Cystic Neck Research Articles

Intraoperative Use of Mixed Reality Technology in Median Neck and Branchial Cyst Excision

The paper considers the possibilities, prospects, and drawbacks of the mixed reality (MR) technology application using mixed reality smartglasses Microsoft HoloLens 2. The main challenge was to find and develop an approach that would allow surgeons to conduct operations using mixed reality on a large scale, reducing the preparation time required for the procedure and without having to create custom solutions for each patient. Research was conducted in three clinical cases: two median neck and one branchial cyst excisions. In each case, we applied a unique approach of hologram positioning in space based on mixed reality markers. As a result, we listed a series of positive and negative aspects related to MR surgery, along with proposed solutions for using MR in surgery on a daily basis.

Cystic cervical metastasis: A diagnostic dilemma

Metastasis of head neck squamous cell carcinoma to regional deep cervical nodes is a common and usually are bony hard, solid. But sometimes they may present as a cystic mass which makes it a diagnostic challenge, in absence of evident primary, for the treating doctor. Previously they have been labeled as cancers of branchial cleft cysts which have undergone malignant degeneration. With the advancement in understanding of tumor pathophysiology most researchers now have concluded that these are tumors from tissue of waldeyer’s ring which have the potential of producing cystic cervical metastasis. : A 57-year-old male presented to our department with a right side slow growing neck swelling for 2 years. The rest of ear, nose, throat examination was normal. The fine needle aspiration cytology revealed clear fluid. The diagnosis of branchial cleft cyst was made and patient counselled for surgery for benign lesion. After a period of one month the patient presented with change in voice, difficulty in swallowing and another swelling on left side of the neck. FNAC from the left side swelling revealed metastatic squamous cell carcinoma and PET-CT revealed a tongue base growth. Patient underwent an excision of growth from tongue base and neck dissection on both sides. Even for cystic neck swelling in an adult over 40 years of age, the possibility of malignancy should be kept, until proven otherwise.

Ultrasound Imaging of Cervical Anatomic Variants.

Embryologic developmental variants of the thyroid and parathyroid glands may cause cervical anomalies that are detectable in ultrasound examinations of the neck. For some of these developmental variants, molecular genetic factors have been identified. Ultrasound, as the first-line imaging procedure, has proven useful in detecting clinically relevant anatomic variants. The aim of this article was to systematically summarize the ultrasound characteristics of developmental variants of the thyroid and parathyroid glands as well as ectopic thymus and neck cysts. Quantitative measures were developed based on our findings and the respective literature. Developmental anomalies frequently manifest as cysts that can be detected by cervical ultrasound examinations. Median neck cysts are the most common congenital cervical cystic lesions, with a reported prevalence of 7% in the general population. Besides cystic malformations, developmental anomalies may appear as ectopic or dystopic tissue. Ectopic thyroid tissue is observed in the midline of the neck in most patients and has a prevalence of 1/100,000 to 1/300,000. Lingual thyroid accounts for 90% of cases of ectopic thyroid tissue. Zuckerkandl tubercles (ZTs) have been detected in 55% of all thyroid lobes. Prominent ZTs are frequently observed in thyroid lobes affected by autoimmune thyroiditis compared with normal lobes or nodular lobes (P = 0.006). The correct interpretation of the ultrasound characteristics of these variants is essential to establish the clinical diagnosis. In the preoperative assessment, the identification of these cervical anomalies via ultrasound examination is indispensable.

Diagnostic Approach to Congenital Cystic Masses of the Neck from a Clinical and Pathological Perspective

Background: neck cysts are frequently encountered in pediatric medicine and can present a diagnostic dilemma for clinicians and pathologists. Several clinical items enable to subclassify neck cyst as age at presentation, anatomical location, including compartments and fascia of the neck, and radiological presentation. Summary: this review will briefly describe the clinical, imaging, pathological and management features of (I) congenital and developmental pathologies, including thyroglossal duct cyst, branchial cleft cysts, dermoid cyst, thymic cyst, and ectopic thymus; (II) vascular malformations, including lymphangioma. Key Messages: pathologists should be familiar with the diagnostic features and clinicopathologic entities of these neck lesions in order to correctly diagnose them and to provide proper clinical management.

