METHODOLOGICAL APPROACH TO DIAGNOSIS AND TREATMENT OF LATERAL CYSTS AND FISTULA OF NECK IN CHILDREN

Abstract

In the structure of dento-facial diseases, cysts of the maxillofacial area occupy a leading position. Lateral cysts of the neck are the most common among soft tissue cysts of the maxillofacial area and make up 25% of all soft tissue cysts of this localization; moreover, in recent years there has been a tendency to increase in their number.
 The purpose of the research is to determine the occurrence rate of fistulas and cysts on the lateral neck areas in children and to compare the results obtained with scientific findings regarding the clinical and morphological features of the cysts and fistulas as well as the principles of the treatment.
 Materials and methods. We have analyzed fundamental scientific works and publications in periodicals for this purpose. Based on the data of retrospective analysis of 67 archival case histories of inpatients of the surgical department of the Paediatric Municipal Hospital in Poltava for a 10-year period, the staff of the department of paediatric surgical dentistry established the occurrence rate of the lateral neck cysts and fistulas.
 To make diagnosis, we used general clinical examination, and special examination techniques, diagnostic puncture. In doubtful and complicated cases, ultrasound and magnetic resonance imaging were performed; direct and lateral projections were obtained in cases of fistula.
 The microscopic structure was studied by the staff of the Department of Pathological Anatomy with a section course by using microslides made of postoperative samples by standard techniques.
 Results and discussion. Lateral neck cysts were most commonly observed in the young children, younger and older schoolchildren (66.6%); the localization of the lateral neck cysts was always unilateral, although, according to the literature, the possibility of their bilateral location made up 2%. The lateral neck cysts have a complex topographic and anatomical location: they rise on the lateral surface of the neck behind the common carotid artery, and before descending they bend the hyoid nerve, located in front of the sternocleidomastoid muscle. Thus, the most common typical localization of cysts is the upper neck at the level of the mandible angle in front of the sternocleidomastoid muscle. According to our findings, the factors, which can provoke this condition, are acute catarrhal inflammation of the upper respiratory tract, severe physical exertion or trauma; all patients and their parents noted a rather slow growth of the formations.
 Objective examination has always identified a painless, moving, tight, elastic round mass with clear contours and a smooth surface, no discoloration of the skin above it.
 In uncomplicated courses, ultrasound scanning detects the rounded mass with clear even contours of different sizes, hypo- or isoechogenic structure with areas of hyperechogenicity. In the cases of suppuration the structure of the cavity changes to uniformly hypoechoic. The content of the lateral neck cysts was greyish-white liquid with flakes; in cases of inflammation it was represented by purulent exudates.
 In our studies, 6 cases of congenital and acquired lateral fistulas of the neck were observed over a 10-year period, they were presented with a unilateral variant with localization mainly in the upper and middle thirds of the lateral surface of the neck. Lateral fistulas of the neck were revealed in 1 child (16.7%) immediately after birth; in 4 children (66.6%), fistulas arose after the dissection of the lateral cysts, and in a child (16.7%) this was due to after an unsuccessful surgery.
 The lateral cysts and neck fistulas in children are found in different age groups and make up 31.3% in the structure of soft tissue cysts of the maxillofacial area. Lateral fistulas of the neck, depending on the causes, differ in length, anatomic localization, their structure; therefore, this pathology usually requires the use of modern informative additional manipulations and diagnostic techniques to ensure the success of surgical procedures with the optimal variant of their planning.