Neck cyst

A neck cyst as a type of pathological neoplasm is part of a large group of diseases – cysts of the maxillofacial region (MFR) and neck.

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

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

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

Uniting a single etiological embryonic base, species 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 formulate diagnostic conclusions faster, compare them with international clinical experience, and, consequently, choose more effective therapeutic tactics and strategy. The classifier includes 21 sections, each of which is equipped with subsections - classes, headings, codes. Among other diseases, there is also a neck cyst, the ICD includes it in class XVII and describes it as congenital anomalies (blood defects), deformations, and chromosomal abnormalities. Previously, this class included a pathology - a preserved thyroglossal duct in block Q89.2, now this nosology has been renamed into a broader concept.

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

Neck cyst. Class XVII

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

Q18.0 – Sinus, fistula and cyst of the branchial cleft

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 - Congenital malformation of face and neck, unspecified. Congenital malformation of face and neck NEC.

It should be noted that in clinical practice, in addition to ICD 10, there are internal classifications of diseases, especially those that have not been studied enough, and cystic formations in the neck area can be fully attributed to them. Otolaryngologists-surgeons often use the classification according to Melnikov and Gremilov, previously the classification characteristics of cysts according to R.I. Venglovsky (early 20th century) were used, then the criteria of surgeons G.A. Richter and the founder of Russian pediatric surgery N.L. Kushch came into practice. Nevertheless, ICD remains the only official classifier, which is used to record the diagnosis in official documentation.

Causes of cysts on the neck

Neck cysts and fistulas are in the overwhelming majority of cases 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 of the sulcus branchialis - the branchial groove, and then retention branchiogenic lateral cysts can develop in their place. A four-week embryo already has six formed cartilaginous plates, which are separated by grooves. All arches consist of nervous tissue, arteries and cartilage. In the process of embryogenesis in the period from the 3rd to the 5th week, the cartilages are transformed into various tissues of the facial part of the head and neck, the slowdown in reduction at this time leads to the formation of closed cavities and fistulas.

• Rudimentary remnants of the sinus cervicalis 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 leads to median cysts.

Some researchers of the last 20th century suggested describing all congenital cysts of the parotid zone and neck as thyroglossal, since this most accurately indicates the anatomical source of their formation and clinical features of development. Indeed, the inner part of the capsule of neck cysts, as a rule, consists of multilayered cylindrical epithelium with inclusions of squamous epithelial cells, and the surface of the walls has 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 slits and ducts:

• Arcus branchialis (arcus viscerales) - branchial visceral arches.
• Ductus thyreoglossus – thyroglossal duct.
• Ductus thymopharyngeus – goiter-pharyngeal duct.

The causes of cysts on the neck are still a 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, information has now emerged about a genetic predisposition to early embryonic developmental defects of a recessive type, but this version still requires more extensive, clinically confirmed information.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Cyst in the neck area

A congenital cyst in the neck area can be localized on the lower or upper surface, on the side, be deep or located closer to the skin, 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 pockets due to their insufficiently complete obliteration. According to the concept of branchiogenic etiology, cysts develop from closed gill pockets - dermoid cysts from the external ones, and cavities containing mucus from the external ones. 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 lymphatic cervical nodes is disrupted, and epithelial cells of the salivary glands are interspersed in their structure. Many specialists who have studied this pathology well 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 located deep in the tissues of the neck on large vessels, often merging 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 near 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 trauma or inflammation. A small cyst in the neck area does not cause discomfort to a person, only increasing, suppurating, it disrupts the normal process of food intake, presses on the vascular-nerve cervical bundle. Branchiogenic cysts, not diagnosed in time, are prone to malignancy. Diagnosis of lateral cysts requires differentiation from such neck pathologies with similar clinical manifestations:

• Lymphangioma.
• Lymphadenitis.
• Lymphosarcoma.
• Vascular aneurysm.
• Cavernous hemangioma.
• Lymphogranulomatosis.
• Neurofibroma.
• Lipoma.
• Thyroglossal duct cyst.
• Tuberculosis of the lymph nodes.
• Retropharyngeal abscess.

