I.GANGLIONI.GANGLION

Cystic swelling in relation with Cystic swelling in relation with

Tendon sheathTendon sheath Synovial sheathSynovial sheath Joint capsuleJoint capsule

GANGLION (Cont) GANGLION (Cont) Well Localized smooth, soft, cystic, Well Localized smooth, soft, cystic,

nontender, transilluminant,nontender, transilluminant,swelng –Mobileswelng –Mobile

Mobility restricted when the tendon is tight.Mobility restricted when the tendon is tight. Occasionally communicating with joint.Occasionally communicating with joint.

GANGLION (Cont) GANGLION (Cont)

TreatmentTreatment

ExcisionExcisionRecurrence rate is high.Recurrence rate is high.

Ganglion over the wrist.

I (a)

Ganglion wrist, which is transilluminant I (b)

II.CALCINOSIS CUTISII.CALCINOSIS CUTIS

Circumscribed foci of calcification in or under the skin.Circumscribed foci of calcification in or under the skin. Females are commonly affected.Females are commonly affected. Waist is the common site.Waist is the common site. Usually bilateral.Usually bilateral. Solid and hard swelling of the skinSolid and hard swelling of the skin Mimic calcified lipoma or neuro- fibromaMimic calcified lipoma or neuro- fibroma..

TreatmentTreatmentExcisionExcision

III.III. BURSAEBURSAE

Normally seen between tendon and boneNormally seen between tendon and bone

to reduce friction.to reduce friction. Infection/friction Bursitis Swelling + pain + Infection/friction Bursitis Swelling + pain +

Restriction of movements.Restriction of movements.

Different typesDifferent typesAnatomical.Anatomical.Adventitious.Adventitious.

IV. ANTOMICAL BURSAEIV. ANTOMICAL BURSAE

Subacromial bursitis.Subacromial bursitis. Sybhyoid bursa.Sybhyoid bursa. Bicipitoradial bursitis.Bicipitoradial bursitis. Olecranon bursitis (Student’s elbow)Olecranon bursitis (Student’s elbow) Pre patellar bursitis (housemaid’s knee)Pre patellar bursitis (housemaid’s knee) Infrapatellar bursitis (Clergyman’s knee)Infrapatellar bursitis (Clergyman’s knee) Bursa anserina-semi-tendinosus,strtorius-Bursa anserina-semi-tendinosus,strtorius-

ANTOMICAL BURSAE (Cont)ANTOMICAL BURSAE (Cont)

ComplicationsComplicationsInfectionInfectionBleeding in to the CystBleeding in to the CystMalignant transformationMalignant transformation

TreatmentTreatmentExcisionExcision

Bursa near elbow joint.

IV (a)

Adventitious bursa over medal aspect of foot-a

common siteIV (b)

Prepatellar (housemaid’s knee) and infrapatellar bursae ( Clergyman’s knee)

IV( c)

Adventitious Bursa

IV (d)

Common site of adventitious bursa (BUNION) IV (e)

V. ADVENTITIOUS BURSAV. ADVENTITIOUS BURSA

Bunion-Hallux valgus-over first metatarsalBunion-Hallux valgus-over first metatarsal Tailor’s Bursa-lateralmalleolus.Tailor’s Bursa-lateralmalleolus.

ComplicationsComplicationsInfectionInfectionHemorrhageHemorrhageMalignant transformationMalignant transformation

TreatmentTreatmentExcisionExcision

VI SEMIMEMBRANOSUS VI SEMIMEMBRANOSUS BURSABURSA

Cystic swelling in the upper medial aspect of the popliteal Cystic swelling in the upper medial aspect of the popliteal fossa.fossa.

Under the semimembranosus tendon. Under the semimembranosus tendon. Common in young individuals.Common in young individuals. Soft,smooth,crystic and non tender of the transilluminant.Soft,smooth,crystic and non tender of the transilluminant. On flexion the swelling disappears.On flexion the swelling disappears. No communication with the knee joint. No communication with the knee joint.

SEMIMEMBRANOSUS BURSA (Cont)SEMIMEMBRANOSUS BURSA (Cont)

ComplicationsComplications

InfectionInfectionHemorrhage in to the BursaHemorrhage in to the BursaMalignant transformationMalignant transformation

TreatmentTreatmentExcisionExcision

VII. BRANCHIAL CYSTVII. BRANCHIAL CYST

Cystic swelling from second branchial cleft.Cystic swelling from second branchial cleft. Anterior border of upper third of sternomastoid.Anterior border of upper third of sternomastoid. Smooth,soft and fluctuant ,often transilluminant.Smooth,soft and fluctuant ,often transilluminant. Contains cholesterol crystals.Contains cholesterol crystals. Lined by squamous epithelium.Lined by squamous epithelium.

