CONGENITAL

MASSES &
MALFORMATIONS

Cummings Otolaryngology 6th ed

RULE IN IF:

 gradual dyspnea, dysphagia and stridor

 recurrent respiratory obstruction
 visible and palpable neck mass
 TYPES OF CONGENITAL MASSES AND
MALFORMATIONS
 BRANCHIAL CLEFT CYST
 nontender, fluctuant masses that may
become inflamed and form an abscess
during an upper respiratory infection
 Ultrasound : fluid filled cyst
 THYROGLOSSAL DUCT CYST
 Asymptomatic midline mass that elevates
with swallowing or tongue protrusion
 Thyroid ultrasound and radionucleotide
scanning to differentiate it from ectopic
thyroid (with hypothyroidism)
 TYPES OF CONGENITAL MASSES AND
MALFORMATIONS
 LYMPHANGIOMAS
 failure of lymph spaces to connect to the
rest of the lymphatic system
 soft, smooth, nontender mass that is
compressible and that can be
transilluminated
 Radiography shows fluid-flled spaces with
surrounding connective tissue.
 Infiltrative, needs complete surgical
excision
 HEMANGIOMAS
 proliferative endothelial lesions rather than
true neoplasms
 slowly involute at 18 to 24 months
 red or bluish soft masses that frequently have
a cutaneous component
 CT or MRI with contrast often confirms the
diagnosis of a vascular lesion
 airway obstruction at subglottic larynx
 Observation unless develop complication
treat with systemic corticosteroids and
surgical excision
 TYPES OF CONGENITAL MASSES AND
MALFORMATIONS
 TERATOMAS
 arise from pluripotent cells and consist of
tissues foreign to the site from which they
arise
 firm neck masses
 Tracheal compression may be present
 Intrinsic calcifications seen on CT or MRI
 Surgical excision
 DERMOID CYST
 arise from epithelium that has been
entrapped in tissue during embryogenesis
or by traumatic implantation
 consist of epithelium-lined cavities filled
with skin appendages such as hair, hair
follicles, and sebaceous glands
 painless unless infected
 TYPES OF CONGENITAL MASSES AND
MALFORMATIONS
 LARYNGOCELES
 abnormal dilation or herniation of the
saccule of the larynx
 @ thyroid cartilage – internal; @ beyond
thyroid cartilage – external
 Hoarseness, cough, dyspnea, and dysphagia
suggest a laryngocele
 THYMIC CYST
 Almost all are unilateral, most commonly
on the left side of the neck, and 90% are
cystic
 asymptomatic mass, but it may be painful if
infected, or if the size increase is rapid
 TYPES OF CONGENITAL MASSES AND
MALFORMATIONS
 VASCULAR MALFORMATIONS
 Slow-flow lesions include capillary
malformations and venous malformations,
arterial and arteriovenous malformations
are typically fast-flow lesions
 grow at the same rate as the child and do
not involute
 Jugular malformations present as soft,
compressible masses along the anterior
border of the sternocleidomastoid muscle.
 STERNOCLEIDOMASTOID TUMOR
IN INFANCY
 Congenital torticollis
 firm, painless, discrete, fusiform mass within
the sternocleidomastoid muscle
 usually not apparent at birth but appear at
1 to 8 weeks of age
 Slowly increase in size for 2 to 3 months
and then slowly regress for 4 to 8 months
• RULE OUT since the case is
• a single incident of foreign body aspiration with atis seed
• sudden onset of dyspnea and cyanosis,
• relieved by back tapping
• NO visible and palpable neck mass
• Chest Xray shows that the obstruction is at the lower part of
respiratory tract (Bronchus)