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Junn A, Zhang A, Mantilla-Rivas E, Barrera MC, Episalla NC, Sentosa J, Oh AK, Boyajian MJ, Rogers GF. Pharyngeal Arches, Chapter 2: Ear and Neck Abnormalities. J Craniofac Surg 2024:00001665-990000000-01871. [PMID: 39221927 DOI: 10.1097/scs.0000000000010577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 07/25/2024] [Indexed: 09/04/2024] Open
Abstract
The pharyngeal arches are the foundation of face and neck development. Impaired development of these embryologic structures can result in craniofacial abnormalities. Surgeons who manage head and neck pathology will invariably encounter conditions associated with aberrant pharyngeal arch anatomy, and a thorough understanding of the normal development of these structures is paramount to accurate diagnosis and treatment. This manuscript is the second of a four-part series written for plastic surgeons, focusing on the abnormal development of pharyngeal arches leading to pathologic ear and neck anomalies seen in clinical practice.
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Affiliation(s)
- Alexandra Junn
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC
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2
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Beck CM, Onyekweli T, Ettinger RE, Boos MD. Facial Soft Tissue Lesions in Children. Oral Maxillofac Surg Clin North Am 2024; 36:247-263. [PMID: 38724424 DOI: 10.1016/j.coms.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Facial soft tissue lesions in children are often classified based on their structure or cellular origin and can be benign or malignant. This review focuses on common facial soft tissue lesions in children, their clinical morphology, natural history, and medical and surgical management, with an emphasis on those considerations unique to soft tissue lesions present at this anatomic site.
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Affiliation(s)
- Christina M Beck
- Division of Plastic and Reconstructive Surgery, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, University of Washington, 325 9th Avenue Box 359796, Seattle, WA 98104, USA
| | - Tito Onyekweli
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15212, USA
| | - Russell E Ettinger
- Division of Plastic and Reconstructive Surgery, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, OC.9.833, Seattle, WA 98105, USA.
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3
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Trovalusci E, Pizzolon C, Tesser S, Doratiotto S, Gobbi D, Midrio P. Incidental finding of thyroglossal duct cyst in a neonate during endotracheal intubation: a case report. BMC Pediatr 2024; 24:264. [PMID: 38654283 PMCID: PMC11040807 DOI: 10.1186/s12887-024-04742-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Thyroglossal Duct Cyst (TDC) is a common lesion of the midline neck, originating from an incomplete involution of the thyroglossal duct. It is typically observed in pre-scholar patients and surgery is the treatment of choice to prevent infections. Here reported a case of incidental diagnosis in a newborn patient. CASE PRESENTATION a 3-week-old male baby was admitted to our hospital for weight loss and projectile vomits after breastfeeding. After a diagnosis of hypertrophic pyloric stenosis, the baby underwent pyloromyotomy. During the endotracheal tube placement, the anesthetist noticed the presence of a midline neck mass. The suspect of TDC was confirmed by an intraoperative ultrasound, so, despite the age of the patient, we proceeded with the excision of the lesion according to Sistrunk's procedure to avoid future complications and anesthesia. CONCLUSIONS even if TDC is a common lesion of pediatric patients, anecdotical neonatal cases were described in the literature, all of them symptomatic. An accurate physical examination and ultrasound are essential diagnostic tools to distinguish TDC from other middle neck lesions, particularly ectopic thyroidal tissue. Sistrunk's procedure is the most effective surgical approach. When diagnosis is made in a newborn, we suggest postponing surgery, unless the baby requires general anesthesia for other surgical procedures, such as in our case.
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Affiliation(s)
- Emanuele Trovalusci
- Pediatric Surgery Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy.
- Pediatric Surgery Unit, Ospedale Ca' Foncello, Treviso, Italy.
| | - Carlo Pizzolon
- Pediatric Surgery Unit, Ospedale Ca' Foncello, Treviso, Italy
| | - Silvia Tesser
- Pediatric Anesthesiology Unit, Ospedale Ca' Foncello, Treviso, Italy
| | | | - Dalia Gobbi
- Pediatric Surgery Unit, Ospedale Ca' Foncello, Treviso, Italy
| | - Paola Midrio
- Pediatric Surgery Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy.
- Pediatric Surgery Unit, Ospedale Ca' Foncello, Treviso, Italy.
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Chen C, Liu F, Fang J, Sima L, Ni L, Xiang S, Xia S. Clinical Characteristics and Prognosis of Infants and Children <3 Years of Age With Thyroglossal Duct Cyst Complicated With a Parapharyngeal Mass: A Case Series Study. Clin Pediatr (Phila) 2024; 63:318-324. [PMID: 37139812 DOI: 10.1177/00099228231171784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Thyroglossal duct cysts (TGDCs) are congenital and developmental abnormalities in infants and young children. This retrospective case series study examined the characteristics of 7 patients <3 years (mean age, 1.9 years) with TGDC complicated with a parapharyngeal mass treated at one hospital between January 2019 and 2022. Four patients had a painless mass around the neck, 2 had a painless mass associated with snoring, and 1 presented repeated swelling and pain. B-ultrasound suggested 6 cases of TGDC and 1 possible lymphangioma. All patients were treated with Sistrunk surgery to remove the TGDC. Six patients had no cyst recurrence during follow-up (6 months to 2 years). In conclusion, TGDC complicated with a parapharyngeal mass has complex and variable clinical manifestations. Completely removing the cyst while sparing thyroid cartilage and surrounding vascular and neuroanatomical structures is important to avoid complications. The patients are likely to be free from recurrence after surgery.
