Congenital Lateral Neck Swelling

Congenital Lateral neck
swellings and their

embryological basis
Learning Objectives
By the end of session the student
will be able to discuss the
embryological basis of congenital
neck swellings.
 Acquired (lymph node
enlargement etc)
 Congenital( cyst, sinus,
fistula)
Patient with lateral neck

swelling
Congenital Lateral Neck Swelling
(Along the Anterior Border of SCM)
Congenital lateral neck swelling
(Along the Anterior border of SCM)
PRESENTING COMPLAIN
Age: Usually appear at late childhood and early
adulthood
Progressively enlarging swelling
Painless, fluctuant
Does not move on deglutition.
No associated fever, weight loss, skin changes
Swelling may present with a discharge.

Clinical presentation
Swelling …………….Cyst,
Discharge from swelling…………..Sinus
The tract of the discharging swelling can be
found opening inside…………. Fistula

All three presentations can be Unilateral or
Bilateral
Embryonic basis of
congenital neck swellings
The basic tissues of development within the
head and neck (ectoderm, endoderm,
mesoderm, neuroepithelium) become
organized into the pharyngeal apparatus,
also known as the branchial apparatus,
which is the forerunner of the head and neck
structures.
Pharyngeal/Branchial Arches
Branchial” derives
from the Latin
“branchia,”
meaning gills..
Human embryo
resembles fish at
this stage.
During the fourth week
of embryonic
development, a series of
5 bar-like ridges appear
on the ventrolateral
surface of the head and
neck region.
 The branchial arches in
humans are numbered 1
through 6.
 Branchial arch 5 involutes
during development and does
not contribute to the
formation of adult structures.
 1 and 2 are referred to as the
mandibular and hyoid arches,
respectively.
Pharyngeal Arch
Components
The development of the
branchial arches relies on
contributions from
endoderm, mesoderm,
ectoderm, and neural crest
cells (NCC), which
facilitate the development
of individual structures.
 PHARYNGEAL ARCHES
 GROOVES
 MEMBRANES
 POUCHES
Pharyngeal Apparatus
Embryologic precursors of the
ear and the muscles, blood vessels,
bones, cartilage, and mucosal lining
of the face, neck, and pharynx.
Pharyngeal Apparatus
 First branchial arch:
 Cleft: external auditory canal

 Arch: mandible, incus, malleus, muscles of
mastication, cranial nerves (CN V2 and V3

 Pouch: Eustachian tube, Mastoid air cells
 Nerve: Maxillary nerve and Mandibular
branches of the trigeminal nerve (CN V2 &

V3)
 Second branchial arch:
 Cleft: cervical sinus

 Arch: stapes, the body of the hyoid,
lesser horn of hyoid, muscles of facial

expression, and CNVII
 Pouch: palatine tonsil
 Nerve: facial nerve (CN VII)

Third Branchial Arch:
Cleft: cervical sinus
Arch: the body of the hyoid, greater horn
of hyoid, superior constrictor muscles,

internal carotid arteries, CNIX
Pouch: thymus, piriform recess, inferior
parathyroid glands
Nerve: Glossopharyngeal nerve (CN IX)
Fourth branchial arch:
Cleft: cervical sinus

Arch: thyroid/cuneiform cartilages, CN X,
aortic arch, right subclavian artery, various

laryngeal muscles
Pouch: apex of piriform sinus, superior
parathyroid glands
Nerve: vagus nerve (CN X), superior
laryngeal nerve
Fifth and Sixth branchial arches:
Cleft: None
Arch: Inferior pharyngeal constrictors,
CN XI, various laryngeal muscles

