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Pediatric Surgery (Pg 68-81) - page 13 / 33





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Open biopsy indicated if nodes larger than 2cm and persist for >6wks, or sooner if malignancy is suspected.

Cystic Hygromas (lymphangiomas)

Congenital malformations of the lymphatic vessels characterized by multi-loculated cysts filled with lymph

May occur anywhere,  most common in the posterior triangle of the neck followed by the axilla

Maybe be present at birth, but almost always presents by age 2.

They are usually a soft, compressible mass with ill defined borders.  They may become infected; rarely regress.

Resection is indicated, although there are recent reports of eradication of complex hygromas by injection of sclerosing agents.  

Branchial cleft cysts and sinuses:

Various brachial clefts and arches that do not completely resorb.

In childhood, sinuses are small cutaneous openings that often drain clear fluid.

In older children, cysts are usually noted as subcutaneous masses.  

Remnants of the second branchial cleft are the most common and are located along the anterior border of the SCM.

Remnants of the first branchial cleft are found near the ear or the angle of the mandible.  

Resection is indicated.

Neonatal Torticollis (aka Wry Neck)

Caused by fibrosis and shortening of the SCM.  

Traumatic etiology is hypothesized, with hematoma formation and organization within the muscle.  

The infant has a firm neck mass.  The face is rotated away from the affected side and the head is tilted toward the ipsilateral shoulder.

U/S confirms that the mass is within the muscle.  

Passive rotation exercises by the parents are usually curative.  

Surgical division of the SCM is reserved for rare treatment failures.  

Untreated, torticollis may lead to permanent facial asymmetry.

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