Congenital Neck Masses.

There are many possible causes of congenital neck masses, with the most common ones being thyroglossal duct cysts, branchial cleft anomalies, and vascular malformations. Most congenital neck masses are asymptomatic in the neonatal period, but depending on the location and the size, they can cause airway obstruction and serious complications at birth. Proper diagnosis is important for optimal treatment planning, and if the airway is compromised, multidisciplinary teamwork is critical for proper airway management. This review summarizes the clinical features, etiology, diagnosis, management, and prognosis of different types of congenital neck masses.

Intraoral Foregut Cystic Developmental Malformations: Three cases with a brief review of literature.

Foregut cystic developmental malformations (FCDM) are a type of rare cystic lesion. The occurrence of FCDM is exceedingly uncommon in the intraoral location. We report three cases of FCDM with intraoral location who presented at Chacha Nehru Bal Chikitsalaya, New Delhi, India, in 2016, 2017 and 2018 with symptoms of respiratory distress and feeding difficulties. Two patients were male and one was female with an age range of 29 days to eight years. The clinical differential diagnosis included mucocele, ranula, dermoid, lymphangioma, teratoma, thyroglossal duct cyst, etc. All patients were treated with simple surgical excision and diagnosed, based on histopathology, with FCDM. These should be considered as differential diagnosis of head and neck midline cystic mass lesions. This case report aimed to discuss differential diagnosis and appropriate terminology for these cystic masses as there is varied and ambiguous nomenclature.

Why Central Neck Dissection Works (and Fails) for Recurrent Thyroglossal Duct Remnants.

OBJECTIVE: To review the patient characteristics and outcomes for children and undergoing central neck dissection for control of recurrent thyroglossal duct cysts and fistula following prior Sistrunk procedures and children requiring surgery for refractory infection. METHODS: We performed a computerized review of all children who were evaluated for thyroglossal duct cysts during the years 1999-2018 by a single surgeon operating at an urban children's hospital and an outpatient surgical center. Those requiring a central neck dissection for control of recurrent disease or intractable infection were identified. Age at time of surgery, sex, surgical procedure, and postoperative complications were recorded. These data were combined with similar data from a published report by the same surgeon in the years 1990-1998 to complete a 28-year review. RESULTS: 18 central neck dissections were performed including 13 for recurrent thyroglossal duct remnants after Sistrunk procedures and 5 primary surgeries for intractable infection. Ages ranged from 3 to 19 years (median = 10 years) and 13 of 18 were girls (72%). Four children had their first Sistrunk surgery performed by the senior author. Three children operated elsewhere had intact hyoid bones at the time of revision surgery, suggesting less-than-Sistrunk primary surgeries. Central neck dissection controlled disease in the lower neck in all cases. One child re-fistulized at the level of the hyoid. CONCLUSIONS: Central neck dissection in combination with a Sistrunk-type dissection of the tongue base is effective in the control of recurrent infection following unsuccessful Sistrunk surgery and aids in dissection for children with intractable infection. Although this technique reliably controls infrahyoid disease and improves access to the hyoid and posterior hyoid space, it does nothing to address the difficulties of following the thyroglossal tract into the tongue base.

[Congenital cysts and fistulas on the neck in adults]. / Kystes et fistules congenitaux du cou chez l'adulte.

Cervical congenital malformations are relatively common in children. They can also be found in adults. The embryological development of the cervical region is closely related to the branchial clefts. This must be a diagnosis made by elimination; a cervical tumor must evoke the diagnosis of cancer. A cutaneous fistula or a cervical tumor, chronic or recent appearance in an inflammatory context, are the clinical signs. The thyroglossal duct cysts and the second branchial clefts cysts are the most common causes of median and lateral cervical cysts, respectively. Imaging contributes greatly to the orientation and diagnostic evaluation of the extent of the lesions. Treatment is initially based on antibiotic therapy and then on complete surgical excision, away from an infectious episode, the sole guarantee for the absence of local recurrence.

Congenital Neck Masses.

Congenital neck masses can be a developmental anomaly of cystic, solid, or vascular origin. They can also constitute neoplasms, including malignancies, although this is rare in the pediatric population. The history and examination can help quickly narrow the differential diagnosis. Imaging also plays an essential role in defining the characteristics and likely cause of neck masses. The most common neck masses in young children are thyroglossal duct cysts, branchial cleft anomalies, and dermoid cysts. Also important to consider in the differential diagnosis are solid tumors, such as teratomas, or vascular lesions, such as hemangiomas.