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

A median cyst in the neck is formed from unreduced parts of the ductus thyroglossus - the thyroglossal duct in the period between 3-1 and 5-1 weeks of embryogenesis, when the thyroid tissue is created. The 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 by location - formations in the sublingual region, cysts of the root of the tongue. Differential diagnostics is necessary to determine the difference between a median cyst and a dermoid, adenoma of the thyroid gland, lymphadenitis of the submental nodes. In addition to cysts, median cervical fistulas can form in these areas:

• A complete fistula that has an outlet in the oral cavity at the root of the tongue.
• An incomplete fistula ending in a thickened channel in the oral cavity at the bottom.

Median cysts are treated only by radical surgical methods, which involve the removal of the formation along with the hyoid bone, which is anatomically connected to the cyst.

[ 7 ]

Symptoms of a Neck Cyst

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

Lateral, branchiogenic cysts are diagnosed 1.5 times more often than median ones. They are found in the anterolateral zone of the neck, in front of the sternocleidomastoid muscle. The lateral cyst is localized directly on the vascular bundle near the 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 are clinically more pronounced, since they aggressively affect the vessels and nerve endings. If the cyst is small, the patient does not feel it for a long time, which significantly complicates the course of the process, treatment, and prognosis. A sharp increase in the cyst can occur when it suppurates, pain appears, the skin over the cyst becomes hyperemic, swells, and a fistula may form.

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

A median cyst is slightly less common than lateral formations and is defined as a fairly dense tumor that is painless to 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 fester. Accumulated pus provokes a rapid increase in the cavity, swelling of the skin, and painful sensations. It is also possible to form a fistula with an outlet on the surface of the neck in the area of the hyoid bone, less often in 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 the period of embryogenesis and development up to a certain age without clinical manifestations.
2. Slow development, growth.
3. Typical localization zones according to species.
4. Manifestation of symptoms as a result of exposure to a traumatic factor or inflammation.
5. Compaction, pain, involvement of the skin in the pathological process.
6. Symptoms of the body's general reaction to the inflammatory purulent process are an increase in body temperature and a deterioration in the 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 the neck of a child can be detected at an early age, but there are also frequent cases of a latent course of the 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 the court of colleagues several years ago, a cyst on the neck of a child can be caused by a hereditary factor.

The child inherits the congenital pathology in a recessive manner, statistically it looks like this:

• 7-10% of 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 stages:

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

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

Treatment of a neck cyst in a child is performed surgically from 2-3 years of age, if the formation threatens the breathing process, the operation is performed regardless of age. The complexity 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. Nevertheless, 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 at a later period, provided that the tumor does not cause discomfort and does not provoke functional disorders.

[ 8 ], [ 9 ], [ 10 ]

Cyst on the neck of 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 the development of benign tumors of the neck. According to some researchers, more than half of the neck cysts cannot be considered congenital; in patients aged 15 to 30 years, branchiogenic and median neoplasms and fistulas are diagnosed 1.2 times more often than in children aged 1 to 5 years.

A cyst on the neck of an adult develops faster than in a child, is larger in size, sometimes reaching 10 centimeters. Median cysts tend to frequently suppurate, and lateral tumors are accompanied by more pronounced symptoms and are more often adjacent to fistulas (fistulas). In addition, cysts on the neck of 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 oncological disease. As a rule, this can be explained by the neglect of the disease, which proceeds for a long period without clinical signs and manifests itself with symptoms already in the later stages of development. Most often, malignancy of a cyst is metastases to the lymph nodes of the neck and branchiogenic cancer. Timely diagnosis at an early stage 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 an increase in lymph nodes. This is a direct indication to search for the primary focus of the oncological process. In addition, any visible seal on the neck larger than 2 centimeters may also indicate a serious pathology and requires very careful comprehensive diagnostics. Exclusion of threatening pathology can be considered an indication for a fairly simple operation to remove a lateral or median cyst of the neck. The operation is performed under endotracheal anesthesia and lasts no more than half an hour. The recovery period does not require specific treatment, you need to regularly visit your doctor to monitor the recovery process.