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Affiliation(s)
- Caidi Chen
- Department of Otolaryngology Head & Neck Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Fanli Liu
- Department of Otolaryngology Head & Neck Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Jianjing Fang
- Department of Ultrasonography, Wuma Street Community Health Service Center of Lucheng District, Wenzhou, China
| | - Linyuan Sima
- Department of Otolaryngology Head & Neck Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Liyan Ni
- Department of Otolaryngology Head & Neck Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Songjie Xiang
- Department of Otolaryngology Head & Neck Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Siwen Xia
- Department of Otolaryngology Head & Neck Surgery, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
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Binder MK, Kim G. What the Neck? An Overview of Congenital Lateral Neck Masses. Clin Pediatr (Phila) 2024:99228241226833. [PMID: 38269567 DOI: 10.1177/00099228241226833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Margaret K Binder
- Division of Pediatric Hospital Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Grace Kim
- Division of Pediatric Hospital Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
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Ryu J, Igawa T, Mohole J, Coward M. Congenital Neck Masses. Neoreviews 2023; 24:e642-e649. [PMID: 37777610 DOI: 10.1542/neo.24-10-e642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
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.
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Affiliation(s)
- Jane Ryu
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
| | - Teryn Igawa
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
| | - Jyodi Mohole
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
| | - Melissa Coward
- Department of Pediatrics/Neonatology, University of California, Los Angeles Mattel Children's Hospital, Los Angeles, CA
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Caseiro Alves ME, Nunes A, Galhardo J. Case report: Fourth branchial cleft cyst: a case of acute suppurative thyroiditis. Front Pediatr 2023; 11:1212767. [PMID: 37484775 PMCID: PMC10361755 DOI: 10.3389/fped.2023.1212767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/23/2023] [Indexed: 07/25/2023] Open
Abstract
This case report presents a 4 year-old-female patient with a neck mass who was diagnosed with an infected fourth branchial cleft cyst with left thyroid lobe involvement through fistulation. The case emphasizes the importance of considering uncommon etiologies, such as congenital anomalies, as a differential diagnosis when evaluating pediatric neck masses. The patient was prescribed broad-spectrum antibiotics, which led to the regression of the mass and inflammatory signs. Close follow-up in endocrinology and otorhinolaryngology appointments was maintained, and after 7 months, hypoplasia of the left lobe was observed. Thyroid function was reevaluated, and after two years, no recurrences were noted. The case highlights the significance of a comprehensive examination and assessment of corresponding clinical features, which can significantly reduce the rate of misdiagnoses and achieve an individualized diagnosis.
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Affiliation(s)
- M. Eduarda Caseiro Alves
- Pediatric Department, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
| | - Ana Nunes
- Radiology Department, Hospital Dona Estefânia, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
| | - Júlia Galhardo
- Unit of Pediatric Endocrinology, Centro Hospitalar e Universitário de Lisboa Central, Lisbon, Portugal
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Shadmani G, Don S. What is this bump in my neck? Ultrasonographic evaluation of pediatric neck masses. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:919-930. [PMID: 36426742 DOI: 10.1002/jcu.23400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 06/02/2023]
Abstract
Neck masses are common in pediatric patients, with benign etiologies such as congenital or inflammatory lesions accounting most of these masses. Anatomic location (most important), clinical history, and the appearance in ultrasonography (US) are helpful clues to narrow down differential diagnosis. Because of widespread availability, lack of ionizing radiation, and no need for sedation or contrast administration, US is the preferred initial modality for the evaluation. Further evaluation with cross-sectional imagings is needed for more extensive lesions with trans-spatial extension or suspicion of intrathoracic or retropharyngeal extension. This review will focus on US appearance and clinical presentation of masses of the neck in children, to enable radiologist to arrive at a reasonable differential diagnosis. We also briefly discuss more complex pathologies that need to be evaluated with cross-sectional modalities such as CT scan and magnetic resonance imaging.
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Affiliation(s)
- Ghazal Shadmani
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Steven Don
- Mallinckrodt Institute of Radiology, Washington University in Saint Louis, Saint Louis, Missouri, USA
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Rajan A, Mohiyuddin SMA, A S, Babu P, Mohammadi K. The Outcome of Treatment for Thyroglossal Tract Anomalies. Cureus 2023; 15:e39325. [PMID: 37351250 PMCID: PMC10283078 DOI: 10.7759/cureus.39325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Background Thyroglossal tract anomalies are the most common cause of midline neck swelling. Thyroglossal cysts present between the base of the tongue and cricoid cartilage as painless, midline swelling that moves on deglutition and protrusion of the tongue. If the thyroglossal cyst gets infected or is violated surgically, it can result in a thyroglossal sinus or fistula. Investigations in patients with suspected thyroglossal cysts include a thyroid function test, ultrasonography of the neck, and fine needle aspiration cytology (FNAC). Computed tomography (CT) or magnetic resonance imaging (MRI) can be done for larger cysts or suspected malignancies. The gold standard treatment is Sistrunk surgery. Recurrence rates with Sistrunk surgery are lower when the surgery is performed accurately. This study was conducted to document the clinical presentation and treatment outcome in patients treated for thyroglossal tract anomalies. Methods This is a retrospective analysis of 46 medical case records of patients operated on for thyroglossal tract anomalies at a rural tertiary care hospital from April 1995 to April 2021. Patients fulfilling the inclusion and exclusion criteria were evaluated with a detailed history, various clinical presentations, location, extent of anomalies, and thyroid function test results documented. Ultrasound images were reviewed, and the findings were documented. All patients have consent, and they underwent Sistrunk surgery. Patients in whom the normal thyroid gland was found to be absent were started on replacement thyroxine after surgery. The specimen was subjected to histopathological examination by a senior pathologist. The outcome regarding complications, recurrence, and further treatment were reviewed. The outcome of the thyroglossal fistula was compared with that of thyroglossal cysts, and the outcome of infrahyoid thyroglossal tract anomalies was compared with that of suprahyoid thyroglossal tract anomalies. Results In this study, among the 46 patients, 24 (52.2%) were female and 22 (47.8%) were male. The minimum age was three years, the maximum was 58, and the mean was 20.6 years. In this study, 71.7% of the patients were diagnosed with thyroglossal cysts, 10.9% had thyroglossal fistulas, and two had lingual thyroids. The most common location of the cyst was infrahyoid (73.9%). 44 patients underwent Sistrunk surgery, and two patients diagnosed with lingual thyroid underwent excision. Three patients had complications (two pharyngo-cutaneous fistulas, one wound dehiscence), and all were managed conservatively. There were no recurrences in our study. Conclusion Thyroglossal tract anomalies are the most common congenital cervical anomalies. A complete Sistrunk procedure includes the removal of the entire thyroglossal tract, inclusive of the body of the hyoid bone along with the cuff of base tongue tissue, and gives the best result for thyroglossal tract anomalies.
