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P. 1019
Toronto Notes 2019
Congenital Neck Masses
Otolaryngology OT33
Type I anomaly Type II anomaly
A. First Branchial Anomaly
Internal carotid a. External carotid a.
Hyoid
Thyroid cartilage Cricoid cartilage
XII
C. Third Branchial Anomaly
Figure 19. Branchial cleft anomalies
XII
Thyroglossal Duct Cysts
Embryology
• thyroidoriginatesasventralmidlinediverticulumatbaseoftongue,caudaltojunctionof3rdand4th branchial arches (foramen cecum), and migrates down to inferior aspect of neck
• thyroglossalductcystsarevestigialremnantsofthistract
Clinical Features
• usuallypresentsinchildhoodorduring20-40sasamidlinecystthatenlargeswithURTIandelevates with swallowing and tongue protrusion
Treatment
• pre-operativeantibioticstoreduceinflammation(infectionbeforesurgeryisawell-describedcauseof recurrence)
• smallpotentialforneoplastictransformation,socompleteexcisionofcystandtissuearoundtractupto foramen cecum at base of tongue, with removal of central portion of hyoid bone (Sistrunk procedure) recommended
XII
IX XII
External carotid a.
Internal carotid a. IX
Middle constrictor m. XII
Hyoid
Thyrohyoid membrane
Thyroid cartilage
Common carotid a.
B. Second Branchial Anomaly
XII
Hyoid
Thyroid cartilage
Cricoid cartilage
Left common carotid a. Right common carotid a.
Left subclavian a. Brachiocephalic trunk
Arch of aorta
D. Fourth Branchial Anomaly
© M. Romanova 2010
