Neck Swellings - المنصورة

• The neck is composed of compartments, triangles, tubes (trachea), vessels, and lymph nodes
• Anatomical knowledge is essential for clinical and surgical practice of the neck

Triangles of the neck

• The sternomastoid muscle divides the neck into anterior and posterior triangles
• The digastric muscle and superior belly of the omohyoid muscle divide the anterior triangle into submental, digastric, carotid, and muscular regions

DD of Neck Swellings

• General swellings can affect the skin, subcutaneous tissue (SC), vessels, nerves, lymphatics, and muscles
• Examples include sebaceous cysts, lipomas, hemangiomas, neurofibromas, lymphangiomas, and tumors

DD of Midline Neck Swellings

• Submental abscess
• Ludwig's angina
• Plunging ranula
• Sequestration dermoid cyst: can be submental or suprasternal
• Enlarged lymph nodes: can be submental, prelaryngeal, or pretracheal
• Swelling in the suprasternal (Burns's) space can be cystic or solid
  • Cystic: dermoid cyst (diagnosed by aspiration) or aortic arch aneurysm (characterized by expansile pulsation)
  • Solid: lipoma or lymph nodes

DD of Lateral Neck Swellings

• Submandibular Triangle: salivary gland enlargement, lymph node enlargement, Plunging ranula, Jaw tumors
• Posterior Triangle: lymph node enlargement (commonest), cystic hygroma, prominent cervical ribs, Subclavian aneurysm, Pharyngeal diverticulum, Pneumatocele.
• Carotid & Muscular Triangle: lymph node enlargement (commonest), thyroid lobe enlargement (next commonest), branchial cyst, branchiogenic carcinoma, aneurysm of the carotid vessels, carotid body tumor, swellings of SCM muscle, laryngocele

Rule of 7 in the Neck

• Based on the average duration of the patient's symptoms, the most probable cause can be determined:
  • 7 days: inflammation
  • 7 months: neoplasm
  • 7 years: congenital defect

Rule of 80 in the Neck

• 80% of nonthyroid neck masses are neoplastic
• 80% of neoplastic neck masses occur in males
• 80% of neoplastic neck masses are malignant
• 80% of malignant neck masses are metastatic
• 80% of metastatic neck masses originate above the clavicle

Fistulae & Sinus of Neck

• Thyroglossal fistula:
  • Site: middle line
  • Opening: crescent shaped
  • Track: can be traced
• Tuberculous sinus:
  • Number & Site: multiple over T.B. adenitis
  • Edge: undermined
  • Margin: cyanotic
  • Discharge: thin serous discharge
• Sinus of hyoid bursitis:
  • Site: at the hyoid level
  • Shape: oval
  • Discharge: pus
• Cervicofacial actinomycosis:
  • Number: multiple
  • Discharge: yellowish sulfur granules (colonies)
• Branchial fistula
• Osteomyelitis of mandible
• Salivary fistula

Number of Swellings

• Single swellings can be located in the anterior or posterior triangle
• Anterior triangle swellings may move with swallowing or not
• Multiple swellings typically indicate lymph nodes

Thyroglossal Cyst

• A midline tubulodermoid cyst due to patency of the thyroglossal duct
• Located just below the hyoid bone (commonest site) in the midline
• Except at the level of the thyroid cartilage, where it's pushed to the left
• Contains clear viscid or mucoid fluid; wall may contain thyroid tissue
• Has a narrow fibrous band extending to the hyoid bone

Complications of Thyroglossal Cyst:

• Recurrent infection
• Thyroglossal fistula
• Malignancy (1%), most commonly papillary carcinoma, rarely squamous cell carcinoma, never medullary carcinoma

Clinical Picture of Thyroglossal Cyst:

• Single, midline, rounded or oval, smooth, well-defined, cystic
• Moves up and down with swallowing (deglutition) and protrusion of the tongue
• Does not move from side to side
• Nontender unless complicated
• Track may be palpable

Special Tests:

• Hold track between 2 fingers
• Ask the patient to protrude his tongue → Special tugging sensation

Thyroglossal Fistula

• Always acquired after rupture or incision of a thyroglossal abscess, or incomplete excision
• The track is lined by columnar epithelium connecting the external opening to the hyoid bone
• Connected to wall of cyst or remnant, near the midline

External opening

• Crescentric & convexity directed upwards
• Discharges viscid fluid or pus

History

• Of abscess followed by a small opening, which discharge viscid fluid or pus

Movements

• External opening moves up with deglutition and protrusion of the tongue

Signs

• Hood sign: opening of fistula is overlaid by a fold of skin
• Semilunar sign: has crescentic appearance