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Affiliation(s)
- Akshaya Rajan
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Medical College, Kolar, IND
| | - S M Azeem Mohiyuddin
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Medical College, Kolar, IND
| | - Sagayaraj A
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Medical College, Kolar, IND
| | - Prashanth Babu
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Medical College, Kolar, IND
| | - Kouser Mohammadi
- Otorhinolaryngology & Head and Neck Surgery, Sri Devaraj Urs Medical College, Kolar, IND
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Al-Qahtani MH, ElYahia SA, AlQahtani AS, AlQahtani AJ, Alamer AA, AlQahtani SM, Yousef AA, Albuali WH, Awary BH, Aldajani AA, Al Ghamdi MA. Thyroid Disorders Spectrum in Pediatric Endocrine Clinic; Seven-Year Experience of a Teaching Hospital in Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020390. [PMID: 36832519 PMCID: PMC9955412 DOI: 10.3390/children10020390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 02/18/2023]
Abstract
Thyroid disorders constitute one of the major endocrine disorders in pediatric service. It includes a range of congenital versus acquired anatomic and/or functional thyroid diseases in growing children that has a spectrum of severity from severe intellectual disability effect to subclinical mild pathologies. This study was designed to analyze the demographic characteristics, clinical pattern, and severity of thyroid disorders in the pediatric endocrine clinic patients at the teaching hospital of the university over a 7-year duration. A total number of 148 patients with thyroid disorders were seen in pediatric Endocrine clinic during the time between January 2015 and December 2021. Female patients constitute 64% of them. Acquired Hypothyroidism was the commonest disorder; 34% of the cases followed by the congenital hypothyroidism (CH), then Hashimoto's thyroiditis, and 5.8% for others. While a very small percentage was acquired hyperthyroidism. The majority of referrals were from dermatology and other service for the screening of thyroid disease as association with other autoimmune diseases with percentage of 28.3%. Next was neck swelling manifestation in 22.6%. Thyroid disorders in children, both congenital and acquired, constitute an important medical issue for pediatricians to be aware of its variable presentations, and its potential serious health consequences on the affected children if not diagnosed and treated earlier. Acquired hypothyroidism constitutes more percentage of the thyroid disorders followed in the pediatric endocrinology outpatient clinics. Congenital hypothyroidism is the second most common thyroid disorder in the outpatient unit, having the most potential complications. These results support the international studies with the female predominance in most of thyroid disorders.
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Affiliation(s)
- Mohammad H. Al-Qahtani
- Department of Pediatrics, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
- Correspondence:
| | - Sufian A. ElYahia
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | | | | | - Abdulaziz A. Alamer
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | - Sultan M. AlQahtani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | - Abdullah A. Yousef
- Department of Pediatrics, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | - Waleed H. Albuali
- Department of Pediatrics, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | - Bassam H. Awary
- Department of Pediatrics, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | - Ala’a A. Aldajani
- Department of Pediatrics, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
| | - Mohammed A. Al Ghamdi
- Department of Pediatrics, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34221, Saudi Arabia
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11
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Chen W, Zhou Y, Xu M, Xu R, Wang Q, Xu H, Chen J, Li X. Congenital second branchial cleft anomalies in children: A report of 52 surgical cases, with emphasis on characteristic CT findings. Front Pediatr 2023; 11:1088234. [PMID: 36937970 PMCID: PMC10020344 DOI: 10.3389/fped.2023.1088234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/14/2023] [Indexed: 03/06/2023] Open
Abstract
Objective The objectives of this study was to review the clinical features and surgical treatment outcomes of congenital second branchial cleft anomalies (CSBCAs) and to investigate the characteristic computed tomography (CT) findings of CSBCAs. Methods We conducted a retrospective study of 52 children who were referred to Shanghai Children's Hospital from October 2014 to December 2021 diagnosed as CSBCAs. Results There were 36 males and 16 females. Of them, 35 patients were presented as having a skin pit at birth or discharge from the skin opening on the lateral neck, and 17 patients presented with an asymptomatic or painful mass. The typical CT features of CSBCAs included isolated and homogeneously hypodense cystic lesions surrounded by a uniformly thin, smooth wall. CSBCAs were generally located at the anteromedial border of the sternocleidomastoid muscle, posterior to the submandibular gland, and lateral to the carotid sheath. All patients were treated surgically and only one case underwent ipsilateral tonsillectomy. After a median follow-up of 30 (range 4-90) months, no recurrence or complications were observed. Conclusions The CSBCAs show some characteristic CT findings, which can help clinicians diagnose and plan surgical strategies. High ligation of the lesions is sufficient for complete excision of CSBCAs.
