Chapter 17. Neck Swellings/Lumps: Midline Neck Swellings 175
17.3 Treatment
17.3.1 Thryoglossal Duct Cyst
The treatment is surgical, with excision of the cyst and any associated tract, including the mid-third of the hyoid bone. The classical operation, known as Sistrunk’s procedure, where the cyst and tract are identified and followed to the tongue base is, in many people hands, being superceded by a midline block dissection of neck tissues up to the foramen cecum. The rationale behind this is that the thyroglossal duct is a complex branching structure and this technique is less likely to leave portions of duct remaining which carry the risk of recurrence.
17.3.2 Midline Dermoid Cyst
Simple excision is curative.
17.3.3 Lymph Nodes
These can be managed as any other lymph node in the neck (see Chap. 18).
17.3.4 Plunging Ranula
These me be excised although often marsupialization of the cyst intra-orally with excision of the sublingual glands is sufficient. Excision carries a risk of damage to structures in the floor of mouth including the hypoglossal nerves.
Chapter 18
Neck Swellings/Lumps:
Lateral Neck Lumps
Neil Bateman
Key Points
››Lymphadenopathy in children is the commonest cause of laterally placed neck lumps.
››The majority of children with a lymph node in the neck have self limiting viral induced reactive lymphadenopathy.
››Referral and/or biopsy is indicated where there is persistent adenopathy greater than 2 cm in diameter, systemic symptoms, nodes in multiple sites or where the lump has a sinister clinical appearance.
››Cancer is the second commonest cause of death in children. Where there is any doubt about the cause of a neck lump then biopsy should be urgently considered.
››Hemangiomata are an entirely distinct clinical entity from vascular malformations and require different treatment strategies.
18.1 Introduction
The majority of laterally placed neck lumps in children originate in lymph nosed. Cervical lymphadenopathy is very common in children and in the vast majority of children will be
P.P. Godbole et al. (eds.), Guide to Pediatric Urology and |
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Surgery in Clinical Practice, DOI: 10.1007/978-1-84996-366-4_18,
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