Pedia Neck Masses Flashcards
treatment algorithm for pedia neck masses
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what is a branchial cleft cyst
- congenital epithelial cyst
- benign, nontender fluctuant mass
- can become inflamed and form an abscess during an urti
types of branchial cleft cysts
1st: near angle of mandible
2d: high in neck, deep to anterior border of scm (most common)
3rd: upper pole of thyroid gland
management of branchial cleft cysts
radio: uts, ct, mri
surgical excision
what are thyroglossal duct cysts
- form in persistent thyroid descent tract
- elongation of thyroid diverticulum at foramen cecum of tongue -> thyroid gland
- remnant cysts not associated with cutaneous sinus or fistula tract unless surgically drained and inadequately excised
manifestation and treatment of thyroglossal duct cyst
- asymptomatic midline neck mass that elevates with swallowing or tongue protrusion
- treatment: sistrunk procedure
what are lymphangiomas
- lymphatic malformation from failure of lymph spaces to connect to lymph system
- soft, smooth, nontender, can be compressed and transilluminated
complications of lymphangiomas
can cause significant cosmetic deformity
can impair respiration and alimentation
types of lymphatic mallformations
- combined venolymphatic malformation (lymphatic and venous)
- macrocystic lymphatic malformation (cystic hygroma)
management for lymphangiomas
sclerotherapy if macrocystic (>2 cm)
surgical excision
what are hemangiomas
- proliferative endothelial lesion (red or blue soft mass)
- present at birth, involutes at 18-24 mos
- may have bruit over lesions
- ct/mri
management of hemangiomas
- observation: involutes after several years
- surgical excision or laser therapy for incomplete involution
- propanolol to reduce angiogenesis and vasoconstriction
what are dermoid cysts
- similar to teratomas which are pathologically related
- epithelium lined cavities filled with skin appendages
- from entrapped epithelium during embryogenesis
- common in midline/submental region
- painless
management of dermoid cysts
complete surgical excision
what are laryngocoeles
- abnormal dilation or hernation of the saccule of the larynx
- hoarseness, cough, dysphagia
- ct scan
types of laryngoceles
internal: within thyroid cartilage
external: extends cephalad, protrudes through thyrohyoid membrane
management for laryngocoele
surgical excision from external approach
what is congenital torticollis
- dense fibrous tissue and absence of normal striated muscle in scm
- firm, painless, discrete, fusiform mass
- appears at 1-8 wks, increased for 2-3 mos, regress for 4-8 mos
management of congenital torticollis
conservative mgt with physiotherapy (passive and active motion) preventes teh development of restrictive torticollis
resistant: surgical section of scm
more common type of acquired neck mass
viral
what is reactive lymphadenopathy
- bilateral
- reactive from benign self-limiting viral urti (adeno, rhino, entero, ebv)
- nodes are small, rubbery, modile, discrete, and minimally tender WITHOUT erythema
management of reactive lymphadenopathy
supportive
what is suppurative lymphadenopathy
- unilateral
- tender, warm, erythematous, non-discrete, and poorly mobile
- w/ associated symptoms but non toxic
- usually at submandibular and anterior or posterior cervical triangles
most common organisms in suppurative lymphadenopathy
s aureus
group a beta hemolytic strep
management of suppurative lymphadenopathy
- single course broad spectrum antibiotic, reassessment in 1-2 wks
- s aureus/gas: 10 day cefalexin, coamoxiclav, clindamycin
what is non-tuberculous mycobacterial lymphadenopathy
- firm and nontender
- grows overr several weeks
- skin becomes violaceous and thin
what are lipomas
- benign encapsulated fatty tumors in the subcutaneous tissue (rare in h&n)
- mgt: surgery
what are neurofibromas
- circumscribed tumors of schwann cells, nerve fibers, and fibroblasts
- small cutaneous nerves or cranial nerves
- rarely occur as multiple fibromas (may be nf1)
- mgt: excision
what are pleomorphic adenomas
- uncommon
- usually salivary gland tumors
- mgt: excision
most common neck malignancy in pedia
lymphoma
types of hodgkin and non hodgkin lymphomas
h: nodular sclerosing, mixed cellularity, lymphocyte predominant, lymphocyte depleted
nh: lymphoblastic, large cell, undifferentiated
___ lymphoma is more common in the neck
hodgkin
mgt for lymphoma
h: chemo or radio
nh: chemo
clues for diagnosing nasopharyngeal carcinoma
- unilateral otitis media
- rhinorrhea
- nasal obstruction
- 1-2 cn palsies
- blacks and asian adolescents
- elevated ebv type 2 and 3 titers
diagnostics for nasopharyngeal carcinoma
- biopsy
- ct/mri for tumor extent
- bone scan/abdominal ct for bone or liver metasases
mgt for nasopharyngeal carcinoma
combined chemo-radiotherapy
what is neuroblastoma
- originate from neuroblasts and neural crest cells
- associated with ipsi horner syndrome
- sx: lump in abdomen/chest, bone pain, bruising around eyes
diagnostics for neuroblastoma
ct/mri of the neck, chest, and abdomen
elevated vanillylmendelic acid in 24 hr collection
mgt: surgery, radio, chemo