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Affiliation(s)
- Wei Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yilong Zhou
- Department of Pediatric Otorhinolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Mengrou Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Xu
- Department of Radiology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qingyu Wang
- Department of Pathology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongming Xu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiarui Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Correspondence: Xiaoyan Li
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León Sanguano D, Jara Santamaria C, Jara Santamaria B, Burbano Piñuela L, Vásquez Bracho D, Palacios Molina A. Persistent brachial cleft as an infrequent cause of infraglottic stridor and airway obstruction in a 24 year old woman. A case report. Int J Surg Case Rep 2022; 99:107668. [PMID: 36183589 PMCID: PMC9568760 DOI: 10.1016/j.ijscr.2022.107668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/21/2022] Open
Abstract
Background We present the case of a 24-year-old woman with respiratory distress associated with a cyst of the fourth branchial cleft that displaced and compressed the upper airway, so the cervical mass was surgically resected, the patient recovered completely. Case presentation We present the case of a 24 year old female no other pertinent medical history who presents to the emergency department of way outpatient to respiratory distress associated with a cervical mass. A computed tomography (CT) scan shows a right cervical cystic mass that was displacing and compressing the upper airway. A total resection of the cystic mass was performed, after which the patient recovered completely. The histopathological analysis indicated a branchial cleft cyst which, due to its location, was thought to be the fourth branchial cleft, a rare congenital anomaly. Conclusions Fourth branchial cleft cysts are rare malformations. They should be taken into consideration in the differential diagnosis of cervical masses in young adults, especially in situations of potentially life threatening airway compromise where an emergent procedure should be performed to guarantee the patient's life, the diagnosis is based on an adequate history and physical examination, with the support of imaging studies, with CT scan imaging being preferred as it provides information for surgical planning. Treatment is based on complete resection of the cystic mass, which relieves the symptoms of mass effect and decreases the risk of recurrence. Fourth branchial cleft cysts are rare pathology, representing 1–4 % of all branchial apparatus pathologies. No case reports of fourth branchial cleft cysts in adults that cause airway obstruction. Surgical resection of the fourth branchial cleft cysts allowed the complete recovery of the patient without recurrence.
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Messina MV, Pozzilli P, Palermo A. An Investigation Through Time: What Hides Behind the Neck of This Ancient Roman Woman? Thyroid 2022; 32:1007-1009. [PMID: 35838126 DOI: 10.1089/thy.2022.0331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Paolo Pozzilli
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
- Centre of Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, University of London, London, United Kingdom
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
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14
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Tunkel A, Vezina G, Espinel AG. Congenital Cystic Neck Mass in a 2-Month-Old Infant. JAMA Otolaryngol Head Neck Surg 2022; 148:787-788. [PMID: 35679037 DOI: 10.1001/jamaoto.2022.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Alexandra Tunkel
- School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Gilbert Vezina
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC
| | - Alexandra G Espinel
- Department of Otolaryngology-Head & Neck Surgery, George Washington University, Children's National Hospital, Washington, DC
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15
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Neuberger I, Tutman JJ, White CJ, Mirsky DM. Isolated lesions of the suprasternal notch in pediatric patients. Pediatr Radiol 2022; 52:1266-1271. [PMID: 35237855 DOI: 10.1007/s00247-022-05314-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 01/04/2022] [Accepted: 02/03/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Palpable masses of the head and neck are a common indication for imaging in the pediatric population. Midline lesions of the infrahyoid neck, particularly lesions isolated to the suprasternal notch, are not well studied. OBJECTIVE To delineate the histopathological and imaging spectrum of masses that occur within and isolated to the suprasternal notch. MATERIALS AND METHODS A retrospective study was performed to identify patients with an isolated lesion of the suprasternal notch that had available pathological diagnoses. Available imaging was reviewed and characterized by fellowship-trained pediatric radiologists and compared by descriptive statistics to the final pathological diagnoses. RESULTS Eighteen masses isolated to the suprasternal notch with available pathological diagnoses were identified. Of these, congenital epithelial inclusion cysts were diagnosed in 14 patients (77.8%) with dermoid cysts comprising 11 of those (61.1%) and epidermoid cysts accounting for 3 (16.7%). The most common imaging appearance was a cystic or pseudosolid appearance without vascularity. CONCLUSIONS Isolated resected lesions of the suprasternal notch in pediatric patients are most frequently dermoid/epidermoid cysts, with a differential diagnosis including other less common entities.
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Affiliation(s)
- Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave., Box 125, Aurora, CO, 80045, USA.
| | - Jeffrey J Tutman
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave., Box 125, Aurora, CO, 80045, USA
| | - Christina J White
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave., Box 125, Aurora, CO, 80045, USA
| | - David M Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado, 13123 E. 16th Ave., Box 125, Aurora, CO, 80045, USA
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16
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Firth PG. Ether Day Revisited: The Surgical Records of Edward Gilbert Abbott. ANNALS OF SURGERY OPEN 2022; 3:e166. [PMID: 37601617 PMCID: PMC10431558 DOI: 10.1097/as9.0000000000000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 04/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background The details of the public demonstration of the effects of ether that initiated the modern era of surgery and anesthesia are often misreported. Existing published transcripts of the clinical records are incomplete or inaccurate. Methods The patient notes of Gilbert Abbott were photographed, transcribed, and reviewed. Results The records are handwritten in "Surgical Records for 1846; Volume 30," of the Massachusetts General Hospital. The patient was admitted on September 25. The presenting condition was a congenital, mobile, compressible, multilobed, small lesion at the angle of the left mandible, and base of tongue. The operation on October 16 was an attempted ligation of the blood supply to the lesion. The postoperative diagnosis was a vascular lesion ("erectile tumor"). Postoperative management included application of sclerosants. The mass was unchanged in size on discharge on December 7. There is no documentation of the anesthetic administration in the progress note but a retrospective report of the anesthetic is pasted into the Records book. This account reported that the patient did not respond to the initial incision. He moved and cried out during the latter part of the procedure. Although he was aware of the operation taking place, he later said he had not experienced pain. The commentary concluded that the demonstration of the analgesic effectiveness of ether was inconclusive but that subsequently ether was shown to be effective. Conclusions The surgery on October 16, an unsuccessful ligation of a congenital lymphovascular malformation, was performed under incomplete general anesthesia. Examination of the primary documents may allow for more accurate accounts of circumstances surrounding the discovery of anesthesia.
