Head, Eyes, Ears, Nose, Mouth & Neck Flashcards
What is required for a complete exam of the head and neck?
visual inspection, obtaining measurements, palpation, ophthalmoscope, auscultation and transillumination
What state is optimal for assessment?
to facilitate an optimal assessment with minimal discomfort, a quiet alert state allows for examination of the eyes and a crying state allows for examination of the oropharynx
What is included in general initial observation?
infant’s state; race-specific variations; color of the skin and mucous membranes; size and symmetry of the head and face; obvious deformations, malformations or evidence of birth trauma
What percentage of all anomalies seen at birth occur in the region of the head and neck?
90%; minor anomalies of the head and neck are common
What is the first step in the assessment of head size?
measurement of the occipital-frontal circumference (OFC)
How is an OFC measurement properly obtained?
by measuring 3 times and recording the largest value obtained; encircling the head at the widest occiput prominence and anteriorly 1-2 cm above the glabellar space at the largest frontal prominence
What is the average OFC measurement of a 40 week term infant?
35 cm, ranging from 33-37cm between the 10th and 90th percentile
Prior to the closure of the fontanels, the OFC is an indirect measurement of what?
intracranial contents including the brain, cerebrospinal fluid, cerebral blood volume and bone
How can an OFC measurement after birth be possibly misleading?
r/t cranial molding, scalp edema or hemorrhage under the periosteum; subsequent measurements should be taken for several days after birth
What is required to diagnose symmetric v asymmetric growth restriction and micro- v macrocephaly?
the percentile of OFC, weight and length respective to gestational age
What qualifies as microcephaly?
OFC <10% for GA
What causes microcephaly?
poor brain growth
How are cranial sutures affected by microcephaly?
cranial sutures become prematurely fused because the expansive force of brain growth that enlarges the cranial vault is lacking
Is microcephaly an isolated finding?
Sometimes, or it may be associated with a genetic syndrome or congenital infx
Under what circumstances might an OFC measurement be less than expected?
prematurity; discrepancies may be d/t inaccurate dating and/or pathologic restriction of growth; non-caucasian infants have a smaller OFC as a normal race variation
Which occurs more frequently: growth restriction or growth acceleration?
growth restriction
What qualifies as macrocephaly?
OFC >90% despite appropriate weight and length for GA
Why might macrocephaly present?
may be a familial characteristic or caused by hydrocephalus or a/w dwarfism or OI
What is the typical presentation of familial macrocephaly?
more often presents as macrencephaly (large brain volume) without hydrocephalic features
How is familial macrocephaly confirmed?
confirmation requires obtaining measurements of the parents’ heads and plotting them on a Weaver curve
When is cranial transillumination indicated?
When the infant’s head has an unusual shape or size or the neurological exam is abnormal
What is implied by a ring of light >2cm larger than the light source when performing a cranial transillumination?
increased fluid volume or decreased brain tissue in the cranium
Under what circumstances might an examiner obtain a “false positive” when performing a cranial transillumination?
when the infant has a large caput because the scalp edema will transmit a halo of light
In the infant presenting with a high level of suspicion for hydrocephalus, transillumination is often replaced by what other more definitive studies?
cranial ultrasound, CT scan or MRI
The relative shape of an infant’s head typically relates to what?
molding of the skull during delivery
What is the typical shape of an infant’s head delivered via CSX?
well rounded
What is the typical shape of an infant’s head delivered in breech position?
molded posteriorly into an egg shape with a prominent occiput
What is the typical shape of an infant’s head delivered following prolonged diagonal pressure?