Pouch: parafollicular C cells of the
thyroid
Nerve: vagus nerve (CN X), recurrent
laryngeal nerve
Ist groove forms the adult derivate. Rest
of the grooves are obliterated to form the
smooth contour of the neck
Cervical sinus
The second arch grows
faster, so it overhangs
the 3rd and 4th arch.
It fuses to the skin
caudal to these arches,
the cervical sinus is
formed. Eventually, the
edges of cervical sinus
fuse and the ectoderm
within the tube
disappears
Congenital Neck Swelling on lateral
side
Persistence of branchial
cleft or pouch results in a
cervical anomaly located
along the anterior border
of the sternocleidomastoid
muscle from the tragus of
the ear to the clavicle
 The range of anomalies can
include:
 cyst: No internal or external
communication
 fistula: Communicates both
internally and externally

 sinus: Incomplete tract
Congenital neck swellings lie
along SCM.
Remnant of each cleft has its
peculiar location
corresponding to its
embryonic location
Position of Fistulas of the corresponding
arches
SITE: pre auricular,
angle of mandible,
above hyoid
First branchial arch anomalies

5% of branchial anomalies
Type I (recurrent
otorrhea)
Pre-auricular mass or
sinus
Ectoderm only
Sinus tract Lateral to
CNVII, Parallels
EAC ,Ends in EAC or
middle ear
Type II
More common than
Type I
Ectoderm and
Mesodermal elements
Presents at the angle of
mandible or
submandibular region
Lateral or medial to CN
VII - Ends in concha or
bony-cartilaginous
junction of EAC.
2 branchial arch anomaly
nd
Most common branchial

cyst anomaly (90%)
Typically present as a
rounded swelling just
below the angle of
mandible anterior to
the sternocleidomastoid
Second branchial arch fistula
Unilateral Fistulae
most common on the right
(89%)
Bilateral anomalies associated
Branchio-oto-renal syndrome
Open into tonsillar sinus or palatopharyngeal arch.
Second pharyngeal arch
sinus
There is profuse discharge
Tract of 2nd cleft sinus or
fistula
Anterior neck - Along carotid
sheath Between external and
internal carotid arteries –
superficial to CN IX and XII
–
Penetrates the middle
pharyngeal constrictor and
opens into tonsillar fossa
A complete fistula is a tract that
has an internal opening and an
external OPENING.
Communication between
the persistent parts of 2nd
pharyngeal groove&pouch
2nd Branchial fistula opens

internally into tonsillar sinus
and externally in the side of
neck in front of SCM
tissue,platysma, carotid
sheath & finally b/w interna
l& ext carotid a
sinus of the second
branchial arch
 Internal sinus opens
into tonsillar fossa. It
results from persistence
of proximal part of
second pharyngeal
pouch.
 External is due to
persistence of cervical
sinus opening on the
surface
3rd branchial cleft
 2-8% of Branchial Cleft malformation DUE
TO PERSISTENC OF REMNANATS OF 3rd
and 4th cleft.
Most third branchial cleft cysts tend to lie in
the posterior cervical space, posterior to
the sternocleidomastoid muscle
Lateral neck (mid-lower 1/3 SCM) -
Deep to carotids - Deep CN IX, superficial
to CN XII, Superficial to superior laryngeal
nerve -> Pierces thyrohyoid membrane -
Opens into apex of pyriform sinus(laryngeal
opening)
 The mesoderm that contributes to the formation of ligaments and
bones sometimes remains on the side of neck usually anterior to
inferior one third of SCM under the skin.
Branchial vestiges

Congenital Lateral Neck Swelling

Uploaded by

Copyright:

Available Formats

Congenital Lateral Neck Swelling

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Congenital Lateral Neck Swelling

Uploaded by

Copyright:

Available Formats

Congenital Lateral neck

swellings and their

Patient with lateral neck

Does not move on deglutition.

No associated fever, weight loss, skin changes

Swelling may present with a discharge.

Discharge from swelling…………..Sinus

The tract of the discharging swelling can be

found opening inside…………. Fistula

 Cleft: external auditory canal

mastication, cranial nerves (CN V2 and V3

 Nerve: Maxillary nerve and Mandibular

branches of the trigeminal nerve (CN V2 &

 Cleft: cervical sinus

lesser horn of hyoid, muscles of facial

 Nerve: facial nerve (CN VII)

Arch: the body of the hyoid, greater horn

of hyoid, superior constrictor muscles,

Cleft: cervical sinus

aortic arch, right subclavian artery, various

CN XI, various laryngeal muscles

internally and externally

First branchial arch anomalies

Most common branchial

2nd Branchial fistula opens

You might also like