TRANS 49 - 51 Congenital salvador Flashcards
What is the common wall between the trachea and the
esophagus?
Trachealis muscle
Nasal placodes become the nasal pits at ___________ AOG that further deepens forming nasal cavities
30 days
forms from the fused nasofrontal process and medial nasal prominence
nasal septun
Turbinates form as swellings of the lateral nasal wall starting at about
38 days AOG
Primitive choana is posterior to the primary palate and is patent at
7 weeks
Nasolacrimal groove separated the lateral nasal prominence from the maxillary prominence at?
10 weeks
The floor of the nasolacrimal grove thickens to form the
Nasolacrimal duct
The vomer and perforated portions of the cribriform ossify by
3 years
Adenoids peak in size between______ years and start to regress by __________
3-5 years; 8 years
Nasal cavity grows rapidly in the first
6 years of life
External nasal dimensions are greatly mature by ______ in females and _______ in males
13; 15 years
Most common site of epistaxis is the
Kiesselbach’s plexus
cyanosis at rest and resolution with crying and agitation (when the child is in open mouth position), is typical of infants with bilateral choanal atresia
Cyclical stenosis
Crucial function of the sinuses
production of mucus;
• Related to overgrowth of nasal process of the maxilla causing
obstruction of the pyriform appertures
Kahit may dalawang butas yung ilong, kakaiba yung
mukha niya, then one central incisor, kapag
inendoscopy mo yan or anterior rhinoscopy, wala kang
makikitang butas sa loob kasi your pyriform aperture,
kasi diba yung sa skull, triangular, that is your pyriform.
Kasi yung cartilages mo sa front nose minsan
nagdedevelop pero yung pinaka-bone, the pyriform
apperture, closed pala or walang butas.
CONGENITAL PYRIFORM APERTURE STENOSIS
• Results from the failure of the caudal nasolacrimal duct to
canalize
• 90% are unilateral
• F:M =2:1
NLD OBSTRUCTION/CYSTS
- Includes dura, organized neural elements, and communication with the subarachnoid space
- Sincipital encephaloceles present as a mass at the nasal dorsum (nasoethmoid), orbits (naso-orbital) or glabella (nasofrontal)
- Basal encephaloceles usually present as intranasal masses
ENCEPHALOCELE
- Derived from glial cells
- Intranasal or extranasal, based upon the relationship with the nasal skeleton
- Approximately 15% of gliomas have a fibrous stalk continuous with the dura
GLIOMAS
- Composed of ectodermal and mesodermal elements
- Often associated with a pit in the midline nasal dorsum
- May have communication with floor of anterior cranial fossa through the foramen caecum
NASAL DERMOIDS
• The functional abnormality results from the defective dynein arms • Maybe familial • Kartagener Syndrome o Sinusitis o Situs inversus o Bronchiectasis o Maybe associated with infertility
IMMOTILE CILIA SYNDROME (PRIMARY CILIARY DYSKINESIA)
separates the anterior and posterior ethmoid cells
The basal lamella of the middle turbinate
Sphenoid sinuses start to pneumatize at about
2 years of age
All structures of the oral cavity grow postnatally. True or false?
True
- Condition of the tongue in which there is restriction or limitation of the movements or range of motion of the tongue
- May interfere with feeding or speech
ANKYLOGLOSSIA
Complete vs incomplete cleft palate
A cleft lip contains an opening in the upper lip that may extend into the nose. (The opening may be on one side, both sides, or in the middle.)
Pag umabot siya sa nose, it said to be complete. Incomplete if hindi umabot sa nose.
- Obstruction of the sublingual gland
* Usually seen as unilateral cystic lesion in the floor of the mouth
RANULA
physical exam to check sublingual and submandibular gland. You’ll palpating the floor of the mouth and submandibular triangle.
bimanual palpatioin
Results from abnormal descent of the thyroglossal tract into the neck
Sometimes there’s a tongue base mass
LINGUAL THYROID
are congenital epithelial cysts, which arise on the lateral part of the neck from a failure of obliteration of the branchial cleft in embryonic development
Branchial cleft cysts
fistula vs sinus vs cyst?
You should differentiate a fistula from a sinus to a cyst. Anatomically, a cyst is completely enclosed by an epithelium, a sinus has one opening, and a fistula have an internal opening and an outer opening.
what pouch is the most common cyst?