[ 11 ], [ 12 ], [ 13 ], [ 14 ], [ 15 ]

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 a median and lateral cyst, is formed from the remains of embryonic tissues - parts of the ectoderm, displaced to one zone or another. The cyst capsule is formed from connective tissues, 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, on the bottom, between the hyoid bone and the inner bone of the chin. When the cyst increases, its growth occurs, as a rule, in the inward direction, into the sublingual region. Less often, a cyst can be seen as an atypical convex formation of the neck, thus, a dermoid on the neck is considered a rather rare pathology. A dermoid grows very slowly, and may manifest itself with symptoms during 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, a dermoid cyst of the neck is very similar to other cysts of this area, it is not fused with the skin, has a typical round shape, the skin over the cyst does not change. The only specific sign of a dermoid may be its denser consistency, which is determined during the initial examination by palpation. Dermoid cysts are differentiated in the diagnostic process from atheromas, hemangiomas, traumatic epidermal cysts and lymphadenitis.

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

[ 16 ], [ 17 ]

Branchiogenic cyst of the neck

Lateral gill cyst or branchiogenic cyst of the neck is a congenital pathology that is formed from the epithelial cells of the gill pockets. The etiology of lateral cysts has been little studied - there is a version about the origin of branchiogenic formations from the goitroglantharyngeal duct, but it still causes controversy. 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 histological results of cyst examination 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 rudimentary remnants of the gill apparatus.
2. Cysts located below the hyoid bone area are formed from the ductus thymopharyngeus – the goiter-pharyngeal duct.

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

Signs of cyst growth may include difficulty swallowing food, periodic pain in the neck due to pressure from the tumor on the vascular-nerve 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 vascular-nerve bundle of the neck.
• Pain in the area of the tumor.
• Suppuration of the cyst increases the pain.
• If the cyst opens on its own into the oral cavity, the symptoms temporarily subside, but the fistula remains.
• If the cyst is large (more than 5 cm), the patient's voice timbre may change and hoarseness may develop.
• A cyst that has opened on its own is prone to recurrence and is accompanied by complications in the form of phlegmon.

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

• Dermoid of the 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 by radical surgical methods; any conservative methods cannot be effective and often end in relapses.

[ 18 ], [ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ]

Congenital neck cyst

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, have a specific histological structure, due to the embryonic source of development.

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

Type of cyst	Source	Superficial zone of the neck	Location on the neck (half)	Depth of placement
Median cyst	Ductus thyroglossus - thyroglossal duct	In the middle, front zone	Upper neck	Deep
Branchiogenic cyst	Arcus branchialis – gill arches (rudiments)	On the side, closer to the front zone	Top or closer to the middle on the side	Deep
Timopharyngeal cyst	Rudiments of the thymo-pharyngeal duct	From the side	Between the 2nd and 3rd fascia of the neck	Deep on the neurovascular bundle
Dermoid cyst	Rudiments of embryonic tissues	In any zone	Lower half	Superficial

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

[ 24 ], [ 25 ], [ 26 ]

Congenital cysts and fistulas of the neck

Congenital cysts and fistulas in the neck area are considered to be embryonic developmental defects that form between the 3rd and 5th weeks 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 surface area of the sternocleidomastoid muscle, they are elastic in structure, quite dense, do not cause pain when palpated. A lateral cyst can be diagnosed at an early age, but there are often cases of its detection at a later period, in 3-5% of cases, the cyst is detected in patients over 20 years old. Diagnosis of a lateral tumor is difficult due to non-specificity, and sometimes the absence of symptoms. The only clear criteria can be the localization of the cyst and, of course, the data of diagnostic measures. A branchiogenic cyst is determined using ultrasound, fistulogram, probing, contrast, staining puncture. A lateral cyst can only be treated surgically; the entire capsule and its contents are removed, right up to the end of the fistula opening in the tonsil area.

Median congenital cysts and fistulas also have an embryonic origin, most often they are caused by dysplasia of the pharyngeal pocket, non-closure of the thyroglossal duct. The localization of the median cyst is determined by their 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 clinical manifestations. If the median cyst suppurates or increases, especially at the initial stage of inflammation, the patient may feel discomfort when eating, turning into bearable pain.