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Affiliation(s)
- Paul G. Firth
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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17
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Congenital Ewing Sarcoma Presenting as a Rapidly Growing Neck Mass in a Newborn. Adv Neonatal Care 2022; 22:42-46. [PMID: 33417327 DOI: 10.1097/anc.0000000000000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ewing sarcoma (EWS) is an aggressive soft-tissue and bone malignancy. Congenital EWS is extremely rare, and its presenting features can be unique from that of EWS occurring in older children. CLINICAL FINDINGS A full-term female infant with a neck mass present at birth was admitted to a level I nursery with an otherwise well appearance and normal vital signs. After consultation with a neonatologist, she was transferred to a neonatal intensive care unit where she developed sudden respiratory collapse from rapid growth of the mass causing airway obstruction, leading to emergent intubation. Ultrasound and MRI scans of the neck mass demonstrated cystic and vascular components, and a timely biopsy revealed small round blue cells with diffuse CD99 expression and chromosomal translocation 11;22. PRIMARY DIAGNOSIS Ewing sarcoma. INTERVENTIONS An accelerated workup for EWS was done due to the patient's critical status. On day of life (DOL) 8, she was started on treatment of EWS as per the current standard-of-care AEWS0031. On DOL 24, she underwent tracheostomy placement. OUTCOMES The patient completed 14 total cycles of chemotherapy and is more than 12 months old. Her tracheostomy was decannulated at 6 months of age. PRACTICE RECOMMENDATIONS The rarity of EWS in neonates and its presentation as a neck mass make this disease difficult to recognize unless clinicians have a high index of suspicion. The aims of this case report are to increase awareness of malignancy as a potential cause of neck masses in neonates and to prompt nurses and physicians to prepare for airway stabilization at appropriate levels of care if a neck mass is present at birth.
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18
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Ho ML. Pediatric Neck Masses: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:1-14. [PMID: 34836558 DOI: 10.1016/j.rcl.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Neck masses commonly present in children and several potential diagnostic and management pathways exist, though with a paucity of evidence-based recommendations. The purpose of this article is to evaluate the current literature and utilization of various diagnostic imaging modalities , with a review of imaging features and management pearls for pediatric neck masses. A comprehensive understanding and practical imaging workflow will guide optimal patient workup and management.
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Affiliation(s)
- Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive - ED4, Columbus, OH 43205, USA.
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19
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Barrette LX, Morales CZ, Oliver ER, Gebb JS, Feygin T, Lioy J, Howell LJ, Hedrick HL, Jackson OA, Adzick NS, Javia LR. Risk factor analysis and outcomes of airway management in antenatally diagnosed cervical masses. Int J Pediatr Otorhinolaryngol 2021; 149:110851. [PMID: 34311168 DOI: 10.1016/j.ijporl.2021.110851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate antenatally-determined imaging characteristics associated with invasive airway management at birth in patients with cervical masses, as well as to describe postnatal management and outcomes. STUDY DESIGN A retrospective analysis of 52 patients with antenatally diagnosed neck masses was performed using single-center data from January 2008 to January 2019. Antenatal imaging, method of delivery, management, and outcomes data were abstracted from the medical record and analyzed. RESULTS Antenatal diagnosis of neck masses in this cohort consisted of 41 lymphatic malformations (78.8%), 6 teratomas (11.5%), 3 hemangiomas (5.8%), 1 hemangioendothelioma (1.9%), and 1 giant foregut duplication cyst (1.9%). Mean gestational age at time of diagnostic imaging was 29 weeks 3 days (range: 19w4d - 37w). Overall, 22 patients (42.3%) required invasive airway management at birth, specifically 18 patients (34.6%) required endotracheal intubation and 4 (7.7%) required tracheostomy. 15 patients (28.8%) underwent ex-utero intrapartum treatment (EXIT) for the purposes of securing an airway. Polyhydramnios, tracheal deviation and compression, and anterior mass location on antenatal imaging were significantly associated with incidence of invasive airway intervention at birth, EXIT procedure, and tracheostomy during the neonatal hospitalization (p < 0.025; Fisher's exact test). Logistic regression analysis demonstrated statistically significant association between increasing antenatally-estimated mass volume and incidence of invasive airway management at birth (p = 0.02). Post-natal cervical mass management involved surgical excision (32.7%), sclerotherapy (50%), and adjuvant therapy with rapamycin (17.3%). Demise in the neonatal period occurred in 4 (7.7%) patients. CONCLUSION This series documents the largest single-center experience of airway management in antenatally diagnosed cervical masses. Fetal imaging characteristics may help inform the appropriate method of delivery, airway management strategy at birth, and prenatal counseling.
