL FEATURES Congenital but appears at 20-25 years of age (the fluid accumulates very slowly) Located

11 BRANCHIAL CYST CLINICAL FEATURES Congenital but appears at years of age (the fluid accumulates very slowly) Located at junction of upper & middle 3 rd of anterior border of sternomastoid muscle Smooth, soft & fluctuant Non-transilluminant

12 BRANCHIAL CYST - PATHOLOGY Lined by squamous epithelium with sebaceous glands Filled with thick, turbid, cheesy material containing cholesterol crystals

13 BRANCHIAL CYST - DIAGNOSIS Essentially clinical Ultrasound shows a cystic mass Needle aspiration reveals clear-to-turbid fluid rich in cholesterol crystals

14 BRANCHIAL CYST COMPLICATIONS Recurrent infection Branchial sinus Branchiogenic carcinoma

15 BRANCHIAL CYST TREATMENT Excision through a transverse incision

16 PHARYNGEAL POUCH

17 PHARYNGEAL POUCH protrusion of pharyngeal mucosa through a weak area in the posterior pharyngeal wall called Killian s dehiscence

19 PHARYNGEAL POUCH CLINICAL FEATURES Dysphagia Regurgitation of undigested food Swelling behind the sternomastoid muscle at the level of thyroid cartilage increases on deglutition smooth; ill-defined; reduces with gurgling sounds on pressure Recurrent chest infections

20 PHARYNGEAL POUCH - INVESTIGATIONS Barium swallow: outlines the pouch Flexible endoscopy: shows opening of the pouch

21 PHARYNGEAL POUCH TREATMENT Excision of pouch and cricopharyngeal myotomy Endoscopic division of wall between the pouch and cricopharyngeal muscle to widen neck of the pouch to allow free drainage of contents into esophagus

22 CYSTIC HYGROMA

23 CYSTIC HYGROMA a developmental malformation (hamartoma) of the lymphatic system resulting from failure of jugular sac to join the main lymphatic system

24 CYSTIC HYGROMA CLINICAL PRESENTATION Presents at birth or in early infancy May cause obstructed labour due to large size

27 CYSTIC HYGROMA CLINICAL PRESENTATION Situated in lower part of posterior triangle of the neck Soft, cystic, partially compressible Brilliantly trans-illuminant

29 CYSTIC HYGROMA - COMPLICATIONS Secondary infection Respiratory obstruction due to rapid increase in size

30 CYSTIC HYGROMA - TREATMENT Excision of all cysts with preservation of normal neurovascular structures

31 CAROTID BODY TUMOUR

33 CAROTID BODY TUMOUR Tumour arising from chemoreceptor cells Higher incidence seen in people living at high altitudes; chronic hypoxia leading to hyperplasia

34 CAROTID BODY TUMOUR CLINICAL FEATURES Lump under the anterior border of sternomastoid muscle Firm Can be moved side to side but not above downwards Pulsatile Audible bruit

35 CAROTID BODY TUMOUR - INVESTIGATIONS Duplex ultrasound Carotid angiogram: splaying of carotid bifurcation blush of tumour

36 TREATMENT Excision along with excision of carotid artery

37 STERNOMASTOID TUMOUR

38 STERNOMASTOID TUMOUR - ETIOLOGY TRAUMA TO STERNOMASTOID MUSCLE AT BIRTH HEMATOMA FORMATION CAUSING SWELLING FIBROSIS LEADING TO MUSCLE SHORTENING

39 STERNOMASTOID TUMOUR CLINICAL FEATURES Presents shortly after birth Swelling small & hard; palpable in the body of the sternomastoid muscle Muscle stretched and chin deviated to the opposite side

40 STERNOMASTOID TUMOUR TREATMENT Physiotherapy to stretch sternomastoid muscle; spontaneous resolution with no long-term effects Surgical release of the contracture

41 LYMPHADENOPATHY

42 GOITRE

43 THYROGLOSSAL CYST

Congenital Neck Masses C. Stefan Kénel-Pierre, MD

Congenital Neck Masses C. Stefan Kénel-Pierre, MD SUNY-LICH Medical Center Department of Surgery Case Presentation xx year old male presents with sudden onset left lower neck swelling x 1 week Denies pain,