Treatment

• Sistrunk Operation

Cystic Hygroma (Hydrocele of the Neck) (Cavernous Lymphangioma)

• Sequestration of a portion of jugular lymph sac

Site

• Posterior triangle of the neck (75%) commonest
• Axilla (20%)
• Cheek, tongue, groin, mediastinum
• Can extend across two or more lymphatic regions

Structure

• Multilocular containing aggregation of cysts
• Does not communicate with lymphatics
• Filled with clear mucous from endothelium
• Fluid does not coagulate

Clinical Features

• Present at birth
• Occasionally present in early infancy
• Smooth, soft & cystic (fluctuant), and increases during crying
• Brilliantly transilluminant, partially compressible but not reducible

Complications

• Disfigurement of face, rapidly increases in size, causing respiratory obstruction
• May lead to infection and abscess formation
• Septicemia (life threatening)
• Rupture can occur (chylous fistula – chylothorax)
• Recurrence of cyst (15%)

Treatment

• Preoperative MRI
• Aspiration of the contents
• Preoperative injection of sclerosants
• Excision of entire aggregation of cysts is indicated when fibrosis develops
• Meticulous dissection across all planes including deeper muscular layers is vital to clear the cyst wall and prevent recurrence; under antibiotics if abscess is present; aspiration and tracheostomy are done if respiratory obstruction is present

Branchial Cyst

• Arises from 2nd branchial cleft remnants, rarely 1st, 3rd, 4th

Site

• Anterior border of upper 1/3 of SCM muscle

Age

• Congenital, but seen in adolescents & early 3rd decade

Sex

• Equal in both sexes

Side

• Often unilateral, bilateral in 3% (can be familial)

Pain

• Usually painless unless infected

Surface

• Smooth

Consistency

• Soft/tensely cystic, fluctuant

Special

• Often transilluminant; not compressible or reducible

Pathology

• Contains cholesterol crystals; cheesy toothpaste like material

Histologically

• Lined with squamous epithelium, may contain ciliated columnar epithelium
• Cyst wall shows plenty of lymphoid tissue

Complications

• Recurrent infection
• Rupture may cause acquired branchial fistula
• Branchiogenic carcinoma is rare

Investigations

• CT scan and aspiration to differentiate it from chemodectoma or cold abscess
• If it feels solid, do CT

Treatment

• Excision under general anesthesia is needed as cyst is near carotids, 12th, 9th, 11th nerves and posterior belly of digastric so careful dissection required
• Complications of surgery include injury to major structures, infection, and recurrence from incomplete removal of track

Branchial Fistula

Etiology

Congenital

• Failure of fusion between 2nd & 5th branchial arches

Acquired

• Infection of branchial cyst
• Incomplete excision of branchial cyst

External Opening

Congenital

• Lies on lower 1/3 of SCM

Acquired

• Lies on upper part of anterior border of sternomastoid

Internal Opening

• High in lateral wall of pharynx behind tonsil (Supratonsillar fossa of Rosenmuller)
• Usually blindly (sinus) or rarely opening into it (fistula)

Tract

• Passes () bifurcation of carotid and lined by ciliated columnar epithelium; surrounded by lymphoid tissue

Discharge

• Mucus or pus if infected

Type of Patients

Congenital

• Usually present at birth in children and early adolescent period

Acquired

• Appears in adulthood on top of pre-existing cyst

Symptoms & Signs

• Small opening discharging mucoid fluid rich in cholesterol, or pus; a fibrous track may connect to the pharynx

Investigations

• Discharge study, fistulogram, MR/CT fistulogram

Treatment

• 2-3 transverse incision (Step-Ladder incision)
• Through a transverse elliptical incision around the external opening, and Higher skin incision is added to facilitate & complete dissection

Pharyngeal (Zenker's) Diverticulum

• Failure of relaxation of the cricopharyngeal muscle during swallowing leads to increased intraluminal pressure and herniation of pharyngeal mucosa

Site

• Develops as midline mucosal herniation on the posterior aspect of pharyngo-esophageal junction through Killian dehiscence
• As posterior extension is limited by the spine, it lies to the side (usually left) or behind the esophagus

Structure

• Composed of only Mucosa – Submucosa - Incomplete muscular coat

Complications

• Bleeding is rare; can also cause aspiration leading to Pneumonitis - Lung abscess - Pulmonary collapse and lastly, perforation
• Predisposes to carcinoma (0.3%)

Signs

• Regurgitated material is non-acid
• The pouch is globular at first then becomes pear shaped

Gurgling Sound

• On palpation of left side of neck performed after patient is asked to swallow air (While breathing sound in pneumatocele).

