23. Congenital lesions of the face and neck Flashcards
Development of the face
Many opportunities for abnormal development
Critical periods of development
At which age of gestation is it most likely for facial abnormalities occur?
4-5 weeks nasal pit -> nose oropharyngeal membrane/stomodeum -> mouth maxillary process -> maxilla mandibular processes -> mandible
Basic facial structure
1 x frontonasal 2 x nasomedial 2 x nasolateral 2 x maxillary 2 x mandibular maxillary and mandibular 1st pharyngeal arch mandibular arch
Formation of the palate
Palatal shelf are extensions from the maxillary process which will grow towards each other to form the palate
Cleft lip
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
Cleft palate
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
Pharyngeal arches
four arches mandibular hyoid third and fourth mesoderm cartilage nerve aortic arch artery
Which will give rise to the future mandible?
meckel’s cartilage
What is the first pharyngeal arch?
mandibular
Which pharyngeal arch do the muscles of facial expression originate from?
2nd pharyngeal arch; hyoid
What is the second pharyngeal arch?
hyoid
thyroglossal cyst and fistula
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
Branchial fistula
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
Ranula
Accumulation of mucous due to blocked saliva gland
External angular dermoid
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
Cystic hygroma
Vascular malformation, can be arterial or venous
Haemangioma
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.
Management of cystic hygroma
Cystic Hygroma:
Injection of sclerosants
Surgery
Management of haemangioma
Haemangioma
Many will resolve with time
May need intervention if affecting peri-orbital area leading to problems with vision – Interferons.
Cleft lip and palate occurence
More common in males
Both genetic and environmental factors
Commoner in Asian populations
May be associated with syndromes
Things to consider in cleft palate or lip
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
Members of a cleft palate/lip multidisciplinary team
Paediatrician Plastic Surgeon/Maxillo-facial surgeon Speech therapist Dentist ENT surgeon/Audiology Psychologist
