Congenital anomalies of the head

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Congenital anomaliesof thehead neck

• Haytham Kubba
• Consultant Paediatric Otolaryngologist
• RHSC, Yorkhill, Glasgow

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Head Neck

• Thyroglossal duct anomalies
• Preauricular sinuses
• Branchial anomalies
• Vascular lesions
• Cystic hygroma
• Haemangioma

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Thyroglossal duct cysts

• US scan essential
• To document normal thyroid gland
• Complete excision of tract
• Sistrunks

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Recurrence rates

• Hoffman 1988 Boston 9/90 (10)
• Pelausa 1989 Toronto 38/143 (26)
• Athow 1989 Guys 17/31 (47)
• Horisana 1999 Japan 8/83 (10)
• von Bismarck 2001 Graz 5/26 (19)

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Thyroglossal tract histology

• widely branching

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Take-home message 1thyroglossal duct cysts

• U/S scan
• Wide excision in normal tissue
• central strip of straps
• pretracheal fascia
• central 1/3 hyoid
• tongue base muscle up to foramen caecum

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Preauricular sinusesand accessory auricles

• No imaging of lesion
• Consider renal US

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Wide local excisionsupra-auricular

• excise in normal tissue
• shave helix cartilage
• down to temp fascia
• rotate pinna forwards if needed
• Lam et al, Laryngscope 2001 111 317-9

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Take-home message 2preauricular sinuses

• Excise if symptomatic
• U/S scan kidneys
• Wide excision in normal tissue

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Idiots guide to branchial anomalies

• Branchial clefts are on the outside
• cleft anomalies have an opening on skin
• Pharyngeal pouches are on the inside
• pouch anomalies have an opening on mucosa
• Pouches and clefts do not communicate
• congenital fistulae are very rare
• most things you see are sinuses
• Only clefts 12 and pouches 34 give trouble

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1st branchial cleft sinus

• Cysts / masses around the ear
• Sinus opening in ear canal or around lobule
• Reduplication of ear canal
• Variable relation to VII

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Imaging?

• MRI or US may help decide extent of lesion
• Wont help with deciding if VII is at risk
• Parotidectomy with nerve monitor

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2nd branchial cleft sinus

• Sinus opening anterior neck
• No imaging of lesion required
• Renal US?
• Branchio-oto-renal syndrome

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3rd / 4th pharyngeal pouch sinus

• Recurrent left-sided neck abscesses
• Barium swallow may show tract
• Endoscopic cautery or left hemithyroidectomy

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Take-home message 3branchial anomalies

• 1st 2nd branchial cleft sinuses
• Sinus opening on skin (ear canal or anterior
  neck)
• 3rd 4th pharyngeal pouch sinuses
• Sinus opening on mucosal surface (piriform fossa)

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Vascular lesionsMullikens classification

• Haemangioma
• Endothelial tumour
• Solid
• Not present at birth
• Rapid growth to 18/12
• Involution to 3-5yrs
• Responds to steroids

• Vascular malformation
• Present at birth
• Grow with child
• Abnormal vessels
• Capillary (port wine stain)
• Venous (cavernous)
• Arteriovenous
• Lymphatic (cystic hygroma)

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Take home message 4haemangiomas

• Most need no treatment or investigation
• Medical treatments may avoid surgery
• Steroids
• Interferon
• Vincristine

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Take-home message 5cystic hygroma

• Excise whenever possible
• Surgery is challenging
• MRI essential for extent prior to excision
• US-guided OK432 injections if not operable