Neonatal Head and Neck

Question 1

Microcephaly
-possible causes

Answer 1

Normal variation
Familial
Congenital infection
Perinatal brain injury - hypoxic ischemic encephalopathy
Fetal alcohol syndrome
Genetic syndromes - Patau
Craniosynostosis

Question 2

Macrocephaly
-possible causes

Answer 2

Normal variation
Familial
Hydrocephalus
Cranial vault abnormalities
Genetic abnormalities

Question 3

Caput succedaneum
-what is it
-causes
-presentation
-management

Answer 3

Scalp edema at presenting part of head
-mechanical trauma from prolonged delivery through cervix or secondary use of kiwi

Present at birth
Soft, puffy swelling from localised edema
Cross suture lines

Self limiting in days

Question 4

Cephalohematoma
-what is it
-causes
-presentation
-management
-complication

Answer 4

Bleeding between periosteum and skull
-mechanical trauma from prolonged delivery through cervix or secondary use of kiwi

Develops several hours after birth
Commonly in parietal region
DOES NOT cross suture lines

Self limiting in months

Jaundice

Question 5

Subgaleal hematoma
-what is it
-causes
-presentation
-management

Answer 5

Bleeding between periosteum and scalp galea aponeurosis
-emissary veins rupture (connect dural sinus and scalp veins

Kiwi

Fluctuant boggy mass over scalp with superficial bruising
Spreads across whole head, crosses suture lines
Significant blood loss => hypovolemic

NICU => blood and plasma transfusion

Question 6

Craniosynostosis
-what is it
-causes
-presentation
-management

Answer 6

Bones in skull fuse too early, before brain is fully formed
-brain grows => misshapen skull => high ICP

No soft spot on skull
Abnormal shaped skull
Slow head growth

Depends on severity
-may need surgery to relieve pressure

Question 7

Hydrocephalus
-what is it
-causes
-presentation
-investigations
-management

Answer 7

Excess CSF in ventricular system
-imbalance in CSF prod and absorption

Chiari malformation
Craniosynostosis
Neural tube defect/spina bifida
Brain tumour
Infection

Increased head circumference
Open anterior fontanelle => bulge and tense
Sunsetting eyes - downward deviation
-compression of superior colliculus
Irritability
Seizures
Sleepy
Vomiting

Imaging through
-US/CT/MRI

Address underlying cause
Ventriculoperitoneal shunts

Question 8

Cleft lip and palate
-causes
-structures affected
-problems it causes
-management

Answer 8

Polygenic inheritance
Maternal AED use

Cleft lip - failure of fusion in frontonasal and maxillary process (both embryological structures)
Cleft palate - failure of fusion in palatine process of maxilla and nasal septum

Feeding, speech affected
Increased risk of OM if cleft palate

Cleft lip - repaired in 1st week of life - 3 months
Cleft palate - repaired between 6-12months

Question 9

Thyroglossal cyst
-embryology
-presentation
-management

Answer 9

Thyroid develops from floor of pharynx and descends into neck
Connected to tongue by thyroglossal duct
Normally atrophies but can persist

Midline, between isthmus and thyroid and hyoid
Moves upwards with protrusion of tongue
Painful if infected

Surgical excision of cyst and entire duct

Question 10

Branchial cyst
-embryology
-presentation
-management

Answer 10

Arise from remnants of branchial apparatus
-filled with acellular fluid and cholesterol crystals

Unilateral, lateral neck, anterior to sternocleidomasoid
Slowly enlarge
Smooth, soft, fluctuant
Painless unless infected
No movement on swallowing
No transillumination
May have fistula
Enlarge after resp infection

Conservative
Surgical excision

Question 11

Cystic hygroma
-what is it

Answer 11

Congenital benign tumour of lymphatics

Most commonly found in posterior triangle of neck
Soft, compressible
Not painful
No movement on swallowing
Transilluminate

If in older child
-consider if this is malignant

US, CT, MRI

Conservative
Surgical excision