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Branchial anomalies in the pediatric population.Otolaryngol
Head Neck Surg. 2007 Aug;137(2):289-95.
OBJECTIVE: We
sought to review the presentation, evaluation, and treatment of
branchial anomalies in the pediatric population and to relate these
findings to recurrences and complications. STUDY DESIGN AND SETTING:
We conducted a retrospective study at a tertiary care pediatric
hospital. PATIENTS: Ninety-seven pediatric patients who were treated
for branchial anomalies over a 10-year period were reviewed. Patients
were studied if they underwent surgical treatment for the branchial
anomaly and had 1 year of postoperative follow-up; 67 children met
criteria, and 74 anomalies were studied. RESULTS: Patients with cysts
presented at a later age than did those with branchial anomaly
fistulas or sinus branchial anomalies. 32% of branchial anomalies were
previously infected. Of these, 71% had more than one preoperative
infection. 18% of the BA were first arch derivatives, 69% were second
arch derivatives and 7% were third arch derivatives. There were 22
branchial cysts, 31 branchial sinuses and 16 branchial fistulas. The
preoperative and postoperative diagnoses differed in 17 cases. None of
the excised specimens that contained a cystic lining recurred; all
five recurrences had multiple preoperative infections. CONCLUSIONS:
Recurrence rates are increased when there are multiple preoperative
infections and when there is no epithelial lining identified in the
specimen.
Recurrent
thyroglossal duct cysts: a 23-year experience and a new method for
management.
Ann
Otol Rhinol Laryngol. 2006;115(11):850-6.
OBJECTIVES: We
present an experience in the management of primary and recurrent
thyroglossal duct cysts (TGDCs) and describe a novel method for
recurrent TGDC removal. METHODS: We performed a retrospective review
of TGDC surgery at Children's Hospital in Seattle from 1980 to 2003.
The surgical techniques for primary and recurrent TGDCs and the
factors associated with TGDC recurrence were evaluated and analyzed.
RESULTS: During the study period, 231 patients underwent 296 TGDC
surgeries. Thirty-four of the 231 patients (15%) underwent a total of
88 procedures for recurrent TGDCs. Successful procedures used for
secondary TGDC management included central neck dissection with
directed base of tongue (BOT) excision in 6 of 9 patients (67%),
secondary Sistrunk operation with limited BOT resection in 12 of 27
patients (44%), revision Sistrunk operation with BOT dissection in 7
of 11 patients (64%), and suture-guided transhyoid pharyngotomy in 8
of 8 patients (100%). Ten of the 231 patients (4%) had initial TGDC
incision and drainage and then underwent a total of 21 procedures,
excluding the incision and drainage. The factors associated with TGDC
recurrence were inaccurate initial diagnosis (17 of 34 or 50%),
infection (5 of 34 or 15%), unusual TGDC presentation (5 of 34 or
15%), and lack of BOT musculature removal (7 of 34 or 20%). The level
of surgeon training affected the surgical outcome. CONCLUSIONS:
Successful TGDC treatment requires consideration of factors associated
with recurrence. Recurrent TGDCs can be treated by several methods,
including suture-guided transhyoid pharyngotomy.
Thyroglossal
duct and other congenital midline cervical anomalies.Semin
Pediatr Surg. 2006 May;15(2):70-5.
Thyroglossal duct
anomalies and dermoid cysts comprise the vast majority of congenital
midline cervical masses seen in children. Unusual lesions of the
midline neck include ranulae and midline cervical clefts. Workup and
management is lesion-dependent, and an accurate preoperative diagnosis
is essential for planning and performing an appropriate surgical
procedure. This discussion presents an overview of the relevant
embryology, pathophysiology, and diagnostic modalities for these
congenital midline cervical anomalies. Additionally, the current
principles of surgical management are described.
Pediatric
dermoid cysts of the head and neck.Otolaryngol
Head Neck Surg. 2005 Jun;132(6):938-42.
OBJECTIVE: To
review the characteristics and determine treatment outcomes of
pediatric dermoid cysts. STUDY DESIGN AND SETTING: Retrospective
review of the presentation, diagnosis, treatment, and outcomes of all
pediatric dermoid cysts of the head and neck examined between 1980 and
2002 at Mayo Clinic. RESULTS: Forty-nine patients (59% girls) had a
dermoid cyst of the head and neck. The median age at diagnosis was 22
months. The most common presenting sign was a palpable mass, noted in
100% of patients. During evaluation, approximately 25 patients (51%)
had imaging studies. The most common location of the cysts was
periorbital (61%), followed by the neck (18%; including 1 submental
cyst). Various surgical approaches were chosen. In 2 patients (4%),
the dermoid cyst had an intracranial extension. Only 1 patient
experienced recurrence. The median pathologic diameter of the cysts
was 1.2 cm. CONCLUSIONS: Dermoid cysts are unusual neoplasms that
often present in childhood, with the orbit being the area most
commonly affected in the head and neck region. Imaging studies help
rule out an intracranial or intraorbital extension. With complete
excision, recurrence is unusual. Significance Our review will assist
both primary care physicians and subspecialists in diagnosing and
treating dermoid cysts.
