There was no recurrence of the median neck cyst. Median neck cyst

Cyst on the neck is a tumor-like formation localized in the anterior or lateral cervical areas, and filled with a mushy substance or liquid. It develops as a result of changes in the embryonic formation of the fetus and belongs to the class of congenital pathologies.

A cervical cyst is benign in nature, however, it can become complicated or complicated by suppuration, as well as the formation of a fistula. Ignore this pathology extremely dangerous - there is a high probability of the cyst degenerating into an atypical formation.

Classification of neck cyst

Despite the variety of studies and clinical descriptions, a significant part of the issues in the field of cystic cervical neoplasms remains poorly understood. We are also talking about a unified structural classification. Taking into account the characteristic features of cysts, it is customary to distinguish two main types of neoplasms:

The reason for the formation of midline tumors is the abnormal formation of the thyroglossal duct in the first trimester of pregnancy, when the process of creating the structure begins thyroid gland. A median neck cyst in an adult requires differential diagnosis to exclude pathologies such as thyroid adenoma, lymphadenitis, and dermoid.

The lateral neck cyst is distinguished by its late manifestation. It can be noticed on the body of a child aged 11-13 years, when, during the period of active growth of the young body, neoplasms also begin to grow. Owners of cysts do not notice discomfort until they suppurate, which causes compression of nerve and vascular fibers, as well as disruption of habitual eating.

Based on the principle of formation and structure, cysts are divided into the following forms:

• Gill - localized under the tongue in the bone area;
• Dermoid - a cyst of the soft tissues of the neck, located on the surface, there is no fixation with the pharynx. Usually it is filled with elements of sweat and sebaceous glands.

The classification according to the nature of education is also widespread:

• Lymphogenic cyst of the neck - is an anomaly in the development of lymphatic vessels;
• Hygroma is a soft formation with glandular contents located at the bottom of the cervical spine;
• Venous hemangioma is a rare neoplasm of brown or bluish color;
• Neurofibroma is a formation with a dense structure, ranging in size from 0.5 to 4 cm;
• Primary lymphoma - represented by a cluster of compacted nodules;

Symptoms

A submandibular cyst formed on the neck or, for example, a soft tissue cyst, for many years may be asymptomatic. Only the growth of tumor tissue provokes the appearance of the following symptoms:

• Painful sensations when touching the formation;
• Difficulty moving the neck;
• Local hyperemia (redness) of the skin;
• Impaired sensitivity of areas of the face due to compression of nerve fibers;
• Inability to hold your head up independently (important for infants).

As the process of suppuration progresses, the clinical picture is supplemented by symptoms such as:

• Swelling against the background of local hyperemia;
• Increase in body temperature to subfebrile levels (up to 38° C);
• Pain at the site of formation, increasing with palpation;
• Breakthrough of purulent contents;
• Lethargy and dizziness.

Availability of the above clinical signs serves as an indication to seek medical advice. The inflammatory process poses a danger to human health, as it can provoke the development of such serious pathologies as abscesses and phlegmons.

Diagnosis of a neck cyst

Diagnostic measures begin with a visual examination and palpation of the cyst, including the lymph nodes. The doctor collects the patient’s individual and family history.

To confirm or refute the diagnosis, the following laboratory and instrumental studies are necessary:

1. Taking a puncture of the contents of the cyst for histological examination.
2. Blood test for tumor markers.
3. Fistulography.
4. Ultrasound of neck cysts.
5. CT scan according to indications.

General clinical tests of urine and blood for this disease do not represent significant diagnostic value, therefore they are carried out exclusively in preparation for surgical treatment.

Differential diagnosis plays a key role - it determines the tactics and algorithm of surgical intervention. A neck lymph node cyst must be differentiated from diseases such as:

• Lymphogranulomatosis;
• Hemangioma;
• Tuberculosis of the cervical lymph nodes;
• Lymphoma;
• Lymphadenitis.

It is noteworthy that the only possible method of treatment is considered both easier and more difficult. This is explained by the fact that any cystic tumor in maxillofacial area implies removal, regardless of differential diagnosis.

Treatment of a cyst on the neck

Treatment of neck cysts without surgery is not possible. Neither puncturing, nor homeopathic medicines, nor methods traditional medicine unable to provide due therapeutic effect. Moreover, the listed methods can provoke the development of undesirable consequences.

They operate not only on adults, but also on children from 3 years of age. Surgical treatment is indicated for children if the cyst suppurates and poses a threat to the breathing process, and is also a source of intoxication in the body.

In adults, the median cyst is excised if its benign nature is determined, and the size of the tumor is no more than 1.5 centimeters.

Despite the rare diagnosis of congenital cystic neoplasms in the neck, there is a small risk (about 2-3%) of malignancy of the formation. An operation performed in the early stages will ensure the fastest formation of a scar - it will become barely noticeable after 4-5 months.

Cysts at the time of inflammation or suppuration are subjected to anti-inflammatory therapy, and only with the neutralization of the acute period does surgery become possible. This type of intervention is a minor operation that is performed as planned.

1. Extirpation (removal) of the median cyst is indicated in the early stages in order to prevent its infection through the hematogenous route. The tumor is removed under local anesthesia. If a tissue fistula is detected during surgery, its course is stained with methylene blue, which provides clear visualization. Careful intervention and complete removal of the structural elements of the cystic formation guarantees the absence of relapses.
2. The branchiogenic cyst of the neck, along with the median cyst, undergoes radical removal, but is a more complex intervention. This is justified by its localization - there is a high risk of injury blood vessels. Extirpation is performed together with the capsule or fistula, if it is identified. It is extremely rare for a relapse to occur, which is associated with incorrect diagnosis or erroneous surgical technique.

After surgery, the patient is prescribed antibacterial and anti-inflammatory therapy. IN mandatory It is necessary to treat the oral cavity with antiseptic solutions by rinsing. In the first days after surgical treatment, medical monitoring of the patient’s speech and swallowing is necessary.

Modern surgical techniques make it possible to perform such a “jewelry” excision of the tumor that after treatment the patient is unlikely to worry about the presence of an unsightly scar. In some cases, the doctor may recommend treating the scar with absorbable gels, such as Contractubex.

After 2.5-3.5 months, a control ultrasound of the neck is performed. If treatment was carried out in a timely manner, then the risk of relapse or the development of oncology is minimal. The operation does not require a long period of rehabilitation - after 10 - 12 days the patient can begin studying or working.

A neck cyst is a rare congenital anomaly that requires surgical treatment. The disease is quite complex, since diagnosis is somewhat difficult and there is a need to differentiate from a whole list pathological conditions in this anatomical region.

If a cystic tumor is detected, you should not hesitate to undergo surgery. Timely and competently carried out radical removal of tumor tissue, as well as adequate postoperative therapy, can guarantee up to 98% of a positive outcome.

Neck cyst A benign formation in the form of a tumor filled with fluid is considered to be located on the lateral or anterior cervical part.

The disease is most often congenital, formed during embryonic development, and sometimes has an acquired nature.

Often, a neck cyst is detected in combination with a cervical fistula, which is also congenital. The formation of a fistula occurs at any age when the cyst suppurates, which is noted in half of the cases of its detection.

Medical practice suggests a high probability that the cyst can degenerate into a malignant tumor, so only surgical treatment is offered.

Types of cysts

The classification defines its two main types - lateral and median.

• A lateral or branchiogenic cervical cyst is called hollow formation among the gill grooves formed due to intrauterine pathology of these slits at the beginning of pregnancy (4-6 weeks of the fetus). It is detected immediately during the birth of the child.
• A median cyst develops because the base of the thyroid gland moves to the front of the neck. The thyroid rudiment usually disappears during normal fetal development.

Middle(thyroglossal) cyst is the result of the remnants of the thyroid gland moving from the site of formation to the anterior surface of the neck. The age of the fetus when pathology can be determined is 6-7 weeks. Such a cyst is not detected immediately; it can be detected in childhood from 4 to 14 years.

Congenital fistula is never an independent disease; this pathology is a companion to both types of cysts.

There are 2 types of fistulas known. One is called complete if it has two outlets - in the oral mucosa and on the surface of the skin. An incomplete fistula has only one hole, in one of these places (skin or oral cavity).

Cysts have varieties according to their structure and principle of occurrence:

1. Dermoid. Refers to congenital formations. They can be lateral or median, determined by location. This tumor formation is based on the remains of embryonic tissue. It is a capsule of connective tissue cells, where cells of the hair follicles, sebaceous and sweat glands are found. A cyst of this type lies on the surface, not attached to the wall of the pharynx.
2. Branchiogenic (branchial). This cyst is also a congenital tumor. They consist of etithelium of gill pockets formed by elements of the thyropharyngeal duct. Located in the bone area under the tongue.
3. Lymphatic duct cyst.

A congenital form of cyst that occupies the lower part of the neck. It consists of different components, so it can have a cystic, cavernous, capillary-cavernous and cystic-cavernous form.

Types of cysts

There are the following types of tumor formations:

• Hygroma of the neck is a tumor formation of the lower cervical region, softer and smoother than with a branchhiogenic cyst, in contrast to which it is transparent. The branchial cyst is located in the upper part of the neck.
• Venous hemangioma is of vascular origin.
• Primary lymphoma is a group of adhesive nodes and differs from a cyst in its denser composition. Sometimes it's a single node. The structure of lymphoma is lobular.
• Neurofibromas are dense, immobile neoplasms with a diameter of 1-4 cm.
• A thyroid-lingual cyst is similar to a branchiogenic cyst and attaches to the bone under the tongue, starting in the mouth. Localized in the middle of the neck in the area of ​​the larynx. Moves up or down during swallowing.
• Other formations of this type include fatty tumors, benign lipomas (lipomas), consisting of blood vessels, tumors (hemangiomas).