A Cross-Sectional Evaluation of Outcomes of Pediatric Thyroglossal Duct Cyst Excision

Introduction: Thyroglossal duct cysts (TGDCs) are the most common form of congenital neck cysts. They may become infected causing dysphagia or respiratory distress. Accordingly, the treatment is always surgical removal. Objectives: The objectives of this article were to examine complications following TGDC excision by surgical specialty, demographics, and comorbid conditions. Methods: A retrospective review of the National Surgical Quality Improvement Program database was performed. Pediatric cases from January 1, 2014 to November 1, 2015 with a current procedure terminology code of 60,280 (excision of TGDC or sinus) were included. Statistical analysis was performed to assess associations between complications and surgical specialty, demographics, and comorbidities. Results: Of the 867 cases that met inclusion criteria, the median age was 4 years. There were 448 males (52.3%) and 408 females (47.7%). Thirty-six patients (4.2%) experienced at least one 30-day complication. The most predominant complications were reoperation (19 patients, 2.2%), readmission (18 patients, 2.1%), and surgical site infection (16 patients, 1.9%). There was no statistically significant difference between complications and surgical specialty. In those experiencing a complication, there was a statistically significant difference between males (86.1%) and females (13.9%). Of patients with at least one comorbidity, 36.67% had a complication, while 17.22% did not have a complication. There was also a statistically significant difference in the percentage of patients with a past medical history of asthma between those with at least one complication (16.67%) compared to those without any complications (4.76%). Conclusions: excision is a generally safe procedure across surgical specialties. There is a higher complication rate in males compared to females as well as those with a history of at least one medical comorbidity and those with asthma. The most common 30-day complications are reoperation, readmission, and surgical site infection.

English

Neck swellings are usually the most visible and noticeable pathologies. These swellings include enlarged lymph nodes, swellings of thyroid gland, congenital / developmental cysts and lipomas.1 Cystic congenital neck masses are usually very well diagnosed in childhood. Congenital cystic masses of the anterior neck include thyroglossal duct cyst (TDC), branchial cleft cyst & cystic hygromas from uncommon pathologies to very rare thymic and bronchogenic cysts.2 Painless and soft or fluctuant nature of neck mass is usually the first clinical presentation in most cases. Ultrasonography (USG) helps to define the size, shape and extent of mass and confirms the cystic nature of lesion, whereas histopathological examination is the gold standard.3 The purpose of this article is to impress upon all that USG is an adjuvant imaging modality which helps in diagnosing cystic nature of the neck lesions. But most of the time, it cannot differentiate between dermoid cyst and thyroglossal cyst. The present case of infected thyroglossal duct cyst was reported to have diagnostic dilemma between clinical diagnosis and sonographic diagnosis. Histopathological examination confirmed the clinical diagnosis of Infected TDC.

Primary Hydatid Cyst of Neck, A Rare Case Report.

Hydatid cyst is a result of parasite infection. The neck is an uncommon site for this infection so it is not considered as a differential diagnosis of neck swelling commonly. We hereby report a case of 24year female with left postero-lateral neck swelling for 5years that was insidious in onset and gradually increased in size. We diagnosed the case as hydatid cyst of neck on FNAC and MRI. Pre operatively oral albendazole was given for 1month and continued post operatively. Our case has not shown recurrence for 6months after successful surgical excision. So primary hydatid cyst should be considered as a differential diagnosis of neck swelling and should be treated accordingly.

