Neck lumps in children

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Walter Sims
5 years ago
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1 Neck lumps in children Midline Lateral

2 Midline neck lumps Thyroglossal cyst - 80% Dermoid cyst Submental lymph node Ectopic thyroid Some rare lesions

3 Thyroglossal cyst Diagnosis: midline, usually overlying hyoid bone demonstrate attachment to hyoid Investigations only if diagnostic uncertainty

4 Thyroglossal cyst Most common midline lesion Adherent to the hyoid bone Usually midline or just to left Moves on protrusion of the tongue Can present acutely as an abscess

5 Submental lymphadenopathy More anterior than thyroglossal cyst May be multiple nodes Look for source of infection eg dental caries, mouth ulcer Little movement with tongue protrusion or swallowing

6 Lateral neck lumps in children Lymph nodes reactive hyperplasia lymphadenitis/abscess MAIS Malignancy Rarely: branchial remnants, parotitis, cystic hygroma

7 Reactive hyperplasia Normal response to infection Vary in size, never disappear May be mildly tender No overlying skin changes History usually gives diagnosis FNA not indicated

8 Cervical abscess Common in first years of life Poorly localised swelling Starts as acute lymphadenitis Fails to respond to antibiotics Redness usually indicates suppuration Central softening is the signal for I & D Fluctuance often not demonstrable

Endemic MAIS = Mycobacterium avium, intracellulare,

over 3-6 weeks Common in pre-school kids (2-6)

9 Endemic MAIS = Mycobacterium avium, intracellulare, & scrofulaceum Painless enlargement of lymph nodes over 3-6 weeks Common in pre-school kids (2-6) Starts as a non-tender lump Suppuration penetrates fascia to give collar stud abscess Skin discolouration means abscess Chronic discharging sinus if untreated

10 Hodgkin s disease Adolescent Painless enlargement of cervical lymph nodes Fever Night sweats Rubbery contiguous nodes

11 Remnants of 2 nd Branchial Cleft Sinuses are common, fistulae less so Internal opening of fistulae in tonsillar fossa Fistulae penetrate platysma and cervical fascia, ascend along the carotid sheath to level of the hyoid then pass between carotids. Remnants can be found anywhere along this course

12 Branchial sinus Inconspicuous opening at junction of middle and lower thirds of sternomastoid muscle Commonly discharge clear saliva from ectopic salivary glands May pass down or up

13 Branchial cyst - 2 nd cleft Treatment is excision Better cold i.e. not infected If inflamed Increased risk of nerve injury Higher incidence of recurrence Technically more difficult Malignant transformation later can occur

blindly Attached to or penetrate cartilage of crus Become

16 Pre-auricular Pits & Sinuses Ectodermal inclusions Stratified squamous epithelial lining Sinuses usually short and end blindly Attached to or penetrate cartilage of crus Become branched after infection Familial and often bilateral Common in Chinese

or multicystic Sudden swelling (bleed or infection) can compromise

17 Cystic hygroma Is a hamartoma of the jugular lymph sacs Often associated with venous malformation More common in boys May be simple or multicystic Sudden swelling (bleed or infection) can compromise airway Otherwise, treatment is for cosmetic reasons Sclerosant injection now preferred

18 Torticollis Sternomastoid muscle fibrosis Postural torticollis Cervical hemivertebrae Squint Posterior fossa tumours Retropharyngeal abscess/cervical lymphadenitis Atlanto-occipital subluxation

19 Sternomastoid tumour Shortening by fibrosis of the sternomastoid muscle Appears in third week of life History of breech and forceps common 90% resolve in 9-12 months Role of physiotherapy controversial

21 External angular dermoid Common anomaly of cosmetic significance Fusion between the frontonasal and maxillary processes trap ectoderm. Often beneath the pericranium Excision curative Beware internal angular & midline dermoids -?deep extension, nasal glioma

22 Mucous retention cyst Usually inside lower lip May be traumatised by biting Often resolve over 3-6 months Excision curative if needed Diathermy excision, no sutures, is preferred

23 Tongue tie Does not interfere with swallowing May affect pronunciation of some consonants No other effects on speech May interfere with latch on Can improve spontaneously Usually divided under GA at 2-4 years

PEDIATRICS WK 3 HEAD AND NECK ALISON WALLACE MD, PHD

PEDIATRICS WK 3 HEAD AND NECK ALISON WALLACE MD, PHD Topics 1. Cervical lymphadenopathy 2. Lymphatic malformation 3. Thyroglossal duct cysts 4. Branchial cleft cysts 5. Thyroid masses CASE 1 Case 1 A 2