Specialist ENT RETROPHARYNGEAL ABSCESS

CYSTIC HYGROMA

Definition: This is a congenital malformation affecting the lymphatic channel and arises from ’embryonic lakes’ which are precursors of adult lymph channels.

Also called lymphangioma or cavernous lymphangioma.

Age: Often occurs in infant or children younger than 2 years of age.

Clinical features:

  1. Young children.
  2. A cystic swelling.
  3. Margins not well defined.
  4. Fluctuant.
  5. Partially compressible.
  6. Brilliantly transilluminant.
  7. Regional lymph nodes are not enlarged.
Specialist ENT Screenshot 2020 12 03 ORAL CAVITY AND PHARYNX SEMIFINAL BS

Usual sites of cystic hygroma:

  1. Root of the neck in the posterior triangle, deep to sternomastoid is the commonest site. It may extend to the cheek, mouth, tongue, parotid, ear or downwards towards the axilla and or mediastinum.
  2. Axilla.
  3. Groin.
  4. Mediastinum.

Atypical Presentation:

  1. During birth, a big cystic hygroma may cause obstructed labour.
  2. It may present as a pyogenic abscess.
  3. Cystic hygroma in the mediastinum may present as ‘mediastinal syndrome’.

Histopathology:

Cystic Hygroma is lined by large multinodular cystic mucosa which may communicate or be single. The walls are thin and contain fluid.

Histologically, the cyst is lined by a single layer of flattened epithelium with fetal fat and cholesterol crystals.

Diagnosis:

  1. Lymphatic malformations may be detected in the human fetus by ultrasound if they are of sufficient size. 
  2. MRI of the head and neck.
Specialist ENT Screenshot 2020 12 03 ORAL CAVITY AND PHARYNX SEMIFINAL BS

Treatment:

MEDICALSURGICAL
  1. Child can be observed for 2 years for spontaneous remission.
  2. Aspiration followed by injection of alcohol, bleomycin, polidocanol and doxycycline as sclerosing agents can be done.
  1. Surgical excision of the cyst.
  1. Surgical excision with preservation of neural and vascular structures. Complete excision may not be possible in a single operation.
  2. Recurrence rate after surgical excision is only 5% if whole tumor is removed macroscopically but it is 50% if some part is left. 
  3. Cystic hygroma causing respiratory distress may be aspirated or may require tracheostomy to relieve respiratory obstruction.
  4. Injection of sclerosing agents is not favored as it makes later dissection more difficult.
  5. Latest treatment includes excision of cystic hygroma using laser and radiofrequency ablation.

Differential Diagnosis:

  1. Branchial Cysts.
  2. Cold abscess in neck.
  3. Collar stud abscess.
  4. Solitary lymph cyst.

Complications:

  1. Recurrent infection.
  2. Respiratory distress.

Spontaneous remission has been seen after 24 years.

This tumor never turns malignant.

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