THE INFLUENCE OF DIFFERENT TYPES OF CHRONOTYPE ON SCAR FORMATION DURING THE USE OF PLACENTAL CRYOEXTRACT AT THE INTRAOPERATIVE STAGE

To define the individual features of the organization of circadian rhythms, the term "chronotype" was proposed, which is becoming increasingly popular in research in the field of medicine. According to the analysis of literature data, biological rhythm affects not only the mental state, obesity but the human condition as a whole. Biological rhythms are a manifestation of the fundamental properties of the organic world, provide the ability of man to adapt and survive in the environment. In this aspect, of particular interest is the functioning of the organism, taking into account its individual characteristics in terms of the organization of biorhythmic processes. The research was conducted on the basis of the Department of Maxillofacial Surgery on the basis of CE «Poltava M. V. Sklifosovskyi Regional Clinical Hospital of the Poltava regional council». A total of 24 patients participated in the study. To study the materials, we analyzed patients who were hospitalized for routine surgery for congenital neck cysts and tumors of the head and neck. Patients were interviewed during hospitalization, as well as a questionnaire to determine the chronotype. Patients were divided into the following 2 groups, namely: group 1, which in turn comprised 2 subgroups: 1.1 - Patients with morning chronotype; 1.2 - Patients with evening chronotype. The first subgroup (1.1 - with the morning chronotype) consisted of 7 subjects who underwent surgery in the morning. The second subgroup (1.2 - with evening chronotype) consisted of 9 patients who underwent surgery at about 15:00. In each of these subgroups during surgery, intradermal administration of the drug "Cryocel" was performed. - group 2 (control). The second control group consisted of 8 patients, all patients in this group were operated on according to the classical method without the use of additional preventive measures. On the 90th day of the clinical study, we could observe a significant difference in the comparison of postoperative scars, namely in patients with morning chronotype and in patients with evening chronotype it was 42%, the difference with control was 71% and the difference between the subgroup 2 and the control group was 50%. On the 180th day of the study, we observed a significant difference between the groups, in patients of subgroups 1 and 2, as compared to the control group, clinical data in the description of postoperative scars were better by 25%. When comparing subgroups 1 and 2, no difference was observed. Thus, on the 180th day when examining patients, the clinical picture was more favorable in subgroups 1 and 2. According to the data obtained, we can say that in patients who underwent surgery in the morning and injected with placental cryoextract, wound healing and scar formation on the 90th day was faster and better than in patients who underwent surgery at lunchtime, and patients who underwent surgery according to the classical method without the use of additional preventive measures.

Weichgewebezysten der Kopf-Hals-Region

Soft tissue cysts of the head and neck region usually manifest as slowly enlarging, well defined painless swellings, which may be accompanied by symptoms due to the increasing displacement of surrounding tissues or superinfection. They are often associated with soft tissue fistulas. Diagnosis should always be preceded by thorough evaluation of the medical history, since some cysts (e.g. lateral/medial neck cysts) develop in early childhood, whereas others can be trauma associated with a very short history (e.g., submucous cysts). Clinical examination can be supplemented by ultrasound. In unclear cases or for better therapeutic planning, three-dimensional imaging may be helpful. Treatment of choice is complete extirpation of the cyst; histopathological work-up to confirm the diagnosis and exclude other differential diagnoses is mandatory. Due to the increased risk of recurrence and incomplete histological examination, cystostomy and sclerotherapy should currently be viewed as a therapeutic alternative reserved for exceptional cases only.

Sclerotherapy for Benign Cystic Lesions of the Head and Neck: Systematic Review of 474 Cases.

The role of sclerotherapy for vascular lesions of the head and neck is well established. However, the efficacy of sclerotherapy for benign cystic lesions of the head and neck is less clear. The objective of this review is to determine the efficacy and safety of sclerotherapy for benign cystic lesions of the head and neck. PubMed/MEDLINE, Cochrane Library, and Embase. The PRISMA guidelines (Preferred Reporting Systems for Systematic Reviews and Meta-analyses) were followed for this systematic review. Studies of patients with benign head and neck cystic masses treated primarily with sclerotherapy were included. Thirty-two studies met criteria for inclusion. A total of 474 cases of sclerotherapy were reviewed. Agents comprised OK-432, ethanol, doxycycline, tetracycline, and bleomycin. Lesions in the analysis were ranula, thyroglossal duct cyst, branchial cleft cyst, benign lymphoepithelial cyst, parotid cyst, thoracic duct cyst, and unspecified lateral neck cyst. A total of 287 patients (60.5%) had a complete response; 132 (27.9%) had a partial response; and 55 (11.6%) had no response. OK-432 was the most widely utilized agent, with a higher rate of complete response than that of ethanol (62.0% vs 39.4%, P = .015). Fifty-three cases (11.2%) required further surgical management. One case of laryngeal edema was reported and managed nonoperatively. Sclerotherapy appears to be a safe and efficacious option for benign cystic lesions if malignancy is reliably excluded. Efficacy rates are comparable to those of sclerotherapy for vascular malformations. The rate of serious complications is low, with 1 incident of airway edema reported in the literature.