Reasons for development

The cyst in the vast majority of cases is a consequence of congenital pathology of fetal tissue. Most often diagnosed at birth, and in adults at any age, it can be the result of injury, lymphatic disease, a precursor cancer.

A lateral cervical cyst forms already at early several weeks of pregnancy due to the pathological development of gill arches and slits, which should have disappeared during normal development.

If this formation is not removed in childhood, then in an adult it can reach impressive sizes, and this inevitably leads to compression of the larynx, neurovascular bundle and trachea.

In the case of a purulent process, branchial fistulas or fistulas are formed in the cysts, which also require surgical excision.

A median cyst develops due to the movement of the base of the thyroid gland towards the front of the neck. Its rudiment disappears if the fetus develops normally, but the pathological process in the body leads to the formation of a closed cavity.

A thyroglossal cyst is formed in the sixth week of a woman’s pregnancy. This type of cyst develops asymptomatically and is detected in children at 4-7 years of age, and then in adolescents at 10-14 years of age with rapid growth of the body.

Growing over time, the cyst begins to manifest as pus and swelling. A symptom of this tumor is pain when swallowing.

Lateral neck cysts

Neoplasms of this type are formed as single-chamber or multi-chamber. This is the most common cyst formation in life, accounting for 60% of the number of diagnosed pathologies of cervical cysts.

The lateral cyst is more dangerous for humans, since it is prone to oncological degeneration in a malignant form than the median one.

Increasing in size, it compresses nearby organs, tissues of nervous and vascular origin.

If there are no symptoms of the disease such as suppuration and squeezing sensations in cervical regions, then there are no complaints from the patient.

When examined by a doctor, a tumor formation in the shape of a circle or oval may be revealed, which is especially clearly visible when the patient turns his head in the opposite direction.

In this case, the examination of the cyst by palpation causes the patient to feel pain in the neck. The mobility and elasticity of the neoplasm is diagnosed, its connection with the skin is not detected, which does not change externally.

It is possible to determine a fluctuation indicating the presence of fluid in the cavity of the neoplasm.

If the lateral cyst festers, then it opens, having the appearance of a non-healing gill fistula or fistula, increased in size and painful to the touch. The skin over the cyst becomes red and swollen.

When the lateral cyst is opened through an outlet in the skin, the mouth of the fistula is found at the edge of the sternocleidomastoid muscle in front.

And excision through the oral mucosa allows you to see the mouth of the fistula in the mouth, in the area of ​​the palatine tonsil.

With a purulent cyst, the skin has hyperpigmentation and maceration (softening of tissue), often its manifestations are confused with lymphogranumatosis, adenophlegmon.

The diagnosis of this type of neck tumor disease is made in accordance with the history and clinical picture of the disease.

It is confirmed after a puncture, after which the detected opaque dirty white liquid is subjected to special examination.

TO additional ways diagnostics include:

• Probing;
• Fistulography with dye preparations.

Median neck cysts

A median cyst is formed due to the fact that the thyroid gland channel did not close in due time and instead of ducts, a thyroglossal cord is formed, due to which the pathology is formed.

Symptoms of a median cyst are obvious when visual inspection. There are many varieties, it is often differentiated from each of them - from lipoma to lymphadenitis.

They differ in the anatomical and physiological properties of the neoplasm tissues. These features allow you to make an accurate diagnosis and prescribe treatment.

The share of this type of cyst is 40% of all diagnosed cervical formations. When swallowed, it moves easily, since it has no connections with the skin.

A symptom of a median cyst is considered to be impaired speech and difficulty swallowing, caused by its location close to the root of the tongue, which rises at the same time, which causes such disorders.

Diagnosis of the disease is made by external examination with palpation of the organ. Manual palpation does not cause pain, unlike a lateral cyst.

More than half of the cases of this type of cyst are accompanied by suppuration, causing inflammation and swelling of the tissues and pain when swallowing.

Opening the abscess causes the formation of a fistula with an orifice, located in the front of the neck, in the area of ​​the cartilage and hyoid bone.

When the fistula opens into the oral cavity, its mouth is on the lingual surface.

A more accurate diagnosis is made after examining a sample of the median cyst for the presence of infections. Often accompanying this cyst are cultures of white staphylococcus.

A median cyst that opens randomly due to the accumulation of pus is called a median fistula of the neck, which can be pinpoint or clearly visible.

It is easily determined by a clear, dense formation that does not adhere to the skin. And the median cyst is often defined as a dermoid cyst, which is not always true, since the latter is denser and the swallowing process does not cause its displacement.

The symptoms of a median cyst are similar in appearance to lipoma or lymphogioma, but the latter have unclear boundaries and dimensions of more than 2 cm in diameter, which are inherent in the former.

The final diagnosis is usually made by studying the clinical picture and medical history, ultrasound and MRI (magnetic resonance therapy).

The study is complemented by the use of the cyst puncture method, after which a cloudy yellowish liquid containing lymphoid elements is obtained. The isolated fluid undergoes cytological examination.

Fistula formations are diagnosed after fistulography and probing.

Treatment of neck cyst

Medical practice shows that The only possible way to treat any type of cyst is to remove it.

After a thorough examination of the tumor, the surgeon chooses a method for removing the cyst depending on its type, because each type of tumor has its own characteristics and is removed differently.

Removal of lateral cysts occurs surgically. Median formations can be excised in childhood, regardless of size, and in adults, if the diameter of the cyst is more than 1 cm, because such tumors on the smaller neck are almost invisible.

Removal of the cyst with capsule occurs using general anesthesia. To do this, the doctor cuts the area above the cyst, isolates the tumor and removes it with all its contents.

During surgical interventions involving a median cyst, it is necessary to remove a piece of the hyoid bone affected by the tumor formation.

Removal of a lateral cyst is complicated by the fact that blood vessels and nerve endings are located next to it. A tumor of the root of the tongue is removed through the mouth or through a skin incision, depending on the size of the tumor.

Removal of a benign tumor during suppuration is not recommended by doctors. In this case, it is enough to open it and drain it.

Urgent surgery is indicated when an acute inflammatory process is detected. A closed fistula and soft tissue abscess (edema, hyperemia) require immediate opening and washing of the cyst cavity with antiseptic solutions.

After the operation, dressings and anti-inflammatory therapy are carried out. Sometimes the cyst cavity does not heal, then it should be removed surgically, but several months after the abscesses have resolved.

Timely contact with specialists will help to avoid malignancy of the cyst with its degeneration into oncology.

Fistulas different types also subject to excision and removal. The presence of thin walls and tortuous passages of the fistula make operations somewhat difficult. The introduction of a probe or coloring agent makes the task easier. All fistula tracts are carefully removed in order to prevent relapse of the disease.

The pathological formation is removed as follows. In order to avoid trauma to the bone under the tongue when isolating the operated area of ​​the neck, the doctor resects the space under it and ties the fistula at the base. After the excision, the wound is sutured.

The most difficult operations are to remove lateral cervical fistulas, since their passages go between the carotid arteries.

Modern operating technologies make it possible to achieve positive cosmetic results.

The appearance of various neoplasms hardly leaves a person indifferent. Anything that appears on the body and in any way resembles a tumor causes well-founded concern. Of course, a tumor-like formation does not always mean sarcoma or cancer. Many tumors are benign and can cause virtually no harm for years, except that, being in a visible place, they can create cosmetic problems. However, the occurrence of tumors means the need to urgently consult a doctor, since the possibility that the tumor is malignant can never be ruled out.

When a tumor-like formation appears on the neck, correct diagnosis is extremely important, and not only because there is a possibility that the tumor is malignant. There are pathologies that, although not as terrible as cancer, are nevertheless serious diseases that require prompt adoption of appropriate measures. These include median neck cyst.

Median neck cyst: appearance

Strictly speaking, such a cyst can be called a neoplasm with a fair degree of convention, since no matter how old the patient in whom it was discovered, the prerequisites for its occurrence appeared in the intrauterine state - even in the third or fifth week of fetal development.

A cervical cyst is the result of an intrauterine developmental defect, which is quite rare. For a long time it may not make itself felt, so diagnosing it can sometimes be difficult. Although this pathology can be found in both children and adults, the most often times the manifestation of its symptoms is a period of intense growth. It is also common for a cyst to grow in adolescence, when noticeable hormonal changes occur in the body.

So, what is this disease, why is it dangerous, how does it manifest itself and how is it treated?

What is a median neck cyst?

The thyroid gland, a vital human organ responsible for regulating metabolism, is located in the neck. However, its rudiment is formed in the fetus in the sublingual region. Subsequently, during intrauterine development, it descends into the neck through a special passage called the thyroglossal duct. After the embryo has descended to the place where the fully formed thyroid gland, the duct must close. However, in some cases this does not happen. This phenomenon is called embryonal dysplasia. On its basis, pathologies such as cysts and fistulas develop.

Diseases arising from embryonal dysplasia are quite rare. According to statistics, a median cyst occurs in one child out of at least three hundred newborns. However, diseases this kind of very serious. They require an accurate diagnosis and urgent surgical intervention.

Mostly, a median cyst develops in children and young adults. However, there are situations when this pathology manifests itself in later years.

