Surgery

Question 1

Congenital neck lump

Answer 1

branchial cleft anomalies (typeI/II/III): unilateral tissue anterior to SCM trapped in developing neck

thyroglossal duct cyst: midline mucous/purulent cyst from thyroid migration from base of tongue to neck

lymphatic malformation: masses composed of small lymph channels subcutaneously in head/neck and benign but may become infected

lymphangioma/cystic hygromas: abnormal collection of lymph channels in neck posterior to SCM, oral cavity, face or airway

dermoid: subcutaneous nodules along embryonic fusion lines (midline neck) with risk of infection

Question 2

Visual testing

Answer 2

Question 3

Thyroglossal duct cyst

Answer 3

incidence: most common congenital cyst in neck

pathophysiology: arises thyroglossal tract descending from foramen caecum to thyroid isthmus which is lined by respiratory epithelium

• may tether to hyoid bone 75%, submental 15%, suprasternal 8%

clinical:

• tender midline lump post RTI
• moves with swallowing
• may become infected
  diagnosis: US, CT

management: avoid surgery during infective phase and treat AB, surgical excision post

Question 4

Cholesteatoma

Answer 4

incidence: 1:100,000, M>F, 5 years

pathogenesis: abnormal growth of squamous epithelium in middle earl

cause: congenital or acquired

clinical:

• recurrent infections, otorrhoea, ear pain, hearing impairment, vertigo, headache, FN palsy

risk factors: OM, T21, TS, abnormal anatomy

diagnosis:

• white mass behind intact TM with deep retraction
• focal granulation on surface of TM in periphery
• otorrhoea >2 weeks

treatment: surgery