Does the Use of a Wrap in Three-Dimensional Surgical Planning Influence the Bony Margin Status of Benign and Malignant Neoplasms of the Oral, Head and Neck Region? An Initial Investigation

<h3>Purpose</h3> Three-dimensional surgical planning (3-DSP) is becoming commonplace in the management of benign and malignant disease for oral and maxillofacial surgery practice within the last decade.¹ In pathologic resections of the head and neck cysts and tumors in particular, a virtual wrap is used to delineate the tumor resection margin. However, there has yet to be a study in regard to the accuracy of this wrap and its effect on bony margin status. This study aims to discuss our experiences with the use of wraps created with 3-DSP and explore the accuracy of the wrap for margin status. We hypothesize that the use of a wrap is a predictable method to obtain negative bony margins. Furthermore, we explore the emerging challenges in the use of this technology specific to pathologic resection margins. <h3>Methods</h3> This is a retrospective chart review. The study included patients over the age of 18 (range, 18-99) treated at 2 centers, John Peter Smith Health Network Oral and Maxillofacial Surgery and Parkland/UTSW Oral and Maxillofacial Surgery. We included patients who obtained a 3-DSP for pathology of the head and neck involving the bone and who also obtained a virtual wrap for bony margins. There were no specific exclusion criteria. There were no exclusions due to racial, ethnic, or gender groups. Data accessed ranged from July 1, 2017, to May 1, 2020. Patient data were collected for processing via multilevel protected electronic health record system (Epic). Once the data were gathered, the identifiable link was destroyed and data were anonymized. Analysis was completed via Excel. <h3>Results</h3> There were 39 cases, but we excluded 1 that required intraoperative adjustment and thus did not follow preplanned case. One out of the 38 cases involved a bony margin (2.6%; 95% confidence interval, 0.1%, 13.8%). Table 1 defines the pathology. We classified SCC (squamous cell carcinoma) and low-grade osteosarcoma as malignant cases and the rest as benign. There were 16 malignant cases (42%) and 22 benign cases (58%). When stratified by pathology, 1 out of the 16 malignant cases (6.3%; 95% confidence interval, 0.2%, 30%) and 0 out of the 22 benign cases (95% confidence interval, 0%, 15.4%) had a positive margin. <h3>Conclusion</h3> Three-dimensional surgical planning with wrap margins is a predictable method to obtain negative bony margins in benign and malignant disease of the maxillofacial complex. The surgeon must be prudent to ensure accurate margin delineation by engineers before simulated wrap creation or resection.