Median neck cyst in a child

Two pathologies are associated with non-closure of the thyroglossal canal:

• median neck cyst;

Which of these two diseases subsequently develops depends on the degree of embryonal dysplasia. If the thyroglossal canal remains completely open, a fistula forms. If the dysplasia is incomplete, then a closed cavity forms inside the neck, which leads to the appearance of a cyst.

The median cyst of the neck is a benign neoplasm, which is a cavity filled with densely elastic or doughy contents.

A cervical cyst can be either median or lateral. These two types of cysts differ in their origin. A lateral cyst develops in the fetus before it reaches six weeks. The site of formation of such a cyst is the gill slits, which should close when the embryo becomes a fetus. As a rule, such cystic formations are detected in a child immediately after birth.

Middle or thyroglossal cervical cyst is a slowly growing painless round protrusion, localized in the midline of the neck in the area between the thyroid cartilage and the hyoid bone. Occasionally, cystic formations form directly under lower jaw in front of the hyoid bone or even above it - near the root of the tongue. IN the latter case the disease is called a tongue root cyst, and the cause of its appearance is the same as that of an ordinary median cyst. Sometimes the cervical cyst is displaced to the right or left of midline. In most cases, this tumor reaches a size of two to three centimeters.

Thyroglossal cervical cyst is characterized by:

• clarity of boundaries;
• absence of color changes and mobility of the adjacent skin;
• limited mobility of the formation itself due to its connection with the hyoid bone by a dense cord, which can sometimes be palpated.
• yellowish color of the liquid obtained during puncture.

The punctuate taken from the cyst contains epithelial cells and lymphoid components. He may have varying degrees turbidity. In case of development of the inflammatory process in it.

A characteristic feature The median cyst is its upward movement during swallowing, which is easily detected when the tumor is held with the fingers. The reason for this phenomenon is the presence of a cord connecting the cyst and the hyoid bone.

Why is a median neck cyst dangerous?

If the cyst is located near the root of the tongue, it complicates swallowing movements and impairs speech. If the cystic formation is large, breathing problems may even occur.

A serious danger is that the cyst can become inflamed, which, in turn, can lead to other complications. The onset of the inflammatory process is indicated by the following signs:

1. Redness of the skin located directly above the cyst.
2. Hyperthermia and swelling of the skin area adjacent to the cystic formation.
3. The appearance of holes in the skin from which viscous mucopurulent fluid oozes.
4. Pain when swallowing.

In more than half of the cases, all these symptoms indicate suppuration of the cyst. Infection occurs as a result of the penetration of pathogens either through thin channels connecting the tumor to the oral cavity, or through the blood. Often, suppuration of a cystic formation is provoked by some kind of injury.

Median neck cyst: ultrasound

Accumulated pus can break out. In this case, a fistula of the middle cyst of the neck is formed. This is not the worst outcome yet. After the abscess breaks through, the inflammatory process usually subsides and the fistula heals. A breakthrough of the abscess inside is much worse. This can lead to infection entering the bloodstream, the development of general sepsis and, ultimately, death.

Fistula of the median cyst of the neck

Some time after the pus has left the area of ​​inflammation, the inflammatory process has subsided, and the fistula has healed, a relapse of inflammation may occur.

What is a median fistula of the neck

This pathology is also a consequence of embryonic dysplasia and occurs when the thyroglossal canal remains completely open. There are complete and incomplete thyroglossal fistulas. The first begin on the skin of the neck, in the area between the thyroid cartilage and the hyoid bone. They end near the root of the tongue, passing through the hyoid bone.

An incomplete fistula can be external or internal. An external fistula begins on the cervical skin and rests on the hyoid bone, without going further. An internal fistula begins near the hyoid bone and ends near the root of the tongue.

An external fistula is characterized by the presence of scars on the surrounding skin and its maceration - swelling and softening of its upper layer. In the subcutaneous tissue, you can feel the cord that connects the fistula opening and the hyoid bone and moves when swallowing. Sometimes the fistula hole temporarily closes. This is the reason for the presence of scars on the skin.

Median neck fistula in an adult

If the fistula opens on its own, or is surgically opened, then pus is discharged from it, which, after the inflammatory process has calmed down, is replaced by scanty mucus.

An internal fistula may not manifest any symptoms at all, since the discharge drains into the oral cavity. The development of an inflammatory process, accompanied by pain, occurs when the outflow of fluid from the fistula is disrupted.

How is a median neck cyst diagnosed in a child?

One of the main ways to diagnose a cervical cyst is to examine the child and palpate the tumor. If this approach does not provide a comprehensive answer regarding the nature of the formation, then additional diagnostic methods are used, in particular, cytological examination of fluid taken from the cyst.

The final clarity when making a diagnosis is provided by ultrasound examination, magnetic resonance imaging and computed tomography. These methods allow you to set:

• form of neoplasm;
• cyst size;
• presence of fistulas.

The length of the fistula tracts is determined using probing and fistulography - an x-ray technique that uses contrast agents. The fistulographic method of examining fistulas allows one to determine the shape of the tracts and their length, as well as establish the presence of branches, cavities, and connections with nearby organs.

When diagnosing a median cervical cyst, it is important to differentiate this pathology from diseases such as:

• lipoma;
• tumor of the lymphatic vessels;
• dermoid cyst;
• lymphadenitis.

Lipoma and lymphatic tumor are usually larger than the median cyst. They are much softer to the touch and do not have clear outlines. In addition, there may be an increase in the amount of their content. A dermoid cyst, on the contrary, is a denser formation. Swallowing movements do not cause its displacement, and the embryonic duct cannot be felt during palpation. Lymphadenitis usually develops in the presence of a focus of infection. To diagnose this disease, knowledge of the patient's medical history is important.

Treatment of median neck cyst

There is only one way to treat this pathology - surgery. It is permissible to perform surgical treatment of cervical cysts in children over three years of age. Conservative treatment methods are almost never used, except during the rehabilitation period after surgery. Modern surgical methods make it possible to completely remove the cyst, as well as return the child to the original shape of the neck. The latter is an argument in favor of the fact that this operation should be done as early as possible.

Removing a median neck cyst involves the following steps:

• ligation of cystic fistula;
• excision of the cyst and its capsule;
• removal of part of the hyoid bone - in the place where the cord from the cyst passes;
• applying cosmetic stitches.

Removal of median neck cyst

Fistulas are also subject to excision. Moreover, this operation is quite complicated, since the walls of the fistula are thin, and the passages can be quite tortuous. Therefore, in such operations, staining with special dyes is used. All fistula tracts, including the smallest ones, must be completely removed, otherwise the pathology may recur.

Median neck cyst after surgery

Thanks to the use of modern methods, surgery to remove a cervical cyst, despite its complexity, usually ends successfully. The child, as a rule, easily tolerates the rehabilitation period and soon returns to normal life.

The likelihood of a midline neck cyst turning into a malignant tumor is extremely low. However, this is not a reason to ignore the problem. The cyst is especially dangerous in infancy, since if it is large enough it can cause compression of the respiratory tract.

The neck cyst, as a type of pathological neoplasm, is included in a large group of diseases - cysts of the maxillofacial area and neck.

The vast majority of cystic formations in the neck are congenital; they are a hollow tumor consisting of a capsule (wall) and contents. A cyst can develop as an independent pathology, long time remaining a benign formation, but sometimes the cyst is accompanied by complications - fistula (fistula), suppuration, or transforms into a malignant process.

Despite many clinical descriptions and studies, some issues in the field of cystic neoplasms of the neck remain incompletely studied, this primarily concerns a unified species classification. In general ENT practice, it is customary to divide cysts into median and lateral; also, in addition to the international classifier ICD 10, there is another systematization:

• Sublingual-thyroid cysts (median).
• Thymopharyngeal cysts.
• Branchiogenic cysts (lateral).
• Epidermoid cysts (dermoids).

United by a single etiological embryonic basis, the specific forms of cysts have different development and diagnostic criteria that determine the tactics of their treatment.

Neck cyst - ICD 10

The International Classification of Diseases, 10th revision, has been a single generally accepted standard document for coding and specifying various nosological units and diagnoses for many years. This helps doctors quickly formulate diagnostic conclusions and compare them with international clinical experience therefore, choose more effective therapeutic tactics and strategies. The classifier includes 21 sections, each of them is equipped with subsections - classes, headings, codes. Among other diseases, there is a neck cyst; the ICD includes it in class XVII and describes it as congenital anomalies (blood defects), deformations and chromosomal disorders. Previously, this class included pathology - the preserved thyroglossal duct in block Q89.2, now this nosology has been renamed into a broader concept.

Today, the standardized description, which includes a neck cyst, is presented by the ICD as follows:

Neck cyst. Class XVII

Block Q10-Q18 – congenital anomalies (malformations) of the eye, ear, face and neck

Q18.0 – sinus, fistula and branchial cleft cyst

Q18.8 – other specified malformations of the face and neck:

Medial defects of the face and neck:

• Cyst.
• Fistula of the face and neck.
• Sinuses.

Q18.9 – unspecified malformation of the face and neck. Congenital anomaly of the face and neck NOS.

It should be noted that in clinical practice, in addition to ICD 10, there are internal systematizations of diseases, especially those that have not been sufficiently studied, which fully include cystic formations in the neck. Otolaryngologists-surgeons often use the classification according to Melnikov and Gremilov; previously, the classification characteristics of cysts according to R.I. Venglovsky (beginning of the 20th century), then the criteria of surgeons G.A. Richter and the founder of domestic pediatric surgery N.L. Kushch came into practice. However, the ICD remains the single official classifier, which is used to record the diagnosis in official documentation.