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

[ 27 ], [ 28 ], [ 29 ]

Cyst of lymph node on neck

A cervical lymph node cyst does not always belong to the category of congenital neoplasms, although it is often detected immediately after birth or at the age of up to 1.5 years. The etiology of the lymph node cyst is unclear and is still a subject of study by ENT doctors. During embryogenesis, the lymphatic system undergoes repeated changes, the congenital etiological factor is obviously due to the transformation of the lymph nodes into oval multi-chamber formations due to dysplasia of embryonic cells. Lymphangioma - a lymph node cyst on the neck is specific in structure, has very thin capsule walls, which are lined from the inside with endothelial cells. The typical localization of lymphangioma is the lower neck on the side, when enlarged, the cyst can spread to the tissues of the face, to the bottom of the oral cavity, to the anterior mediastinum (in adult patients). According to the structure, a lymph node cyst can be like this:

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

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

Diagnosis of lymph node cysts on the neck is quite simple, unlike 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. In case of uncomplicated development of lymphangioma, surgical manipulations are indicated from 2-3 years.

In infants, treatment consists of puncturing and aspirating lymphangioma exudate; if the lymph node cyst is diagnosed as multi-chambered, puncture will not yield results and the neoplasm must be excised. Removal of the cyst involves excising a small amount of nearby tissue to neutralize pressure on the respiratory tract. Radical surgery may be performed after the patient's condition improves at an older age.

Diagnosis of 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 variants, is poorly systematized and does not have an extensive statistical base. At best, researchers cite examples of studying diseases of 30-40 people, which cannot be considered objective, generally accepted information.
• Diagnosis of neck cysts is difficult due to the lack of study 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 practicing doctors.
• 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 species categories.
• The most difficult to diagnose are lateral and gill cysts, as they are very similar in clinical presentation to other tumor pathologies of the neck.

Differential diagnosis of neck cysts is very important, as it determines the correct and precise tactics of surgical treatment. However, the only possible method of treatment can be considered both a difficulty and a relief, since any type of cystic formation in the maxillofacial region, as a rule, is subject to removal, regardless of differentiation.

Diagnostic measures involve the use of the following methods:

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

The following data can be used as specific diagnostic criteria:

Localization	Location Description
Lateral localization
Cysts caused by anomalies of the gill 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	A lump with a tumor in the mid-neck area adjacent to the hyoid bone The middle of the neck down to the bottom of the mouth An elastic formation in the chin area, under it Below the middle of the neck
The whole neck
Lymphangioma Invasive hemangioma	Multi-chambered formation determined by ultrasound In the area of the scalene, trapezius or sternomastoid muscle

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.

[ 30 ], [ 31 ], [ 32 ], [ 33 ]

Treatment of neck cyst

If a patient is diagnosed with a neck cyst, especially when the patient is a child, the question immediately arises - is it possible to treat this tumor conservatively. The answer to this question is unambiguous - treatment of a neck cyst can only be surgical. Neither homeopathy, nor cyst puncture, nor so-called folk methods, nor compresses will give results, moreover, they are fraught with serious complications. Even taking into account the rather rare detection of congenital cysts in the neck area, one should not forget about the 2-3% risk of malignancy of such tumors. In addition, timely surgery in the early stages, when the cyst has not yet increased, contributes to the fastest healing of the scar, which is almost invisible after 3-4 months.

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

Treatment of a neck cyst is considered a minor operation that is performed on a planned basis.

The median cyst should be removed as early as possible to eliminate the risk of its infection by hematogenous route. Extirpation of the cyst is performed under local anesthesia, during the procedure the tumor is excised together with the duct. If a fistula is found during the opening of the neck tissue, its course is “painted” by introducing methylene blue for clear visualization. If the ductus thyroglossus (thyroglossal duct) does not close, it can be removed up to the foramen caecum – the blind opening of the tongue. 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 detected fistula. Complicated branchial cysts may require simultaneous tonsillectomy. Treatment of a lateral neck cyst is more complicated, since its localization is associated with the risk of damage to multiple vessels. However, statistics do not present any alarming facts about postoperative complications. This confirms the almost 100% safety of surgical treatment, in addition, it remains the only generally accepted method that helps to get rid of a neck cyst.