Second branchial ‘cleft’ cyst – tract linked to tonsillar fossa (palatine tonsils)
The larynx, trachea, and esophagus are formed by
the 8th week AOG
is the narrowest part of the neonatal airway, measuring about 4-5 mm in diameter
Subglottis
-• Is a congenital abnormality of the laryngeal cartilage
• It is a congenital laryngeal anomaly of the newborn
characterized by flaccid laryngeal tissue and inward collapse
of the supraglottic structure leading to upper airway
obstruction
• It is a dynamic lesion resulting in collapse of the
supraglottic structures during inspiration, leading to
airway obstruction
LARYNGOMALACIA
“Omega shaped” epiglottis is a common laryngoscopic
finding
• Most patients do not require any intervention because of high
rate of spontaneous improvement
LARYNGOMALACIA
2nd most common laryngeal anomaly of infancy
• Most commonly idiopathic in infants
• Most commonly iatrogenic in older children
• Left vocal cord more commonly affected
VOCAL CORD DYSFUNCTION
Vocal cord positions?
median- midline paramedian - 1.5 mm intermediate - 3.5 mm partial abduction-7 mm full abduction - 9.5 mm
- A condition of narrowing of the subglottic airway
- Although it is relatively rare, it is the third most common congenital airway problem
- Can present as a life-threatening airway emergency
subglottic stenosis
grading of subglottic stenosis
grade 1 - stenosis 0-50%
grade 2 - 51-70
grade 3 - 71 -99
grade 4 - 100%
- Incomplete separation of the foregut extending cephalad to include the inter-arytenoid space
- Classification system based upon inferior extent of the cleft
LARYNGEAL CLEFTS
classification of laryngeal clefts?
✓ Type 1 – inter-arytenoid musculature
✓ Type 2 – into cricoid
✓ Type 3 – through entire posterior cricoid
✓ Type 4 – extending through membranous trachea
Surfactant is secreted at ______ weeks and is sufficient in quantity to prevent lung collapse at _____ weeks
23-24; 28-32
Normal ratio of tracheal cartilage to membranous wall is approximately
4:1
intrinsic vs extrinsic tracheomalacia?
✓ Intrinsic – ratio of cartilage to membrane about 2:1
✓ Extrinsic – normal ratio with extrinsic compression
• Vascular anomalies (artery compression)
• Mediastinal masses (space occupying lesion)
VACTERL syndrome
✓ V – Vertebral/ vascular ✓ A – Anorectal ✓ C – Cardiac ✓ T – Tracheo ✓ E – Esophageal ✓ R – Radial / Renal ✓ L – Limb deformities
4 main types of TEF?
- Proximal esophageal atresia with distal tracheoesophageal fistula near bifurcation (90% of cases)
- H-type fistula – may be very difficult to diagnose (connection can happen in any location along the length of the trachea and esophagus)
- Proximal TEF with distal esophageal atresia (lahat ng food can enter the lungs)
- Proximal esophageal atresia with TEF and distal esophageal atresia with second TEF
- Result of unequal partitioning of the foregut into the trachea and esophagus
- May be associated with TEF of complex congenital heart disease
Tracheal Stenosis
last part of the auricle to form
lobule
The medial EAC ossifies within the
first 2 years of life
The EAC reaches adult size by about
9 years of age
Ossicles start to develop in the
first 4-6 weeks AOG
Ossicles are of adult size and shape by
6 mos AOG
- Result of persistent epithelial rests in the middle ear space
- Most commonly presents as “closed” keratotic cyst medial to the anterior superior TM
- Less commonly presents as an “open” infiltrative lesion which is more extensive
- Diagnosis may be obscured by history of eustachian tube dysfunction
- Average age of diagnosis between 2.5-5 years of age
CONGENITAL CHOLESTEATOMA
The otic vesicle is the precursor of the
membranous labyrinth
an act establishing a universal newborn hearing screening program for the prevention, early diagnosis, and intervention of hearing loss
REPUBLIC ACT 9709
• Most common neoplasm of the childhood
HEMANGIOMA
most common cystic lesion of the anterior triangle of the neck in children
Branchial Cleft Cysts
o External pit may be located at any point along the anterior border of the sternocleidomastoid (SCM)
o Internal communication defined by embryologic origin
Branchial Cleft Fistulas or Sinus Tracts
Type 1 vs type 2 first branchial cleft remnants
o Type 1 – ectodermal origin; duplication of membranous EAC
o Type 2 – ectodermal and mesodermal origin; may consist of fistula from the EAC to the upper neck
Can be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages
• The most common cause of midline neck masses and are generally located caudal to (below) the hyoid bone
THYROGLOSSAL DUCT CYSTS
- Moves with protrusion of the tongue
- May contain ectopic thyroid tissue
- May contain all of the functioning thyroid
THYROGLOSSAL DUCT CYSTS`
