Neck cysts are congenital pathological anomalies of benign nature that are noticeable at birth and are most commonly discovered during adolescence.
WHY DO NECK CYSTS FORM?
The embryology and pathogenesis of neck cysts are not completely understood. It is presumed that their formation is due to a disturbance in the embryonic development of the pharyngeal (branchial) arches, specifically a congenital malformation of the residual segment of the thyroglossal duct (canal).
TYPES OF NECK CYSTS
Based on histological appearance, it can be concluded that neck cysts belong to lymphoepithelial formations.
According to their localization, they are classified into:
MEDIAL (CENTRAL) NECK CYSTS
Medial cysts are smooth changes located in the middle part of the neck, beneath or at the level of the hyoid bone. They form as the thyroid gland moves forward, along the thyroglossal duct.
These cysts usually move when the tongue is protruded from the oral cavity. They are filled with yellowish fluid (purulent in case of infection) and are lined with epithelial tissue.
They are more common in early childhood (up to 10 years of age), can be up to 3 cm in diameter, and are painless. If they are not large or inflamed, they do not present a functional disturbance. Occasionally, they may be accompanied by complications such as purulent infection and the formation of a fistula.
The most common congenital neck cyst (70% of all congenital neck anomalies) is the thyroglossal duct cyst.
LATERAL (BRANCHIAL) NECK CYSTS
Lateral or branchial cysts are cysts of the branchial arches and are more frequent than medial cysts. They are localized in the upper or middle third of the anterolateral surface of the neck, in front of the sternocleidomastoid muscle, and near the jugular vein. They measure 1–5 cm in size
Lateral (branchial) cysts can be unilocular (formed as a single cavity) or multilocular (having multiple separate cavities with a common opening), while medial cysts are usually unilocular.
Neck cysts are in communication with the pharynx. Medial and lateral fistulas of the neck share the same etiology. However, unlike cysts, they have two openings: one in the pharynx and the other on the skin of the neck.
SYMPTOMS
Cysts in the neck are initially asymptomatic. As they grow, they present as protrusions on the neck, which are soft and painless.
The first symptoms, in terms of pressure and difficulty in moving the neck, are noted in cases of significant growth of a few centimeters.
When infection occurs, and the cyst fills with purulent material, pain at rest develops, especially during neck movement. Additionally, redness of the surrounding skin appears, along with pain on touch, as well as fever and malaise.
NECK CYSTS – DIAGNOSIS AND TREATMENT
The diagnosis for neck cysts is established through medical history, clinical examination, and ultrasound (in children), as well as computed tomography and magnetic resonance imaging. In cases of unclear clinical presentation, scintigraphy and cytological analysis of the aspirate may be utilized.
The treatment of these formations is exclusively surgical. For large lateral cysts, aspiration is often performed first to reduce volume. This is followed by surgery, which involves removal of the cyst and ligation of the opening to the pharynx.
Surgery for a medial cyst also involves resection of the central part of the hyoid bone, through which the channel passes to the pharynx. If resection is avoided, recurrence typically occurs.
Surgery for neck fistulas involves excising the skin opening, identifying and dissecting the fistulous tract to the pharynx, and ligating the opening at the pharynx.
Cyst and fistula surgeries are performed by a maxillofacial surgeon under general anesthesia. The patient stays in the hospital for one day.