Noncancer Surgery of the Neck

Noncancer Surgery of the Neck

Mark R. Rowe Alfred A. Simental Jr.

♦ Common Noncancerous Masses in the Neck

Midline neck masses
- Thyroglossal duct cysts
- Dermoid cysts
- Lymphangiomas (cystic hygromas)
Lateral neck masses
- Lymph nodes
- Lipomas
- Branchial cleft anomalies

♦ Timing of Surgery

When possible, delay surgery on infants (<6 months) and toddlers because minimal blood loss represents a substantial volume in the small child.
Avoid resecting infected masses. A 6-week “cooling off” period is usually recommended.

♦ Potential Pitfalls

Position the patient so maximum surgical field visualization will be attained.

Use nerve monitoring whenever possible.

Although small incisions are desirable, adequate visualization of the operative field is key.
Drain operative fields regardless of admission requirement.
Anticipate airway impingement or subsequent swelling in large upper neck lesions.

♦ Thyroglossal Duct Cysts

Indications for Surgical Removal

Recurrent infections
Compressive symptoms
Cosmetic appearance
Coexistent malignancy

Surgical Technique

Surgery is performed under general anesthesia. Avoid muscle paralysis to allow for nerve monitoring and stimulation.

A small shoulder roll is placed to slightly extend the neck.

Prep from the lower face to the clavicles to allow access to the oral cavity.

The incision is injected with lidocaine 1% with epinephrine 1:100,000. Avoid injecting into the cyst or mass.

Make the incision in a line of relaxed skin tension. Excise an ellipse of skin for any dimple or sinus tract.

Superior and inferior subplatysmal skin flaps are elevated above the hyoid and to the thyroid cartilage. Retract strap muscles laterally. Cysts that have been infected or previously operated on may require sacrifice of adherent strap muscles.

The hypoglossal nerve will usually course just lateral and superior to the greater horn of the hyoid bone.

During superomedial dissection, avoid transection of the thyroglossal duct tract.

The cyst and the central portion of the strap muscles should be followed up to the hyoid bone. A clamp can then be used to grasp the hyoid.

Always visualize the thyroid cartilage notch to avoid accidental trauma to the laryngeal framework if the thyroid cartilage were mistaken for the hyoid bone. This problem is more likely to occur in younger children where the thyroid cartilage is small, located in a high position, and very close to the hyoid.

Using Mayo scissors or a bone rongeur, the hyoid bone is cut just medial to the lesser horn. This allows the attachment of the stylohyoid and digastric muscle to remain, stabilizing the remaining hyoid and also avoiding injury to the hypoglossal nerve.

If a sinus tract exists, it must be followed into the base of the tongue. Palpate the base of the tongue and avoid inadvertent entry into the aerodigestive tract. Apply gentle traction to prevent avulsion of the cyst and stalk as they are traced to the base of the tongue.

If the cyst is inadvertently breached, the contents can be gently suctioned, followed by the use of a lacrimal probe placed into the cyst and used to trace the stalk.

The course of the tract may take an inferior route prior to superior ascent and should be followed closely to be sure it is not transected prematurely.
The specimen should contain the cyst, the midportion of the hyoid, a portion of the base of the tongue, and occasionally a portion of the midline strap muscles.
The wound is irrigated and closed in layers with resorbable sutures. Absorbable cutaneous sutures are very useful in children.
Drainage is provided by a suction drain or a small Penrose drain/rubber band and is removed on the first postoperative day.
Thyroglossal duct cysts may contain the only functioning thyroid tissue. If the thyroglossal duct cyst is removed with thyroid tissue, postoperative thyroid-stimulating hormone (TSH) levels should be checked 6 weeks after surgery.

♦ Cervical Dermoid Cyst

Surgical Indications/Considerations

Cosmetic appearance
Concern for pathologic diagnosis on part of patient/family
Recurrent infection
Compressive complaints
These cysts may mimic thyroglossal duct cyst in relation to appearance and position
May also present in neck and yet extend into or near oral cavity

Surgical Technique

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Tags: Otolaryngology a surgerial notebook

Jun 14, 2016 | Posted by admin in OTOLARYNGOLOGY | Comments Off

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Fastest Otolaryngology & Ophthalmology Insight Engine

Noncancer Surgery of the Neck

Noncancer Surgery of the Neck

Mark R. Rowe Alfred A. Simental Jr.

♦ Common Noncancerous Masses in the Neck

♦ Timing of Surgery

♦ Potential Pitfalls

♦ Thyroglossal Duct Cysts

Indications for Surgical Removal

Surgical Technique

♦ Cervical Dermoid Cyst

Surgical Indications/Considerations

Surgical Technique

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Noncancer Surgery of the Neck

Noncancer Surgery of the NeckMark R. Rowe Alfred A. Simental Jr.

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Noncancer Surgery of the Neck

Mark R. Rowe Alfred A. Simental Jr.