Investigations

• Barium swallow (tea-pot appearance with fluid level), endoscopy (perforation risk), and pharyngeal manometry

Treatment

• Incision along anterior margin of left sternomastoid from level of hyoid bone to anterior end of clavicle

Cricopharyngeal Myotomy

• Heller's operations, is indicated for small non-dependent diverticula

Diverticulectomy

• Best for large dependent pouches when combined with cricopharyngeal myotomy.

Diverticulopexy

• For moderate-sized, non-infected pouches, combined with cricopharyngeal myotomy to create moderate-sizes pouches that are not infected or adherent to adjacent structures

Endoscopic Division of Septum

• Elderly poor-risk patients with large dependent diverticula

Carotid Body Tumor (Potato Tumor | Chemodectoma | Non-Chromaffin Paraganglioma)

Normal Carotid Body

• Site: adventitia of common carotid artery
• Consists of Chief cells (catecholamine granules) and supportive cells
• Nerve supply: glossopharyngeal nerve
• Sensitive to changes in pH and hypoxia

Role

• Help in autoregulation of respiration

Changes

• Carotid body hyperplasia can occur in people residing in high altitudes and those who are exposed to chronic hypoxia

Pathologically

• It's a non-chromaffin-paraganglioma which is benign but can recur locally and rarely metastasize; hard and whitish yellow, well encapsulated with dense fibrous septa; the cells are not hormonally active

Clinical Features

• Consists of chemoreceptor tissue in carotid body and unilateral
• Oval and variable in size
• Well-capsulated, yellowish, and firm to hard with dense fibrous tissue
• Behavior: generally benign locally or malignant (10%), regional lymph nodes and lungs spread occur in 20%
• Tumor does not secrete epinephrine or any endocrine substances

Blood supply

• From external carotid artery

Histology

• consists of solid masses of cells resembling chief cells and slowly pleomorphic nuclei stain black chromic acid

Pain

• Painless

Rate of Growth

• Very slowly growing (75%)
• It can range from size 2-10cm

Site

• Vertically placed, oval, located at the level of the hyoid bone deep to anterior edge Symptoms
• Also includes Vertically placed, oval, located at the level of hyoid bone deep to anterior edge of SCM in the carotid triangle (2-10 cm) surface is Lobulated

Surface

• Lobulated, with firm to hard, ‘potato’ like swelling

Movement

• Sways only side to side but not in vertical direction, has a well defined edge, pulsatile (Transmitted pulsation) and increased pressure causes fainting (Carotid sinus syndrome)

Other

• Headache, neck pain (35%), dysphagia, and syncope; a thrill may be felt or bruit heard

Diagnosis

• Familial and found in high altitudes
• Site is usually unilateral and occurs in females and often causes transient ischemic attacks and may extend into the cranial cavity along with dumbbell tumour

Complications

• Compression over esophagus and larynx, presenting with unilateral vocal cord palsy; can cause Horner's syndrome
• Doppler, followed by carcinoma if larger

Treatment

• It's better to have the external incision in order to have wide dissection

Clinical

• It's well located from the aorta as dumbbell

What

• Barium swallow with fluid inside with

Investigation

• Carotid angiography, CCA widely divergent (pathognomonic). Lyre,High vascularity of tumor
  • NO FNAC

Treatment

• If is small it can be excised easily
• Large complete excision must occur with with ligations which includes cardioid body tumor

Complications

Cranial to lead contralateral, blocking

Laryngocele

• Is also a soft swelling and is very smooth
• Is air containing divirticula

Where:

• Is lateral of the head

Features

Has:

• Compressible
• Cough
• Translucent In elderly

Treatment

Excision

Pneumatocele

• Is hernation of the sibson,s facia
• Occurs in Supraclavicular
• Gets soft Increase s when straing
• breathing sounds compressable

Sternomastoid Tumour

• Caused due to birth injury of sternomastoid muscle and is a misnomer due to rupture.
• Is normal
• abnormal
• causes haematoma in muscle Seen in infants and Adherent to the muscle

Clinical Features

• Seen in infants that age weeks surface and tender 2
  • Age infants that are 3–4 weeks
  • Size Swelling of 2cm
  • Adhering to the muscles
  • And hard Consistencys: head tilt towards to affected and muscle face rotates, non tender skin

