Transcript CYSTIC SWELLINGS OF THE NECK

பிறப்பபொக்கும் எல்லொ உயிர்க்கும் சிறப்பபொவ்வொ
பசய்ப ொழில் வவற்றுமை யொன்.
CLASSIFICATION
MIDLINE SWELLING:
1.Sublingual dermoid
2.Thyroglossal cyst
3.Subhyoid bursitis
LATERAL SWELLINGS;
1.Digastric triangle -plunging ranula
2.Carotid triangle -bronchial cyst
POSTERIOR TRIANGLE;
1.Cytic hygroma
THYROGLOSSAL CYST
 Fibrous cyst that forms from a
persistent thyroglossal duct
 midline swelling with slight
inclination to left
 Out pouching from floor of first
and second bronchial pouch
 pseudo stratified columnar
epithelium with lymphoid tissue,
fluid is formed by un- obliterated
duct it contains cholesterol
crystals
 tubulo-dermoid type
 may contain thyroid tissue /only
functiong thyroid tissue
 age 15-30 yrs of females
COMMON SITES
1. SUBHYOID -MC
2. THYROID
CARTILAGE
3. SUPRAHYOID
4. FLOOR OF THE
MOUTH
5. BENEATH TH
FORAMEN CAECUM
SYMPTOMS:
 Painless
 Oval in shape
 Gradually increased in size
 Skin free
 Occasionally -Translucent
 mobility-sideways
 Moves on protrusion of tongue
 Fluctuant
 Lymph node enlarged if infected
 Examine the base of the tongue
COMPLICATIONS:
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Recurrent infection
fistula formation
Malignancy
Cosmetic
In advent surgery
INVESTIGATIONS:
 USG thyroid/MRI
 FNAC
 Uptake studies
DIFFERENTIAL DIAGNOSIS
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Subhyoid bursal cyst
Sublingual dermoid
Enlarged cervical node
Ectopic thyroid
Solitary nodule from isthmus
TREATMENT:
Excision-track
with body of
hyoid bone
Sistrunk’s
operation
SUBLINGUAL DERMOID
 Sequestration dermoid
 Entrapped ectoderm level of
first or mandibular arch
 Above or below mylohyoid
 Lined by squamous
epithelium/
 Contain -sweat
glands/sebaceous glands
 Cheesy materials
 It never contains hair
SUBLINGUAL DERMOID
 Occurs at 10-15 years
 Male= female
 Position :supra omohyoid or sublingual variety
 Under the tongue or beneath the chin
 Mucosa free/ fluctuation positive
 non -Transillumination
 Intra omohyoid or cervical variety
 bimanual palpation
Sublingual drmoid cyst
 Investigation - USG /MRI/FNAC
 Treatment- excision under GA(intra/extra
oral)
BRONCHIAL CYST
 congenital cyst persistence of
second bronchial cleft ecto derm
 At the upper part of
sternocleidomastoid
 Posteromedial part in the deeper
plane
 Oval in shape
 Smooth surface /soft
 Well-defined
 Fluctuation positive
 Trans illumination negative
BRONCHIAL CYST
not reducible/compressible
Cholesterol crystals on
aspirated fluid
BRONCHIAL CYST
COMPLICATIONS:
Cosmetic
Infection
fistula formation
DIAGNOSIS:
FNAC
MRI/FISTULAGRAM
TREATMENT:
Excision
Course BRANCHIALCYST
 Subcutaneous at the level of upper border
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thyroid cartilage
Pass through bifurcation of common
carotid artery
Superficial to internal carotid,deep to
ext.carotid
Deep to the post.belly of digastric and
stylohyoid muscle
Superficial to
IJV,hypoglossal,glossopharyngeal nerves
Pierces the sup.constrictor ,open behind
post.pillar of the tonsil.
Rx:Excision ( STEP - LADDER OPERATION )
•The Neck of the cyst passes between
the int and ext carotid art.
•Can Recur.
op
Ranula
 Cystic swelling floor of
mouth
 Mucous extravasation
from sublingual salivary
gland
 Plunging Ranula, extend
through FOM muscles into
neck
 The name is derived
form the word rana,
because the swelling
may resemble the
translucent
underbelly of the
frog.
Plunging ranula
 Penetrates
Mylohyoid muscle
to enter neck
 Soft painless
fluctuant dumbbell shaped
swelling
 Bi digital palpation
Plunging ranula
 Rare form of retention cyst
 May arise from SM/SL SG
 Mucous collects around gland
 Surgical excision via neck
CYSTIC HYGROMA
 Arises from jugular lymph sac
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6th to 14th week
sequestration of lymphatic sac
Multiloculated
Lined by endothelium
Posterior triangle of neck
Ascends to ear lobule or
descends to axilla
Early infancy or at birth
presentation
Lump in the lower third of
posterior triangle
CYSTIC HYGROMA
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Increases in size
smooth
Indistinct margin
Smooth or lobulated
Cystic consistency
Impulse on coughing
Can be compressible
Translucent brilliantly
CYSTIC HYGROMA
COMPLICATIONS:
Cosmetic
Respiratory difficulty
Infection following incomplete removal
Recurrence
INVESTIGATIONS:
MRI
TREATMENT:
Sclerotherapy
Hot water injection
Subsequent RT for recurrence
Subhyoid bursal cyst
 Enlargement subhyoid bursa
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with accumulation fluid
Below the hyoid bone/front of
the thyrohyoid membrane
Swelling with pain
Oval with long
axis(cf.thyroglossal cyst)
Mid line /move with deglutition
Cystic/fluctuation +/nontransillumation /turbid
Subhyoid bursal cyst
 Investigation
MRI/FNAC
 TREATMENT
Complete excision-transverse
incision
THANKS TO MY TEACHERS
 PROF.DR.S.NARENDRAN M.S Ph.D
TANJAVUR MEDICAL COLLEGE
 PROF.DR.A.SUKUMAR M.S
Rtd. Director of Medical and Rural services
 PROF.DR.C.M.K REDDY FRCS
Rtd. Prof. Stanley Medical College
 PROF.DR.T.MOHANA PRIYA M.S
Sri Ramachandra Medical College and
R.I
 The wood is lovely dark and deep
 But I have promises to keep
 Miles to go before I sleep
 Miles to go before I sleep