[ENT] Head & neck

• Malformations of the head and neck include cysts, sinuses, and fistulas
• Cyst


  Epithelium lined cavity that does not have a internal or external opening
• Sinus


  Epithelium lined cavity that opens either internally or externally
• Fistula


  Epithelium lined tract that has both an internal and external opening
• Malformations of the head and neck


  • Cyst
  • Sinus
  • Fistula
• Branchial Cleft Cyst


  • Manifested between 15 and 25 years of age, both sexes equally affected, fistula more common than cyst, one of the main causes of neck swelling in children, rare for malignant transformation
• Branchial Cleft Cyst


  Persistence or incomplete regression of cervical sinus, internal fistula (2nd branchial pouch), external fistula (2nd branchial cleft)
• Thyroglossal Duct Cyst and Fistula


  • 75% before 5 years of age, most are diagnosed before 12 mos of age, malignant transformation rare
• Thyroglossal Duct Cyst and Fistula


  Incomplete obliteration or resorption of the thyroglossal duct
• Lymphangioma


  • 90% manifested in the first 2 years of life, tends to grow by expansion and infiltration, typically located in the lateral side of the neck, rarely undergoes spontaneous regression
• Lymphangioma


  Developed from sequestered portions of the primordial lymphatics, do not establish connection with venous system, degenerate to form cystic cavities
• Hemangioma (hamartomas)


  • 10% during first year of life, premature infants are predominantly affected, females (superficial hamartomas), 80% regress spontaneously
• Hemangioma (hamartomas)


  Dysontogenic growth of normally formed tissue, natural course: proliferative phase, stable plateu (lesion ceases growth), involutional growth
• Hemangioma


  • 10% during first year of life
  • Premature infants are predominantly affected
  • Females (superficial hamartomas)
  • 80% regress spontaneously
• Paraganglioma (glomus tumor)


  • Mostly solitary
  • 10-20% malignant
• Teratomas


  • Consist of all 3 germ layers (ecto, meso,ento)
  • 5% of all congenital teratomas
  • Manifest before 12mos of age
  • Potential for malignant transformation
• Dermoid


  • Composed mainly of ectodermal elements
  • Composed of dermal appendages (hair follicles, sebaceous gland, sweat glands)
• Acute cervical lymphadenitis


  • "Reactive lymphadenitis" - Most common cause in children (streptococcal infection of the palatine tonsils)
  • Others: CMV, rubella & mycobacteria
  • Infectious mononucleosis: epstein-barr virus (DNA virus)
• Chronic cervical lymphadenitis


  • Diagnosis: Hx: risk factors
  • PE
  • UTZ
  • Serology
  • Histology - Excision biopsy
• Cervical cellulitis


  • Diffuse inflammation of cervical soft tissue
  • May be a life threatening condition
• Lipoma


  Soft, circumscribed painless mass
• Malignant lymphomas


  • Solitary or multiple nodes may be involved
  • Has extra nodal sites