Flashcards in Pediatric Airway II Deck (83):
True or false: as opposed to adults, most pediatric neck masses are benign
True or false: an adult neck mass is malignant until proven otherwise
The majority of pediatric neck masses have what underlying etiology?
What is the first step in characterizing neck masses?
Identify location (relative to SCM and clavicle)
How do you take a h/o a neck mass?
-Congenital (at birth)?
What are the two major congenital causes of lateral neck masses?
What is fibromatosis coli?
a benign proliferation of fibrous tissue infiltrating the lower third of the, (SCM) and is the most common cause of neonatal torticollis.
The mass, also known as a hematoma of the sternocleidomastoid, is firm and hard on palpation, but is neither tender nor inflamed.
What are laryngoceles?
A congenital anomalous air sac communicating with the cavity of the larynx, which may bulge outward on the neck.
What are thymic cysts?
Cysts in the thymus that ascend into the neck, causing a cystic mass
What type of branchial anomalies are the most common?
What is a type II branchial cleft cyst? Where does it end up?
Remnant of the division between the 2nd and 3rd branchial arch, ending up in the mouth
What is a type I brachial cleft cyst? Where does it end up?
Remnant of the division between the 1st and 2d arch, ending up in the ear canal
What is the location for a type II branchial cleft cyst?
at the level of the cricoid, and anterior to the SCM
What is the nerve that is affected with type I brachial cleft cyst?
What is a type III branchial cleft cyst? Where does it end up?
Remnant of the division of the 3rd and 4th branchial arch
What is a pyriform sinus fistula?
Type III branchial cyst
What is the anatomical location of type III branchial cleft cysts?
Neck to the ipsilateral piriform sinus to the the ipsilateral thyroid
What is the anatomical location of type I branchial cleft cysts? Where do they usually end up?
Between the bifurcation of the carotid, just posterior to the angle of the mandible
End up in the ear, with the facial nerve
What is the most common cause for acute onset of a lateral neck mass?
Acute viral lymphadenitis
What is the bacteria that causes cat scratch fever?
Dog bite cellulitis - what bacteria?
What are the top 3 viruses that cause acute viral lymphadenitis?
What is the most common bacterial cause of acute bacterial lymphadenitis?
1. Staph Aureus
What are the uncommon bacterial causes of acute bacterial lymphadenitis?
What are the cutaneous changes associated with mycobacterial lymphadenitis?
Purplish discoloration with palpable fluctuance
What is the usual h/o mycobacterial lymphadenitis?
Slow growing neck mass that does not respond to usual abx, and is NOT associated with illness or discomfort
True or false: PDD testing is usually positive with mycobacterial lymphadenitis?
What is the usual cause of mycobacterial lymphadenitis?
What is the treatment for mycobacterial lymphadenitis?
-Ethambutol and azithromycin
What is the treatment for MAC infections, in general?
Macrolide and ethambutol
What is the MA and classic side effect of ethambutol?
-It disrupts arabinogalactan synthesis by inhibiting the enzyme arabinosyl transferase
What is the general presentation of Cat scratch disease?
-Low grade fever
-Swelling at the inoculation site
How do you diagnose cat scratch disease?
What is the prognosis for cat scratch disease?
What is the first time that a congenital neck mass usually presents itself?
When it becomes infected, following a URI
Most congenital neck masses are lined with what sort of epithelium? What is the significance of this?
Respiratory--URIs are often the cause of infections of the cysts
What are the three major infections of the deep neck that can present as bacterial lymphadenitis? Which are the most common?
What are the major non-infectious etiologies of inflammatory lateral neck masses? (3)
What is the usual presentation of thyroglossal duct cysts?
Central, slow growing, segmental mass, that is not identifiable at birth.
What are thyroglossal duct cysts?
Embryological remnant of the migratory path of the thyroid from the foramen cecum to its home in the neck
How do you prevent recurrences of thyroglossal duct cysts?
Excise the portion within the hyoid bone
What is the treatment for thyroglossal duct cysts?
excise, and place on thyroid replacement
What must be done with excision of a thyroglossal duct cyst?
Must follow back to the hyoid bone
What is the base for the tongue muscles?
What are dermoid cysts? Where in the neck are they usually found?
a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues
Usually a midline structure
How common are dermoid cysts?
What is the prognosis for untreated dermoid cysts?
Will continue to grow unless resected
True or false: dermoid cysts often become infected
What is a plunging ranula?
Prolapse of the salivary secretions through the mylohyoid into the neck, causing a bullfrog swelling in the submental triangle
What is the source of the secretions that cause a plunging ranula?
What is the usual presentation of a plunging ranula?
Frog like neck
What is the usual source (anatomic location) of bacterial lymphadenitis in the neck?
What is the most common pediatric neoplasm of the head and neck?
What are the major issues with vascular malformations of the neck?
-Suffocation if involves the airway
-Substantial functional defects
What is the pharmacological treatment for vascular hemangiomas?
What is the most common neoplasm in the pediatric airway? What about the vocal fold?
Hemangiomas are most common in general
Vocal fold = Papillomas
What are the adult derivatives of the 1st aortic arch?
What are the adult derivatives of the 2nd aortic arch?
What are the adult derivatives of the 3rd aortic arch?
"C is the third letter of the alphabet"
What are the adult derivatives of the 4th aortic arch?
Left - aortic arch
right - right subclavian
"4th arch = 4 limbs"
What are the adult derivatives of the 5th aortic arch?
What are the adult derivatives of the 6th aortic arch?
Pulmonary artery and the ductus arteriosus
What are the bony derivatives of the 1st branchial arch? (3)
What are the CNs of the first arch?
V2 and V3
What is treacher collins syndrome?
1st arch neural crest cells fail to migrate, leading to mandibular hypoplasia, and facial abnormalities
What are the bony derivatives of the 2nd branchial arch?
What are the muscular derivatives of the 2nd branchial arch?
What is the CN that innervate the 2nd branchial arch?
CN VII (Smile nerve)
What is the congenital abnormality caused by failure of the 2nd branchial arch to obliterate?
Fistula between the tonsillar area and lateral neck
What cartilaginous structure that comes from the 3rd branchial arch?
Greater horn of the hyoid
What are the muscles derived from the 3rd branchial arch? Which nerve?
-GlossoPharyngeal nerve from CN IX
What are the muscular derivatives of the 4th arch? (3)
-Levator veli palatini
What CN goes with the 4th branchial arch?
What are the muscular derivatives of the 6th arch?
all intrinsic muscle of the larynx, except the cricothyroid
What is the CN that goes with the 6th branchial arch?
What is the classic presentation of a type II branchial cleft cysts?
Young female that has recurrent cysts at the level of the piriform sinus on the left side
True or false: teratomas are often present in utero
What is the most common type of malignancy in the head and neck area?
Most lymphomas of the head and neck appear after what age?
What is the most common neck malignancy under six years of age?
What is the most common type of sarcomas?
A lymph node greater than how many cm in an infant within one year is considered abnormal? What about greater than 1 year?
Greater than 1 cm within one year
Greater than 3 cm older than 1 year