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Affiliation(s)
- Louis-Xavier Barrette
- Division of Otolaryngology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Carrie Z Morales
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Edward R Oliver
- Department of Radiology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Juliana S Gebb
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Tamara Feygin
- Department of Radiology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Janet Lioy
- Division of Neonatology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Lori J Howell
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Holly L Hedrick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Oksana A Jackson
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, Leonard and Madlyn Abramson Pediatric Research Center, 3615 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - N Scott Adzick
- Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA; Division of Pediatric General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Luv R Javia
- Division of Otolaryngology, Children's Hospital of Philadelphia, The Perelman School of Medicine at the University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
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20
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Xian Z, Chen Y, Teng Y, Han S, Li L. Second branchial cleft cyst with snoring during sleep as initial symptom: A case report and literature review. Medicine (Baltimore) 2021; 100:e27037. [PMID: 34449485 PMCID: PMC8389974 DOI: 10.1097/md.0000000000027037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/10/2021] [Indexed: 01/04/2023] Open
Abstract
The second branchial cleft cyst lacks typical symptoms, and its clinical manifestations are complex and varied. Among them, the second branchial cleft cyst manifested by sleep snoring is relatively rare, and it can easily lead to missed diagnosis or misdiagnosis. This paper reports a case of a second branchial cleft abscess with snoring as the main manifestation. The branchial cleft cyst was removed using an endoscopic branchial cleft.
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21
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Khalaf S, Sarwani A, Al Fardan R, Maki M, Al Saeed M. A Uniquely Challenging Case of Poorly Controlled Hyperthyroidism With a Coexisting Thyroglossal Cyst. Cureus 2021; 13:e14271. [PMID: 33959451 PMCID: PMC8093102 DOI: 10.7759/cureus.14271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Hyperthyroidism is a common disease. Thyroglossal duct cysts are also a very common type of congenital anomalies. Their co-existence is, however, rare with only a few cases described in the literature of the same. We describe the case of a 44-year-old female who presented initially 16 years ago with hyperthyroid symptoms related to Graves’ disease diagnosed serologically and by thyroid scan and ultrasound. Incidentally, she was also noted to have a non-complicated thyroglossal duct cyst. She was initially started on anti-thyroid medications but remained in a hyperthyroid state throughout most of her illness. Radioiodine ablative therapy and surgical resection were delayed due to the patient’s dispreference. After a long period of missed follow up, she presented with a thyroid storm and underwent a total thyroidectomy and cyst resection. The key endocrine issues learned from this case include: 1) dealing with non-compliant patients in terms of poorly controlled hyperthyroidism and refusal to follow the recommended treatment, 2) observing the natural disease progression of untreated Graves’ disease coexisting with a thyroglossal duct cyst, and 3) describing a rare incidental finding of a thyroglossal duct cyst coexisting with Graves' disease in the absence of ectopic hormone production. A few cases have described hyperthyroidism related to remnants of thyroid tissue in the thyroglossal duct or related to the thyroid gland. To the best of our knowledge, there are no cases reported of Graves’ disease coexisting with a non-complicated thyroglossal duct cyst making our case unique and first of its kind.
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Affiliation(s)
- Saeed Khalaf
- Endocrinology, Salmaniya Medical Complex, Manama, BHR
| | - Aysha Sarwani
- Endocrinology, Salmaniya Medical Complex, Manama, BHR
| | | | - Mohammed Maki
- Internal Medicine, Salmaniya Medical Complex, Manama, BHR
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22
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Tokarz E, Gupta P, McGrath J, Szymanowski AR, Behar J, Behar P. Proposed ultrasound algorithm to differentiate thyroglossal duct and dermoid cysts. Int J Pediatr Otorhinolaryngol 2021; 142:110624. [PMID: 33485097 DOI: 10.1016/j.ijporl.2021.110624] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/31/2020] [Accepted: 01/10/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE 1) To assess reproducibility of the previously established SIST score. 2) To determine inter-observer agreement in using ultrasound (US) characteristics to differentiate thyroglossal duct cyst (TGDC) from dermoid cysts (DC) 3) Improve the method used to pre-operatively differentiate TGDC from DC. STUDY DESIGN Retrospective chart review. SETTING Tertiary care pediatric hospital. SUBJECTS AND METHODS: An electronic medical record was queried to identify children with midline neck masses who underwent pre-operative neck US and had a histopathologic diagnosis of either TGDC or DC. Two pediatric radiologists, blinded to the pathologic diagnosis, evaluated the US images and documented the presence of pre-determined characteristics of each mass. Potential differentiating factors were analyzed for their predictive power. The SIST (septations, irregular walls, solid components = TGDC) score was determined as well as inter-observer agreement. Using the characteristics that had significant predictive power, we used the data to develop an algorithm to improve predicting cyst type. RESULTS Pathologically, there were 47 TGDC and 25 DC. The inter-observer agreement about the pathologic diagnosis between the two radiologists was substantial, K = 0.66. Overall, the SIST score predicted the correct diagnosis 67% of the time. Radiologist 1 and radiologist 2 were more accurate than the SIST score alone, making the correct diagnosis 96% and 86% of the time, respectively. In our study, we found that the most important US characteristics in differentiating TGDC and DC are: internal Septations, depth relative to Strap muscles, Shape and Solid parts (4 S algorithm). The SIST score criteria were individually shown to be significant and sensitive in recognizing DC, however, they were not specific and often misclassified TGDC as DC. We developed a new sequential filtering algorithm that more accurately differentiates cysts. This new algorithm uses step-wise filtering of characteristics, first for Septations, then for depth to Straps, then Shape of the cyst and lastly Solid parts (4 S algorithm). This algorithm correctly categorized cyst type in 100% of patients in our study. CONCLUSIONS Pre-operatively differentiating TGDC and DC continues to be a challenge. Using our 4 S algorithm, we can more definitively differentiate TGDC from DC compared to the SIST score. All SIST score characteristics were significant and sensitive in detecting dermoid cysts, however, not very specific. The radiologists' judgment and accuracy was better than the SIST score. The 4 S algorithm uses sequential filtering of important characteristics: Septations, depth to Straps, Shape of cyst and lastly Solid parts to improve diagnostic accuracy.