“out of round” or asynclitic when viewed from above
What can be expected of distorted skull shape due to positional, external pressures in utero or during labor?
to spontaneous resolve; molding usually resolves within a few weeks following birth
What is a suture?
fibrous bands of tissue that separate bones
What is a fontanel?
occur at the intersection of sutures
Where is the metopic suture located?
the metopic suture extends midline down the forehead between the two frontal bones and intersects with the coronal suture
Where is the coronal suture located?
the coronal suture is situated anterolaterally across the cranium separating the frontal and parietal bones
What is formed at the intersection of the metopic, coronal and sagittal sutures?
the anterior fontanel (AF)
What is the typical size of the AF?
the size of the AF varies from 0.6-3.6cm across; in African American infants, it is commonly larger (1.4-4.7cm)
How are fontanels measured?
diagonally from bone to bone rather than from suture to suture
What can fontanel measurement provide?
because there is a wide variation of fontanel size at birth, the measurement may serve only as a baseline for serial comparison. Individual measurements have no clinical significance and limited reproducibility
How is the AF typically described?
flat and soft is assessed with the infant in a quiet state with the infant held in the sitting position
What might a tense or bulging fontanel indicate?
increased ICP or may occur with a crying infant
What might a sunken fontanel indicate?
severe dehydration and is rarely seen in the newborn nursery; may indicate excessive or acute decompression by an EVD
What might a very large AF indicate?
congenital hypothyroidism
When is the AF expected to close?
between 6-24mo of age
Where is auscultation performed?
over the fontanels and lateral skull bones
When is auscultation of the fontanels specifically indicated?
infants with multiple hemangiomas or heart failure
What does the appreciation of a bruit over the fontanels or lateral skull indicate?
may be a normal finding; a bruit in infant with suspected cardiac failure is a/w an intracranial arteriovenous malformation- which may be the cause of the CHF
Where is the sagittal suture located?
the sagittal suture extends midline between the two parietal bones to the PF
Where is the lambdoidal suture located?
the lambdoidal suture extends posterolaterally across the cranium to separate the occipital and parietal bones
What is formed at the intersection of the lambdoidal and sagittal sutures?
the PF
What is the approximate size of the PF?
0.5cm in Caucasian infants; 0.7cm in AA
When does the PF close?
approximately by 2-3mo of age
How does the PF typically present?
soft and flat on palpation
If present, where can a third fontanel be found?
may occur along the sagittal suture between the AF and PF
Is the third fontanel a true fontanel?
No, it is a defect of the parietal bone
What might the presence of a third fontanel indicate?
may be a normal variation or may be a/w Down syndrome or congenital hypothyroidism
Where is the squamosal suture located?
extends above the ear to separate the temporal bone from the parietal bone
Where is the sphenoid fontanel located?
at the intersection of the coronal and squamosal sutures and posterior to the frontal bone, distal to the parietal bone and anterior to the temporal bone
Where is the mastoid fontanel located?
at the intersection the squamosal and lambdoidal sutures and posterior to the temporal bone, distal to the parietal bone and anterior to the occipital bone
Under what conditions can the mastoid fontanel, sphenoid fontanel and squamosal suture be palpated?
only with increased ICP as with severe hydrocephalus, but may be palpable in preterm infant r/t rapid brain growth
How is mobility of the sutures assessed?
placing the thumbs on the bones on either side of the suture and gently pressing down alternately with one thumb then the other
How are normal sutures described?
approximated and mobile, may be split up to 1 cm
What are overriding sutures?
with molding, the edge of the bone on one side of the suture will feel as if is it on top of the edge of the opposing bone
What suture is commonly overriding?
lambdoidal sutures- the parietal bone on top of the occipital bone due to molding after birth or with minor decrease in hydration
What is craniosynostosis?
premature fusion of the suture
How is craniosynostosis differentiated from an overriding suture?
presents as a peaking of the approximated bones and is immobile
How is head shape affected by craniosynostosis?
premature closure stops perpendicular growth to the suture but allows parallel bone growth and compensatory expansion at the functional sutures leading to abnormal head shape
When can craniosynostosis present?
may be present at birth, or later in infancy
How does brachycephaly occur?
fused coronal sutures limit forward growth of the skull and lead to a broad shaped skull
How does scaphocephaly occur?
premature closure of the sagittal suture limits lateral growth and results in a long, narrow head
How does plagiocephaly occur?
closure of a laterally positioned suture results in asymmetric skull shape
What is the term for an abnormally shaped preterm infant’s head relating to postnatal positioning and without craniosynostosis?
dolichocephaly
How can craniosynostosis present?
can be a primary finding or may be a/w a genetic syndrome (Apert or Crouzon) or the result of a metabolic disorder (hypothyroidism)
what is the incidence of isolated craniosynostosis?
