182 N. Bateman
FIGURE 18.3. CT scan showing mulitioculated lymphatic malformation in the parapharyngeal space extending inferiorly on the left side of the neck. There was airway obstruction and the child presented with snoring.
group of lesions (Fig. 18.3). They do not proliferate and do not resolve spontaneously. Treatment is either conservative, surgical (where the functional or cosmetic problem outweighs the implications of surgery), or, in the case of lymphatic malformations sclerotherapy may be considered (Fig. 18.4).
18.2.2.1 Investigations
Investigations for lymphadenopathy are aimed at determining the likelihood of there being any sinister underlying pathology in order to identify those children who should undergo excision biopsy. Lymph nodes in the neck are a very common problem and many children would undergo unnecessary surgery if they were all biopsied.
Ultrasound is a very useful modality to identify numbers and size of nodes. In experienced hands (and this is a very
Chapter 18. Neck Swellings/Lumps: Lateral Neck Lumps 183
FIGURE 18.4. The lesion in Fig. 18.3 at surgical excision.
operator dependant modality) abnormalities in node morphology can indicate sinister pathology.
CXR may indicate mediastinal lymphadenopathy in children with lymphoma.
FBC may be abnormal in patients with hematological malignancy.
Serology may be helpful in establishing a diagnosis and thereby avoiding unnecessary biopsies.
Fine needle aspiration is uncommonly performed in children. It is less acceptable for patients and parents than in adults and FNAC has limited usefulness in the diagnosis of lymphoma.
Excision biopsy is, in general, indicated in those children:
Who have multiple nodes in many areas of the neck, especially those with supraclavicular nodes (which have an increased likelihood of sinister pathology)
Who have a fixed node or one with obvious skin involvement
Who have persistent nodes of greater than 2 cm diameter Who have abnormalities on CXR or FBC
Who have unexplained systemic symptoms (e.g., anorexia, weight loss, night sweats, etc.)
Chapter 19
Neck Swellings/Lumps:
Torticollis
Stephanie Jones
Key Points
››Torticollis, or wryneck, is a congenital or acquired condition of infants and children that causes tilting of the neck to one side secondary to contraction of the neck muscles.
››Congenital torticollis can resolve spontaneously, but rarely resolves spontaneously if infant >1 year old.
››Children with torticollis may have associated bony or intracranial abnormalities.
››Lackoftreatmentmayleadtodeformationalplagiocephaly, cosmetic deformity, or functional impairment.
19.1 Introduction
Torticollis is a condition seen in newborns and children that results in an effective shortening of the sternocleidomastoid muscle (SCM) causing the head and neck to rotate toward the affected side, the chin to rotate opposite. This condition can be congenital or acquired. The incidence can be as high as 1:250 infants in the newborn period for congenital muscular torticollis, most studies show an incidence of 1–2% in the general population. Acquired torticollis has an incidence of
P.P. Godbole et al. (eds.), Guide to Pediatric Urology and |
185 |
Surgery in Clinical Practice, DOI: 10.1007/978-1-84996-366-4_19,
© Springer-Verlag London Limited 2011