English

BACKGROUND Neck swellings consists of a wide spectrum of pathological entities. These swelling can occur due to a variety of aetiologies consisting of congenital, acquired inflammatory, neoplastic, or vascular origin. It is essential to have an extensive knowledge of the anatomy and contents of each cervical compartment to achieve a diagnosis. The age of presentation and clinical findings often narrows down the differential diagnosis. Ultrasonography (USG) is helpful in differentiating the nature of the lesions and differentiating solid from cystic neck lesions. Ultrasound is often used as an initial modality for pre-treatment assessment of any neck swelling. METHODS Patients with clinically palpable / non-palpable neck swellings were scanned using 7.5 - 11 MHz transducers, excluding patients with diagnosed thyroid swellings. RESULTS In total 120 cases were studied; the mean age of patients was 34 years with a male to female ratio of 1.1:1. The age wise categorisation included paediatric population (34.2 %) and adult population (65.8 %). 96 (80 %) cases presented with painless neck swelling, 76 (63.3 %) cases were non-neoplastic and 44 (36.7 %) cases were neoplastic in nature. Cervical lymphadenopathy being the most common ultrasound finding in both paediatric and adult population. Malignant lesions were most common in adult age group. Heterogeneous echotexture, rounded nodes, intranodal necrosis, loss of echogenic hila, peripheral nodal blood flow and increased pulsatility index (PI) and resistive index (RI) were important features of malignant lymph nodes. Sensitivity and specificity of USG and Doppler in differentiating neoplastic from non-neoplastic lesions were 97.7 % and 98.3 % respectively and for differentiating benign from metastatic nodes were 97.7 % and 98.3 % respectively. CONCLUSIONS Considering the study results and observations, USG is the best initial investigation for the evaluation of inflammatory, cystic and neoplastic swellings in various age groups. It is non-invasive, cost effective readily available and repeatable technique. It is relatively easier to use and does not involve radiation hazards. Colour Doppler can evaluate the vascularity of the lesions and provide details of any vascular invasion of metastatic lesions. Ultrasound can differentiate aetiology of lymph node enlargement to a significant extent. KEYWORDS High Resolution Ultrasound, Paediatric Neck Mass, Metastatic Lymph Node, Histopathology, FNAC, Tubercular Lymph Nodes, Colour Doppler, Non-Thyroidal

Clinicopathological Features of Patients Nominated for Head and Neck Biopsies: A One-Year Series.

BackgroundHead and neck lesions, which are predominantly benign, were widely reported. Some of these tumors are potentially neoplastic and others are non-neoplastic. Therefore, this study aimed to assess the clinicopathological features of patients nominated for head and neck biopsies.MethodologyIn this study, data regarding head and neck biopsies were retrieved from the Department of Pathology at King Khalid Hospital, Hai'l, Northern Saudi Arabia. Data referring to head and neck biopsies of patients who were diagnosed during the period from January 2018 to December 2018 were included.ResultsThe initial clinical presentations were stated for 50/64 (78.1%) head and neck lesions, 12/64 (18.8%) head and neck cysts, 1/64 (1.6%) keloid, and 1/64 (1.6%) ischemia. With regard to the biopsy's site, most were taken from the nose followed by oral cavity, scalp, ear, face, and eye, constituting 19/64 (29.7%), 15/64 (23.4%), 9/64 (14.1%), 5/65 (7.8%), 4/64 (6.2%), and 3/64 (4.7%), respectively.ConclusionHead and neck benign lesions, predominantly inflammatory lesions, are common in Northern Saudi Arabia. Accurate identification of these lesions is important during histopathological diagnosis, as some have pathological features that mimic some potentially neoplastic lesions.

Oropharyngeal squamous cell carcinomas: Can imaging findings predict HPV status?

This is first Australian population-based retrospective study in HPV-induced OPSCCs utilising CT. Contrast enhanced computed tomography (CECT) was utilised to assess if imaging findings of metastatic cystic lymph nodes (LNs) can predict human papillomavirus (HPV) status, as defined by p16 immunostaining of oropharyngeal squamous cell carcinomas (OPSCCs). The location and p16 status of primary tumours and LNs were recorded. Metastatic LNs were assessed for size, shape, margins and cystic changes. Hounsfield Units (HU) value of primary tumours and LNs were measured and tabulated. p16-positive and p16-negative groups were compared with respect to these variables. The two-sample t test and two-sample Mann-Whitney test was used. A total of 364 CECT scans were reviewed with 209 patients (187 p16 positive and 22 p16 negative). Primary sites of OPSCCs were tonsils (58.8%), base of tongue (37.4%) and other oropharyngeal sites (3.8%). The HU values of p16-positive OPSCCs with mean of 78.6HU; 95% CI (76.5-80.8) were lower for p16-negative tumours, mean 96.0 HU CI 95% (85.5-106.6) for all oropharyngeal sub-sites. The mean HU values of p16-positive and p16-negative metastatic LNs were 38.8 HU 95% CI: (13-103 HU) versus 88.7 HU 95% CI: (54-131) (P<0.0001). The association between p16-positive status and the tonsillar cancer site is very high. Imaging features of p16-positive metastatic LNs include relatively large cystic neck nodes with low HU values. This is an imaging signature of p16-positive OPSCCs and can potentially influence patient's early diagnosis and prognosis.

