23. Congenital lesions of the face and neck

Question 1

Development of the face

Answer 1

Many opportunities for abnormal development

Critical periods of development

Question 2

At which age of gestation is it most likely for facial abnormalities occur?

Answer 2

4-5 weeks
nasal pit -> nose
oropharyngeal membrane/stomodeum -> mouth
maxillary process -> maxilla
mandibular processes -> mandible

Question 3

Basic facial structure

Answer 3

1 x frontonasal
2 x nasomedial
2 x nasolateral
2 x maxillary
2 x mandibular
maxillary and mandibular 1st pharyngeal arch
mandibular arch

Question 4

Formation of the palate

Answer 4

Palatal shelf are extensions from the maxillary process which will grow towards each other to form the palate

Question 5

Cleft lip

Answer 5

A cleft lip contains an opening in the upper lip that may extend into the nose.[1] The opening may be on one side, both sides, or in the middle.

can result in feeding problems, speech problems, hearing problems, and frequent ear infections

Question 6

Cleft palate

Answer 6

A cleft palate is when the roof of the mouth contains an opening into the nose.

can result in feeding problems, speech problems, hearing problems, and frequent ear infections

Question 7

Pharyngeal arches

Answer 7

four arches
mandibular
hyoid
third and fourth
mesoderm
cartilage
nerve
aortic arch artery

Question 8

Which will give rise to the future mandible?

Answer 8

meckel’s cartilage

Question 9

What is the first pharyngeal arch?

Answer 9

mandibular

Question 10

Which pharyngeal arch do the muscles of facial expression originate from?

Answer 10

2nd pharyngeal arch; hyoid

Question 11

What is the second pharyngeal arch?

Answer 11

hyoid

Question 12

thyroglossal cyst and fistula

Answer 12

thyroglossal tract extending from thyroid to pharynx/base of tongue. Originates from little tract extended from foramen cecum.
cyst can give discharge - need to remove
tract closely associated with hyoid so need to remove hyoid to get cyst out

Treated by Sistrunk’s operation
Important to remove the body of the hyoid bone

Question 13

Branchial fistula

Answer 13

Get these types of cysts along lines of fusion e.g. external dermoid cyst where two mandibles fusing, can get in neck where its called branchial. Dermoid cysts or teratomas in the abdomen can stay as cysts or can rupture, leaving tracts. When the embryo elongates, the tract elongates with it. These fistulae come from the 1st arch or the 2nd arch and elongate and grow as the baby grows. When removing them have to follow the tract all the way up - stepladder excision. Can cause recurrent infections, tract must be excised completely

Question 14

Ranula

Answer 14

Accumulation of mucous due to blocked saliva gland

Question 15

External angular dermoid

Answer 15

Trapping of epithelium under the skin. Cosmetic problem. Will keep getting bigger and doesn’t look very nice, so is usually removed by excision under the eyebrow to keep the scar not visible

Question 16

Cystic hygroma

Answer 16

Vascular malformation, can be arterial or venous

Question 17

Haemangioma

Answer 17

Hemangioma is a benign tumor derived from blood vessel cell types, most commonly infantile hemangioma, a common benign tumor of infancy. Infantile hemangiomas, known colloquially as strawberry marks and seen at birth or in the first weeks of life, are most commonly seen on the skin.
Need to treat if blocking eye through surgical excision to stop loss of that eye’s visual field, but most of these disappear without leaving a scar by the age they’re 2 or 3.

Question 18

Management of cystic hygroma

Answer 18

Cystic Hygroma:
Injection of sclerosants
Surgery

Question 19

Management of haemangioma

Answer 19

Haemangioma
Many will resolve with time
May need intervention if affecting peri-orbital area leading to problems with vision – Interferons.

Question 20

Cleft lip and palate occurence

Answer 20

More common in males
Both genetic and environmental factors
Commoner in Asian populations

May be associated with syndromes

Question 21

Things to consider in cleft palate or lip

Answer 21

Orbicularis Oris - need to make sure its properly adjusted so can smile, whistle
Philtrum - looks strange without it
Vermiform border - top of lip

Surgery
Dental implications
Speech

Question 22

Members of a cleft palate/lip multidisciplinary team

Answer 22

Paediatrician
Plastic Surgeon/Maxillo-facial surgeon
Speech therapist
Dentist
ENT surgeon/Audiology
Psychologist