[Congenital neck mass. Diagnosis and treatment]. / Malformaciones congénitas del cuello. Diagnóstico y tratamiento.

Congenital neck masses are a challenge for general practitioners and specialists. Although some of them are diagnosed in utero, most of them remain silent until complications appear in the adult age. The anatomical location, consistency and age are determinants in guiding the possible diagnosis. A midline infrahyoid mass may be a thyroglossal cyst, however a lateral neck mass is more possible to result in a brachial cyst. Complementary imaging studies are essential such as pathological tests like needle aspiration fine needle aspiration (FNA).

Management of congenital neck lesions in children.

INTRODUCTION: A retrospective clinical trial was conducted to evaluate the clinical features and treatment outcomes and to determine the incidence of complications in children with congenital neck lesions (CNLs) treated at our institution with a special emphasis on thyroglossal duct remnant (TGDR), branchial cleft anomaly (BCA), and dermoid cyst (DC). MATERIALS AND METHODS: This series had 72 patients with CNL. The diagnosis of CNL was made by physical examination, ultrasound (US) in most, and for a potential extension of the mass computed tomography (CT) or magnetic resonance imaging (MRI) in a few patients and confirmed by histopathological examination in all of the children. RESULTS: Of the patients in this series, 39 (54.2%) children had thyroglossal duct remnant (TGDR). The most common surgical procedure (n = 36) in these children was Sistrunk's procedure. Four children (10.3%) with TGDR had associated anomalies including Turner syndrome and Morgagni hernia. During the study period, 25 (34.7%) children with branchial cleft anomaly (BCA) were treated and most of these were second branchial anomalies. There were eight children (11.1%) with dermoid cyst (DC). CONCLUSION: TGDR is the most common CNL and is presented clinically rather late with regard to BCA and DC in this series. Surgical resection is optimal choice of therapy in CNLs not only for aesthetic reasons but also for the recurrent infections and the potential danger of malignancy. Definitive surgery may be associated with high morbidity, especially recurrence. Associated anomalies may be observed, especially in children with TGDR. Although the Sistrunk's procedure is a safe and successful technique, life-threatening complications should also be kept in mind during the management of these lesions and early and adequate surgical treatment is suggested.

Congenital cystic neck masses: embryology and imaging appearances, with clinicopathological correlation.

Congenital cystic masses of the neck are uncommon and can present in any age group. Diagnosis of these lesions can be sometimes challenging. Many of these have characteristic locations and imaging findings. The most common of all congenital cystic neck masses is the thyroglossal duct cyst. The other congenital cystic neck masses are branchial cleft cyst, cystic hygroma (lymphangioma), cervical thymic and bronchogenic cysts, and the floor of the mouth lesions including dermoid and epidermoid cysts. In this review, we illustrate the common congenital cystic neck masses including embryology, clinical findings, imaging features, and histopathological findings.

Congenital cervical cysts, sinuses, and fistulae in pediatric surgery.

Congenital cervical anomalies are essential to consider in the clinical assessment of head and neck masses in children and adults. These lesions can present as palpable cystic masses, infected masses, draining sinuses, or fistulae. Thyroglossal duct cysts are most common, followed by branchial cleft anomalies and dermoid cysts. Other lesions reviewed include median ectopic thyroid, cervical teratomas, and midline cervical clefts. Appropriate diagnosis and management of these lesions requires a thorough understanding of their embryology and anatomy. Correct diagnosis, resolution of infectious issues before definitive therapy, and complete surgical excision are imperative in the prevention of recurrence.

Lingual thyroglossal duct cysts--a review.

