Cervical cystic hygroma is a benign congenital malformation of the lymphatic system secondary to lack of development of communication between lymphatic and venous system. Incidence of cystic hygroma is 1/6000 live births. We present a case of giant anterior neck cystic hygroma which was initially asymptomatic and eventually developed stridor in a newborn.
The patient was a term baby girl delivered by elective cesarian section with Apgar were 7,8,10 at 1,5,10 minutes respectively. There was an incidental finding of an anterior neck mass in fetal ultrasound and was described on postnatal ultrasound as a large cystic lesion in the anterior neck which inferiorly followed the course of the right carotid artery, consistent with cystic hygroma. She was asymptomatic initially, She developed a stridor after one week, and a follow-up USS neck showed increased size of the cystic hygroma. Dexamethasone was started to reduce fluid buildup in the mass. Intraoperatively, as Cystic hygroma was found to be inseparable from the right half of the thyroid gland, hemithyroidectomy was performed. Post operatively Right side mandibular neuropraxia noted.
Cystic hygromas may be associated with trisomies, Turners, chromosomal aneuploidy and cardiac anomalies. Indications for surgery are cosmetic deformity, obstructive symptoms, bleeding and recurrent infections. Other treatment modalities include aspiration, radiation, and injection of sclerosing agents.
The neuropraxia involving the marginal mandibular branch of the facial nerve, was expected to correct with time. Large cervical cystic hygromas may surround or displace neurovascular structures making their identification quite challenging intraoperatively. A team of experienced surgeons will help to ensure a successful surgical outcome.