A Century of Progress
in Head & Neck Cancer

July 26 – 30, 2014
Marriott Marquis
New York, NY
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Presentation: P0604
Topic: Poster Session
Type: Poster
Authors: Tan S N, MD, Primuharsa Putra S H A, MD, MSurg, ORLHNS, Professor, Muhaizan W M, MD, MPath, Saim L, MD, MSurg, ORLHNS, FRCS, Professor
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Institution(s): KPJ Healthcare University College
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Introduction:  Cervical teratomas are extremely uncommon lesions of the head and neck. Teratomas occur in 1 of 4000 live births with head and neck teratomas accounting for less than 5% of the total. Second branchial cleft cysts are almost always located in the neck. Occurrence of the second branchial cyst in the parapharyngeal space is extremely uncommon.Cervical teratomas are managed with early surgical excision. This is particularly important in light of the possible malignant degeneration of these lesions.

Material and methods:  A 1-year-old baby boy with uneventful birth history presenting with right ear discharge for 5 months. The baby  was initially treated as chronic otitis media but not resolving with antibiotics. Subsequent follow up, noted to have granulation polyp of the right external auditory canal close to tympanic membrane. However despite antibiotics and excision of granulation polyp, right ear discharge is still persistent. Clinically, granulation and discharge of floor of right external auditory canal with a single lump of lower angle of right jaw. Other systemic examinations were normal.

Results:  A complete blood count and tuberculosis investigations were normal. MRI of the mastoids and internal acoustic meatus showed a cystic mass in right posterior parapharyngeal space with fistula of external auditory canal.  He underwent surgery  via parotidectomy approach with facial nerve preservation. Intraoperatively, a multiloculated mass measuring 2 cm x 4 cm deep to parotid was removed.  Post-operative recovery was uneventful and histopathology report confirmed benign mature teratoma.

The patient presented again with right ear discharge 6 months later. Repeat MRI of mastoid and internal acoustic meatus  showed a residual soft tissue mass lies at right posterior parapharyngeal space in communication with external auditory canal. He underwent second surgery via the same approach. Histopathology report of the mass confirmed to be branchial cyst with chronic inflammation and scarring. No recurrence was seen during follow-up.

Conclusion:   Teratomas are mostly benign congenital tumour which usually present in the neonates. Early complete excision is usually followed by cure.

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