Neck cyst

The cyst of the neck as a type of pathological neoplasm is included in a large group of diseases - cysts of the CHO (maxillofacial region) and neck.

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

Despite a lot of clinical descriptions, studies, some issues in the field of cystic neoplasm of the neck remain not fully studied, this primarily concerns a single species classification. In the general ENT practice, it is common to separate the cysts into median and lateral cysts, and in addition to the international classifier ICD 10, there is another systematization: 

• Sublingual-thyroid cysts (median).
• Timofaringingal cysts.
• Branhiogenic cysts (lateral).
• Epidermoid cysts (dermoids).

Combining a single etiological embryonic base, the 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 of the 10th Revision has for many years been the single generally accepted standard document for coding, specifying various nosological units and diagnoses. This helps doctors to more quickly formulate diagnostic findings, compare them with international clinical experience, therefore, choose a more effective therapeutic tactics and strategy. The classifier includes 21 sections, each of them is equipped with subsections - classes, categories, codes. Among other diseases there is also a cyst of the neck, the ICD includes it in class XVII and describes both congenital anomalies (blood defects), deformations and chromosomal abnormalities. Previously, this class included pathology - the preserved thyroid-lingual duct in the block Q89.2, now this nosology was renamed into a broader concept.

To date, the standardized description, which includes the cyst of the neck, the ICD is thus:

Cyst of neck. Class XVII

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

Q18.0 - sinus, fistula and cyst gill slit

Q18.8 - Other specified defects of face and neck:

Medial facial and neck defects: 

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

Q18.9 - malformation of face and neck, unspecified. Congenital anomaly of the face and neck of the BDU.

It should be noted that in clinical practice, in addition to ICD-10, there are internal systematization of diseases, especially those that have not been adequately studied, including cystic neck lesions. Otorhinolaryngologists-surgeons often use the classification of Melnikov and Gremilov, previously used classification characteristics of cysts by R.I. Venglovsky (the beginning of the 20th century), then the criteria of the surgeons GA Richter and the founder of the national children's surgery NL Kushcha entered into practice. Nevertheless, the ICD remains the only official classifier that is used to record the diagnosis in official documentation.

Causes of a cyst on the neck

Cysts and fistulas of the neck in the vast majority are congenital anomalies. Pathogenesis, causes of the cyst of the neck are still being clarified, although as early as the beginning of the last century a version appeared that cystic formations develop from the rudiments of the branchial arches. The fistula is in turn formed due to the incomplete closure of the sulcus branchialis - the gill groove, and then retention branhyogenic lateral cysts may develop in their place. The four-week embryo already has six formed cartilaginous plates, which are separated by furrows. All arcs consist of nerve 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, slowing down of the reduction at this time leads to the formation of closed cavities and fistulas. 

• Rudimentary remnants of sinus cervicalis - the cervical sinus form the lateral cysts.
• Reduction anomalies of the second and third cracks contribute to the formation of fistula (external), the gill slits do not separate from the neck.
• The non-germination of the ductus thyroglossus - the thyroid duct - leads to the middle cysts.

Some researchers of the last 20th century proposed to describe all congenital cysts of the parotid and neck as thyoglossal, since this most accurately indicates the anatomical source of their formation and clinical features of development. Indeed, the inner part of the capsule of the cysts of the neck, as a rule, consists of a multilayered cylindrical epithelium with impregnations of cells of the flat epithelium, and the wall surface has cells of the thyroid gland tissues.

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

• Arcus branchialis (arcus viscerales) - gill arch visceral.
• Ductus thyreoglossus - thyroid-lingual duct.
• Ductus thymopharyngeus - the pharyngeal duct.

The causes of cysts around the neck are still a subject of discussion, the opinions of doctors converge only in one thing - all these neoplasms are considered congenital and their frequency in the 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%.
• Older than 15 years - 2-3%.

In addition, information has now appeared on the genetic predisposition to early vestigial embryonic developmental recessive development, but this version still needs more extensive, clinically validated information.

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

Cyst in the neck

The congenital cyst in the neck can be localized in the lower or upper surface, laterally, be deep or be located closer to the skin, have different anatomical structure. In otolaryngology cysts of the neck are divided into several general categories - lateral, middle, dermoid formations. 

The lateral cyst in the neck region is formed from the rudimentary parts of the gill pockets because of their insufficient full obliteration. According to the concept of branhyogenic etiology, from the closed gill pockets develop cysts - from the outer dermoid, from the outer - cavities containing mucus. Out of the pharyngeal pockets, fistulas are formed-through, full or incomplete. There is also a version of the origin of branhyogenic cysts from the rudiments of the ductus thymopharyngeus - the thymopharyngeal duct. There is an assumption about the lymphogenous etiology of the lateral cysts, when in the process of embryogenesis the formation of lymphatic cervical nodes is disrupted, and epithelial cells of the salivary glands are embedded into their structure. Many specialists, who have studied this pathology well, divide the lateral cysts into 4 groups: 

• The cyst located under the cervical fascia is closer to the anterior margin of Musculus sternocleidomastoideus - the sternocleidomastoid muscle.
• The cyst, localized in the depths of the neck tissue on large vessels, often fused with the jugular vein.
• The cyst located in the zone in the side wall of the larynx, between the external and internal carotid artery.
• The cyst, located next to the pharyngeal wall, medially carotid artery, often such cysts form from gill fistula closed with scarring.