0.4-1 per 1,000 live births
What are craniotabes?
palpation of the skull may reveal areas of soft or thinning bone
What is the Macewen sign?
palpating the skull in an area of thinning bone that elicits collapse with recoil of the underlying bone and a snapping sensation
Why are craniotabes sometimes present?
an incidental finding on the parietal bones near the sagittal suture; d/t external pressure from prolonged vertex engagement or pressure of the fetal head on the uterine fundus with breech position; or r/t internal pressure and hydrocephalus
If craniotabes are present due to external pressures, when can they be expected to resolve?
a few weeks
If craniotabes are present due to internal pressures, when can they be expected to resolve?
resolution depends on the degree and persistence of internal pressure causing bone thinning
What is the most common form of trauma to the head during birth?
caput succedaneum
What is a caput?
edema of the presenting part of the scalp caused by pressure that restricts the return of venous and lymph flow during labor and delivery; may be accentuated by vacuum assist
What are the defining characteristics of a caput?
edema pits with pressure, edges are poorly defined and crosses suture lines
When can a caput be expected to resolve?
caput is noted immediately after birth and resolves within a few days (unlike a cephalhematoma)
How is a cephalhematoma formed?
the result from the collection of blood between the periosteum and the skull
Why might a cephalhematoma not be evident at birth?
may be obscured by a caput
What are the defining characteristics of a cephalhematoma?
clearly demarcated edges confined by suture lines
How long does it take for a cephalhematoma to resolve?
with time it may liquefy and become fluctunant on palpation; takes weeks to months to resolve completely
What are the most common locations for a cephalhematoma to present?
the parietal and occipital bones
How frequently are cephalhematomas associated with depressed skull fractures?
rarely
What is the most potentially serious lesion presenting from birth trauma?
a subgaleal hemorrhage
What actions in a delivery increase the risk of a resultant subgaleal hemorrhage?
most common with instrumental vaginal delivery, especially vacuum; sometimes occurs with CSX or any maneuver during delivery that produces a shearing forces to the scalp resulting in tearing of the large emissary veins
What is a subgaleal hemorrhage?
bleeding into the galen aponeurotica or subaponeurotica space, which extends from the orbital ridges to the nape of the neck and laterally to the ears
Why is a subgaleal hemorrhage potentially life threatening?
this potential space produces a large compartment capable of containing the total blood volume of an infant (5-22% mortality rate is blood loss is extensive and not diagnosed early)
How does a subgaleal hemorrhage typically present?
generalized scalp edema, usually with ecchymosis, BL or unilateral periorbital and periauricular edema
How does a subgaleal hemorrhage present on palpation?
the ballotable fluid mass crosses the sutures and can be manually repositioned from the eyebrows to the nape of the neck, differentiating it from a caput.
If permitted to progress, a subgaleal hemorrhage will result in, what?
severe anemia, hypotension and death
How is a subgaleal hemorrhage managed?
volume resuscitation, blood replacement and treatment of presenting clot abnormalities
What additional scalp traumas may occur resulting from delivery?
puncture from scalp electrodes, lacerations from fetal blood sampling or uterine incision, bruises, abrasions or subQ fat necrosis from an instrument delivery
How should trauma from a delivery be described?
by appearance, size, location near sutures or fontanel or underlying bones
When are open scalp defects (aplasia cutis congenita) observed?
may be a normal variant but are sometimes a/w trisomy 13
What skull malformations are the result of an incomplete neural tube closure?
