7.2.3 Head and Neck Abnormalities

Question 1

Where will 3rd and 4th branchial cleft anomalies be located?

Answer 1

Lower 1/3 of anterior neck

Sinus/fistula ends in pyriform sinus

Associated with thyroid gland

Question 2

What are the derivatives of the 6th arch? (Cartilage, muscle, artery, CN)

Answer 2

Question 3

What is the management of 3rd and 4th branchial cleft anomalies?

Answer 3

+/- hemithyroidectomy

direct laryngoscopy

endoscopic cauterization

Question 4

What are some malformations associated with a 1st pouch anomaly?

Answer 4

Eustachian tube dysfunction - recurrent ear infections

Absent tympanic cavity - CHL

Absent mastoid cavity

Question 5

Condition? Type of anomaly?

Answer 5

Pierre Robin Sequence; 1st arch anomaly

Question 6

What are the two branchial cleft anomalies? Why is it important to distinguish b/t them?

Answer 6

Type 1 and Type 2

Important to distinguish b/t them because of their relationship to CNVII. Type 1 is always lateral to CNVII. Type 2 can be lateral or medial

Question 7

What condition?

Answer 7

Treacher Collins

Question 8

What type of anomaly is DiGeorge syndrome? What are the presenting features?

Answer 8

3rd & 4th Pouch anomaly

CATCH-22

Cardiac anomalies

Abnormal facies

Thymic aplasia

Cleft palate

Hypocalcemia

22nd chromosome deletion 22.q

Question 9

What type of vascular anomaly is associated with a 4th arch anomaly?

Answer 9

Double aortic arch

Question 10

What type of anomaly will present with chronic drainage from areas around the EAC, angle of mandible, SCM? These can get infected. If so, what is the treatment?

Answer 10

Branchial cleft anomaly

Abx, Avoid I&D and surgery by 3-4 y/o (CT and MRI often used to confirm diagnosis)

Question 11

What type of vascular anomaly is associated with a 6th arch anomaly?

Answer 11

Pulmonary artery sling

Question 12

What are some features of hemifacial microsomia?

Answer 12

Malformed auricle - microtia/anotia

Ossicular malformation - stapes, malleus, incus, CHL

Facial muscle assymmetry

Hyoid malformation

Question 13

What surgery can be done in attempt to correct the micrognathia of Piere Robin sequence?

Answer 13

Mandibular Distraction

Question 14

What are the derivatives of the 4th arch? (Cartilage, muscles, artery, CN)

Answer 14

Question 15

How will 2nd branchial cleft anomalies present? Their location?

Answer 15

Painless, fluctuant cyst, sinus, or fistula in anterior triangle

Anterior border of SCM

Question 16

What are some of the important aspects in the initial management of patients with Piere Robin Sequence?

Answer 16

Avoid respiratory distress (nasal airway, positioning, tongue lip adhesion, intubation)

Feeding (Habermann nipple, special bottle

Question 17

What type of anomaly is hemifacial microsomia?

Answer 17

2nd arch anomaly

Question 18

What type of anomaly is a thyroglossal duct cyst?

Answer 18

3rd and 4th pouch

Question 19

What presents as reddish mass at the base of the tongue and is a result of failed descent?

Answer 19

Lingual thyroid - complete failute of thyroid descent

Question 20

Where are thyroglossal duct cysts located along the neck?

Answer 20

Midline; may move/elevate with protrusion of the tongue

Question 21

What are some of the presenting features of Treacher Collins?

Answer 21

Midface & Mandibular hypoplasia

Cleft Palate

Ear: CHL (conductive hearing loss), microtia, atresia

Question 22

What is the genetics of Treacher Collins?

Answer 22

AD, variable penetrance

Question 23

What are the derivatives of the second second arch? (Cartilage, Muscle, Artery, CN)

Answer 23

Question 24

What type of vascular anomaly is associated with a 3rd arch anomaly?

Answer 24

Carotid artery aneurysm

Question 25

What is used to evaluate TGDC and lingual thyroid? What are the management options?

Answer 25

Question 26

What are the features of Pierre Robin Sequence?

Answer 26

1. Micrognathia
2. Glossoptosis (posterior displacement of tongue)
3. Cleft palate (U-shaped)

Question 27

Name the condition and type of anomaly

Answer 27

Treacher Collins; 1st arch anomaly

Question 28

What are the derivates of the 3rd arch? (cartilage, muscles, artery, CN)

Answer 28

Question 29

What surgery can be done after mandibular distraction to correct the u-shaped cleft palate of Piere Robin sequence?

Answer 29

Palatoplasy

Question 30

What is the most common branchial anomaly?

Answer 30

2nd branchial cleft

Question 31

What are the derivatives of the 1st arch? (Cartilage, Muscle, Artery, CN)

Answer 31

Question 32

What is the most common congential neck mass?

Answer 32

Thyroglossal duct cyst - failure of complete obliteration of the thyroglossal duct