பிறப்பொக்கும் எல்லா உயிர்க்கும் சிறப்பொவ்வா செய்தொழில் வேற்றுமை யான்.

1. பிறப்பொக்கும் எல்லா உயிர்க்கும் சிறப்பொவ்வா செய்தொழில் வேற்றுமை யான்.

2. ASI Chennai City Branch Welcomes you all

4. CYSTIC SWELLINGS OF THE NECK Prof.Dr.D.Nagarajan M.S

5. CLASSIFICATION MIDLINE SWELLING: 1.Sublingual dermoid 2.Thyroglossal cyst 3.Subhyoid bursitis LATERAL SWELLINGS; 1.Digastric triangle -plunging ranula 2.Carotid triangle -bronchial cyst POSTERIOR TRIANGLE; 1.Cytic hygroma

6. THYROGLOSSAL CYST • Fibrous cyst that forms from a persistent thyroglossalduct • midline swelling with slight inclination to left • Out pouching from floor of first and second bronchial pouch

7. pseudo stratified columnar epithelium with lymphoid tissue, fluid is formed by un- obliterated duct it contains cholesterol crystals • tubulo-dermoid type • may contain thyroid tissue /only functiong thyroid tissue • age 15-30 yrsof females

8. COMMON SITES • SUBHYOID -MC • THYROID CARTILAGE • SUPRAHYOID • FLOOR OF THE MOUTH • BENEATH TH FORAMEN CAECUM

9. SYMPTOMS: • Painless • Oval in shape • Gradually increased in size • Skin free • Occasionally -Translucent • mobility-sideways • Moves on protrusion of tongue • Fluctuant • Lymph node enlarged if infected • Examine the base of the tongue

10. COMPLICATIONS: • Recurrent infection • fistula formation • Malignancy • Cosmetic • In advent surgery INVESTIGATIONS: • USG thyroid/MRI • FNAC • Uptake studies

11. DIFFERENTIAL DIAGNOSIS • Subhyoidbursal cyst • Sublingual dermoid • Enlarged cervical node • Ectopic thyroid • Solitary nodule from isthmus

12. TREATMENT: Excision-track with body of hyoid bone Sistrunk’soperation

13. SUBLINGUAL DERMOID • Sequestration dermoid • Entrapped ectoderm level of first or mandibular arch • Above or below mylohyoid • Lined by squamous epithelium/ • Contain -sweat glands/sebaceous glands • Cheesy materials • It never contains hair

14. SUBLINGUAL DERMOID • Occurs at 10-15 years • Male= female • Position :supra omohyoid or sublingual variety • Under the tongue or beneath the chin • Mucosa free/ fluctuation positive • non -Transillumination • Intra omohyoid or cervical variety • bimanual palpation

15. Sublingual drmoid cyst • Investigation - USG /MRI/FNAC • Treatment- excision under GA(intra/extra oral)

16. BRONCHIAL CYST • congenital cyst persistence of second bronchial cleft ectoderm • At the upper part of sternocleidomastoid • Posteromedial part in the deeper plane • Oval in shape • Smooth surface /soft • Well-defined • Fluctuation positive • Trans illumination negative

17. BRONCHIAL CYST not reducible/compressible Cholesterol crystals on aspirated fluid

18. BRONCHIAL CYST COMPLICATIONS: Cosmetic Infection fistula formation DIAGNOSIS: FNAC MRI/FISTULAGRAM TREATMENT: Excision

19. Course BRANCHIALCYST • Subcutaneous at the level of upper border thyroid cartilage • Pass through bifurcation of common carotid artery • Superficial to internal carotid,deep to ext.carotid • Deep to the post.belly of digastric and stylohyoid muscle • Superficial to IJV,hypoglossal,glossopharyngeal nerves • Pierces the sup.constrictor ,open behind post.pillar of the tonsil.

21. Rx:Excision( STEP - LADDER OPERATION ) • The Neck of the cyst passes between the int and ext carotid art. • Can Recur.

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23. Ranula • Cystic swelling floor of mouth • Mucous extravasation from sublingual salivary gland • Plunging Ranula, extend through FOM muscles into neck

24. The name is derived form the word rana, because the swelling may resemble the translucent underbelly of the frog.

25. Plunging ranula • Penetrates Mylohyoid muscle to enter neck • Soft painless fluctuant dumb-bell shaped swelling • Bi digital palpation

26. Plunging ranula • Rare form of retention cyst • May arise from SM/SL SG • Mucous collects around gland • Surgical excision via neck

27. CYSTIC HYGROMA • Arises from jugular lymph sac 6th to 14th week • sequestration of lymphatic sac • Multiloculated • Lined by endothelium • Posterior triangle of neck • Ascends to ear lobule or descends to axilla • Early infancy or at birth presentation • Lump in the lower third of posterior triangle

28. CYSTIC HYGROMA • Increases in size • smooth • Indistinct margin • Smooth or lobulated • Cystic consistency • Impulse on coughing • Can be compressible • Translucent brilliantly

29. CYSTIC HYGROMA COMPLICATIONS: Cosmetic Respiratory difficulty Infection following incomplete removal Recurrence INVESTIGATIONS: MRI TREATMENT: Sclerotherapy Hot water injection Subsequent RT for recurrence

30. Subhyoidbursal cyst • Enlargement subhyoid bursa with accumulation fluid • Below the hyoid bone/front of the thyrohyoid membrane • Swelling with pain • Oval with long axis(cf.thyroglossal cyst) • Mid line /move with deglutition • Cystic/fluctuation +/non-transillumation /turbid

31. Subhyoidbursal cyst • Investigation MRI/FNAC • TREATMENT Complete excision-transverse incision

32. THANKS TO MY TEACHERS • PROF.DR.S.NARENDRAN M.S Ph.D TANJAVUR MEDICAL COLLEGE • PROF.DR.A.SUKUMAR M.S Rtd. Director of Medical and Rural services • PROF.DR.C.M.K REDDY FRCS Rtd. Prof.Stanley Medical College • PROF.DR.T.MOHANA PRIYA M.S Sri Ramachandra Medical College and R.I

33. The wood is lovely dark and deep • But I have promises to keep • Miles to go before I sleep • Miles to go before I sleep

34. thankyou