Congenital Cystic Neck Masses

Congenital cystic masses are commonly encountered when imaging a patient presenting with a neck mass. Congenital cysts are present at birth; however, these cysts may not present until later in life with some growing slowly and others rapidly increasing in size due to hemorrhage of infection. A neonatal presentation is rare but when present may allow a narrower differential diagnosis. Imaging plays a significant role in defining a lesion as cystic, assessing location, and directing the next step in evaluation and or intervention.

The ontogeny of Na+ uptake in larval rainbow trout reared in waters of different Na+ content

Teleost fish have a remarkable capacity to maintain ion homeostasis against diffusion gradients in hypo-ionic freshwater. In adult teleosts the gills are the primary site for ion uptake; however, in larvae, the gills are underdeveloped, and as ion-regulation is primarily cutaneous, branchial mechanisms of plasticity are not yet available. In larval rainbow trout, the gills become the primary site for Na⁺ uptake at ~ 15 days post hatch (dph). To address how Na⁺ uptake develops in response to differences in water [Na⁺], the present study characterised the ontogeny of Na⁺ uptake in rainbow trout larvae, at a time when ion regulation transitions from being a primarily cutaneous to a primarily branchial process. Results indicate that initially (0-15 dph), when ion-regulation is cutaneous, low-[Na⁺] reared larvae had a higher Na⁺ affinity (lower K_m) compared to the high-[Na⁺] treatment. In addition, larvae reared in low-[Na⁺] water had a lower internal Na⁺ content, despite similar Na⁺-uptake rates ([Formula: see text]) across treatments. But, once the gills became the dominant site for ion-regulation (> 15 dph), larvae in all treatments maintained the same Na⁺ content, despite large differences in [Formula: see text], indicating plasticity in those mechanisms that control Na⁺ efflux ([Formula: see text]). The mechanisms of Na⁺ uptake in larval rainbow trout showed plasticity during all stages of development. However, in young larvae that relied on cutaneous Na⁺ uptake, the internal Na⁺ content was significantly affected by the [Na⁺] in the water, perhaps revealing challenges to ion homeostasis and a period of heightened vulnerability to external stressors during early larval development.

Bilateral Second Arch Branchial Fistula-A Case Report

Introduction:

Branchial arch anomalies represent defects in embryological developments whereby parts of the branchial arch persist in the head and neck regions as sinuses, fistulas, or cysts. These anomalies usually present as a unilateral lesion in the head and neck of young adults and children, which are excised upon the emergence of complications.

Case Report:

Herein, we presented a rare case of a 4-year-old child, who had been diagnosed with a complete bilateral second arch branchial fistula. The excision was made using the bilateral stepladder approach and tonsillectomy.

Conclusion:

The bilateral stepladder approach was a feasible method in excising a complete bilateral branchial fistula. However, larger-scale studies should be conducted on the surgical techniques of bilateral branchial fistulae excision in order to optimize the cosmetic outcome of the surgery.

Long-term outcome of pre- and perinatal management of congenital head and neck tumors and malformations

INTRODUCTION

Congenital head and neck pathology may cause direct postnatal airway obstruction. Prenatal diagnosis facilitates safe delivery with pre- and perinatal airway assessment and management and Ex-Utero-Intrapartum-Treatment (EXIT) if necessary. Fetoscopic airway evaluation can optimize the selection of patients in need of an EXIT procedure.

METHODS

Description of 11 consecutive fetuses, born with a potential airway obstruction between 1999 and 2011 and treated at the University Hospitals Leuven, with a long-term follow-up until 2018. An algorithm including fetoscopic airway evaluation is presented.

RESULTS

In utero imaging revealed seven teratomas, one fourth branchial pouch cyst, one thymopharyngeal duct remnant, one lymphatic malformation and one laryngeal atresia. A multidisciplinary team could avoid EXIT in eight patients by ultrasonographic (n = 2) or fetoscopic (n = 6) documentation of accessible airways. Three patients needed an EXIT-to-airway-procedure. Neonatal surgery included tracheostomy during EXIT (n = 2) and resection of teratoma (n = 7) or branchiogenic pathology (n = 3). All patients do well at long-term (minimum 54 months) follow-up.

CONCLUSIONS

Combining prenatal imaging and perinatal fetoscopy, EXIT-procedure and neonatal surgery yields an optimal long-term outcome in these complex patients. Fetoscopy can dramatically reduce the number of EXIT-procedures.