encephalocele
Where do encephaloceles most commonly present?
central nervous tissue can protrude from a defect anywhere on the skull but most commonly midline and in the occipital area
A through examination of the scalp should include what elements?
assessment of the hair for quantity, texture, distribution and hair whorls
What attributes of the hair may be a/w congenital anomalies?
a low hair line, an increased quantity of hair and brittleness
What accounts for the presence of hair whorls?
the slope of each hair follicle is a/w the stretch of skin during brain growth
Why are hair whorls typically present in the posterior parietal region?
the most rapid brain growth occurs at 16 to 19 weeks GA and results in a hair whorl in it’s corresponding region of concentrated growth
How many hair whorls is considered normal?
1-2
What scalp features may indicate mental retardation or aberrant brain growth?
an abnormally placed whorl, absence of a hair whorl or unusual hair growth
What feature of the scalp correlates with central nervous system development?
scalp hair in the newborn has variable coarseness and the thickness of scalp hair growth patterns correlates with CNS development
What is alopecia?
an abnormal deficiency of hair that may be diffuse or focal
What is typical of diffuse alopecia?
commonly due to a genetic anomaly in the hair follicles or is syndromic
What is typical of focal alopecia?
often traumatic or a/w underlying scalp lesions
What is hirsutism?
excessive hair growth
What can cause hirsutism?
genetic, syndromic, metabolic, drug-induced or an isolated finding
What is aplasia cutis congenita and where is it commonly found?
an uncommon scalp lesion found primarily at the vertex just in front of the lambda
How does aplasia cutis congenita typically present?
a hairless, circumscribed area of 1cm or more, surface is often shiny, cicatrical and flat/keloid; occasional blistering/ulceration w/serosanguinous exudate or fresh granulation
What is the risk of aplasia cutis congenita?
potential underlying defect and other assoc major defects; usually is an isolated finding
What are the long term implications for an aplasia cutis congenita?
resolves with a residual scar formation and absence of hair growth
How should examination of the face begin?
observation of the relationships b/w eyes, ears, nose & mouth
What is the relative size of the newborn forehead and why?
takes up the upper half of the face and reflects the large cranial volume needed for rapid brain growth
What may indicate face or brow presentation at delivery or nuchal cord?
facial bruising, petechiae and progressive edema
What might occur as the result of prolonged intrauterine compression from oligohydramnios?
unusual flattening of facial features
What can occur from a forceps assisted delivery?
bruises, abrasions or subQ fat necrosis
How are facial movements assessed for symmetry?
during crying
How will an infant present if there has been damage to CN7 prior to or during delivery?
paralysis of the affected side of the face; extensive damage can involve the entire side of the face and cause drooping of the muscles on the affected side of the face
What portion of CN7 is most commonly damaged?
the mandibular branch which controls the muscles around the lips
How do infants present if the mandibular branch of CN7 has been damaged?
decreased mv’mt on the affected side bc weakened facial muscles allow the mouth to be pulled to the unaffected side (“drooping mouth”)
How can CN7 damage be differentiated from asymmetric crying facies?
loss of forehead wrinkling and nasolabial fold and partial closing of the eye on the affected side
if nerve damage is caused by pressure, when are facial effects expected to resolve?
hours to weeks after birth
When does congenital facial palsy occur?
often spontaneous but is also a/w difficult or instrumented delivery requiring forceps
What might a persistent palsy indicate?
an underlying, more central abnormality
What is asymmetric crying facies?
a congenital absence or hypopasia of the depressor anguli oris muscle (DAOM) on one side
What does the depressor anguli oris muscle (DAOM) control?
frowning; with resulting asymmetry of the face with crying
Abnormal formation or placement of the ears may be associated with what?
chromosomal anomalies and syndromes, however a wide variety of minor structural variations fall within the normal range
In a term infant, how should the pinna appear?
should be well formed with cartilage that recoils easily after folding
Why might there by temporary asymmetry of the ears?