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Affiliation(s)
- Ellen Tokarz
- State University of New York at Buffalo, Department of Otolaryngology - Head and Neck Surgery, Buffalo, NY, USA.
| | - Puneet Gupta
- Department of Radiology, Oshei Children's Hospital, Buffalo, NY, USA
| | - John McGrath
- Department of Radiology, Oshei Children's Hospital, Buffalo, NY, USA
| | - Adam R Szymanowski
- State University of New York at Buffalo, Department of Otolaryngology - Head and Neck Surgery, Buffalo, NY, USA
| | - Jerry Behar
- Pediatric Ear, Nose and Throat Associates, PLLC, Buffalo, NY, USA
| | - Philomena Behar
- State University of New York at Buffalo, Department of Otolaryngology - Head and Neck Surgery, Buffalo, NY, USA; Pediatric Ear, Nose and Throat Associates, PLLC, Buffalo, NY, USA
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23
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Yang G, He T. The congenital sternoclavicular sinus: a single-institution retrospective study of 88 patients. Orphanet J Rare Dis 2021; 16:46. [PMID: 33485384 PMCID: PMC7824924 DOI: 10.1186/s13023-021-01691-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 01/15/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Sinus near the sternoclavicular joint was considered as a rare congenital neck abnormality. Though it was reported as a dermoid sinus in some literatures, the embryological origin of the sinus was unclear. This study aimed at reviewing the clinical and histological characteristics and analyzing the possible embryological origin of this malformation in children. METHODS The medical records of all patients with congenital sternoclavicular sinus who underwent surgical resection between March 2018 through June 2020 were reviewed retrospectively. The clinical presentations, complications, histological examination, and treatment were analyzed. RESULTS Of the 88 patients with congenital sternoclavicular sinus included, the mean age of surgery was 2.73 ± 1.71 years old. The sinuses occurred on the left side in 73 (83.0%) cases. Sixty-three patients experienced sinus infection and 44 patients underwent incision and drainage before excision. All patients received surgical resection with one patient who recurred after surgery. Histopathological examination showed that the sinuses were lined by squamous epithelium in most patients. However, ciliated epithelium was observed in one patient and salivary glands were detected in two patients. CONCLUSIONS The congenital sternoclavicular sinus should be excised promptly to prevent recurrent infection. According to the ciliated epithelium and salivary gland were found in the wall of sinus, it should be viewed as the skin side remnant of the fourth branchial cleft rather than a dermoid cyst/sinus.
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Affiliation(s)
- Gang Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
| | - Taozhen He
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
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24
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Role of prenatal imaging in the diagnosis and management of fetal facio-cervical masses. Sci Rep 2021; 11:1385. [PMID: 33446872 PMCID: PMC7809128 DOI: 10.1038/s41598-021-80976-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/29/2020] [Indexed: 12/01/2022] Open
Abstract
Congenital facio-cervical masses can be a developmental anomaly of cystic, solid, or vascular origin, and have an inseparable relationship with adverse prognosis. This retrospective cross-sectional study aimed at determining on the prenatal diagnosis of congenital facio-cervical masses, its management and outcome in a large tertiary referral center. We collected information on prenatal clinical data, pregnancy outcomes, survival information, and final diagnosis. Out of 130 cases of facio-cervical masses, a total of 119 cases of lymphatic malformations (LMs), 2 cases of teratoma, 2 cases of thyroglossal duct cyst, 4 cases of hemangioma, 1 case of congenital epulis, and 2 cases of dermoid cyst were reviewed. The accuracy of prenatal ultrasound was 93.85% (122/130). Observations of diameters using prenatal ultrasound revealed that the bigger the initial diameter is, the bigger the relative change during pregnancy. Magnetic resonance imaging (MRI) revealed that 2 cases of masses were associated with airway compression. In conclusion, ultrasound has a high overall diagnostic accuracy of fetal face and neck deformities. Prenatal US can enhance the management of ambulatory monitoring and classification. Furthermore, MRI provided a detailed assessment of fetal congenital malformations, as well as visualization of the trachea, presenting a multi-dimensional anatomical relationship.
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25
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Kim YH, Lee J. Cutaneous ciliated cyst on the anterior neck in young women: A case report. World J Clin Cases 2020; 8:4481-4487. [PMID: 33083407 PMCID: PMC7559661 DOI: 10.12998/wjcc.v8.i19.4481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/07/2020] [Accepted: 08/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A cutaneous ciliated cyst (CCC) is a rare, benign tumor in young female adults, which is usually found on the lower extremities.
CASE SUMMARY We found an uncommon location of CCC in the anterolateral cervical area and reviewed the literature. A 20-year-old female complained of a well-defined, painless, palpable mass that started several years ago. The mass was tense and movable and located at the anterolateral aspect of the neck. Imaging showed a non-enhancing round mass. Surgical excision biopsy was performed, and the cystic mass was revealed to be a CCC.
CONCLUSION The rare location of CCC can be found in anterior neck area, which should be another diagnostic option for mass on anterior neck.
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Affiliation(s)
- Yon Hee Kim
- Department of Pathology, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea
| | - Jihyoun Lee
- Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul 04401, South Korea
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26
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Rossi NA, Gietzen R, Clement CG, Ohlstein JF, Pine HS, Szeremeta W, McKinnon BJ, Daram S. Bilateral Cervical Pilomatricoma: A Diagnostic Dilemma for the Pediatric Otolaryngologist. EAR, NOSE & THROAT JOURNAL 2020; 101:368-371. [PMID: 32986491 DOI: 10.1177/0145561320958978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Pilomatricomas are benign skin tumors often encountered by otolaryngologists but frequently misdiagnosed. Although they can occur at any age, they commonly present in children as a discolored superficial lesion adhered to the overlying skin. Accurate preoperative diagnosis is crucial for appropriate management, which is surgical in most cases. Here, we present bilateral pilomatricomas mimicking features of several other diagnoses in a pediatric patient. The patient was successfully treated with surgical excision. This case presented a unique diagnostic challenge, as the lesions exhibited features of several common diagnoses. In general, surgical management of pilomatricoma is curative, and recurrence is rare.
