midline lump's discrete fortune
TRANSCRIPT
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THE EMBRYOLOGICAL REMNANTS
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PERSISTANT REMNANTS OF BRANCHIAL APPARATUS & THYROGLOSSAL DUCT
• First branchial arch fistula – cervico aural
• Second branchial arch fistula• Third and fourth branchial
arch abnormalities• Disorders of thyroglossal duct
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DESTINATION•A MIDLINE LUMP’S EN-ROUTE
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A MIDLINE LUMP’S DISCRETE FORTUNEDR. AJAY MANICKAMJUNIOR RESIDENTDEPARTMENT OF OTOLARYNGOLOGY RG KAR MEDICAL COLLEGE
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CASE HISTORYWith C/O Swelling in the front of neck for the past
14 yrs Foreign body sensation in throat for the
past 1 month
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NO HISTORY
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Examination in opd•The mass in the neck
was around 5 x 4 cm•It was mobile, non
tender, insidious in onset and gradually progressive
•Moves with deglutition•Moves with protrusion
of tongue
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EXAMINATION OF ORAL CAVITY
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INDIRECT LARYNGOSCOPY EXAMINATION
• Mass in the supraglottis, extending to vallecula, glottic chink was narrow, bilateral arytenoids, AE folds, Vocal folds were mobile
• NO PALPABLE NECK NODES
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DIAGNOSTIC DILEMMA•1. Laryngeal carcinoma •2. Sebaceous cyst•3. Dermoid cyst•4. Lipoma•5. Branchial Cleft cyst•6. Metastatic Lymphnode•7. Ectopic thyroid
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CLINCAL EXAMINATION•CLASSICAL APPEARANNCE•MOVEMENT•POSITION•HISTORY NEARLY 14 YEARS
•AGE•H/O SMOKING, ALCOHOLISM
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PLAN•ADMISSION•INVESTIGATION
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INVESTIGATIONS•ULTRA SONOGRPHY OF NECK
Solid SOL with echogenic matter, measuring 4x3cm, anterior and superior to the thyroid gland
•FNACThyroglossal cyst
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CT SCAN OF NECK• Heterogeneously enhancing necrotic,mass lesion with
• Superior extent to the left supraglottic region upto valeculla
• Lateral extension into left paraglotticSpace
• Anteriorly it extended within the subcutaneous tissue with erosion of left thyroid lamina
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MANAGEMENT
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MANAGEMENT
•Sistrunk operation
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TRACHEOSTOMY
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Post operative management
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DAY 0 –DAY 7
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HISTOPATHOLOGICAL REPORT
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THYROGLOSSAL CYST
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DISCUSSION
1. INFRA HYOID2. SUPRA HYOID3. INTRA LINGUAL4. SUPRA STERNAL
Laryngeal extension
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THYROGLOSSAL CYSTENROUTE LARYNX
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•Clinical examination •Radiological guidance in
cases with diagnostic dilemma
•Intra laryngeal extension though rare to be kept in mind
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THANK YOU