r/t unequal intrauterine pressure on the sides of the head (common)
Especially hairy ears involving both the pinna and the lobes are present in what groups of infants?
may be familial, syndromic or infants of mothers with poorly controlled DM
Pits and tags are remnants of what embryologic structures and where are they located?
these minor malformations are located anterior to the tragus and are thought to be remnants of the first brachial cleft or arch
How can a preauricular sinus present?
may be blind or it may communicate with the internal ear or brain
In the context of chronic infx, what treatment may be necessary for a preauricular sinus?
surgical removal of the entire tract
What is a Darwinian tubercle and what does it indicate?
small nodule appearing on the upper helix; normal variant
What does a poorly formed external ear possibly indicate?
a possible chromosomal anomaly or syndrome
How can ear position be assessed?
by extending a line from the inner to the outer canthus of the eye toward the ear; if insertion of the ear falls below this line, it is considered low set
Describe the appearance of an infant’s external auditory canal.
it is short and may contain vernix, interpartum blood or mec debris (making otoscopic examination difficult)
What should the external ear be examined for?
inspected visually to assess presence and patency of the auditory canal
What may increase an infant’s risk for hearing loss?
a small or abnormally developed ear
What trauma to the eyes can occur with a NSVD?
bruises, edema of the eyelids and sclera hemorrhage
What causes a conjunctival or subconjunctical hemorrhage?
results from the rupture of a capillary of the mucous membrane that lines the eyelids and is reflected onto the eyeball (conjunctiva)
How does a conjunctival or subconjunctical hemorrhage present?
it is seen as a bright red area on the sclera near the iris
When does a conjunctival or subconjunctical hemorrhage resolve?
spotaneously resolves within a week to ten days without residual effect
What can cause inflammation of the conjunctiva?
prophylaxis silver nitrate gtt (less often with erythromycin ointment)
What is a coloboma?
an absence or defect of some ocular tissue, including the eyelid
What is ptosis?
a paralytic drooping of an eyelid when the lids are fully open
How does nevus simplex present on the eyelids and glabella?
as a common vascular birthmark
When does tear formation begin?
not usually until 2-3mo of age
When does the nasolacrimal duct become fully patent?
not until 5-7 mo
Until the nasolacrimal duct is patent, what is a common finding?
purulent of mucoid eye drainage
When is nasolacrimal duct drainage concerning?
When in the context of conjunctival inflammation with redness or swelling
When infection is not suspected, how can nasolacrimal duct drainage be treated?
lacrimal massage and gentle cleansing with water and a cotton ball
What is the relative size of symmetric eyes?
the distance bw the outer canthi can be divided into equal thirds, with one normal palpebral fissure length fitting into the inner canthal distance
What is hypertelorism?
if the eyes are more widely spaced
What is hypotelorism?
if the eyes are closely spaced
What is an eye characteristic found in Asian population and 20% of non-Asian population?
the epicanthal fold is a vertical fold of skin on either side of the nose that covers the lacrimal caruncle
Why does the epicanthal fold that covers the lacrimal duct disappear in non Asian populations?
By 10 y; the growth of the nasal bridge catches up to that of the medial canthal skin
What might epicanthal folds with upslanting palpebral fissures and hypertelorism?
Down syndrome
How are eyebrows normally positioned?
eyebrows normally extend above the eye in a curve approximately the length of the palpebral fissure
What do eyebrows that meet at the glabella and abnormally long or tangled eyelashes suggest?
