68.1 Thyroglossal Cyst

• If USS shows no thyroid gland—refer to paediatric endocrinologist for further assessment

• First described by Sistrunk in 1920

• Recurrence rate 10 to 30%

• Thyroglossal tract is a multiple branching structure—ensuring this is removed means performing a central neck dissection—this may be reserved for recurrent cases

68.2 Branchial Anomalies

68.2.1 Preauricular Sinuses

• 1/100 incidence

• Remove only if symptomatic

• Recurrence of 32% after sinusectomy

• Avoid recurrence by taking wide margin of normal tissue around the sinuses

68.2.2 Branchial Cysts/Sinuses/Fistulas

• Sinogram may be useful to confirm pathway of fistula

• Tonsillectomy probably unnecessary

68.2.3 First Branchial Cleft Anomalies

• Type I—superficial to VII n

• Type II—may lie deep to VII n

68.2.4 Fourth Pouch Sinus

• Opening in piriform fossa

• Causes cervical abscesses

• Endoscopic diathermy to internal opening can be effective

68.3 Vascular Abnormalities

68.3.1 Haemangiomas

• Flat/absent at birth

• Proliferate and then regress

• Involute spontaneously

• Intervention only for functional problems

• Corticosteroids or interferon may be used

• Vincristine may also be used

68.3.2 Vascular Malformations

• Low flow lesions—lymphatic/venous/capillary

• High flow lesions—AV malformations (mostly intracranial)

• Cystic hygromas—excision is first choice when below digastric but injection sclerotherapy also effective

• If tongue involved—laser may be needed

• Sclerotherapy—OK 432/sodium amidotrizoate (Ethibloc)/bleomycin—intracystic injection under US

• Complications: acute inflammatory response, abscess, scarring, surgery following sclerotherapy has higher morbidity

68.4 Acute Inflammatory Problems

• Suppurative LNs—I&D and pack/drain overnight

68.4.1 Lymphadenopathy in Children (Algorithm for Management)

• Be suspicious for neoplasia + consider excision if:

History of malignancy

Node >2 cm

Supraclavicular node (61–89% malignant)

Parents’ demands

• FNA not useful as will be done under GA

• Duration of history not useful predictor of malignancy

• Fever, wt loss, organomegaly, number of nodes, and consistency of nodes useful but published evidence is inadequate as a predictor

• 1st visit

CXR:

– ¾ neoplasia will have abnormal CXR

– If abnormal consider excision