Causes of cysts on the neck

The vast majority of neck cysts and fistulas are congenital anomalies. The pathogenesis and causes of neck cysts are still being clarified, although at the beginning of the last century a version appeared that cystic formations develop from the rudiments of the branchial arches. The fistula, in turn, is formed due to incomplete closure sulcus branchialis - gill grooves, and then in their place retention branchiogenic ones can develop lateral cysts. A four-week embryo already has six formed cartilaginous plates, which are separated by grooves. All arches consist of nervous tissue, arteries and cartilage. During embryogenesis, in the period from the 3rd to the 5th week, cartilage is transformed into various tissues of the facial part of the head and neck; a slowdown in reduction at this time leads to the formation of closed cavities and fistulas.

• Rudimentary remains of the sinus cervicalis - the cervical sinus - form lateral cysts.
• Anomalies in the reduction of the second and third slits contribute to the formation of fistulas (external), while the gill slits are not separated from the neck.
• Non-closure of the ductus thyroglossus - thyroglossus duct leads to median cysts.

Some researchers of the last 20th century proposed to describe all congenital cysts of the parotid zone and neck as thyroglossal, since this most accurately indicates the anatomical source of their formation and the clinical features of development. Indeed, the inner part of the capsule of neck cysts, as a rule, consists of stratified columnar epithelium interspersed with squamous epithelial cells, and the surface of the walls contains thyroid tissue cells.

Thus, the theory of congenital etiology remains the most studied and the causes of cysts on the neck are the rudiments of such embryonic clefts and ducts:

• Arcus branchialis (arcus viscerales) - gill visceral arches.
• Ductus thyreoglossus – thyroglossus duct.
• Ductus thymopharyngeus - goitrous-pharyngeal duct.

The causes of cysts on the neck are still the subject of debate, the opinions of doctors agree on only one thing - all these neoplasms are considered congenital and their frequency in statistical form looks like this:

• From birth to 1 year – 1.5%.
• From 1 to 5 years – 3-4%.
• From 6 to 10 years – 3.5%.
• From 10 to 15 years – 15-16%.
• Over 15 years old – 2-3%.

In addition, there is now information about genetic predisposition to early defects of embryonic development of the recessive type, however, this version still needs more extensive, clinically confirmed information.

Cyst in the neck area

A congenital cyst in the neck area can be localized in the lower or upper surface, on the side, be deep or located closer to the skin, and have a different anatomical structure. In otolaryngology, neck cysts are usually divided into several general categories - lateral, median, dermoid formations.

A lateral cyst in the neck area is formed from rudimentary parts of the gill pouches due to their insufficiently complete obliteration. According to the concept of branchiogenic etiology, cysts develop from closed gill pouches - from the external ones - dermoid cysts, from the external ones - cavities containing mucus. Fistulas are formed from the pharyngeal pockets - through, complete or incomplete. There is also a version about the origin of branchiogenic cysts from the rudiments of the ductus thymopharyngeus - the thymopharyngeal duct. There is an assumption about the lymphogenic etiology of lateral cysts, when during embryogenesis the formation of the cervical lymph nodes is disrupted, and epithelial cells of the salivary glands are interspersed into their structure. Many specialists who have thoroughly studied this pathology divide lateral cysts into 4 groups:

• A cyst located under the cervical fascia, closer to the anterior edge of the Musculus sternocleidomastoideus - the sternocleidomastoid muscle.
• A cyst localized deep in the tissues of the neck on large vessels, often fused with the jugular vein.
• A cyst located in the area of ​​the lateral wall of the larynx, between the external and internal carotid arteries.
• A cyst located next to the wall of the pharynx, medial to the carotid artery; often such cysts are formed from branchial fistulas closed by scars.

Lateral cysts in 85% appear late, after 10-12 years, begin to increase, demonstrate clinical symptoms as a result of injury or inflammation. A small cyst in the neck area does not cause discomfort For a person, only increasing and suppurating, it disrupts the normal process of eating and puts pressure on the neurovascular bundle of the cervical bundle. Branchiogenic cysts that are not diagnosed in a timely manner are prone to malignancy. Diagnosis of lateral cysts requires differentiation from the following neck pathologies with similar clinical manifestations:

• Lymphangioma.
• Lymphadenitis.
• Lymphosarcoma.
• Vascular aneurysm.
• Cavernous hemangioma.
• Lymphogranulomatosis.
• Neurofibroma.
• Lipoma.
• Cyst of the thyroglossal tract.
• Tuberculosis of the lymph nodes.
• Postopharyngeal abscess.

A lateral cyst on the neck can only be treated surgically, when the cyst is completely removed along with the capsule.

A median cyst in the neck area is formed from unreduced parts of the ductus thyroglossus - the thyroid-lingual duct in the period between 3-1 and 5-1 weeks of embryogenesis, when thyroid tissue is created. A cyst can form in any area of ​​the future gland - in the area of ​​the blind opening of the root of the tongue or near the isthmus. Median cysts are often subdivided according to their location - formations in the sublingual region, cysts of the root of the tongue. Differential diagnosis is necessary in order to determine the difference between a median cyst and a dermoid, adenoma of the thyroid gland, and lymphadenitis of the mental nodes. In addition to cysts, median cervical fistulas can form in these areas:

• A complete fistula, which has an opening in the oral cavity at the root of the tongue.
• An incomplete fistula ending in a thickened canal in the oral cavity at the bottom.

Median cysts are treated only with radical surgical methods, suggesting removal of the formation along with the hyoid bone, anatomically associated with the cyst.

Symptoms of a neck cyst

The clinical picture and symptoms of different types of neck cysts differ slightly from each other, the difference is only in the symptoms of purulent forms of formations, and visual signs of cysts may depend on the area of ​​their location.

Lateral, branchiogenic cysts are diagnosed 1.5 times more often than median cysts. They are found in the anterolateral area of ​​the neck, in front of the sternocleidomastoid muscle. The lateral cyst is localized directly on the vascular bundle near jugular vein. Symptoms of a branchiogenic cyst of the neck may depend on whether it is multi-chambered or simple, single-chambered. In addition, the symptoms are closely related to the size of the cysts; large formations appear faster and clinically more pronounced, as they aggressively affect blood vessels and nerve endings. If the cyst is small, the patient does not feel it for a long time, which significantly aggravates the course of the process, treatment, and prognosis. A sharp growth of the cyst can occur when it suppurates, pain appears, the skin over the cyst becomes hyperemic, swells, and the formation of a fistula is possible.

Upon examination, a lateral cyst is defined as a small tumor, painless on palpation, elastic in consistency. The cyst capsule is not fused to the skin, the cyst is mobile, and the liquid contents in its cavity are clearly palpable.

The median cyst is slightly less common than the lateral formations; it is defined as a fairly dense tumor, painless on palpation. The cyst has clear contours, is not attached to the skin, and its displacement is clearly visible when swallowing. A rare case is a median cyst of the root of the tongue, when its large size makes it difficult to swallow food and can cause speech impairment. The difference between median cysts and lateral ones is their ability to frequently suppurate. Accumulated pus provokes a rapid enlargement of the cavity, swelling of the skin, and pain. It is also possible to form a fistula with access to the surface of the neck in the area of ​​the hyoid bone, less often into the oral cavity in the area of ​​the root of the tongue.

In general, the symptoms of a neck cyst can be characterized as follows:

1. Formation during embryogenesis and development up to a certain age without clinical manifestations.
2. Slow development, growth.
3. Typical localization zones by species.
4. The manifestation of symptoms as a result of exposure to a traumatic factor or inflammation.
5. seal, painful sensations, involvement of the skin in the pathological process.
6. Symptoms general reaction body to an inflammatory purulent process - increased body temperature, deterioration general condition.

Cyst on the neck of a child

Cystic neoplasms on the neck are a congenital pathology associated with embryonic dysplasia of germinal tissues. A cyst on a child’s neck can be detected in early age, but there are also frequent cases of a latent process, when the tumor is diagnosed at a later age. The etiology of neck cysts is currently unclear; according to available information, it is most likely of a genetic nature. According to a report by English otolaryngologists, presented to colleagues several years ago, a cyst on a child’s neck may be due to a hereditary factor.

A child inherits a congenital pathology of a recessive type, statistically it looks like this:

• 7-10% of the examined children with a neck cyst were born to a mother who was diagnosed with a benign tumor in this area.
• 5% of newborns with a neck cyst are born to a father and mother with a similar pathology.

Frequency of detection of congenital neck cysts by age:

• 2% - age up to 1 year.
• 3-5% - age from 5 to 7 years.
• 8-10% - age over 7 years.

Small percentage early detection cysts in the neck area are associated with their deep location, asymptomatic development and the long period of formation of the neck as an anatomical zone. Most often, cysts in a clinical sense debut as a result of an acute inflammatory process or neck injury. With such provoking factors, the cyst begins to inflame, enlarge and manifest itself with symptoms - pain, difficulty breathing, eating, and less often - changes in the timbre of the voice. Congenital suppurating cysts of the neck in children can spontaneously open into the oral cavity, in such cases symptoms of general intoxication of the body clearly appear.

