头颈部囊肿和窦道Cysts and Sinuses

小儿头颈部囊肿和窦道

概述

头颈部的囊肿和窦道包括各种质软通常无压痛的良性肿块或包块，这些是先天性的（出生前就形成了），可在面部、头皮、颈部或耳朵等不同位置的皮肤下（皮下）被发现。

症状及病因

深入一些

虽然大多数囊肿和窦道不会对你孩子的健康构成危险，但是有些会出现感染而必须手术切除。有些成年后会成为癌症的位置，而另一些会因为美容问题而被手术切除

囊肿和窦道的类型：

皮样囊肿

•皮样囊肿是一种生长缓慢的肿块，最常在头皮、面部（通常在眉毛的下面或靠近鼻梁）或颈部被发现。

•这种囊肿（表现为孤立包块没有引流道的囊肿）呈进行性生长。你孩子的医生会向您转介小儿外科医生作进一步评估。

•如果皮样囊肿位于你孩子的头皮位置，外科医生会看它是否穿过颅骨。出于这个原因，在皮样囊肿长在头皮位置的孩子可能需要做头颅的X线检查。

•皮样囊肿，由于其进行性生长的性质，应手术切除。

耳前窦道或皮赘

•耳前窦道就是一个小管，位于耳廓（耳朵的外面部分）上部与头相连接之处。（窦道是指只有一个出口的囊状结构）。皮赘指的是在同一个位置上的一个皮肤小肿物。

•耳前皮赘可因美容问题被手术切除，而窦道如果有感染的话也应该被切除。

颈部肿块

•颈部肿块可以位于从颈的顶部、耳前或耳后，到颈的底部、锁骨上方的任何位置。这些肿块中最常见的是肿大的淋巴结（指小豌豆大小的组织结，它产生淋巴细胞，即白细胞的一种，淋巴结通常因对感染原产生反应而发炎或增大）。

•淋巴结肿大，通常是无害的，被称为淋巴结炎。淋巴结炎是由细菌，猫抓热，甚至不典型的结核病产生。

•如果你孩子的医生担心，他/她可能会开抗生素；或者如果肿块看起来令人担忧，他/她可能会把你的孩子转诊到小儿外科医生那里去做活检（从肿块切除一些组织样本进行分析）。

•另一种类型的颈部肿块是鳃裂囊肿或窦道。它们的大小和形状通常会改变，并且第一次发现常常是在上呼吸道感染后，上呼吸道感染会导致肿块增大。鳃裂囊肿或窦道都应该切除，以确认诊断，改善外观，预防感染，并且防止它在成年后成为一个潜在癌症的位置。

•甲状舌管囊肿，可在颈部的正中被发现，呈一个可推动、软且无压痛的圆形肿块。

•您孩子的医生可能会要将这样的一个囊肿，连同其底层在舌骨（位于舌根支持舌头）附着的部分，进行手术切除，以防止感染或潜在的恶变。

Cysts and Sinuses of the Head and Neck in Children

Overview

Cysts and sinuses of the head and neck include a variety of soft, usually non-tender benign lumps or masses that are congenital (developed prior to birth) and are found below the skin (subcutaneous) in different locations on the face, scalp, neck or ear.

Symptoms & Causes

In-Depth

While most cysts and sinuses will never pose a health risk to your child, some can become infected and must be surgically removed. Some can become the site for cancer in adults, and others can be surgically removed for cosmetic

Types of cysts and sinuses:

Dermoid cyst

· A dermoid cyst is a slow-growing mass most often found on the scalp, face (usually beneath the eyebrow or near the bridge of the nose) or the neck.

· This kind of cyst (a cyst is an isolated mass with no drainage tracts) grows progressively. Your child's doctor will refer you to a pediatric surgeon for further evaluation.

· If the dermoid cyst is located on your child's scalp, the surgeon will to see whether it extends through the cranium. For that reason, a child with a dermoid cyst on the scalp will probably undergo an x-ray of the skull.

· Dermoid cysts, because of their nature to grow progressively, should be removed surgically.

Preauricular sinus or skin tags

· A preauricular sinus is a little tube located where the upper part of the ear's auricle (the outside part of the ear) joins the head. (A sinus is a saclike structure with a single drainage site). A skin tag is a tiny mass of skin in the same location.

· The preauricular skin tag can be surgically removed for cosmetic reasons and the sinus should be removed if an infection has

Neck lumps

· A neck lump may be located anywhere from the top of the neck, in front of or behind an ear, to the bottom of the neck, just above the collarbone. The most common of these is an enlarged lymph node (a small pea-sized knot of tissue that produces lymphocytes, a type of white blood cell typically infected or enlarged due to reaction to an infectious agent.)

· Enlarged lymph nodes, which are usually harmless, are referred to as lymphadenitis. Lymphadenitis is produced by bacteria,cat scratch fever, and even atypicaltuberculosis.

· If your child's doctor is concerned, he/she may prescribe antibiotics or if the lump appears worrisome, may refer your child to a pediatric surgeon to have a biopsy (removal and analysis of a tissue sample from the lump).

· Another type of neck lump is abranchial cleft cyst or sinus. They generally change in size and shape and are often first detected after anupper respiratory tract infection, which causes enlargement of the mass. Branchial cleft cysts or sinuses should be removed to assure the diagnosis, improve appearance, prevent infection, and prevent it as being a site for a potentialcancerin adulthood.

· Athyroglossal duct cyst, a mobile, soft nontender, round swelling, is also found in the center of the neck.

· Your child's doctor will probably want to have this kind of a cyst and its underlying attachment to the hyoid bone (located at the base of the tongue to support the tongue) surgically removed to prevent infection or potential malignancy.

中山大学附属第一医院小儿外科

孙俊杰医生

Department of Pediatric Surgery, the First Affiliated Hospital of Sun Yat-Sen University

Dr. SUN Junjie