Paeds - Head and Neck

Question 1

What is Choanal artesia?

Answer 1

Where a membrane (10%) or bone (90%) separates nasal cavity from normal communication with oral cavity

Unilateral or bilateral posterior nasal narrowing with thickening of the vomer

-Usually unilateral but can be bilateral
-Story for bilateral: Cyanosis that improves with crying

-Story for unilateral: Resp distress when feeding or can’t pass NG

Assocaited with CHARGE syndromes

Coloboma
Heart Defect
Atresia (Chonal)
Retarded growth
GU Abnormalities
Ear Anomalies

Question 2

What is Piriform aperture stenosis associated with?

Answer 2

Very rare birth defect where the front opening of the nose is narrow due to an overgrowth in the upper jaw bone. Due to hypertrophy of medial nasal processes

Can cause airway issues

Assc with hypothalamic-pituitary adrenal axis dysfunction

Other associations:
-midline defects of the brain, corpus callosum agenesis, holoproscephaly
-choanal atresia

Question 3

Ectopic thyroid - where is most common position?

Answer 3

Back of throat is most common

Tc-MIBI used to diagnose ectopic thyroid tissue. CT is second (iodine is bright)

Question 4

What is position of thyroglossal duct cyst?

Answer 4

Midline cyst in the neck of a child

Classic locations:
1. Base of tongue
2. Midline anterior to the thyroid

Question 5

Appearance and position of head and neck dermoid cysts?

Answer 5

Either midline sublingual or submandibular space

Have sac of marbles appearance representing fat within fluid

Question 6

Branchial Cleft cyst

Which is most common type?

Answer 6

Most common type is the 2nd branchial cleft cyst (95%)

-Angle of mandible is classic location

Extension of the cyst between ICA and ECA just above the bifurcation is pathonomonic

If asked position - it is LATERAL to everything (mostly)

-posterior and lateral to submandibular gland
-lateral to carotid space
-anterior to SCM muscle

Do NOT mistake a new cystic mass in an 18 year old for a branchial cleft cyst - could be necrotic node from Thryoid or nasopharyngeal cancer

Question 7

What is Septic thrombophlebitis of jugular vein otherwise known as?

Answer 7

Lemmieres syndrome

Classically seen in setting of recent nasopharyngeal infection

Fusobacterium necriphorum is bactera that causes the septic emboli

Question 8

What are the most common congenital vascular lesions in the head and neck?

Answer 8

Hemangiomas

Will be T2 bright with flow voids
Will be vascular on doppler
Enhances

Treat if:
-Large size and causing mass effect on airway or vascular structures

Question 9

Cystic hydroma - where is it and when is it usually seen?

Answer 9

Usually seen in utero on Obs scan

Cystic mass hanging off back of neck

Assc with:
-Downs
-Turners

T2 bright
Does NOT enhance

Question 10

4 week old with palpable neck mass and torticollis towards affected side

What is diagnosis?

Answer 10

Fibromatosis coli

-Benign inflammation of the SCM which enlarges it
-Goes away on its own

Can look nasty on US which is main test (if contains calcifications or is outside SCM think Neuroblastoma)

Question 11

Aggressive masticator space mass in a child

What is most common diagnosis? (although still rare)

Answer 11

Rhabdomyosarcoma

Question 12

Croup

What is cause?

What x-ray sign is typical of it?

Answer 12

Usually caused by parainfluneza virus

Agest 6 months to 3 years

Steeple sign where there is loss of convexity of subglottic trachea

Question 13

Epiglottitis age and cause

Answer 13

Caused by Haemophilus influenzae

Usually aged 3.5 year but can be seen in older kids

Question 14

Tracheal papilloma

Answer 14

Grape like structure in the airway

Caused by HPV transmitted by mother during birthing

-Can be multiple and associated with lung nodules

Question 15

Unilateral tracheal shouldering on a frontal x-ray in child

What is diagnosis?

Answer 15

Subglottic haemangioma

Question 16

NAI kids

Answer 16