OBJECTIVES: Lingual thyroglossal duct cysts (TGDC) are rare and liable to be missed in a cursory clinical examination. This study aimed to report the details of lingual TGDC from the authors' series and review existing literature on the entity. METHODS: A 12 year retrospective survey of all cases of thyroglossal duct anomalies managed at a tertiary teaching hospital was conducted to identify those with lingual TGDC. Their clinical presentation, investigations, diagnosis and management were analysed. Case series from anecdotal published English literature were critically reviewed with particular regard to diagnosis and management. RESULTS: Of 78 cases of thyroglossal duct anomalies, 3 were lingual TGDC. All were females. One neonate presented with feeding difficulty and was clinically misdiagnosed as a ranula. The two older children presented with a cyst at the foramen caecum. The varied imaging and diagnostic dilemma are presented. The older children had cysts abutting the hyoid and were managed with transoral excision and a Sistrunk procedure; the neonate was managed with transoral excision only. This report also reviews the sparse literature and discusses specific issues in their treatment. The differential diagnoses encompass a wide array of developmental and neoplastic entities. Specific anatomic imaging with USG/CT/MRI and functional evaluation with radionuclide thyroid scan are essential investigative modalities. Besides a classical Sistrunk procedure and simple transoral excision, newer less invasive treatment options including marsupialisation and alcohol ablation have been reported. CONCLUSIONS: In conclusion, the diagnosis and management of lingual TGDC needs to be individualised depending on their presentation and anatomic location. The Sistrunk's procedure is ideal for those in close proximity to the hyoid; however complete cyst excision would suffice in the rest.

A thyroglossal duct cyst of the anterior mediastinum.

Thyroglossal duct cysts (TGDCs) are developmental anomalies arising from the embryonic thyroglossal duct. They are commonly midline cervical structures associated with the hyoid bone. We report a 3.5-cm diameter isolated TGDC of the anterior mediastinum in a 65-year-old European woman who was treated by transcervical excision. The mass was limited to the mediastinum with a normal neck on computed tomographic scan and clinical examination. This is the second case of mediastinal TGDC known to be reported, and the oldest known age at presentation. The TGDC should be considered as an uncommon differential diagnosis of an anterior mediastinal mass.

Congenital cystic lesions of the head and neck.

This article presents clinical characteristics and radiologic features of congenital cervical cystic masses, among them thyroglossal duct cysts, cystic hygromas, branchial cleft cysts, and the some of the rare congenital cysts, such as thymic and cervical bronchogenic cysts. The imaging options and the value of each for particular masses, as well as present clinical and radiologic images for each, are discussed.

Double thyroglossal duct cyst located in the hyoid region and the tongue base: an unusual coexistence.

Thyroglossal duct cysts originate from persistent epithelial remnants of the thyroglossal duct that are present during the descent of the thyroid gland from the foramen cecum to its final position in the anterior neck. Thyroglossal duct may persist anywhere along the descent from the tongue to the thyroid. Lingually localized thyroglossal duct cysts are congenital lesions of the pharynx, which are very uncommon and may cause morbidity and mortality if not treated expeditiously. Double thyroglossal cysts and the complete failure of the obliterative process of thyroglossal duct are very rare in the literature. In this article, we describe a case of two cysts derived from the same thyroglossal duct, one in the hyoid region and the other in the tongue base. To our knowledge, this coexistence has not been described previously in the literature.

Pattern of congenital neck masses in a Kenyan paediatric population.

BACKGROUND: The distribution of congenital neck masses varies between countries and is important in diagnosis and treatment modalities. Data from Africa is scarce, and altogether absent from Kenya. OBJECTIVE: To describe the pattern of congenital masses in a Kenyan paediatric population. SET UP: Kenyatta National Hospital, Nairobi Kenya. STUDY DESIGN: Prospective descriptive cross-sectional. METHODOLOGY: Children aged 15 years and below with neck masses who presented to various surgical clinics and wards at the Kenyatta National Hospital between December 2006 and April 2007 were included in the study. They were examined for age, gender, type and location of the neck mass. Mode of investigation and final diagnosis were recorded. Data was analyzed by using statistical package for social sciences. Descriptive statistics were applied to determine means, frequencies and modes. Ninety-five percent confidence interval was used and p value of 0.05 taken as significant. Data are presented in form of tables. RESULTS: Two hundred and thirty-five children (129 male) with neck masses were examined. Fifty-one (22%) of these masses were congenital. Thyroglossal duct cysts were the most common (29%) followed by cystic hygromas (21%) and branchial cleft cysts (20%). Fifty-one percent of the masses were present at birth. The midline was the most common location (31.4%) followed by anterior border of sternocleidomastoid (27.5%) and submandibular region (19.6%). Ultrasound was the commonest diagnostic investigation. CONCLUSION: Congenital defects constitute an important differential diagnosis for paediatric neck masses in Kenya. Thyroglossal duct cysts, cystic hygromas and branchial cleft cysts are the most prevalent occurring most commonly in the midline and anterior border of sternocleidomastoid muscle. An understanding of the distribution of these masses improves diagnosis, preoperative decision making and their overall management.