Gaskell revisited: new insights into spinal autonomics necessitate a revised motor neuron nomenclature

Several concepts developed in the nineteenth century have formed the basis of much of our neuroanatomical teaching today. Not all of these were based on solid evidence nor have withstood the test of time. Recent evidence on the evolution and development of the autonomic nervous system, combined with molecular insights into the development and diversification of motor neurons, challenges some of the ideas held for over 100 years about the organization of autonomic motor outflow. This review provides an overview of the original ideas and quality of supporting data and contrasts this with a more accurate and in depth insight provided by studies using modern techniques. Several lines of data demonstrate that branchial motor neurons are a distinct motor neuron population within the vertebrate brainstem, from which parasympathetic visceral motor neurons of the brainstem evolved. The lack of an autonomic nervous system in jawless vertebrates implies that spinal visceral motor neurons evolved out of spinal somatic motor neurons. Consistent with the evolutionary origin of brainstem parasympathetic motor neurons out of branchial motor neurons and spinal sympathetic motor neurons out of spinal motor neurons is the recent revision of the organization of the autonomic nervous system into a cranial parasympathetic and a spinal sympathetic division (e.g., there is no sacral parasympathetic division). We propose a new nomenclature that takes all of these new insights into account and avoids the conceptual misunderstandings and incorrect interpretation of limited and technically inferior data inherent in the old nomenclature.

Congenital midline cervical cleft: A retrospective case series of 8 children

OBJECTIVES

Congenital midline cervical cleft is a rare developmental abnormality of the ventral neck of unclear etiology. It consists of a midline skin defect. This study reports a case series of 8 patients with congenital midline cervical cleft.

METHODS

Retrospective review chart including all children referred with congenital midline cervical cleft over 5 years in tertiary center. The study was conducted to determine the presence of associated malformations, to specify the cleft pathology, to analyze the nature of associated cysts, and to discuss surgical procedure.

RESULTS

Eight patients ranged from 3 days to 5 years. Two had an associated cervical midline cyst, 3 had a significant micrognatia. Pathological observations were in favor of a branchial origin. There was no recurrence of cervical contraction after a mean follow-up of 20 months.

CONCLUSION

Congenital midline cervical cleft is a rare and generally isolated congenital malformation. It does not require either extensive assessment or specific genetic. Described associated cysts might be part of the cleft and not bronchogenic or thyroglossal cysts. Early surgical excision reduces cervical contracture, but linear or Z-plasty closure is still debated.

A branchial cyst of the pyriform fossa transoral laser resection: a case report

Pyriform sinus malformations represent rare third and fourth branchial anomalies. Fistulae at the latter site were initially described and make up less than 1 % of all brachial anomalies. They may be discovered incidentally, or may present as a neck mass with recurrent infection, dysphagia, or airway compromise, and can be an unusual cause of dysphonia in infant and children. Here, we present a case of third branchial cyst located in pharyngeal wall of the left pyriform sinus which presented with dysphonia since birth in a 6-year-old girl. Transoral CO2 laser excision was carried out successfully with no communicating tract. The patient's dysphonia showed progressive regression at 1-year follow-up. Third branchial cyst in the left pyriform sinus (Bailey's type IV) is an unusual cause of dysphonia in pediatric. Our present case report is the first brachial cyst to be reported in the pyriform fossa and the second branchial anomalies to be excised transorally with CO2 laser.

Cervical chondrocutaneous branchial remnants--report of 17 cases

BACKGROUND/PURPOSE

Cervical chondrocutaneous branchial remnants are congenital, benign and rare neck masses. These anomalies are limited in the literature, reported mostly as case reports. Cervical chondrocutaneous branchial remnant is always present at birth, and the lesion is usually unilateral. Understanding and treatment of cervical chondrocutaneous branchial remnants requires knowledge of the related embryology.

METHODS

From January 2005 to December 2008, 17 patients with mean age of 32 months (range from 2 months to 15 years) with CCBRs were treated at the Division of Pediatric Surgery, Department of Plastic and Reconstructive Surgery and Burns at the Institute for Mother and Child Health Care, Belgrade, Serbia. The following objections were recorded: sex, lesion side, surgical data, associated malformations and pathohistology findings.

RESULTS

There were 7 females and 10 males, 4 with bilateral presences. Five children had associated anomalies, as follows: vesicoureteral reflux, atrial and ventricular septal defect, ventricular septal defect, branchiootorenal syndrome and preauricular sinus. There was a positive family history in one patient. Fifteen patients (88%) were treated with complete surgical excision and no connections with deep underlying structures of the neck were found. There were no complications at surgery. No recurrence was found during follow-up. Histopathology analysis revealed both, hyaline and elastic cartilage.

CONCLUSION

Cervical chondrocutaneous branchial remnants are rare anomalies arising from branchial arch, probably originally from remnants of first or second arch. Surgical excision is the treatment of choice. From our experience, we suggest surgical treatment early in childhood because of esthetic reason, simplicity of the intervention and low complication rate. Also, the abdominal ultrasound and cardiac examination is recommended because of associated anomalies.