Division

• Physiotherapy can stimulate muscle Division from the exercise and use the Toricollis

Ludwig's Angina

• Is diffuse brawny inflammatory of submandibular region and in floor of neck
• It spreads to very vast causing dangerous complications

Pathology

• infection

Treatment

requires incision

Definition

Antibiotics

Dermoid Cyst

squamos epithelium of what is inside with some form

• In head External or internal

Types

• Implantatiom in sole, palm and face
• Aetiology

-2 implementation

Clinical Anatomy

In face *external angular dermoid -2skull at suture line

• 3trunk
• 4: -5: never in

Treatment

Excision

Complications

Infection recurrent

Pathology

Is fibrious

Implantation derm

• Forceful 4skin which is common

Treatment

Excision

Features

• Pain is slowly grows

General

If in head

Definition

Def-Teramatous

Tumor Benign tumor and treatments include lymph and blood often in elderly persons

• 2. Tumourbuluous Lymph Nodes** Mycobacterium tuberculosi

Types

• Aetiology: With treatment with features that occur

Treatment

Often lymph etc.

Infections

lymph It is is located around the - node and often affects

Site

Juglo,is common

Treatment

Erosion

Subhycoid Buritis

Duer Is formed

Treatment

Erosion

• The neck is comprised of compartments, triangles, tubes (trachea), vessels, and lymph nodes
• Anatomical knowledge is essential for clinical and surgical practice of the neck

Triangles of the neck

• The sternomastoid muscle divides the neck into anterior and posterior triangles
• The digastric muscle and superior belly of the omohyoid muscle divide the anterior triangle into ½ sub-mental, digastric, carotid, and mascular regions

General swelling sites

• SKIN
• SC
• VESSELS
• NERVES
• LYMPHATICS
• MUSCLES -Sebaceous cyst, Lipoma, Hemangioma, Neurofibroma, Lymphangioma, Tumors

DD of Neck Swellings

• General swellings can affect the skin, subcutaneous tissue (SC), vessels, nerves, lymphatics, and muscles
• Examples include sebaceous cysts, lipomas, hemangiomas, neurofibromas, lymphangiomas, and tumors

DD of Midline Neck Swellings

• Submental abscess
• Ludwig's angina
• Plunging ranula
• Sequestration dermoid cyst: can be submental or suprasternal
• Enlarged lymph nodes: can be submental, prelaryngeal, or pretracheal
• Swelling in the suprasternal (Burns's) space can be cystic or solid
  • Cystic: dermoid cyst (diagnosed by aspiration) or aortic arch aneurysm (characterized by expansile pulsation)
  • Solid: lipoma or lymph nodes

DD of Lateral Neck Swellings

• Submandibular Triangle: salivary gland enlargement, lymph node enlargement, Plunging ranula (57 Q)Jaw tumors
• Posterior Triangle: lymph node enlargement (commonest) (MCQ), cystic hygroma, prominent cervical ribs, Subclavian aneurysm, Pharyngeal diverticulum, Pneumatocele, LN enlargement
• Carotid & Muscular Triangle: LN enlargement the commonest), thyroid lobe enlargement(second most common), branchial cyst, branchiogenic carcinoma, aneurysm of the carotid vessels, carotid aneurysm,

Rule of 7 in the Neck

• Based on the average duration of the patient's symptoms, the most probable cause can be determined:
  • 7 days: inflammation
  • 7 months: neoplasm
  • 7 years: congenital defect

Rule of 80 in the Neck

• 80% of nonthyroid neck masses are neoplastic
• 80% of neoplastic neck masses occur in males
• 80% of neoplastic neck masses are malignant
• 80% of malignant neck masses are metastatic
• 80% of metastatic neck masses originate above the clavicle

Fistulae & Sinus of Neck

• Thyroglossal fistula:
  • Site: middle line
  • Opening: crescent shaped
  • Track: can be traced
• Tuberculous sinus:
  • Number & Site: multiple over T.B. adenitis
  • Edge: undermined
  • Margin: cyanotic
  • Discharge: thin serous discharge
• Sinus of hyoid bursitis:
  • Site: at the hyoid level
  • Shape: oval
  • Discharge: pus
• Cervicofacial actinomycosis:
  • Number: multiple
  • Discharge: yellowish sulfur granules (colonies)
• Branchial fistula
• Osteomyelitis of mandible
• Salivary fistula