BRANCHIAL CYST (Cont)BRANCHIAL CYST (Cont)

Differential DiagnosisDifferential Diagnosis

Cold abscess.Cold abscess. Lymph cyst.Lymph cyst.

TreatmentTreatment Excision under G/AExcision under G/A

Branchial Cyst

VII (a)

VIII. BRANCHIAL FISTULAVIII. BRANCHIAL FISTULA Persistent second branchial cleft with a communication outside.Persistent second branchial cleft with a communication outside. Can be congenitalor or acquired.Can be congenitalor or acquired. Often bilateral.Often bilateral. External orifice at the lower third of the neck along the anterior border of the External orifice at the lower third of the neck along the anterior border of the

sternomastoid.sternomastoid. Internal orifice –anterior aspect of the posterior pillar of the fauces, just behind Internal orifice –anterior aspect of the posterior pillar of the fauces, just behind

the tonsils.the tonsils. Track is lined by ciliated columnar epithelium with patches of lymphoid Track is lined by ciliated columnar epithelium with patches of lymphoid

tissues under it.tissues under it. Discharge from external orifice.Discharge from external orifice.

BRANCHAL FISTULA (Cont)

Investigation Fistulogram

TreatmentExcision of the entire track

IX. PHARYNGEAL POUCHIX. PHARYNGEAL POUCH

Protrusion of mucosa through killing’s dehiscence between Protrusion of mucosa through killing’s dehiscence between thyropharyngeous and cricopharyngeus of the inferior thyropharyngeous and cricopharyngeus of the inferior constrictor muscle.constrictor muscle.

Incomplete relaxation of cricopharyngeousIncomplete relaxation of cricopharyngeous

PHARYNGEAL POUCH –Clinical PHARYNGEAL POUCH –Clinical FeaturesFeatures

Globular swelling on the side of neck.Globular swelling on the side of neck.Smooth, soft and compressible.Smooth, soft and compressible.Often tender and causes dysphagia.Often tender and causes dysphagia.Food particles get trapped.Food particles get trapped.H/o finger evacuation of the pouchH/o finger evacuation of the pouchOften aspiration and pneumonia.Often aspiration and pneumonia.

InvestigationInvestigationBarium swallowBarium swallow

PHARYNGEAL POUCH (Cont)PHARYNGEAL POUCH (Cont)

TreatmentTreatmentExcision through neck.Excision through neck.Cricopharyngeal myotomy.Cricopharyngeal myotomy.

ComplicationsComplicationsMediastinitis.Mediastinitis.Abscess NeckAbscess NeckPharyngeal fistula.Pharyngeal fistula.

Pharyngeal pouch ( Zenker’s diverticulum)IX (a)

Barium swallow showing pharyngeal pouch

IX (b)

X. CYSTIC HYGROMAX. CYSTIC HYGROMA

Cystic swelling due to sequestration of a portion Cystic swelling due to sequestration of a portion of jugular lymph sac.of jugular lymph sac.

SitesSitesPosterior triangle of the neckPosterior triangle of the neckCheekCheekAxillaAxillaTongueTongueGroinGroinMediastinumMediastinumMultiple sitesMultiple sites

CYSTIC HYGROMA (Cont)CYSTIC HYGROMA (Cont)

Clinical featuresClinical features Swelling present from birth.Swelling present from birth. Smooth, soft, fluctuant, brilliantly transilluminant.Smooth, soft, fluctuant, brilliantly transilluminant. Increase in size can lead to Respiratory distress.Increase in size can lead to Respiratory distress.

ComplicationsComplications InfectionInfection Respiratory distressRespiratory distress BleedingBleeding

TreatmentTreatment Excision of the of the entire cyst which may have wide Excision of the of the entire cyst which may have wide ramifications.ramifications.

Cystic hygromaX (a)

XI. LUDWIG’S ANGINAXI. LUDWIG’S ANGINA Inflamation of the floor of the mouth and pharynx.Inflamation of the floor of the mouth and pharynx. Strepto coccal infection.Strepto coccal infection.

ComplicationsComplicationsEdema of sub-mandibular region.Edema of sub-mandibular region.Laryngeal edema and dyspnoea stridor.Laryngeal edema and dyspnoea stridor.Internal jugular venous thrombosis.Internal jugular venous thrombosis.

LUDWIG’S ANGINA (Cont)LUDWIG’S ANGINA (Cont)

Clinical featuresClinical features

Fever, toxicity, diffuse swelling, dyspnea,and trismusFever, toxicity, diffuse swelling, dyspnea,and trismus..

TreatmentTreatment

AntibioticsAntibioticsSurgical decompression of submandibular region.Surgical decompression of submandibular region.Tracheostomy as an emergency.Tracheostomy as an emergency.