Fetal MRI assessment of head &amp; neck vascular malformation in predicting outcome of EXIT-to-airway procedure

Abstract Objectives The objective of this clinical case report is to highlight the MRI features and staging system which may guide clinicians in determining further management. Case presentation Three different cases with fetal head and neck vascular malformation diagnosed during prenatal screening were presented. MRI demonstrates large cystic neck masses which may compromise fetal airway during delivery. Thus, this required multidisciplinary team management among obstetricians, otolaryngologists, pediatricians, anesthesiologists, and radiologists. A decision for complex birth delivery through the cesarean section aided with EXIT-to-airway procedure was made. Each of these procedures demonstrates the different challenges and outcomes of the neonates which correlated with the characterization and staging based on prenatal MRI. Conclusions EXIT-to-airway procedure in head and neck malformation may be beneficial in transiting complicated and potentially catastrophic delivery situations to a more controlled environment. However, it also needs to align with prenatal MRI evaluation, which provides a more objective assessment guide for the clinicians.

Neonatal cervical lymphatic malformation involving the fetal airway the setting of emergency caesarean section

Abstract Objectives Lymphatic malformations are benign vascular anomalies comprised of lymphatic elements and most commonly occur in the neck. They may be diagnosed prenatally on ultrasound, and, in addition to confirming the diagnosis, fetal MRI can delineate the presence and extent of airway involvement. A variety of therapies are available for the treatment of lymphatic malformations including medical management, sclerotherapy, and surgery. Case presentation We report a case of a 28 year-old pregnant female diagnosed with a fetal neck mass by ultrasound at 21 weeks gestation. A fetal MRI was performed which demonstrated a multiseptated cystic neck mass most suggestive of a lymphatic malformation. The mass was noted to be intimately associated with the fetal airway. Follow up ultrasounds showed continued growth of the lesion throughout pregnancy. The baby was born by EXIT procedure and the lymphatic malformation was ultimately treated by a combination of medical treatment, sclerotherapy, and surgery. Conclusions Cervical lymphatic malformations have a classic imaging appearance and can enlarge throughout gestation as well as after delivery. The treatment plan typically involves a multidisciplinary approach.

Ectopic Thymic Cyst Presenting as Lateral Neck Mass in a Young Boy: A Case Report

The thymus is derived from ectoderm and endoderm of third pharyngeal pouches. It descends down along the cervical region to anterior mediastinum and involutes by increasing age. The ectopic thymic tissue in neck is a rarity and few mentioned in literature are described as sporadic case reports. Ectopic thymic cyst accounts for less than 1% of all cystic neck masses in children and even more rare in adults. Worldwide literature states that there are about 150 cases of congenital ectopic thymic tissue. It can occur anywhere along the path of its descent, from mandible to mediastinum. This entity being unusual is infrequently considered in the differential diagnosis of cervical cystic masses. Histopathology forms the mainstay in confirmation of diagnosis. Here, we report a case of 12-year-old boy who presented with right-sided neck mass. The excised specimen revealed presence of lymphoid tissue with Hassalls corpuscles in the wall of cyst. This hallmarking feature is the pointer to arrive at a correct diagnosis of thymic cyst and to exclude its closest differential at this anatomical location including branchial cyst, cystic hygroma, lymphadenopathy and epidermoid cyst. The literature is reviewed and differentials of ectopic thymic cyst in cervical region are being discussed.