Number of Swellings

• Single swellings can be located in the anterior or posterior triangle
• Anterior triangle swellings may move with swallowing or not
• Multiple swellings typically indicate lymph nodes

Thyroglossal Cyst

• A midline tubulodermoid cyst due to patency of the thyroglossal duct
• Located just below the hyoid bone (commonest site) in the midline
• Except at the level of the thyroid cartilage, where it's pushed to the left
• pathology: Lining: Stratified columnar, cubical or squamous epithelium.
• Content: clear viscid or mucoid fluid.
• Wall: Thin & may contain thyroid tissue.
• Has a narrow fibrous band extending to the hyoid bone

Complications of Thyroglossal Cyst:

• Recurrent infection
• Thyroglossal fistula
• Malignancy (1%), most commonly papillary carcinoma, rarely squamous cell carcinoma, never medullary carcinoma

Clinical Picture of Thyroglossal Cyst:

• Single, midline, rounded or oval, smooth, well-defined, cystic
• Moves up and down with swallowing (deglutition) (mqc 58) and protrusion of the tongue open to.
• Does not move from side to side
• Nontender unless complicated
• Track may be palpable

Special Tests:

• Hold track between 2 fingers
• Ask the patient to protrude his tongue → Special tugging sensation

Investigations

• Diagnostic Steps: History and clinical examination – Investigation – Endoscopy & biopsy.
• Thyroid ultrasound or scan (To ensure that thyroid gland in its place)

Management

• Sistrunk Operation MCQ

Thyroglossal Fistula

• Always acquired after rupture or incision of a thyroglossal abscess, or incomplete excision
• The track is lined by columnar epithelium connecting the external opening to the hyoid bone
• Connected to wall of cyst or remnant, near the midline

External opening

• Crescentric & convexity directed upwards (MCQ)
• Discharges viscid fluid or pus

History

• Of abscess followed by a small opening, which discharge viscid fluid or pus

Movements

• External opening moves up with deglutition and protrusion of the tongue

Signs

• Hood sign: opening of fistula is overlaid by a fold of skin
• Semilunar sign: has crescentic appearance

Treatment

• Sistrunk Operation

Cystic Hygroma (Hydrocele of the Neck) (Cavernous Lymphangioma)

• Sequestration of a portion of jugular lymph sac

Site

• Posterior triangle of the neck (75%) commonest
• Axilla (20%)
• Cheek, tongue, groin, mediastinum
• Can extend across two or more lymphatic regions

Structure

• Multilocular containing aggregation of cysts
• Does not communicate with lymphatics
• and Filled with clear mucous from endothelium, and Fluid does not coagulate

Clinical Features

• Present at birth so may result of obstructed labor
• Occasionally present in early infancy
• Smooth, soft & cystic (fluctuant), and increases during crying
• Brilliantly transilluminant, partially compressible but not reducible (MCQ 58, 59,57)

Complications

• Disfigurement of face, rapidly increases in size, causing respiratory obstruction
• May lead to infection and abscess formation
• Septicemia (life threatening)
• Rupture can occur (chylous fistula – chylothorax)
• Recurrence of cyst (15%)

Treatment

• Preoperative MRI
• Aspiration of the contents
• Preoperative injection of sclerosants
• Excision of entire aggregation of cysts is indicated when fibrosis develops
• Meticulous dissection across all planes including deeper muscular layers is vital to clear the cyst wall and prevent recurrence; under antibiotics if abscess is present; aspiration and tracheostomy are done if respiratory obstruction is present

Branchial Cyst

• Arises from 2nd branchial cleft remnants, rarely 1st, 3rd, 4th

Site

• Anterior border of upper 1/3 of SCM muscle (mcq 60 Q)

Age

• Congenital, but seen in adolescents & early 3rd decade

Sex

• Equal in both sexes

Side

• Often unilateral, bilateral in 3% (can be familial)

Pain

• Usually painless unless infected

Surface

• Smooth

Consistency

• Soft/tensely cystic, fluctuant

Special

• Often transilluminant; not compressible or reducible

Pathology

• Contains cholesterol crystals; cheesy toothpaste like material

Complications

• Wall
• Contents

Histologically

• Lined with squamous epithelium, may contain ciliated columnar epithelium Ciliated columnar epithelium
• Cyst wall shows plenty of lymphoid tissue

Complications

• Recurrent infection
• Rupture may cause acquired branchial fistula
• Branchiogenic carcinoma is rare

Investigations

• CT scan to Differentiate() it and chemodectoma
  • If the cyst feels solid
• AspirationTo differentiate() it and cold abscess
  • Contains high cholesterol content

