ppt cong anomalies of neck.

1. By Dr :Hiranya Kumar Gayary
Thursday 31/10/13

2. Introduction
Congenital Anomalies are also known as
 Birth defects
 congenital disorders or
 congenital malformations.
 Congenital anomalies can be defined as structural or
functional anomalies including metabolic disorders
which are present at the time of birth.
 Appro 50% of all congenital anomalies cannot be
assigned to a specific cause
However some causes or risk factors have been
associated to congenital anomalies which are
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3. Causes of congenital anomalies
1-Genetic factors such as chromosomal
abnormalities and mutant genes.
2-Environmental factors e.g.: the mother had
German measles in early pregnancy will cause
abnormality in the embryo.
3-Combined genetic and environmental
factors (mutlifactorials factors).
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4. Congenital anomalies of neck
 Branchial Cysts and Sinuses
 Thyroglossal duct and thyroid abnormalities
 Ectopic thymic and Parathyroid tissue
 Lymphangioma(Cystic Hygroma)
 Haemangiomas
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5. The most typical feature in development of the
neck is formed by the pharyngeal or branchial
arches. These arches appear in the fourth and fifth
weeks of development and contribute to the
characteristic external appearance of the embryo
.Initially, they consist of bars of mesenchymal tissue
separated by deep clefts known as pharyngeal
(branchial) clefts
Pharyngeal Arch Development:
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6. Pharyngeal Arch Development
:(cont)
 Simultaneously, with development of the arches and clefts,
a number of outpocketings, the pharyngeal pouches,
appear along the lateral walls of the pharyngeal gut, the
most cranial part of the foregut The pouches penetrate the
surrounding mesenchyme, but do not establish an open
communication with the external clefts. Hence, although
development of pharyngeal arches,clefts, and pouches
resembles formation of gills in fishes and amphibia, in
 the human embryo real gills (branchia) are never formed.
Therefore, the term pharyngeal (arches, clefts, and
pouches) has been adopted for the human embryo.
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9. Pharyngeal Arch Structures
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10. Branchial Apparatus Derivatives
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11. Branchial Cyst:
 ETIOLOGY:
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Arise from embryonic remnants
of the SECOND branchial cleft.
PATHOLOGY:
Lined by stratified squamous epithelium &
most have lymphoid
tissue in the wall.
Contain straw-coloured fluid rich in
cholesterol crystals.

12. Branchial Cyst: (cont.)
 INCIDENCE:
TREATMENT: 24
Most frequently seen in young adults
Peak age: third decade
CLINICAL PICTURE:
Slowly-growing, painless, soft cystic swelling,
characteristically under the ant. border of the upper &
middle 1/3 of the SCM muscle.
Branchial cysts are not translucent & do not move on
swallowing
INVESTIGATIONS:
FNAC yields acellular fluid that can be rich
in cholesterol crystals.

13. Branchial Cyst: (cont.)
FNAC yields acellular fluid that can be rich in
cholesterol crystals
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Surgical excision
INVESTIGATIONS:
TREATMENT:

14. Branchial remnants
 Present as fistulas or cysts anywhere on the
anterior border of the sternocleidomastoideus
muscle
 Cyst presents with nontender enlarging swelling
 Fistula presents with drainage of saliva from the
ostium
 Treatment: Early excision
 Complication: Cysts and fistulas can become
infected if not resected early in childhood
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15. Thyroglossal Cyst :
 ETIOLOGY:
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A developmental abnormality dt persistence of a part of the
thyroglossal tract (extends from the foramen caecum at the BOT
to the isthmus of thyroid gland).
SITES:
¼ above the hyoid (Intralingual or Suprahyoid).
¾ below the hyoid (Thyrohyoid or Suprasternal).
INCIDENCE:
Most common midline neck cyst.
Mean age: 5 years (about 30% present after 30y).

16. Thyroglossal Cysts Sites
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17. Thyroglossal Cyst : (cont.)
 CLINICAL PICTURE:
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Midline painless neck cyst that moves up &
down with swallowing & on tongue protrusion.
Sometimes may present as an infected cyst.
TREATMENT:
Surgical excision of the cyst + tract
including
the body of hyoid bone (Sistrunk
operation

18. Ectopic Thymic and Parathyroid Tissue
Since glandular tissue derived from the pouches
undergoes migration, it is not unusual for accessory
glands or remnants of tissue to persist along the
pathway. This is true particularly for thymic tissue,
which may remain in the neck, and for the
parathyroid glands. The inferior parathyroids are
more variable in position than the superior ones and
are sometimes found at the bifurcation of the
common carotid artery
Ectopic Thymic And Parathyroid
Tissue
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19. Lymphangioma
 Lymphangiomas are congenital malformations of
lymph tissue that result from the failure of lymph
spaces to connect to the rest of the lymphatic
system.
 Lymphangiomas present as a soft, smooth,
nontender mass that is compressible and can be
transilluminated.
 Depending on the size and location, there might
be respiratory compromise and difficulty in
feeding.
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20. Cystic Hygroma:
 DEFINITION:
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Rare malformations of the lymphatic system that usually
present as a posterior neck swelling.
ETIOLOGY:
Sequestration of a portion of the jugular lymph ducts from the
lymphatic system.
The swelling consists of an aggregation of cysts like a mass of
soap bubbles each filled with lymph.

21. Cystic Hygroma: (cont.)
 INCIDENCE:
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Age at presentation:
60% at birth, 75% by 1y., 90% by 2nd birthday
CLINICAL PICTURE:
Soft easily compressible, translucent, fluctuant, ill-defined posterior
neck swelling.
May spread into cheek, floor of mouth, tongue, parotid & ear canal.
Stridor dt. tracheal displacement with mediastinal involvement.
INVESTIGATIONS:
CT scan with contrast makes
diagnosis apparent.

22. Cystic Hygroma: (cont.)
 TREATMENT:
 Surgical resection via a neck incision.
 Total excision is sometimes difficult and recurrences
are not infrequent.
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23. Hemangioma:
 A benign skin lesion consisting of dense,
usually elevated masses of dilated blood
vessels.

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Blood vessels are tubes of endothelial cells surrounded
by layers of smooth muscle cells and connective tissue
proteins, which develop as a result of biochemical
signals between the two.
Sometimes this communication fails and abnormal
blood vessels form.

24. Types of Hemangiomas
 Strawberry Hemangioma
 Cavernous (Deep) Hemangioma
 Compound Hemangioma
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25. Treatments of Hemangiomas
Medical
 steroid injection
 interferon alfa-2a
(FPDL=flashlight-pumped pulse dye laser)
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Surgical
resection
FPDL
YAG laser

26. THANK
YOU
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