Cystic Neck Swellings in Pediatric: Pattern of Presentation and Outcome After Surgery, Case Series Study

Background: The aim of this research was to assess the pattern of presentation and outcome of Cystic neck swelling in pediatric patients following surgery.Patients and Methods: This study included 126 patients (69 males and 57 females) their age ranged from 9 days to 16 years with cystic neck swellings and had been treated by Excision in surgical procedure in the Maxillofacial/Head and Neck Surgical Unit, Pediatric Surgery Unit at Sohag University Hospitals, in the period from March 2014 to March 2019. Analysis of the clinical presentation, the type of neck swelling was done. All patients were eligible for this study.Results: Total of 126 cases were included in this study, Majority of cases present as midline neck swelling 90 (71.4%) and 31 (24.6%) as lateral neck swelling and 5 (4%) as submandibular swelling, and as regard diagnosis thyroglossal cyst were 82 (65.1%) and 19 (15.1%) were cystic hygroma and 16 (12.7%) were branchial cyst (10 left and 5 right and 1 bilateral) and 8 (6.3%) were dermoid cyst, and one case (0.8%) were cystic teratomaConclusion: Surgical resection is the best treatment option not only for esthetic purposes but also to get rid of the recurrent infection and risk of fistula formation and possible pressure on neck structures.

Parathyroid cyst- missed diagnosis or a misdiagnosis: A case report

Introduction: The neck swellings, specially of cystic nature, may be of thyroid origin, thymic cysts, thyroglossal duct cysts, branchial cleft cysts, bronchogenic cysts or lymphangiomas depending upon the site of origin. Parathyroid cysts constitute 0.5-1% of all neck cysts and are a rare entity. A strong index of suspicion is required for its correct diagnosis. Here, we report a case of parathyroid cyst in a 40 year old female and the clinicopathological findings which posed a diagnostic challenge, thus highlighting the importance of including parathyroid cysts in the differential diagnosis of neck cysts. Case Report: Fine needle aspiration was performed on the swelling and approximately 20 ml of watery, crystal clear fluid was aspirated from the cyst. Cytological examination was acellular. The fluid PTH level was 23.6 pg/ml, serum calcium was 8.6 mg/dl (normal reference range 8.5-10.1 mg/dl) and serum PTH level was 65.88 pg/ml (normal reference range 15-65 pg/ml. Conclusion: Parathyroid cysts are uncommon benign cystic lesions and may be functional or non functional in nature. FNA is a valuable diagnostic tool along with fluid PTH level. The parathyroid cysts should be included in the differential diagnosis of all anterior cystic neck swellings so that they are not missed or misdiagnosed as thyroid lesions. Keywords: Parathyroid cysts, PTH, FNAC, USG.

Transoral endoscopic excision of cystic hygroma vestibular approach in adult (novel approach): a case report

Lymphangioma, soft tissue tumor was originally reported by R. Backer in 1828 and “cystic hygroma” name was first given by Wernker in 1834. It can occur in the head, neck, axilla, cervico-facial regions and below tongue. Although it is well recognized in children, it may present in adulthood. Cystic hygroma neck is traditionally removed via an overlying incision near or over the swelling. The resultant scar can be displeasing to an adult. Various endoscopic approach present in literature for excision are via neck, anterior chest, combined or robotic assisted. We here, are reporting transoral endoscope excision of cystic hygroma via vestibular approach. A 51 year old female with swelling over anterior aspect of neck, trans-illumination positive, diagnosis confirmed on CT neck, of size ~4×4 cm was our case. We decided for transoral endoscopic vestibular approach for excision, first of its kind with no assisted approach. Patient discharged after 3 post-operative days (PODs). There was mild seroma which resolved within a week. Transoral endoscopic excision of cystic hygroma via vestibular approach without any assisted approach can be applied in adult. Various approach present in literature for excision of cystic hygroma are via neck, anterior chest or combined or robotic assisted. Hence this approach can be an excellent choice for adult cystic hygroma patients who desire to avoid a neck incision. Transoral endoscopic excision of cystic hygroma via vestibular approach was successfully performed. Patient was satisfied with good cosmosis. It results in good cosmesis and better dissection. Hence can be a new method of excision of cystic hygroma in adult.