Treatment

• Excision under general anesthesia is needed as cyst is near to Carotids
• 12th, 9th, 11th nerves

• Posterior belly of the digastric

• Pharyngeal wall and the posterior pillar of tonsils that Required Careful dissection is required and Complications that result of surgery Includes - injury to a major, -Reformation Infection

Branchial Fistula

Etiology

Congenital

• Failure of fusion between 2nd & 5th branchial arches (MCQ)

Acquired

• Infection of branchial cyst
• Incomplete excision of branchial cyst

External Opening

Congenital

• Lies on lower 1/3 of SCM

Acquired

• Lies on upper part of anterior border of sternomastoid (58q)

Internal Opening

• Usually blindly (sinus) or rarely opening into it (fistula)
• High in lateral wall of pharynx behind tonsil (Supratonsillar fossa of Rosenmuller )

Tract

• Passes () bifurcation of carotid and lined by ciliated columnar epithelium; surrounded by lymphoid tissue

Discharge

• Mucus or pus if infected

Type of Patients

Congenital

• Usually presents at birth and is common in children & in early adolescent period

Acquired

• Appears in adulthood on top of pre-existing cyst

Symptoms & Signs

• Small opening Discharging mucoid fluid and a fibrous track or Rich in:
• Cholesterol or Pu

Investigations

• Discharge study
• Fistulogram
• MR/CT fistulogram

Treatment

2-3 transverse incision (Step-Ladder incision) (mcq)

Higher skin incision is added to facilitate complete dissection

Pharyngeal (Zenker's) Diverticulum

ETIOLOGY

• Failure of relaxation of cricopharyngeal muscle during swallowing Increased intraluminal Herniation pulsion

Develops

• A midline (Develops) Mucosal and a posterior of muscle

Develops as Mucosal

(STRUCTURE) -Submucosa coat

Complications

• rare
• Aspiration and is common in elderly person

What

• Is Globular
• Swallowing and with fluid inside with MCQ

Treatment

For Incision in - Hellers, For large - Electromy if you are to do a or in

Where is it

• ( Develops) From the

Azygos

Procedure

• For small - Mictomy

Carotid Body Tumor (Potato Tumor | Chemodectoma | Non-Chromaffin Paraganglioma)

Normal Carotid Body

• Site: adventitia of common carotid artery
• Consists of Chief cells (catecholamine granules) and supportive cells
• Nerve supply: glossopharyngeal nerve (MCQ)
• Sensitive to changes in pH and hypoxia

Role

• Help in autoregulation of respiration

Changes

• Carotid body hyperplasia can occur in people residing in high altitudes and those who are exposed to chronic hypoxia

Pathologically

• It's a non-chromaffin-paraganglioma which is benign but can recur locally and rarely metastasize; hard and whitish yellow, well encapsulated with dense fibrous septa; the cells are not hormonally active Clinical Features
• Composed with a Chemodectoma or and which Iis unilatera or in in a Ovalshape and it is of Size

And

In

Is located

Consitency

Is firm

Behavior

There is no secreation of substances

In

That occurs there is Solid and looks Like cells

In Elderly

Pain

And that (75%)

Vertical

Is with a located deep the hyoid bone and of triangle

And is 2-10cm there in or high vascularity compression which will cause Presents usually

Diagnosis### Is familial

Treatment

What Is Doppler

It also Includes Crania

Investigations/

In - With a Is a must!!! Or for Treated

The complications Will Be -With and with In the face And to

Complications

• There in bone and muscle

And a. Is also known is

Sternomastoid Tumour

• Caused due to birth injury of sternomastoid muscle and is a misnomer due to rupture. Is normal
• abnormal
• causes haematoma in muscle Seen in infants and Adherent to the muscle

Clinical Features### - Seen in infants that age weeks surface and +tender 2 - Age infants that are 3–4 weeks - Size: Swelling of 2 cm + Adhering to the muscles + And hard Consistencys: head tilt towards to affected and muscle face rotates, non tender

Skin### Is

Division### - Physiotherapy can stimulate muscle Division from the exercise and use the Toricollis harness (6–12 months) ###Ludwig's Angina### - Is diffuse brawny inflammatory of submandibular region and in floor of neck - It spreads to very vast causing dangerous complications

###Pathology###

• Infection

###Treatment###

• Requiressurgical

###Definition###

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• What There's also a - 1.Dermoid Cyst Squamos

Etiology:

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