Atlantic salmon (Salmo salar L.) smolts require more than two weeks to recover from acidic water and aluminium exposure

The detrimental effects of acid rain and aluminium (Al) on salmonids have been extensively studied, yet knowledge about the extent and rate of potential recovery after exposures to acid and Al episodes is limited. Atlantic salmon smolts in freshwater (FW) were exposed for 2 and 7-day episodes (ACID2 and ACID7, respectively) to low pH (5.7±0.2) and inorganic aluminium (Ali; 40±4 μg) and then transferred to good water quality, control water (CW; pH 6.8±0.1; <14±2 μg Ali). Al accumulation on gills after 2 and 7 days of acid/Al exposure was 35.3±14.1 and 26.6±1.8 μg g(-1) dry weight, respectively. These elevated levels decreased 2 days post transfer to CW and remained higher than in control (CON; 5-10 μg Ali) for two weeks. Plasma Na(+) levels in ACID2 and ACID7 smolts decreased to 141±0.8 and 138.6±1.4mM, respectively, and remained significantly lower than CON levels for two weeks post transfer to CW. Similarly, plasma Cl(-) levels in ACID7 smolts (124.3±2.8mM) were significantly lower than in CON, with Cl(-) levels remaining significantly lower in ACID7 (126.2±4.8 mM) and ACID2 (127.6±3.7 mM) than in CON following 9 and 14 days post-transfer to CW, respectively. ACID2 and ACID7 smolts sustained elevated plasma glucose levels post transfer to CW suggesting elevated stress for more than a week following exposure. While gill Na(+), K(+)-ATPase (NKA) activity was only slightly affected in ACID2 and not in ACID7 smolts in FW, acid/Al exposure resulted in a transient decrease in NKA activity following SW exposure in both groups. Acid/Al episodes had limited impact on isoform specific NKA α-subunit mRNA during exposure. However, the transfer of ACID2 and ACID7 smolts to CW showed an increase in NKAα1a mRNA (the FW isoform) and inhibited the up-regulation of NKAα1b (the SW isoform), probably resulting in higher abundance of the enzyme favouring ion uptake. Gill caspase 3B gene transcription did not change in acid/Al treated smolts, indicating no increased apoptosis in gills. ACID2 and ACID7 treatments resulted in lower smolt-related gill transcription of the gene encoding the tight junction protein claudin 10e compared to CON, while the gene encoding claudin 30 showed lower mRNA expression only after 11 days SW exposure in ACID7 fish. Our data suggest that acid/Al conditions affect ion perturbations through a combination of alteration of the preparatory increase in paracellular permeability and negative impact on the SW type NKA α-subunit mRNA transcripts, and raise major concerns regarding the recovery of physiological disruption in smolts following acid/Al exposure. Smolts may require more than two weeks to fully recover from even short moderate episodes of acid/Al exposure. Acid/Al exposure thus probably has greater impact on salmon populations than previously acknowledged.

Congenital anomalies presenting as recurrent post-auricular abscesses: an institution based retrospective study

OBJECTIVES

This report is intended to bring out the association of recurrent postauricular abscess in children with various underlying congenital anomalies.

MATERIALS AND METHODS

A retrospective study was done in tertiary care setting from the year August 2005 to February 2012 using the medical record department database to retrieve the patient details. During this study period, a total of 215 children with an age range of 1-14 years were treated at the hospital with postauricular abscess. We analysed the data using appropriate statistical tests for parametric and nonparametric data and setting the p value at 0.05 for significance. For testing the association between the recurrence of abscess and the presence of underlying congenital anomalies, Fischer's t test was used.

RESULTS

A total of 215 patients were studied, of which 41 patients presented with recurrence. 26 of the 41 patients (63.4%) had recurrent postauricular abscess with associated congenital anomalies. Among the 26 patients, in 16 patients (62%), the recurrent abscesses were due to postauricular sinuses. Other less common causes were infected post auricular dermoid cyst, first branchial cysts, collaural fistula and congenital aural atresia. There was a statistically significant association of the recurrence of abscess with presence of underlying congenital anomalies.

CONCLUSION

Paediatric recurrent postauricular abscesses are rare in the post antibiotic era. Their presence should alert a treating physician of an underlying congenital anomaly.

Second branchial cleft cyst causing internal jugular vein thrombosis - A case report

The branchial cleft cyst also known as lateral cervical cyst is usually present in the lateral part of neck deep to sternocleidomastoid muscle at the junction of its upper third and lower two thirds. Branchial cysts are known for repeated infection with sudden increase in size and pain and for its recurrence. Thrombosis of major vessels of neck secondary to recurrent infection and inflammation of branchial cyst is extremely rare. Here we present the first case of internal jugular vein thrombosis; a rare complication seen with branchial cyst in a 54-year-old male. The patient was treated initially with antibiotics followed by excision of cyst and ligation of internal jugular vein without any complication.