பிறப்பொக்கும் எல்லா உயிர்க்கும் சிறப்பொவ்வா செய்தொழில் வேற்றுமை யான். பிறப்பொக்கும் எல்லா உயிர்க்கும் சிறப்பொவ்வா செய்தொழில் வேற்றுமை யான்.

ASI Chennai City Branch Welcomes you all

CYSTIC SWELLINGS OF THE NECK Prof.Dr.D.Nagarajan M.S

CLASSIFICATION 1.Cytic hygroma POSTERIOR TRIANGLE; MIDLINE SWELLING: 1.Sublingual dermoid 2.Thyroglossal cyst 3.Subhyoid bursitis LATERAL SWELLINGS; 1.Digastric triangle -plunging ranula 2.Carotid triangle -bronchial cyst POSTERIOR TRIANGLE; 1.Cytic hygroma

Fibrous cyst that forms from a persistent thyroglossal duct midline swelling with slight inclination to left Out pouching from floor of first and second bronchial pouch THYROGLOSSAL CYST

pseudo stratified columnar epithelium with lymphoid tissue, fluid is formed by un- obliterated duct it contains cholesterol crystals tubulo-dermoid type may contain thyroid tissue /only functiong thyroid tissue age 15-30 yrs of females

COMMON SITES SUBHYOID -MC THYROID CARTILAGE SUPRAHYOID FLOOR OF THE MOUTH BENEATH TH FORAMEN CAECUM

SYMPTOMS: Painless Oval in shape Gradually increased in size Skin free Occasionally -Translucent mobility-sideways Moves on protrusion of tongue Fluctuant Lymph node enlarged if infected Examine the base of the tongue

COMPLICATIONS: INVESTIGATIONS: Recurrent infection fistula formation Malignancy Cosmetic In advent surgery INVESTIGATIONS: USG thyroid/MRI FNAC Uptake studies

DIFFERENTIAL DIAGNOSIS Subhyoid bursal cyst Sublingual dermoid Enlarged cervical node Ectopic thyroid Solitary nodule from isthmus

Excision-track with body of hyoid bone TREATMENT: Excision-track with body of hyoid bone Sistrunk’s operation

SUBLINGUAL DERMOID Sequestration dermoid Entrapped ectoderm level of first or mandibular arch Above or below mylohyoid Lined by squamous epithelium/ Contain -sweat glands/sebaceous glands Cheesy materials It never contains hair

SUBLINGUAL DERMOID Occurs at 10-15 years Male= female Position :supra omohyoid or sublingual variety Under the tongue or beneath the chin Mucosa free/ fluctuation positive non -Transillumination Intra omohyoid or cervical variety bimanual palpation

Sublingual drmoid cyst Investigation - USG /MRI/FNAC Treatment- excision under GA(intra/extra oral)

BRONCHIAL CYST congenital cyst persistence of second bronchial cleft ecto derm At the upper part of sternocleidomastoid Posteromedial part in the deeper plane Oval in shape Smooth surface /soft Well-defined Fluctuation positive Trans illumination negative

Cholesterol crystals on aspirated fluid BRONCHIAL CYST not reducible/compressible Cholesterol crystals on aspirated fluid

BRONCHIAL CYST COMPLICATIONS: Cosmetic Infection fistula formation DIAGNOSIS: FNAC MRI/FISTULAGRAM TREATMENT: Excision

Course BRANCHIALCYST Subcutaneous at the level of upper border thyroid cartilage Pass through bifurcation of common carotid artery Superficial to internal carotid,deep to ext.carotid Deep to the post.belly of digastric and stylohyoid muscle Superficial to IJV,hypoglossal,glossopharyngeal nerves Pierces the sup.constrictor ,open behind post.pillar of the tonsil.

The Neck of the cyst passes between the int and ext carotid art. Rx:Excision ( STEP - LADDER OPERATION ) The Neck of the cyst passes between the int and ext carotid art. Can Recur.

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Ranula Cystic swelling floor of mouth Mucous extravasation from sublingual salivary gland Plunging Ranula, extend through FOM muscles into neck

The name is derived form the word rana, because the swelling may resemble the translucent underbelly of the frog.

Plunging ranula Penetrates Mylohyoid muscle to enter neck Soft painless fluctuant dumb- bell shaped swelling Bi digital palpation

Plunging ranula Rare form of retention cyst May arise from SM/SL SG Mucous collects around gland Surgical excision via neck

CYSTIC HYGROMA Arises from jugular lymph sac 6th to 14th week sequestration of lymphatic sac Multiloculated Lined by endothelium Posterior triangle of neck Ascends to ear lobule or descends to axilla Early infancy or at birth presentation Lump in the lower third of posterior triangle

CYSTIC HYGROMA Increases in size smooth Indistinct margin Smooth or lobulated Cystic consistency Impulse on coughing Can be compressible Translucent brilliantly

CYSTIC HYGROMA TREATMENT: COMPLICATIONS: Cosmetic Respiratory difficulty Infection following incomplete removal Recurrence INVESTIGATIONS: MRI TREATMENT: Sclerotherapy Hot water injection Subsequent RT for recurrence

Subhyoid bursal cyst Enlargement subhyoid bursa with accumulation fluid Below the hyoid bone/front of the thyrohyoid membrane Swelling with pain Oval with long axis(cf.thyroglossal cyst) Mid line /move with deglutition Cystic/fluctuation +/non- transillumation /turbid

Subhyoid bursal cyst Investigation TREATMENT MRI/FNAC TREATMENT Complete excision-transverse incision

THANKS TO MY TEACHERS PROF.DR.S.NARENDRAN M.S Ph.D TANJAVUR MEDICAL COLLEGE PROF.DR.A.SUKUMAR M.S Rtd. Director of Medical and Rural services PROF.DR.C.M.K REDDY FRCS Rtd. Prof. Stanley Medical College PROF.DR.T.MOHANA PRIYA M.S Sri Ramachandra Medical College and R.I

The wood is lovely dark and deep But I have promises to keep Miles to go before I sleep

thankyou