Cornelia de Lange syndrome
What facilitates the eye exam?
spontaneous opening by the infant
What can encourage spontaneous opening of the eye?
auditory stimulus, changing the infant’s position, gentle swinging or dimming the lights
What happens if the infant’s eyes are forcefully opened?
the eyelids will evert, making visualization impossible
How do you conduct an opthalmoscopic exam?
first adjust for focus and then supply a small round white beam of light; direct the light into the pupil from 6” to assess constriction, PERL
What is a red light reflex?
when a bright light is directed at the newborn’s lens, a clear red color is reflected from the retina back to the examiner
What will interrupt a red light reflex?
an opacity of the lens or cornea
What is implied by a lack of a red light reflex?
congenital cataracts, glaucoma or a retinoblastoma
How might the red light reflex appear in dark-skinned infants?
pales from orange toward grey in the most pigmented infants
What is a keyhole shaped iris?
a coloboma of the iris
Describe the iris of a newborn infant.
generally dark grey, blue or brown at birth
When do infant’s acquire final iris pigmentation?
about 6mo
What are brushfield spots?
white specks scattered linearly around the entire circumference of the iris
With what syndrome do brushfield spots typically present?
Down syndrome, although may be a normal variant
What might a blue sclera indicate?
OI
What might a yellow sclera indicate?
hyperbilirubinemia
In a normal gaze, what part of the sclera should never be visible?
above the iris
What is the sunset sign and what is it associated with?
lid retraction and a downward gaze; seen in infants with hydrocephalus
What is nystagmus?
rapid, searching movements of the eyeballs
How might limited horizontal nystagmus be elicited and when does it disappear?
with rotational eye movement; 3-4 mo of age
What presentation of nystagmus is always aberrant and likely a/w visual and/or neurologic abnormalities?
spontaneous horizontal, vertical or torsional nystagmus and persistent nystagmus
From what does strabismus arise?
from muscular incoordination and gives the appearance of crossed eyes
When does pseudostrabismus from a flat nasal bridge or epicanthal fold usual resolve?
by 1yr
How do pseudostrabismus and strabismus differ?
pseudostrabismus has the presence of a symmetrical corneal light reflex
Proptosis or enlargement of the eyeball is associated with what congenital condition?
hyperthyroidism
What damage might congenital glaucoma cause to the neonatal eye?
damage to the eye with hemorrhage into its orbit
What is the typical presentation of an infant’s nose?
generally smaller and flatter than an adult’s; nose should be symmetric and placed vertically in the midline
Describe the nose of an infant with Down snydrome.
a very low nasal bridge with a broad base
What might cause lateral deviation of the nasal septum?
position in utero or by a dislocated septum
How can you determine if the nasal septum is deviated?
if the septum will not easily straighten and the nares remain asymmetric when the tip of the nose is pushed to midline- will require tx
Elevating the tip of the nose slightly will allow the examiner to assess what features?
the nasal septum, the floor of the nose and the turbinates
How can nasal patency be assessed?
by watching the infant breathe in a quiet state
How will bilateral choanal atresia present in the neonate?
cyanosis at rest and pink when crying (because of breathing through the mouth)
Nasal occlusion can also be acquired from accumulation of secretions and result in what signs and symptoms?
noisy respirations, feeding difficulties, respiratory distress or apnea
What might excessive bulb suctioning cause?
aggravate the occlusive tendency of the nares
How should nasal occlusion secondary to edema be treated?
intermittent installation of NS gtt
What may result from the use of CPAP therapy?
erosive trauma to the nasal labia, nasi columella and nares
How can the trauma r/t CPAP therapy be minimized?
preventative and protective skin coverings, monitoring the area for ulceration will minimize long-term disfiguring and scarring
What anomalies are usually syndromic or a/w major CNS anomalies?
major nasal abnormalities (including clefts, single nares, masses and partial or complete hypoplasia)
How should the lips and mucous membranes of a healthy term infant present?
pink; mild circumoral cyanosis is normal during transition and with crying during the first few days
What is microstomia
small oral opening
When is microstomia typically present?
storage diseases such as the mucopolysaccharidoses
What “facies” are typically present with fetal ETOH syndrome?
a thin upper lip with a smooth philtrum and short palpebral fissures
What elements of an infant’s cry should be assessed?
quality, strength, pitch and hoarseness or stridor
Use of a tongue depressor for oral examination may result in what?
a strong protrusion reflex, making assessment difficult
How might an infant’s mouth be opened safely?
gently pressing down on the chin
How should a typically presenting tongue appear?
the tongue should fit well into the floor of the mouth and appear symmetric
What is the danger with macroglossia?
impedes closure of the mouth, may obscure airway
What conditions present with macroglossia?