[A hereditary case of thyroglossal duct cyst]. / Forme familiale de kyste du tractus thyréoglosse.

OBJECTIVES: The thyroglossal duct cyst (TDC) is a frequent pathology in head and neck surgery whose diagnosis and treatment are well known. Hereditary forms are very rare. In a case report, the author describes the familial cases in the international literature and discusses the genetic inheritance patterns. MATERIAL AND METHOD: The author reports the clinical case of a 7-year-old girl, operated on for a TDC, with a familial history of this disease. After a review of the international literature in PubMed, the features of the reported families are described and the genetic inheritance theories are discussed. RESULTS: This is the first report of a French familial form of TDC. Described in four members of the same family over three generations, the genetic transmission seems to follow the rules of autosomic dominant inheritance. The female preponderance suggests a genetic imprinting theory. CONCLUSION: The genetic inheritance patterns of familial TDC are unclear. The dominant autosomic transmission with incomplete penetrance might be the most likely. Another theory of genetic imprinting might explain the female preponderance, but this theory remains complex and highly debated. However, the search for a familial history of TDC must be part of the initial consultation, a procedure that is not widely known among ENT surgeons.

[The cysts and fistulas of the neck in material of Otolaryngology Department of Rydygier District Hospital in Cracow]. / Torbiele i przetoki szyi w materiale oddzialu Otolaryngologii Wojewódzkiego Szpitala Specjalistycznego im L. Rydygiera w Krakowie w latach 1997-2007.

The retrospective study describes 118 patients treated for congenital cysts and fistulas of the neck between 1997 and 2007 in ORL Department of Rydygier District Hospital in Cracow. Malformation was divided into midline and laterocervical region anomalies. Malformation of midline included thyreoglossal duct and dermoid cyst. The most common malformation of laterocervical were cysts followed by fistulas. The theory of development, method of diagnosis and operative management were presented. Complication and recurrences were rare. Proper differential diagnosis and radical operation led to successful cure.

Congenital neck masses.

Congenital neck lesions reflect abnormal embryogenesis in head and neck development. A thorough knowledge of embryology and anatomy is critical in the diagnosis and treatment of these lesions. The appropriate diagnosis of these lesions is necessary to provide appropriate treatment and long-term follow up, because some of these lesions may undergo malignant transformation or be harbingers of malignant disease.

Congenital neck masses in children and their embryologic and clinical features.

Congenital neck masses in children and their embryologic and clinical features. Neck masses of congenital origin can be diagnostic and therapeutic challenges for internists, paediatricians and surgeons. Treatment modalities of congenital neck masses are different depending on their nature, symptoms and location. Differential diagnosis includes a variety of diseases that can cause cervical masses such as infectious and neoplastic neck tumours. Our objective is to review the embryologic and clinical features of some of the most common congenital neck masses such as the haemangioma, branchial cleft anomalies, thyroglossal duct cyst, ectopic thyroid, congenital midline cervical cleft, congenital cervical teratoma, lymphangioma, cervical thymic cyst, dermoid cyst and congenital muscular torticollis.

Congenital neck masses: a descriptive retrospective study of 252 cases.

PURPOSE: This retrospective study was conducted to analyze congenital neck masses in Jordanians compared with international findings. PATIENTS AND METHODS: The records of patients with congenital neck masses between 1991 and 2002 were retrieved from the Department of Pathology, Jordan University of Science and Technology, and analyzed for age, gender, location, clinical features, and treatment. RESULTS: Within the 12-year period of the study, a total of 2,063 neck mass lesions were found; of these, 252 (12%) were congenital masses. These cases were distributed into 166 (66%) midline, 55 (22%) lateral, and 31 (12%) entire neck masses. The most frequent mass was thyroglossal duct cyst (fistulas) (53%), followed by cysts (fistulas) of the branchial apparatus (22%), dermoid cysts (11%), hemangiomas (7%), and 1ymphangiomas (6%). The majority of branchial arch anomalies (85%) were of the second arch. The mean age of patients was 16 years, with the greatest number of cases (38%) in the first decade. The male-to-female ratio was 1:1.2, with most lesions affecting females. The majority of lesions presented with painless neck swelling, and all lesions were surgically excised. CONCLUSIONS: The overall frequency and age distribution of congenital neck masses in northern Jordanians are similar to international findings. However, the gender distribution and relative frequency of individual types of neck masses are somewhat different from those in other countries. These differences may be attributed to genetic and geographic differences.