Cystic
malformations of the neck in children.Pediatr
Radiol. 2005 May;35(5):463-77.
The most common
cystic malformations of the neck are the result of abnormal
embryogenesis involving the thyroglossal duct (TGD), lymphatic
primordia and the branchial apparatus. When the basic embryology of
these structures is considered, a reasonable differential
diagnosis-and in some cases a definitive diagnosis-can be achieved
based on the location and the imaging characteristics of the cystic
mass.
Cervical
bronchogenic cysts: a consideration in the differential diagnosis of
pediatric cervical cystic masses.Int
J Pediatr Otorhinolaryngol. 2004 May;68(5):563-8.
OBJECTIVE: To
discuss the clinical and histopathologic features of cervical
bronchogenic cysts. METHODS: Retrospective case series. RESULTS: A
22-year pathology database search identified 24 patients 18 years of
age and younger with bronchial/bronchogenic cysts, four of which
presented in the cervical region. CONCLUSION: Cervical bronchogenic
cysts are rare in the pediatric population but deserve inclusion in
the differential diagnosis of cystic neck masses. Such cysts result
from abnormal tracheobronchial tree development with characteristic
pathology including respiratory-type epithelium, mural cartilage,
smooth muscle, and seromucinous glands. Definitive treatment requires
surgical excision.
Pathological
analysis of congenital cervical cysts in children: 20 years of
experience at Chang Gung Memorial Hospital.Chang
Gung Med J. 2003 Feb;26(2):107-13.
BACKGROUND:
Congenital cervical cysts are frequently encountered in pediatric
populations, and constitute one of the most intriguing areas of
pediatric pathology. This report analyzes cervical cysts in Taiwanese
children diagnosed at Chang Gung Memorial Hospital (CGMH) over the
past 20 years. The pathologic and clinical findings are reviewed.
METHODS: Files on 331 patients under the age of 18 years, with a
diagnosis of congenital cervical cyst at CGMH from January 1, 1983 to
June 30, 2002, were retrieved from the Department of Pathology. There
were 204 boys and 127 girls. We reviewed the histology of all cases
and correlated it with clinical information in the medical records.
RESULTS: Thyroglossal duct cysts, the most common congenital neck
cyst, accounted for 54.68% of all cases, followed by cystic hygromas
(25.08%), branchial cleft cysts (16.31%), bronchogenic cysts (0.91%),
and thymic cysts (0.30%). Nine cases (2.72%) remained unclassified.
CONCLUSIONS: This is the largest series regarding pediatric cervical
cysts in the literature to date. Thyroglossal duct cysts were the most
common congenital cervical cyst encountered. Our experience indicates
that each type of cyst has its unique location in the neck and is
highly associated with its embryonic origin. Complete and precise
clinical information is a prerequisite in order for pathologists to
make accurate diagnoses of congenital cervical cysts.
Congenital
cysts and fistulas of the neck.Int
J Pediatr Otorhinolaryngol. 2000 Sep 29;55(2):117-24.
This
retrospective study describes a series of 191 children treated for
congenital cysts and fistulas of the neck between 1984 and 1999 in the
pediatric ORL Department of La Timone Children's Hospital.
Preauricular fistulas and cystic hygromas were not included. The
anomalies in this series were classified as either malformations of
the midline or malformations of laterocervical region. Malformations
of the midline included the thyroglossal duct cysts (n=102) and
dermoid cysts (n=21). The most common malformations of the
laterocervical region were cysts and fistulas of the second cleft
(n=37) followed by those of the first cleft (n=20),those of the fourth
pouch (n=7), and thymic cysts (n=4). Diagnosis of malformations of the
midline is usually straightforward. However, diagnosis of malformation
of the laterocervical region can be problematic. Misdiagnosis often
leads to inadequate treatment with recurrence and functional as well
as cosmetic sequelae.
Cysts of the
thyroglossal duct: analysis of diagnostic errors and causes of
recurrence.
An Esp Pediatr.
1992 Feb;36(2):121-4.
Thyroglossal-duct
cysts usually present as an anterior midline neck mass, ranking first
in this location in the pediatric age. We have carried out a
retrospective revision of 52 pediatric patients with a preoperative
diagnosis of thyroglossal-duct cyst. All of them were treated in our
surgical unit between 1982 and 1989. The male to female ratio of cases
was 34:18 with symptoms appearing at an average age of 4 years. The
most frequent clinical presentation was that of a cystic mass without
any inflammatory signs (65%), located in the mid-line at the hyoid
level (75%). In this paper we analyze the existing possibilities as
regards to the clinical presentation, location and characteristics of
this type of cervical swellings, as well as the most frequent causes
of misdiagnosis. We also make a comparison between the results we have
obtained with the different surgical techniques used. We conclude that
it is necessary to perform a radical surgical treatment of the
thyroglossal-duct remnants, which includes removal of the middle third
of the hyoid bone and excision of the thyroglossal duct as far as the
foramen cecum.
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