Bechwith-Wiedemann, hypothyroidism and mucopolysaccharidosis
Is there macroglossia associated with Down syndrome or Robin sequence?
No, the tongue may appear large with micrognathia
What is the frenulum?
attaches the underside of the tongue to the floor of the mouth, usually midway between the tongue’s ventral surface and tip
When does a tongue tie require treatment?
a very thick and prominent frenulum is rare; if limiting movement or pulls the tongue to a V at the tip- it is abnormal and requires tx
What might white patches on the tongue and mucous membranes be?
residual milk or leukoplakia (normal in darkly pigmented infants)
How do lesions of a Candida (oral thrush) present?
if the white coating cannot be easily removed with a tongue blade or cotton swab
What is a mucocele or ranula?
a translucent of bluish swelling under the tongue, mucous or salivary gland retention cysts that usually spontaneous resolve
What should be palpated within the oral cavity?
continuity of the hard and soft palate, strength and coordination of suck, gag reflex, lumps or masses on the gum line
What are Epstein pearls and where do they present?
small whitish-yellow clusters- epithelial inclusion cells; at the junction of the hard and soft palates and on the gums
When are Epstein pearls expected to resolve?
by a few weeks of age
In what population are natal teeth a common variant?
Native American; rarely seen in Causcasian infants
Where are natal teeth or eruption cysts with teeth usually seen?
lower incisor region
Why are natal teeth a potential risk?
they are usually immature caps of enamel and dentine with poor root formation and may be very mobile; caus ulceration of tongue, pain w/feeding, presumed risk for aspiration
If natal teeth are firmly planted, what is a dentist’s likely recommendation for tx?
removal may impact future dentition and the dentist may choose to leave it in place and do a f/u exam to assess for complications
What are possible etiologies for excessive oral secretions?
esophageal atresia, poor swallow from a neurologic abnormality
How can esophageal patency be assessed?
passage of a large bore (usually 10Fr) OGT with CXR confirmation
What is the typical presentation of an infant’s neck?
normally short, severe shortness may be syndromic
How can the shape and symmetry of the neck best be observed?
elevate the shoulders, allowing the head to fall back slightly
Asymmetry of the neck is most likely due to what forces?
in utero positioning
Is it possible to palpate the thyroid gland?
very difficult to do unless it is enlarged
What is the etiology of a congenital goiter?
intrauterine deprivation of thyroid hormone, very rare
What is the most commonly seen neck mass in neonates?
Cystic hygroma
What is the etiology of cystic hygromas?
development of sequestered lymph channels, which dilate into cysts
Describe a cystic hygroma.
soft and fluctuant, transilluminate well and usually visualized laterally over the clavicle
What are the potential risks a/w cystic hygromas?
may cause severe feeding difficulties or airway compromise
How are cystic hygromas managed?
very small lesions may regress spontaneously, but surgical resection is usually required
A mass appearing high in the neck may be…?
a thyroglossal duct cyst or a brachial cleft cyst
Where can a branchial sinus be visualized?
anywhere along the sternocleidomastoid muscle
Why is surgery often indicated for a branchial sinus?
it may communicate with deeper structures and infx may necessitate surgical removal of the entire sinus tract
What syndromes present with neck webbing?
Turner, Noonan and Down syndrome
What birth history increases the risk for clavicle fx?
h/o shoulder dystocia or macrosomia
How may an infant in pain relating to a clavicular fx present?
nonrespiratory tachypnea
What might be felt from a manual exam of the clavicles?
movement of the bone ends and crepitus may not be felt soon after birth; or a fx may not be evident for wks until a callus has formed and can be palpated as a mass