Treatment of a neck cyst in a child is carried out surgically from the age of 2-3 years; if the formation threatens the breathing process, the operation is performed regardless of age. The difficulty of surgical intervention lies in the age of young patients and the anatomical proximity of the cyst to important organs and vessels. That is why the frequency of relapses after surgery in the period up to 15-16 years is very high - up to 60%, which is not typical for the treatment of adult patients. However, surgery remains the only possible method of treating cystic tumors in childhood; the only option may be puncture of the purulent cyst, anti-inflammatory conservative therapy and surgery in more advanced cases. late period provided that the tumor does not cause discomfort and does not provoke functional impairment.

Cyst on the neck in an adult

The frequency of detection of cysts in the neck area in adults is quite high. This is an argument in favor of one of the versions explaining the etiology of development benign tumors neck. According to some researchers, more than half of neck cysts cannot be considered congenital; in patients aged 15 to 30 years, branchiogenic and midline neoplasms and fistulas are diagnosed 1.2 times more often than in children aged 1 to 5 years.

A cyst on the neck in an adult develops faster than in a child and is larger in size, sometimes reaching 10 centimeters. Median cysts are prone to frequent suppuration, and lateral tumors are accompanied by more severe symptoms and are often adjacent to fistulas. In addition, cysts on the neck in children are less likely to become malignant; according to statistics, only in 10% of all clinical cases. In adult patients over 35 years of age, the frequency of degeneration of a neck cyst into a malignant process reaches a ratio of 25/100, that is, for every hundred cases there are 25 diagnoses of one or another type of cancer. As a rule, this is explained by the neglect of the disease, which proceeds for a long period without clinical signs and manifests symptoms already in the later stages of development. Most often, malignant cysts are metastases to the lymph nodes of the neck and branchiogenic cancer. Timely diagnosis at an early stage it helps to eliminate a neck cyst and eliminate the risk of such a serious pathology. The first sign and alarming symptom for both the patient and the diagnostician is considered to be enlarged lymph nodes. This is a direct indication of the search for the primary focus of the oncological process. In addition, any visible lump on the neck measuring more than 2 centimeters can also indicate a serious pathology and requires a very careful comprehensive diagnosis. The exclusion of a threatening pathology can be considered an indication for a fairly simple operation to remove a lateral or median neck cyst. The operation is performed under endotracheal anesthesia and lasts no more than half an hour. No recovery period required specific treatment, you need to regularly visit your doctor to monitor the healing process.

Dermoid cyst on the neck

A dermoid cyst, wherever it is localized, develops asymptomatically for a long time. An exception may be a dermoid cyst on the neck, since its enlargement is immediately noticed by the person himself, in addition, large cysts interfere with the process of swallowing food. A dermoid is an organoid congenital formation, which, like the median and lateral cysts, is formed from the remains of embryonic tissue - parts of the ectoderm, displaced to one or another zone. The cyst capsule is formed from connective tissue; inside there are cells of sweat, sebaceous glands, hair and hair follicles. Most often, dermoids are localized in the sublingual or thyroid-lingual zone, as well as in the tissues of the oral cavity, at the bottom, between the hyoid bone and inner bone chin. When the cyst enlarges, its growth occurs, as a rule, in the internal direction, into the sublingual region. Less commonly, a cyst can be seen as an atypical bulging formation in the neck, so a dermoid on the neck is considered a rather rare pathology. Dermoid grows very slowly and can become symptomatic during the period of hormonal changes - during puberty, during menopause. The cyst, as a rule, does not cause pain; suppuration is not typical for it. In a clinical sense, the dermoid cyst of the neck is very similar to other cysts in this area; it is not fused to the skin and has a typical rounded shape, the skin over the cyst does not change. The only one specific sign The dermoid may become denser in consistency, which is determined during the initial examination by palpation. Dermoid cysts are differentiated during the diagnostic process from atheromas, hemangiomas, traumatic epidermal cysts and lymphadenitis.

A dermoid cyst can only be treated surgically; the sooner the tumor is removed, the lower the risk of dermoid malignancy. The festering dermoid cyst is removed in the remission stage, when the inflammatory process subsides: the cavity is opened, the contents of the capsule are evacuated. The cyst is exfoliated within the boundaries of healthy skin, after the procedure the wound quickly heals, with virtually no scar. In adults, surgical treatment of a dermoid cyst on the neck is carried out under local anesthesia; in children, operations are performed after 5 years under general anesthesia. Treatment for dermoid usually does not cause complications, but the neck area is an exception. Surgical intervention in this area is often fraught with difficulties, since the cyst has a close anatomical connection with muscles and functionally important arteries. It happens that along with the tumor, the fistula passage and hyoid bone are also removed to eliminate the risk of relapse. The prognosis for treatment of dermoid in the neck is favorable in 85-90% of cases; postoperative complications are extremely rare; relapses are more often diagnosed when the cyst capsule is not completely removed. Lack of treatment or refusal of surgery on the part of the patient can lead to inflammation and suppuration of the tumor, which is also prone to developing into a malignant tumor in 5-6%.

Branchiogenic cyst of the neck

Lateral branchial cyst or branchiogenic cyst of the neck is a congenital pathology that is formed from epithelial cells gill pockets. The etiology of lateral cysts has been little studied - there is a version about the origin of branchiogenic formations from the goitrous-pharyngeal duct, but it is still controversial. Some doctors are convinced that the formation of gill tumors is influenced by the embryonic growth of lymph nodes, when salivary gland cells are included in their structure; this hypothesis is confirmed by the histological results of the study of cysts and the presence of lymphoid epithelium in their capsule.

The most common interpretation of the pathogenesis of lateral cysts is:

1. Branchiogenic neoplasms localized above the hyoid bone develop from the rudimentary remains of the branchial apparatus.
2. Cysts located below the hyoid bone area are formed from the ductus thymopharyngeus - the goitrous-pharyngeal duct.

A branchiogenic cyst of the neck is very rarely diagnosed at an early stage of development, having formed in utero; even after the birth of a child, it does not manifest itself clinically and develops latently for a long time. The first symptoms and visual manifestations may debut under the influence of provoking factors - the inflammatory process, injury. Often, a lateral cyst is diagnosed as a simple abscess, which leads to therapeutic errors when, after opening the cyst, suppuration begins and a stable fistula with a non-closing tract is formed.

Signs of cyst growth may include difficulty swallowing food, periodic pain in the neck due to pressure of the tumor on the neurovascular node. An undetected cyst can grow to the size of a large walnut when it becomes visually visible, forming a characteristic bulge on the side.

The main symptoms of a formed branchiogenic cyst:

• Increase in size.
• Pressure on the neurovascular bundle of the neck.
• Pain in the area of ​​the tumor.
• Suppuration of the cyst increases pain.
• If the cyst opens on its own from the oral cavity, the symptoms temporarily subside, but a fistula remains.
• With a cyst large sizes(more than 5 cm), the patient’s voice timbre may change and hoarseness may develop.
• A cyst that opens on its own is prone to recurrence and is accompanied by complications in the form of phlegmon.

A lateral cyst requires careful differential diagnosis; it must be separated from the following pathologies of the maxillofacial area and neck:

• Dermoid neck.
• Lymphangioma.
• Hemangioma.
• Lymphadenitis.
• Abscess.
• Cystic hygroma.
• Lipoma.
• Accessory thymus gland.
• Tuberculosis of the lymph nodes of the neck.
• Aneurysm.
• Neurofibroma.
• Lymphosarcoma.

Branchiogenic tumor of the neck is treated only with radical operational methods, any conservative methods cannot be effective and often result in relapses.

Congenital cyst of the neck

Congenital cysts and fistulas in the neck area are conventionally divided into two types - median and lateral, although there is a more detailed classification, usually used in otolaryngology and dentistry. A congenital neck cyst can be located in different areas and have a specific histological structure, caused by the embryonic source of development.

In the 60s of the last century, based on the results of a study of several hundred patients with pathological neoplasms of the neck, the following scheme was drawn up:

Type of cyst	Source	Superficial neck area	Neck location (half)	Location depth
Median cyst	ductus thyroglossus - thyroglossus duct	Middle, front zone		Glubokoe
Branchiogenic cyst	arcus branchialis – gill arches (rudiments)	From the side, closer to the front zone	Top or closer to the middle from the side	Glubokoe
Thymopharyngeal cyst	Rudiments of the ductus thymo-pharyngeus - thymopharyngeal duct		Between the 2nd and 3rd fascia of the neck	Deep on the neurovascular bundle
Dermoid cyst	Rudiments of embryonic tissues	In any zone	Bottom half	Superficial

Congenital neck cysts are diagnosed relatively rarely and account for no more than 5% of all tumor neoplasms of the maxillofacial region. It is believed that lateral, branchiogenic cysts form less frequently than median cysts, although reliable statistical data does not exist today. This is due to the small number of clinically manifested cysts at an early age, to a fairly large percentage of errors in the accurate diagnosis of these pathologies, and, to a greater extent, to the fact that the neck cyst is, in principle, little studied as a specific disease.

Congenital cysts and fistulas of the neck

Congenital cysts and fistulas in the neck area are considered embryonic developmental defects that form during the period from the 3rd to the 5th week of pregnancy.

