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- Male and female incidences are equal - Nearly all these lesions are recognized by the time the patients reaches 30 years of life - Small cysts may not be recognized until the second decade in life Clinical presentation: - Typically present as smooth, round, fluctuant, non-tender masses along the anterior border of SCM muscle, anywhere from the external auditory canal to the clavicle - During upper respiratory tract infections, a painful increase in size is common and occasionally associated with external drainage through an unrecognized fistula
TREATMENT: Preoperative assesment: USG, CTscan and/or MRI is essential; may be combined with a fistulogram or pharyngoesophagram Complete surgical treatment excision is the treatment of choice for branchial cleft anomalies and is indicated for recurrent infection, cosmetic deformity, and potential for malignant degeneration To avoid recurrence, combined endoscopic examination for a pharyngeal pouch and sinus tract with meticulous dissection of a sinus tract It is essential to excise enbloc any portion of the thyroid involved in the sinus tract
Branchiogenic carcinoma
Squamous cell carcinoma arises in a branchial cleft cyst - Cystic squamous cell carcinoma presenting in the neck without an apparent primary is almost universally secondary to metastasis from a neoplasm arising in the faucial or lingual tonsillar crypt epithelium or nasopharyngeal tissue - Malignant transformation with in situ branchial cyst carcinoma is a rarity - Management: wide excision of the tumor and ipsilateral radical neck dissection followed by adjuvant radiation therapy or chemoradiation
Cystic Hygroma
Cystic hygroma: large lymphangiomas; most commonly found in the posterior triagle of the neck and axilla in children Cervical cystic hygroma => appear before 30 weeks gestation => usually associated with karyotypic abnormalities, various malformation syndromes and several teratogenic agents => prognosis: poor Cystic hygroma developing late in pregnancy has a more favorable outcome and is more likely to be encountered by the head and neck surgeon 2/3 are asymptomatic Soft, painless, compressible masses that may increase when patient cries After an URI, sudden enlargement with infamation, infection, dysphagia, and stridor may develop (more commonly seen if the anterior triagle of the neck is involved or in patient with pharyngolaryngeal extension or intraoral involvement)
lingual thyroid: covered with squamos cell epithelium and often exhibits an abundant vascular supply thyroglossal duct cysts and fistulas: squamous, ciliated columnar or transitional cell epithelium the cyst or sinus tract is filled with mucoid or mucopurulent material
Histopathologic Features in lingual thyroid and thyroglossal duct cysts and fistulas
Treatment
LINGUAL THYROID Preoperative thyroid scan and uptake study are mandatory THYROGLOSSAL DUCT CYSTS AND FISTULAS Indications for surgical excision: malignant degeneration (predominantly of the papillary type; usually patients in their forties), recurrent infections, undesirable cosmetic appearance, intermitent upper airway obstruction Incision and drainage => if an abscess has developed high recurrence after excision => Sistrunk procedure to prevent recurrence treatment if papillary carcinoma is found in an abberant position => total thyroidectomy with central lymph node dissection Treatment of thyroglossal duct remnant carcinoma consists of the Sistrunk procedure, total thyroidectomy, central lymph node disection, ablative iodine131 therapy for residual metastatic thyroid carcinoma subsequent thyroid supression therapy and careful interval follow up with whole body thyroid scanning
Thymic Cyst
Extremelly rare, more common in male Most occuring asymptomatically in children and adults Only 10% have involved patients younger than 1 year of age Primarily located anterior and deep to the middle onethird of SCM muscle Ectopic servical thymus is best imaged by MRI whereas thymic cyst has a more consistent appearance on CT Surgical resection provides definitive dx and cure