Introduction: The thyroglossal duct cyst is the most common congenital neck mass.
Clinical Presentation:
1. Painless mid-line neck swelling
2. Discharging sinus.
3. Painful mass (in c/o infected thyroglossal cyst)
Clinical diagnosis: Mid-line neck swelling moves with swallowing & also moves with protrusion of tongue.
Investigations:
1. Thyroid hormone tests T3,T4,TSH
2. Ultrasonography
3. Thyroid scan to rule out ectopic thyroid tissue.
Beside these tests, other optional tests are
4. CT/MRI
5. Fine needle aspiration cytology
6. Fistulography
Management:
Sistrunk procedure: Principle- excision of cyst along with fistulous tract extending up to the foramen caecum with central portion of hyoid bone (through which the tract goes)
In case of infected thyroglossal cyst, the preoperative antibiotic course is given & then the procedure carried out once the infection settles down.
Introduction: Cystic hygroma or lymphangioma occurs because of faulty development of lymph vessels.There is either sequestration or obstruction of the developing vessels.It occurs 1 in 12000 of births every year.
Commonest sites are:
Posterior triangle of the neck
Axilla
Groin
Mediastinum
(though it can occur anywhere in the body)
Age at presentation:
It may appear at birth or can rapidly increase in size over first few months of life.Generally it is disease of infants.
Diagnosis:
Prenatal Ultrasonography
swelling at the time of delivery
Complications:
If the swelling is very large,it can cause compression over the trachea & airway compromise
Infection
Hemorrhage
Treatment:
Injection sclerotherapy
Surgical excision
Principle of surgery:
Total removal of all gross disease without damaging vital structures.
Recurrence rate: 20% with subtotal excision.
Introduction:
Most common congenital Anterior abdominal wall defects are Omphalocele & Gastroschisis.Combined incidence is 1:2000.It occurs equally in males & females.
Etiology:
Omphalocele: Failure of lateral & caudal folds to unite (which forms anterior abdominal wall) causes intestines to remain outside the body wall.
Gastroschisis: Abnormal involution of right umbilical vein resulting in the mesenchymal defects at the junction of the body stalk & body wall.
Pathology:
Omphalocele: There is anterior midline defect at the base of the umbilicus through which abdominal viscera herniates into an avascular hernial sac composed of peritoneum, wharton's jelly & amnion.
Presence or absence of liver in the sac differentiates between large & small omphalocele respectively.
Gastroschisis: There is a defect in the abdominal wall either on right (commonest) or left side of umbilicus without membranous sac.
Diagnosis:
Antenatal: Ultrasonography
Maternal serum AFP
Acetyl Cholinesterase
Amniocentesis & Chromosomal analysis
Postnatal: Clinical & Ultrasonography
Associated Syndromes:
1) Cantrell Pentalogy: Epigastric omphalocele, Anterior diaphragmatic hernia, Sternal cleft,
Ectopia cordis, Cardiac anomaly.
2) Beckwith Wiedemann syndrome: Exomphalos, macroglossia, gigantism
3) Trisomy syndrome
4) Prune belly Syndrome
Associated Conditions:
Intestinal malrotation, Meckel's diverticulum, Treacheo-esophageal Fistula, Undescended testis,
Small bowel atresia.
Management:
Conservative (omphalocele):
1) Topical application of escharotic agents
2) Delayed external compressive reduction of omphalocele
Surgical management:
1) Primary closure of anterior abdominal wall defect
2) Staged silo closure
3) Skin flap closure( ventral hernia)
4) Repair using synthetic grafts
