Paediatric Head & Neck Surgery
Tongue tie (ankyloglossia) and upper lip tie
A Tongue-tie is caused by a tight lingual frenulum that restricts the tongue movements, potentially interfering with feeding in some breast or bottle fed neonates and infants. Maternal factors can also contribute to difficult breast feeding; Dr Pacilli advises you to consult with a lactation consultant before seeking advice regarding division of the tongue tie. Older children with a tongue-tie can have difficulty licking around their lips, or raising the tongue tip inside their mouth. This can potentially cause difficulties with eating (i.e. licking an ice-cream) or pronunciation of certain letters. Dr Pacilli advises you to consult with a speech and language therapist before seeking advice regarding the division of the tongue tie if your child is having speech difficulties.
Dr Pacilli offers division of the tongue tie in the consulting rooms for neonates and infants up to 3 months of age. Your baby is wrapped in a cosy blanket to keep his/her arms steady. The tongue tie is divided with sterile surgical scissors and up to 1 minute of pressure is applied under the tongue with sterile gauze. There might be a minimal amount of bleeding and you can feed your baby straightaway, this will help to stop the bleeding. You will stay in the consulting rooms for 30 minutes to make sure that there is no bleeding. If your child is older than 3 months of age, the procedure will need to be done under a general anaesthetic in hospital as a day surgery case. Dr Pacilli will advise you if the procedure is justified depending on your child’s symptoms.
Dr Pacilli does not perform surgery for upper lip ties in the consulting rooms and he will advise you if the procedure done under a general anaesthetic is justified depending on your child’s symptoms.
Dr Pacilli refers to the 2020 “Clinical Consensus Statement: Ankyloglossia in Children” by the American Society of Pediatric Otolaryngology when assessing and advising for your child’s tongue and upper lip tie surgery; in summary the consensus states:
Ankyloglossia does not typically affect speech;
Ankyloglossia may cause social/mechanical issues in older children (difficulty licking, difficulty keeping teeth clean, lower central incisor diastema, sense of social embarrassment);
Presence of an upper lip frenulum is normal in an infant;
Upper lip tie has an unclear relationship to breastfeeding difficulties;
Upper lip frenotomy in infants or children with primary dentition will not prevent the occurrence of an upper interincisor diastema (teeth gap);
Ankyloglossia does not cause sleep apnoea (breath holding).
Dermoid and epidermoid cyst
A dermoid cyst is a benign lump that contains skin and skin appendages, such as sebaceous glands, hair follicles, and sweat glands. It is often present in the head of the child, commonly at the corner of the eyebrow (angular dermoid cyst) but can be present anywhere in the body. An epidermoid cyst contains solely the upper part of the skin and keratin. Both cysts tend to grow slowly and can rarely get inflamed or infected resulting in an unsightly scar. It is generally recommended to remove them.
Pilomatrixoma
A pilomatrixoma is an uncommon, harmless, hair follicle tumour. It is also called “pilomatricoma” or “calcifying epithelioma of Malherbe”. It presents as a small, hard lump under the skin, usually on the face or neck; the skin might have a blue hue. It is usually painless and tends to grow slowly without causing problems, but can sometimes get inflamed resulting in an unsightly scar. It is generally recommended to remove it.
Branchial cleft cyst, fistula/sinus
Branchial cleft cysts, fistulae and sinuses are congenital abnormalities present at birth (branchial anomalies). During early pregnancy, gill-like structures (branchial) are present in the baby and if not reabsorbed they can be cause cysts, fistulae and sinuses. They can connect with the skin only through a small opening (sinus), draining white material. Other times they connect the throat to the skin, draining mucous through a small opening (fistula), or have no connection at all and slowly fill with mucous over time (cyst).
Branchial anomalies typically are present on the side of the neck, anywhere from around the ear to the lower neck. Branchial anomalies may become enlarged during or following an upper respiratory tract infection. Most often, an ultrasound scan is required to better understand the anatomy of the lesion, rarely, a CT or MRI scan might be needed. All branchial anomalies can be removed surgically.
Thyroglossal duct cyst
A thyroglossal duct cyst is formed during pregnancy when the thyroid gland of the baby, located initially at the base of the tongue, descends into the neck. The cyst is filled with mucous and is connected to a small tract, which goes through the hyoid bone, up to the base of the tongue. Often the thyroglossal duct cyst is noticed around 2-3 years of age as a painless cherry-sized lump in the middle of the neck. Occasionally, the cyst may become infected and red and might need antibiotic treatment before it is removed. Once the infection is settled, it will be necessary to remove the cyst. Removal of the cyst before it becomes infected is preferable. The cyst is removed through a small incision in the neck; it is necessary to remove part of the hyoid bone to avoid a recurrence. Your child might need to spend a night in the hospital after surgery.
Preauricular pit and tags
A preauricular pit (sinus) is a small hole under the skin, just in front of the ear; it might be connected to an underlying cyst. It occurs during prenatal development and it is rarely secondary to genetic causes.
The pit can be present on both sides of the face and is generally only a cosmetic problem and can be observed for a long period of time. The pit can become infected, presenting with pain, swelling, fever, redness and drainage of pus, requiring antibiotic treatment and occasionally drainage. If it becomes infected, it is recommended to be removed once the infection resolves.
A preauricular ear tag is a benign growth of skin, and sometimes cartilage, present at birth and usually located in front of the ear or on the cheek. There might be more than one and on both sides of the face. Rarely, ear tags can occur in association with genetic syndromes or hearing loss which requires screening at birth. A skin tag is normally just a cosmetic problem, but it can be removed by surgical excision that will leave a small scar. The tag does not grow back after surgery.
Disclaimer: Please note that the information contained on this website should not be used for the diagnosis or treatment of any medical condition. If you have specific questions about how the information relates to your child, please ask your doctor.