Lateral, branchial cysts and fistulas develop from parts of the branchial arches, less often from the third pharyngeal sinus. Branchiogenic tumors are most often unilateral, that is, they form on one side of the neck. The localization of lateral neoplasms is typical - in the area of ​​the surface of the sternocleidomastoid muscle; their structure is elastic, quite dense, and does not cause pain upon palpation. A lateral cyst can be diagnosed at an early age, but there are frequent cases of its detection at a later period; in 3-5% of cases the cyst is detected in patients over 20 years of age. Diagnosis of a lateral tumor is difficult due to its nonspecificity and sometimes lack of symptoms. The only clear criteria can be the localization of the cyst and, of course, the data from diagnostic measures. A branchiogenic cyst is determined using ultrasound, fistulogram, probing, contrast, and staining puncture. A lateral cyst can only be treated surgically; the entire capsule and its contents are removed, up to the end of the fistula opening in the tonsil area.

Median congenital cysts and fistulas are also of embryonic origin; most often they are caused by dysplasia of the pharyngeal pouch and non-closure of the thyroglossal duct. The localization of the median cyst is defined in their very name - in the middle of the neck, less often they are located in the submandibular triangle. The cyst can remain latent for a long period without manifesting itself clinically. If the median cyst suppurates or enlarges, especially during the initial stage of inflammation, the patient may feel discomfort when eating, turning into tolerable pain.

Median neoplasms on the neck are also treated surgically. Radical excision of the cyst along with the capsule and part of the hyoid bone guarantees the absence of relapses and a favorable outcome of the operation.

Lymph node cyst in the neck

Lymphatic cyst cervical node does not always fall into the category of congenital neoplasms, although it is often detected immediately after the birth of a child or before the age of 1.5 years. The etiology of lymph node cysts is unspecified and is still the subject of study by ENT doctors. During embryogenesis, the lymphatic system undergoes repeated changes; the congenital etiological factor is apparently caused by the transformation of lymph nodes into oval multi-chamber formations due to dysplasia of embryonic cells. Lymphangioma - a lymph node cyst in the neck is specific in structure, has very thin capsule walls, which are lined from the inside with endothelial cells. Typical location lymphangiomas - the lower side of the neck; when enlarged, the cyst can spread to the tissues of the face, up to the day of the oral cavity, into the anterior mediastinum (in adult patients). The structure of a lymph node cyst can be as follows:

• Cavernous lymphangioma.
• Capillary-cavernous tumor.
• Cystic lymphangioma.
• Cystic cavernous tumor.

The cyst forms in the deep layers of the neck, squeezing the trachea, and can cause asphyxia in newborn babies.

Diagnosis of lymph node cysts in the neck is quite simple, in contrast to the determination of other types of congenital cysts. To clarify the diagnosis, an ultrasound is performed, and a puncture is considered mandatory.

Treatment of such pathology requires surgical intervention. In case of threatening symptoms, surgery is performed regardless of age to avoid asphyxia. With uncomplicated development of lymphangioma, surgical manipulations are indicated from 2-3 years.

U infants treatment consists of puncture and aspiration of lymphangioma exudate; if the lymph node cyst is diagnosed as multi-chamber, puncture will not give results, the neoplasm must be excised. Removing a cyst involves excision of a small amount of nearby tissue to relieve pressure on the cyst. respiratory tract. In the future, radical surgery can be performed after the patient’s condition improves at an older age.

Diagnosis of a neck cyst

Diagnosis of cystic formations in the neck area is still considered difficult. This is due to the following factors:

• Extremely scanty information about pathology in general. Information exists in isolated versions, is poorly systematized and does not have an extensive statistical base. At best, researchers give examples of studying the diseases of 30-40 people, which cannot be considered objective, generally accepted information.
• Diagnosis of a neck cyst is difficult due to the lack of understanding of the etiology of the disease. Existing versions and hypotheses about the pathogenesis of congenital neck cysts are still the subject of periodic discussions among practitioners.
• Despite the existing international classification of diseases, ICD-10, neck cyst remains an insufficiently systematized and classified disease by type.
• Clinically, only two general categories of cysts are distinguished - median and lateral, which clearly cannot be considered the only specific categories.
• The most difficult in terms of diagnosis are considered to be lateral, branchial cysts, since they are very similar in clinical appearance to other tumor pathologies of the neck.

Differential diagnosis of neck cysts is very important, since it determines the correct and accurate tactics of surgical treatment. However, the only thing possible way treatment can be considered both a difficulty and a relief, since any type of cystic formation in the maxillofacial area, as a rule, must be removed, regardless of differentiation.

Diagnostic measures involve the use of the following methods:

• Visual inspection and palpation of the neck, including lymph nodes.
• Fistulogram.
• Puncture according to indications, puncture using a contrast agent is possible.

As specific diagnostic criteria The following data may be used:

Localization	Description of location
Lateral localization
Cysts caused by abnormalities of the branchial apparatus, branchiogenic cysts	Anterior zone of the sternocleidomastoid muscle, between the larynx up to the styloid process
Middle zone:
Thyroglossal duct cyst Deep cystic formation of the sublingual gland Dermoid cyst Goiter cyst	Induration with a tumor in the area of ​​the middle of the neck adjacent to the hyoid bone Middle of the neck down to the bottom of the mouth Elastic formation in the chin area, under it Below the middle of the neck
Lymphangioma Invasive hemangioma	Multi-chamber formation determined by ultrasound In the area of ​​the scalene, trapezius or sternomastoid muscles

Congenital neck cysts should be differentiated from the following diseases:

• Tuberculosis of the lymph nodes of the neck.
• Lymphogranulomatosis.
• Aneurysm.
• Hemangioma.
• Lymphomas.
• Thyroid cyst.
• Abscess.
• Lymphadenitis.
• Struma of the tongue.

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Inflamed or suppurating cysts are subject to initial anti-inflammatory therapy (opening the abscess), when the acute period is neutralized, surgery is performed.

Treatment of a neck cyst is considered a minor operation, which is performed routinely.

The median cyst should be removed as early as possible to eliminate the risk of hematogenous infection. Extirpation of the cyst takes place under local anesthesia; during the procedure, the tumor is excised along with the duct. If a fistula is discovered during the opening of the neck tissue, its course is “stained” by injecting methylene blue for clear visualization. If the ductus thyroglossus (thyroid-lingual duct) is not closed, it can be removed down to the foramen caecum - the blind opening of the tongue. A part of the hyoid bone is also excised when it fuses with the cystic fistula. If the operation is performed carefully and all structural parts of the cyst are completely removed, recurrence is not observed.

Branchiogenic cysts are also subject to radical extirpation. The cyst is excised together with the capsule, possibly together with the identified fistula. Complicated branchial cysts may require simultaneous tonsillectomy. Treatment of a lateral neck cyst is more complex, since its localization is associated with the risk of damage to multiple vessels. However, statistics do not show any alarming facts about postoperative complications. This confirms the almost one hundred percent safety of surgical treatment; moreover, in any case, it remains the only generally accepted method to help get rid of a neck cyst.

Removal of a cyst on the neck

Congenital cysts in the neck area are subject to radical removal, regardless of type and location. The sooner the cyst on the neck is removed, the lower the risk of developing complications in the form of an abscess, phlegmon or malignant tumor.

The median neck cyst is removed surgically. The operation is performed on adults and children starting from 3 years of age. Surgical intervention is also indicated for children, provided that the cyst suppurates and poses a threat in terms of disruption of the breathing process and general intoxication of the body. In adult patients, a midline cyst should be removed if it is defined as a benign cystic tumor larger than 1 centimeter. The cyst is excised completely, including the capsule, this ensures its total neutralization. If cyst tissue remains in the neck, repeated relapses are possible. The extent of surgical intervention is determined by many factors - the age of the patient, the size of the formation, the location of the cyst, its condition (simple, suppurating). If pus accumulates in the tumor, the cyst is first opened, drainage and anti-inflammatory therapy are carried out. Complete removal of a neck cyst is possible only when the inflammation subsides. Also, the median cyst can be removed along with part of the hyoid bone if it contains a cystic or fistulous cord.

Lateral cysts are also operated on, but their treatment is somewhat more complicated due to the specific anatomical relationship between the location of the tumor and nearby vessels, nerve endings, and organs.

Aspiration of neck cysts and treating them with antiseptics is not advisable, since such tumors are prone to repeated relapses. Modern otolaryngology is equipped with all the latest surgical techniques, so tumor removal is often performed on an outpatient basis with minimal trauma to the neck tissue. Inpatient treatment It is indicated only for children, elderly patients or with a complicated form of cysts. Treatment prognosis for early diagnosis and a carefully performed radical operation is favorable. Recurrence of the process is extremely rare, which can be explained by inaccurate diagnosis or incorrectly chosen surgical technique.

Surgery to remove a neck cyst

Modern surgery to remove a cyst should not frighten the patient; the latest techniques, including gentle percutaneous intervention, require the patient to be discharged on the day after the tumor is removed. The meaning of the surgical procedure is to excise the capsule and contents of the cyst within the boundaries of healthy neck tissue, without harm to the surrounding vascular system and nearby organs. Of course, surgery to remove a cyst is not simple. After all, the neck is anatomically connected to important arteries and many functions, including the process of swallowing and speech. Accurate diagnosis and careful implementation surgical procedures possible if the cyst is outside the inflammatory process and does not suppurate. If inflammation is diagnosed, anti-inflammatory therapy is first carried out, the acute symptoms in the form of pain, an autopsy may be performed to drain the purulent contents. When the process goes into remission, the operation is performed quickly enough and without complications. Radical excision of all parts of the cyst is main task surgeon

Extirpation (removal) of a cyst on the neck is a so-called minor operation and is most often performed under endotracheal anesthesia. The protocols of the procedure may vary depending on the type of formation and its size, but in general the scheme is as follows:

• Endotracheal anesthesia.
• A horizontal incision (for a median cyst) in the area of ​​formation along the surface of the cervical fold. To remove a branchiogenic cyst, an incision is made along the edge of the sternocleidomastoid muscle.
• Dissection of skin and tissue.
• Dissection of muscles and fascia.
• Identification of a visible cystic formation and its excision together with the capsule within the boundaries of healthy tissue.
• When removing a median cyst, a portion of the hyoid bone is resected.
• Wound sanitation.
• Hemostasis.
• Suturing the wound and draining the cavity.
• Treatment of the wound.
• Application of a fixing aseptic bandage.
• Postoperative dynamic observation.
• Monitoring hemodynamics and skin condition.
• Control of swallowing and speech functions.
• Removing stitches.
• Ultrasound monitoring after 2-3 months.