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Affiliation(s)
- Nicholas A Rossi
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Rachelle Gietzen
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Cecilia G Clement
- Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA
| | - Jason F Ohlstein
- * Dr. Ohlstein contributed to drafting and editing of the manuscript
| | - Harold S Pine
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Wasyl Szeremeta
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Brian J McKinnon
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Shiva Daram
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
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27
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Li J, Zhong W, Geng X, Liu X, Zhang X, Wang Y, Li H. Ultrasonographic diagnosis, classification, and treatment of cervical lymphatic malformation in paediatric patients: a retrospective study. BMC Pediatr 2020; 20:441. [PMID: 32950065 PMCID: PMC7501610 DOI: 10.1186/s12887-020-02337-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
Background To explore the imaging features, key diagnostic points, classification, treatment, and prognosis of cervical lymphatic malformation. Methods Overall, 320 patients diagnosed with cervical lymphatic malformation were retrospectively analysed in our hospital between 1 January 2014 and 31 December 2017. Imaging modalities included colour Doppler ultrasound, magnetic resonance imaging, and contrast-enhanced computed tomography. Cervical lymphatic malformations were classified by cyst diameter. Treatments included interventional therapy, surgery, and expectant treatment. Results Cervical lymphatic malformation was identified in 320 of 1192 patients with lymphatic malformation. Four were excluded due to misdiagnosis by ultrasonography. Cervical lymphatic malformation was classified as mixed, macrocystic, and microcystic in 184 (57.5%), 117 (36.56%), and 19 (5.94%) patients, respectively. Sixty-four (20%), ten (3.12%), seven (2.19%), and three (0.94%) patients experienced intracystic haemorrhage, infection, concurrent intracystic haemorrhage and infection, and calcification, respectively. Among 260 (81.25%) patients who underwent interventional sclerotherapy, 163 (50.94%) received it once and 96 (30%) received it two or more times. Twenty-eight (8.75%), five (1.56%), and 27 (8.44%) patients underwent surgical resection, interventional sclerotherapy plus surgery, and expectant management, respectively. Conclusions Ultrasonography is useful for diagnosing definite cervical lymphatic malformation. Interventional therapy is the first choice for children with confirmed cervical lymphatic malformation.
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Affiliation(s)
- Jiaoling Li
- Department of Ultrasound, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China.
| | - Wei Zhong
- Neonatal Intensive Care Unit, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
| | - Xiuping Geng
- Department of Ultrasound, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
| | - Xiaofang Liu
- Department of Ultrasound, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
| | - Xiangxiang Zhang
- Department of Ultrasound, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
| | - Yurun Wang
- Department of Ultrasound, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
| | - Haibo Li
- Department of Invasive Technology, Guangzhou Women and Children's Medical Centre, Guangzhou Medical University, Jinsui Road 9, Guangzhou, 510623, China
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28
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Reading J, Nash R, Hartley B. Fourth branchial pouch anomaly presenting as a neonatal neck lump. BMJ Case Rep 2020; 13:13/9/e237551. [PMID: 32895255 DOI: 10.1136/bcr-2020-237551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A 1-week-old female infant presented with a transilluminating neck lump that increased in size with crying. The presumptive diagnosis was lymphatic malformation, but imaging raised the possibility of an abscess or necrotic tumour. A biopsy revealed a likely developmental cyst with local inflammatory change. Microlaryngoscopy revealed a fourth branchial pouch sinus, which was cauterised. The sinus and neck lump resolved without need for further treatment.
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Affiliation(s)
- Jacob Reading
- Paediatrics, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
| | - Robert Nash
- Ear, Nose and Throat Surgery Department, Great Ormond Street Hospital For Children NHS Trust, London, UK
| | - Benjamin Hartley
- Ear, Nose and Throat Surgery Department, Great Ormond Street Hospital For Children NHS Trust, London, UK
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29
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Surgical resection of antenatally diagnosed orbital teratoma resulting in preservation of the globe. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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30
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Miller E, Finn LS, Boos MD. Subcutaneous Nodule of the Midline Anterior Neck in an Infant. JAMA Otolaryngol Head Neck Surg 2020; 146:196-197. [PMID: 31774475 DOI: 10.1001/jamaoto.2019.3551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Laura S Finn
- Department of Laboratories, Seattle Children's Hospital, Seattle, Washington.,Department of Pathology, University of Washington School of Medicine, Seattle
| | - Markus D Boos
- Division of Dermatology, Department of Pediatrics, University of Washington School of Medicine, Seattle.,Seattle Children's Hospital, Seattle, Washington
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31
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Liaw J, Cochran E, Wilson MN. Primary Papillary Thyroid Cancer of a Thyroglossal Duct Cyst. EAR, NOSE & THROAT JOURNAL 2019; 98:136-138. [PMID: 30938240 DOI: 10.1177/0145561319825555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Papillary thyroid carcinoma in a thyroglossal duct cyst is very rare. We present the case of a teenage boy with a large thyroglossal duct cyst containing papillary thyroid carcinoma. There was no evidence of carcinoma within the thyroid gland, making this an important case of primary thyroglossal duct cyst carcinoma.
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Affiliation(s)
- Jeffrey Liaw
- 1 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Eric Cochran
- 2 Division of Otolaryngology-Head and Neck Surgery, Department of Pathology, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
| | - Meghan N Wilson
- 1 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA, USA
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