28. Surg 4

Question 1

What is this

Answer 1

strawberry naevus

Question 2

What is this? How extensive is it?

How is it treated? Is surgery required?

Answer 2

Lymphangioma - smooth soft mass full of fluid

Extensive - usually need MRI to confirm full extent

Treated with aspiration of fluid and injection of sclerosant under image guidance

Surgery only required for multicystic lesions

Question 3

Why is this here? How is it treated?

Answer 3

chronic infection of pre-auricular sinus

treated with complete excision of sinus

Question 4

Why is this here? What causes it?

Answer 4

chronic infection in lymph nodes of parotid spreading into subcutacneous abscess cavity.

Germ= atypical TB

Question 5

Differential diagnosis?

What does it cause?

How is it treated?

Answer 5

Torticollis also known as ‘wry neck’

caused by short sternomastoid muscle caused by scar tissue. Occasionally caused by a posterior fossa tumour.

Torticollis causes asymmetry in growth of facial skeleton as restriction of movement restricts growth.

Tx: surgical division of scarred sternomastoid to lengthen muscle

Question 6

Where is the abnormality here and what causes it?

Does it need tx?

Answer 6

lower 3rd of sternomastoid muscle- lump - probably tearing of muscle during traumatic breech delivery. The mass ‘sternomastoid tumour’ is healing muscle.

Tx- gentle physiotherapy can help, but healing is complete by 3-6 months, and surgical only needed later if significant scarring/limitation of head movement

Question 7

What causes this?

Answer 7

it’s tortocollis in older boy - torn sternomastoid in infancy, but residual scar overlooked until torticollis became pronounced

Question 8

What is the protruding mass called?

Will there be any dental anomaly?

When is cleft reapired?

Answer 8

protruding mass= globluar process of frontonasal process - it inclues the anterior section of the future maxilla,

Yes - tooth dev is disrupted by the cleft

Question 9

What is the anomaly here? What are the problems?

Answer 9

significant tongue tie

cosmetic, may interfere with speech and breastfeeeding

Question 10

Likely diagnosis and treatment?

Answer 10

pyogenic abscess in lymph nodes

IV anti staphyloccocal abx

incision and drainage

common in infants and toddlers- lots of infections after passive maternal protection

Question 11

5 causes of midline neck lump in childhood

1. thyroglossal cyst
2. ectopic thyroid
3. submental lymph nodes
4. inclusion dermoid cyst

rarely thyroid enlargment

Question 12

What are the features of a thyroglossal cyst?

Answer 12

It is located near, and may even feel attached to the hyoid bone.

feels like a ‘half moon’ - can’t palpate the back of the cyst

is attached to hyoid and tongue so moves with sticking out tongue and swallowing

Question 13

Which midline neck lumps can be inflamed?

Answer 13

thyroglossal cyst

or submental lymph nodes

This mass is cellulitis in a thryoglossal cyst, which has a pathognomic sign of lymphangitis with a red flare spreading laterally around the neck

Question 14

Is this an infected thyroglossal cyst?

Answer 14

no, it is too high/too close to the chin, consistent wiht submental lymph node infection (circular redness rather than lateral flaring)

germs - decayed tooth sockets in mandible

Question 15

What is this?

Answer 15

Inclusion dermoid on line of fusion in neck in embyrogenesis

Question 16

Is this a dermoid?

Answer 16

it is in site of fusion but it’s pedunculated (not deep to skin); could still be a rare dermoid on a stalk