Next, restorative therapy is prescribed according to indications and the suture is treated with special absorbable gels, for example, Contratubes. Modern surgical techniques involve such “jewelry” incisions that after the operation the patient has virtually no scar traces.

Prevention of neck cysts

Since neck cysts are considered congenital, there are no recommendations for the prevention of such pathologies. Prevention of neck cysts in the sense of preventing suppuration and malignancy lies in timely dispensary examinations. Rare cases of detection of cystic formations in the first year of life do not exclude their detection at a later age, even with an asymptomatic course of the process. Any experienced otolaryngologist, examining a child, conducts all the necessary and fairly simple examinations - visual identification of visible pathologies of the larynx, pharynx and neck, palpation of the lymph nodes and neck. The slightest signs of a tumor are a reason for more detailed diagnostic measures. Despite the fact that a neck cyst can only be treated with surgical methods, its removal is a guarantee that a pathological process, especially cancer, will not develop in this area.

If the cyst manifests itself with severe symptoms, pain and suppuration, you should immediately consult a specialist and not self-medicate. Tumor formations are very sensitive to thermal procedures, so various home recipes and compresses can only aggravate the disease and lead to complications.

Prevention of neck cysts, although not developed as a measure to prevent tumor formations, is still possible as routine measures to promote health and maintain a healthy lifestyle, which includes systematic examinations with the attending physician.

Neck cyst prognosis

Since a congenital neck cyst can only be treated surgically, as with any other operation, there is a possible risk of complications. As a rule, 95% of surgical interventions are successful, treatment is carried out in outpatient setting and the patient does not require hospitalization. However, subsequent dynamic observation is indicated for literally all patients, since the prognosis of neck cysts depends on the postoperative recovery period. In addition, the neck is considered a specific topographic-anatomical area associated with muscles, nerve endings, and vital organs, so surgery in this area is much more difficult than removing cystic formations in other places. This is due to the risk of damage to large vessels of the neck, for example, when removing a median cyst that is in close contact with the carotid artery. It is also difficult to remove a neoplasm that is closely fused with the walls and tissues of the neck.

The extent of the surgical procedure is determined by the size of the cyst; small tumors are removed laparoscopic method, large formations require radical excision to avoid relapses. The prognosis of a neck cyst, or rather prognostic assumptions based on the results of treatment, is usually favorable, with the exception of cases of detection of malignant foci during surgery. Branchiogenic cysts are prone to malignancy, which are 1.5 times more common than median cysts, so these types of formations must be removed as early as possible to prevent branchiogenic cancer from developing.

A neck cyst is considered a fairly rare congenital pathology, which, according to statistics, accounts for 2 to 5 percent of all tumors of the maxillofacial area and neck that require surgical treatment. Despite the small number, such cystic formations represent a rather complex disease, since their diagnosis is complex and requires differentiation from many diseases in this anatomical zone. The danger of congenital neck cysts lies in the asymptomatic development; in addition, in 10% of cases the cysts are accompanied by fistulas, and in 50% they tend to fester and carry the danger of spreading infection throughout the body. Therefore, if a benign cystic tumor is detected, there is no need to delay surgery; the sooner the cyst is removed, the lower the risk of it developing into a malignant process, and the faster the recovery will occur. Timely radical enucleation of the cyst and adequate postoperative treatment guarantees an almost 100% favorable outcome.

Congenital developmental anomalies in children are quite rare; benign tumors and cysts, which are included in the category of pathologies of embryogenesis, according to statistics account for no more than 5% of tumors of the maxillofacial region, however, they are quite serious diseases that are asymptomatic, in addition, difficult to diagnose. A median neck cyst can form at an early stage of embryonic development - from the 3rd to the 5th week of pregnancy; it clinically manifests itself at any age, but most often during intensive growth or during the period of hormonal changes in the body. In medical practice, a median cyst is often called thyroglossal, this is due to its etiology and pathogenetic specificity of development.

Causes of median neck cyst

The etiology of the median cyst is still the subject of scientific debate, obviously, this is due to the fact that such congenital anomaly is quite rare. Statistically, the median cyst occupies no more than 2-3% of the total number of neck tumors; accordingly, it is not possible to study the tumor in full and confirm its etiology with multiple clinical observations. It is believed that thyroglossal benign tumors are a pathology of the embryonic basis for the formation of the maxillofacial region, that is, an anomaly of the branchial apparatus.

1. Some doctors support the version that claims that the causes of the median cyst of the neck lie in the unclosed

in a timely manner, the ductus thyreoglossus - the thyroid-lingual duct or duct of the thyroid gland. This theory was put forward in the 19th century by the famous German doctor, anatomist, and specialist in the study of embryogenesis, Wilhelm His. A specific canal connecting the embryo of the thyroid gland and the oral cavity, which is reduced in the last period of intrauterine development, was named after him. The His canal or thyroglossal duct can be the source of the formation of cysts and median, thyroglossal fistulas.

1. The causes of the median cyst of the neck can be explained by another version, which also deserves attention. At the end of the 19th century, the outstanding surgeon Venglovsky proposed his own version explaining the etiology of the development of thyroglossal tumors, according to which they are formed from epithelial cells of the oral cavity, while the thyroglossal duct is replaced by a cord.

Obviously, these two hypotheses need further study and clinical confirmation, and the causes of the median neck cyst will soon be clarified.

However, the first version of His is more reliable in a statistical sense - more than 55% of diagnosed cases showed a close connection of the median cyst with the hyoid bone and the foramen cecum linguae - the blind opening of the tongue, which fully corresponds to the topography of the ductus thyreoglossus - the thyroid rudiment.

Symptoms of a median neck cyst

Clinical manifestations birth defects necks are almost always hidden in initial period development. There are extremely rare cases where the symptoms of a median neck cyst are visible to the naked eye in the first months after birth. Much more often the cyst appears between the ages of 5 and 14-15 years and older. A feature of almost all types of benign neck tumors is an asymptomatic course that can last for many years. A median cyst in a latent state does not cause pain and does not provoke dysfunction of nearby structures. Its development can be started by an inflammatory disease acute form, as well as periods of hormonal changes in the body, for example, puberty. Even when it appears, the cyst grows very slowly; upon palpation, it is defined as a rounded elastic formation in the midline of the neck; the tumor is not fused to the skin; during swallowing, it can move upward along with the hyoid bone and nearby tissues. Objective complaints from the patient begin when the cyst becomes infected, inflamed and interferes with food intake. The tumor can open outward, less often into the oral cavity, releasing purulent exudate, but the fistulous tract never heals on its own and remains as a permanent channel for the outflow of inflammatory secretory fluid. The release of exudate helps to reduce the size of the cyst, but does not contribute to its resorption. Moreover, a tumor that is not diagnosed and not removed in a timely manner can provoke serious problems with swallowing food, impaired speech (diction), and in rare cases, malignancy, that is, development into a malignant process.

Median neck cyst in a child

Despite the fact that, according to statistics, a median cyst on the neck of a child is extremely rare - only 1 case in 3000-3500 newborns, this disease remains one of the serious congenital pathologies requiring differential diagnosis and inevitable surgical treatment.

Symptoms of a median cyst in a child rarely appear in the first years of life; more often the tumor is diagnosed during a period of intensive growth - between the ages of 4 and 7-8 years and later, during puberty.

The etiology of median cysts is presumably due to incomplete fusion of the thyroglossal duct and close connection with the hyoid bone.

As a rule, in the initial period of development, a median cyst on a child’s neck is diagnosed during random examinations, when an attentive doctor carefully palpates lymph nodes and neck. Palpation is painless, the cyst is felt as a dense, clearly defined round formation small size.

The clinical picture, which more clearly shows signs of a thyroglossal cyst, may be associated with inflammatory, infectious process in the body, the cyst enlarges and can fester. This development is manifested by visible symptoms - an enlargement of the area in the middle of the neck, low-grade body temperature, transient pain in this area, difficulty swallowing food, even of liquid consistency, hoarseness of the voice.

Clinically, a suppurating cyst is very similar to abscesses, especially if it opens and releases purulent contents. However, unlike a classic abscess, a median cyst is not capable of resorption and healing. In any case, the tumor requires careful differential diagnosis, when it is separated from atheroma, submental cyst, dermoid, and lymphadenitis with similar symptoms.

A thyroglossal cyst in a child is treated surgically, just like a cyst in an adult patient. Cystectomy is performed under local anesthesia; the capsule and contents of the tumor are completely removed; resection of a separate part of the hyoid bone is possible. If the cyst suppurates, it is first drained, inflammatory symptoms are relieved, and surgery is performed only in a state of remission. Surgical treatment median cyst in children is indicated from the age of 5, but sometimes such operations are performed at an earlier period, when the pathological formation interferes with the process of breathing, eating and for cysts larger than 3-5 centimeters.