Neck Cyst Removal

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

A median cyst of the neck is removed surgically. The operation is performed on adults and children from the age of 3. Surgery is also indicated for babies, provided that the cyst is suppurating and poses a threat in terms of disruption of the breathing process and general intoxication of the body. In adult patients, a median 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, which ensures its total neutralization. If cyst tissue remains in the neck, multiple relapses are possible. The extent of surgical intervention is determined by many factors - the patient's age, 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 performed. Complete removal of the neck cyst is possible only at the stage of subsiding inflammation. Also, a median cyst can be removed together with a part of the hyoid bone if it contains a cystic or fistulous strand.

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

Aspiration of neck cysts and their treatment with antiseptics is inappropriate, 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 tissues. Inpatient treatment is indicated only for children, elderly patients, or complicated cysts. The prognosis for treatment with early diagnosis and carefully performed radical surgery is favorable. Recurrence of the process is extremely rare, which can be explained by inaccurate diagnosis or an incorrectly chosen surgical technique.

[ 34 ], [ 35 ], [ 36 ], [ 37 ], [ 38 ]

Neck Cyst Removal Surgery

Modern cyst removal surgery should not frighten the patient; the latest techniques, including gentle percutaneous intervention, suggest discharging the patient on the day after the tumor is enucleated. The purpose of the surgical procedure is to excise the capsule and contents of the cyst within the healthy tissues of the neck, without harming the surrounding vascular system and nearby organs. Of course, cyst removal surgery is not simple. After all, the neck is anatomically connected with important arteries and many functions, including the process of swallowing and speech. Accurate diagnostics and careful surgical manipulations are possible if the cyst is outside the inflammatory process and does not suppurate. If inflammation is diagnosed, anti-inflammatory therapy is first administered, acute symptoms in the form of pain are relieved, and an incision may be performed to drain the purulent contents. When the process goes into remission, the surgery is performed quickly enough and without complications. Radical excision of all parts of the cyst is the main task of the surgeon.

Extirpation (removal) of a cyst on the neck refers to the so-called minor operations 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 the formation along the surface of the cervical fold. To remove a branchiogenic cyst, the 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 resection of part of the hyoid bone is performed.
• Wound debridement.
• Hemostasis.
• Suturing the wound and draining the cavity.
• Wound treatment.
• Application of a fixing aseptic dressing.
• Postoperative dynamic observation.
• Monitoring hemodynamics and skin condition.
• Control of swallowing and speech functions.
• Removing stitches.
• Ultrasound control in 2-3 months.

Next, restorative therapy is prescribed according to indications and the suture is treated with special absorbable gels, for example, Kontratubex. Modern surgical techniques involve such "jewelry" incisions that after the operation the patient is left with virtually no scars.

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 terms of preventing suppuration and malignancy consists of 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 detection 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 is treated only by surgical methods, its removal is a guarantee that a pathological process will not develop in this area, especially cancer.

If the cyst manifests itself with pronounced symptoms, hurts and suppurates, you should immediately contact a specialist and not self-medicate. Tumor formations are very sensitive to thermal procedures, so various home recipes, 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 improve health and lead a healthy lifestyle, which includes regular examinations by the attending physician.

Neck Cyst Prognosis

Since a congenital neck cyst is treated only by surgery, as with any other operation, there is a risk of complications. As a rule, 95% of surgical interventions are successful, treatment is carried out on an outpatient basis 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 zone associated with muscles, nerve endings, 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 damaging large vessels of the neck, for example, when removing a median cyst, closely adjacent to the carotid artery. It is also difficult to enucleate a neoplasm closely fused with the walls of the neck tissues.

The volume of the surgical procedure is determined by the size of the cyst, small tumors are removed laparoscopically, 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 such types of formations must be removed as early as possible to prevent the development of branchiogenic cancer.

A neck cyst is considered a rather rare congenital pathology, which, according to statistics, accounts for 2 to 5 percent of all tumors of the maxillofacial region and neck that require surgical treatment. Despite the small number, such cystic formations are a rather complex disease, since their diagnosis is difficult 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, cysts are accompanied by fistulas, and in 50% they tend to fester and carry the risk 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 its development into a malignant process, and the faster the recovery will come. Timely radical enucleation of the cyst and adequate postoperative treatment guarantees an almost 100% favorable outcome.