Case Presentation: Cervical-Facial Cystic Hygroma

No.  2

Pictures

Case Presentation (Cervico-Facial Cystic Hygroma)

History

A 3-year-old patient was referred to our OTO-HNS

Clinic due to a left sided neck mass noted

approximately 12 months prior to be seen in

our service. The patient was otherwise asymptomatic.

Physical

Examination

Soft non-tender neck mass localized on the left side in the lower aspect of the parotid area to the upper aspect of the neck at the level of the upper jugular-digastric area.

CT scan with

contrast

Axial CT image of the neck after contrast material enhancement.

The entire CT axial and coronal cut series (not shown here) revealed a mass in the above-described location.

(CT-1  Click here to enlarge the picture)

Procedure

(1)

(1)

“S” type on skin incision usually used in the parotid surgery localized in the area of the lesion.

(Surg-1  Click here to enlarge the picture)

(2)

(2)

Anterior facial flap elevation done. Silk traction sutures used for wide exposure of the surgical area.

(Surg-2  Click here to enlarge the picture)

(3)

(3)

The silk traction sutures as shown in the picture, are very useful in flap retraction with minimal trauma to the tissue. 

(Surg-3  Click here to enlarge the picture)

(4)

(4)

The facial nerve is exposed in its exit through the mastoid. The facial nerve bifurcation is clearly seen in the enlarged picture.  The superior division is seen in its normal pathway through the parotid gland. The inferior division of the nerve is exposed through surgical dissection and the mass, which was localized above, is retracted inferiorly with surgical clamps.

The sternocleiodomastoid muscle is seen exposed inferiorly.

(Surg-4  Click here to enlarge the picture)

(5)

(5)

This photography is one step further in the dissection compared to the previous picture but basically the same description is valid.

(Surg-5 Click here to enlarge the picture)

(6)

(6)

The surgical area after the specimen was removed.  Silk fracture sutures are still in place as described initially. Main trunk of the facial nerve with the superior division undersexed and the inferior division dissected. The sternocleidomastoid muscle is displaced with an Allis retractor. The posterior belly of the digastric muscle is seen just anteriorly attaching to the mastoid tip.

(Surg-6  Click here to enlarge the picture)

(7)

(7)

The sternocleidomastoid muscle was further retracted laterally to expose the accessory nerve not clearly seen in the previous picture.

In summary, the excision involved the exposure of the inferior division of the left facial nerve as well as a neck dissection of the zone II of the neck (Corner bound by the posterior belly of the digastric and the sternocleidomastoid muscles).

(Surg-7 Click here to enlarge the picture)