Median neck cyst in adults

In adult patients, among congenital pathologies of the neck, lateral cysts are more often diagnosed, however, thyroglossal tumors also pose a certain threat in terms of the risk of malignancy. The percentage of transformation of the cystic process and the malignant one is very small, however, untimely diagnosis and treatment may carry the risk of developing neck phlegmon and even cancer.

Median neck cyst in adults develops without clinical manifestations for a very long time; its latent state can last for decades. Traumatic factors provoke an increase in the cyst - blows, bruises, as well as inflammation associated with the ENT organs. The cyst increases in size due to the accumulation of inflammatory exudate, often pus. The first noticeable clinical sign is swelling in the middle zone of the neck, followed by pain, difficulty swallowing food or liquid, and less commonly, changes in voice timbre, shortness of breath, and impaired diction. Serious complication The median cyst of the neck is considered to be compression of the trachea and the degeneration of tumor cells into atypical, malignant ones.

Thyroglossal cyst is treated exclusively by surgery, puncture, conservative methods are ineffective and even delay the process, provoking various exacerbations. The sooner surgery is performed to remove the cyst, the faster the recovery. The prognosis for treatment of a median cyst in adult patients is generally favorable, provided that the tumor is detected early and is radically removed.

Diagnosis of median neck cyst

How is a median cyst determined?

Thyroglossal congenital anomalies develop in 75-80% without obvious clinical signs. Diagnosis of a median neck cyst may initially be aimed at examining the ENT organs and lymph nodes; in this case, the neoplasm is diagnosed along the way, with careful palpation.

Primary observations and information are confirmed by the following methods:

• Ultrasound of the neck, lymph nodes.
• X-ray.
• Fistulography (probing and application of a contrast dye).
• Computed tomography according to indications.
• Puncture.

Since diagnosing a median neck cyst is quite difficult due to the similarity of symptoms of many diseases of the maxillofacial region, the doctor is required not only to have theoretical knowledge, but also to have extensive practical experience. The choice of treatment method depends on how correctly the diagnosis is made.

The median cyst should be distinguished from such diseases of the parotid region and neck:

• Congenital dermoid cyst of the neck.
• Atheroma.
• Lymphadenitis.
• Adenophlegmon.
• Struma of the tongue.

Treatment of median neck cyst

Treatment of congenital cystic tumors of the neck is currently carried out exclusively by surgery. A median cyst is also subject to cystectomy, regardless of its size and condition. An inflamed cyst containing pus is first treated symptomatically, and the purulent exudate is drained. After neutralizing the acute process, surgery is indicated for adult patients. Surgical treatment of a median cyst in the neck in a child may be delayed for several years until he reaches a more mature age and is able to adequately undergo the operation. This is only possible if the cyst does not grow and does not interfere with the functioning of the entire maxillofacial area.

A median cyst in remission is subject to radical removal, regardless of its location - above or below the hyoid bone. Cystectomy is performed under local anesthesia by layer-by-layer dissection of tissue and resection of the tumor itself along with the body or part of the hyoid bone. Often, a thyroglossal cyst is combined with a fistula, which is also excised, having previously been filled with a contrast agent to visually determine the fistula tract. The difficulty of treating a median neck cyst lies in its close location to important organs - the larynx, pharynx, large vessels. Also, difficulties can be caused by the branches of the fistula, which are not visible during the operation. Incomplete removal of all structural parts of the cyst can provoke a relapse, when the operation has to be repeated after 3-4 months. Therefore, preliminary examinations of the tumor are so important, including a fistulogram using contrast agents, showing all possible fistulous tracts.

If all diagnostic measures are carried out, correct and accurate surgery is carried out, recovery occurs very quickly. In addition, such operations are classified as “minor surgery” and have an almost 100% favorable prognosis.

Removal of median neck cyst

The median cyst of the neck must be removed - this is considered a standard method, excluding any option of conservative therapy or puncture. Removal of a median neck cyst is performed surgically, by radical excision of the capsule and contents of the tumor. Operations are indicated for all patients - adults and children, starting from the age of three. Less commonly, cystectomy is performed infants, there are certain indications for this - a threat to life with a large cyst and compression of the trachea, an extensive purulent inflammatory process and the risk of general intoxication of the child’s body.

The preference for removal rather than resorption therapy is associated with the etiology of the formation of cysts - all of them are considered congenital anomalies of embryogenesis, therefore the only way to eliminate the consequences of impaired reduction of the branchial apparatus is surgery.

Removal of a thyroglossal cyst is performed under endotracheal or intravenous anesthesia. Careful excision of all parts of the cyst, as well as the fistula, fistula tract and a certain area of ​​the hyoid bone, guarantees almost one hundred percent relapse-free recovery. Unlike removal of lateral cysts, cystectomy of median tumors is considered less traumatic and has a favorable prognosis.

Surgery for median cyst of the neck

How is surgery performed for a median cyst of the neck:

1. After a thorough examination, the patient is given an anesthesia procedure, usually local anesthesia.
2. After administration of the anesthetic drug, a layer-by-layer incision is made in the area where the cyst is located. The incisions are made along the natural folds, so post-operative scars are almost invisible.
3. The walls and capsule of the cyst are peeled off, the contents of the tumor, depending on the consistency, are drained or washed out.
4. If a concomitant fistula is detected, part of the hyoid bone is also resected, since the cord of the fistula is located in this area.
5. The fistula is removed simultaneously with the cyst; it is first visualized using methylene blue.
6. The surgical wound is sutured with neat cosmetic stitches.

Modern surgical technologies, techniques and equipment make it possible to remove the median cyst as safely and minimally traumatic as possible. Sutures are placed from the inside of the wound, this allows one to achieve a good cosmetic effect when, after six months, the patient has practically no external postoperative scars or scars on the neck.

Surgery for a median cyst lasts on average from 30 minutes to an hour and a half in extreme, complicated cases. The complexity of surgery and the extent of the procedure may depend on the size of the tumor and its contents. A purulent median cyst takes longer to remove, as it requires drainage and careful postoperative revision. If parts of the cyst or fistula are not completely excised, relapses are possible, so the favorable outcome of the operation depends on the attentiveness of the doctor. But even relapses are not considered a threatening complication; as a rule, reoperation is indicated 2-4 months after the primary and ends 100% successfully. The recovery period lasts no more than a week, after which the patient can return to ordinary life and do everything necessary functions, both household and work. Swelling at the incision site is possible within a month, but it disappears without a trace if all medical recommendations are followed. Full recovery depends on the general health and regenerative properties of the body.

Prevention of median neck cyst

Unfortunately, it is not possible to say that the development of a median cyst can be prevented. No preventive measures are taken various reasons, but the main one is congenital etiological factors. Developmental anomalies in the prenatal period are, in principle, considered difficult to predict; geneticists deal with these issues. Some scientists have put forward a version about the inheritance of congenital tumors of the maxillofacial region, but this information is controversial and not statistically confirmed. Prevention of a median neck cyst can consist of standard recommendations that apply to any disease in principle:

• Dispensary examinations must be systematic and regular.
• All children should be examined starting from the moment of birth.
• Early detection of tumor formations helps to take timely measures to stop the process and plan surgical intervention.
• Diagnosing a median cyst at an early stage allows you to avoid extensive surgery, which is indicated when removing large, inflamed neck tumors.
• Self-examination can also help identify cysts at an early stage of development. In this sense, even the so-called “false alarm” is much better than the late detection of a purulent, developed cyst.
• Thyroglossal cyst has the property of malignancy. The percentage of such cases is small, however, the risk of developing a malignant process exists. Therefore, visits to an ENT doctor or dentist should be scheduled once every six months.
• In some cases, the enlargement and suppuration of the median cyst provoke injuries to the neck, which is a complex and vulnerable part of the body. Therefore, preventing injuries, bruises and blows in this area helps reduce the risk of development and inflammation of hidden latent neoplasms.

Prognosis of median neck cyst

Almost 100% of operations to remove a median cyst on the neck end successfully. Of course, surgical intervention in this anatomical area cannot be considered completely safe, however, modern equipment, the use of the latest techniques, medical experience and developments in the field of otolaryngology allow us to talk about a favorable outcome of treatment.

The prognosis of a midline neck cyst is usually favorable. The risk of tumor malignancy is possible only in rare cases when the tumor is clinically manifested but not treated. An advanced process, accompanying inflammation, and infection of the cyst can lead to the transformation of tumor cells into malignant ones. There are no confirmed and indisputable statistics on this issue; it is believed that a median cyst extremely rarely degenerates into cancer, according to some sources, in only 1 case out of 1,500 diagnoses. The most dangerous thyroglossal cyst is in infancy, especially if it reaches a large size and compresses the airways.

The median cyst of the neck is a congenital anomaly, which is currently successfully operated on and does not pose any difficulties in terms of treatment. The only " dark spot"in its history is an incompletely studied etiology and pathogenesis. However, the study process has not stopped, and currently many geneticists and doctors continue to accumulate clinical reliable information to come to a consensus in determining the root cause of congenital tumors, and therefore to new, more advanced methods of treating them.

Important to know!

A Bartholin gland cyst is a formation that occurs as a result of blockage of the gland duct and the accumulation of its own secretion. The cyst can reach significant sizes (3-4 cm) and is manifested by swelling in the labia area, pain and discomfort when walking or having sexual intercourse.