Lateral cysts in 85% appear late, after 10-12 years, begin to increase, show clinical symptoms as a result of trauma or inflammation. A small cyst in the neck does not give uncomfortable sensations to a person, only increasing, getting tired, it disrupts the normal process of food intake, presses on the vascular-nervous cervical fascicle. Branhyogenic cysts, undiagnosed in a timely manner, are prone to malignancy. Diagnosis of the lateral cysts requires differentiation with such similar clinical manifestations of the neck pathology: 

• Lymphangioma.
• Lymphadenitis.
• Lymphosarcoma.
• Vascular aneurysm.
• Cavernous hemangioma.
• Lymphogranulomatosis.
• Neurofibroma.
• Lipoma.
• Cyst of the tongue-tied tongue.
• Tuberculosis of lymph nodes.
• Oedopharyngeal abscess.

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

The median cyst in the neck region is formed from unreduced parts of the ductus thyroglossus - thyroid-lingual duct in the period between 3-1 and 5-1 weeks of embryogenesis, when thyroid tissue is created. The cyst can form in any zone of the future gland - in the region of the blind hole of the root of the tongue or near the isthmus. Median cysts are often subdivided by the location - the formation in the sublingual region, the root cyst of the tongue. Differential diagnosis is necessary in order to determine the difference between the middle cyst and dermoid, thyroid adenoma, lymphadenitis of the chin nodes. In addition to cysts, middle neck fistulas can form in these zones: 

• Complete fistula, which has an outlet in the oral cavity at the root of the tongue.
• Incomplete fistula, ending with a thickened canal in the oral cavity at the bottom.

Medicated cysts are treated only by radical surgical methods, involving the removal of education along with the hyoid bone, anatomically related to the cyst.

[7]

Symptoms of the cyst of the neck

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

Lateral, branhyogenic cysts are diagnosed 1.5 times more often than middle. They are found in the anterolateral area of the neck, in front of the nodding muscle. The lateral cyst is located directly on the vascular bundle near the jugular vein. Symptoms of the branchial cyst 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 are manifested more quickly and clinically more pronounced, as they aggressively affect the vessels, nerve endings. If the cyst is small, the patient does not feel it for a long time, which considerably burdens the course of the process, treatment, and prognosis. A sharp overgrowth of the cyst may occur with its suppuration, pain appears, skin over the cyst is hyperemic, swelling, and possibly fistula formation.

When viewed, the lateral cyst is defined as a small tumor, painless in palpation, elastic in consistency. Capsule cysts are not soldered with skin, the cyst is mobile, in its cavity the liquid contents are clearly palpable.

The median cyst occurs a little less frequently 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, when swallowed, its displacement is clearly visible. A rare case is the midline cyst of the root of the tongue, when its large size makes it difficult to swallow food and can cause speech disturbance. The difference between the middle cysts and the lateral cysts is their ability to frequent festering. Accumulated pus provokes a rapid increase in the cavity, swelling of the skin, painful sensations. It is also possible to form a fistula with an exit to the surface of the neck in the region of the hyoid bone, less often into the oral cavity into the root zone of the tongue.

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

1. Formation in the period of embryogenesis and development to a certain age without clinical manifestations.
2. Slow development, growth.
3. Typical zones of localization by species.
4. Manifestation of symptoms as a result of the influence of a traumatic factor or inflammation.
5. Condensation, pain, involvement of the skin in the pathological process.
6. Symptoms of the general reaction of the body to the inflammatory purulent process - an increase in body temperature, worsening of the general condition.

Cyst on the neck of a child

Cystic neoplasms on the neck are an inborn pathology associated with embryonic dysplasia of embryonic tissues. A cyst on the neck of a child can be detected at an early age, but cases of a latent flow of the process when the tumor is diagnosed at a later age are also not uncommon. The etiology of the cysts of the neck is not clear to-day, according to available evidence, it is most likely to be of a genetic nature. According to the report of the English otolaryngoles, presented to a court of colleagues several years ago, a cyst on the neck of a child may be due to a hereditary factor.

The child inherits congenital pathology by the recessive type, statistically it looks like this:

• 7-10% of the examined children with cysts of the neck were born to a mother who had a benign tumor in this zone.
• 5% of newborns with a cyst of the neck are born from the father and mother who have a similar pathology.

Frequency of definition of congenital cysts of the neck 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 is associated with their deep disposition, asymptomatic development and a long period of the formation of the neck as an anatomical zone. Most often, cysts in the clinical sense make their debut as a result of an acute inflammatory process or trauma to the neck. With such provoking factors, the cyst begins to become inflamed, enlarged and manifested with symptoms - pain, difficulty in breathing, eating, less often - changes in the timbre of the voice. Congenital festering cysts of the neck in children can open themselves in the oral cavity, in such cases the symptoms of total intoxication of the body clearly manifest themselves.

Treatment of the cyst of the neck in a child is carried out operatively from 2-3 years, if the education threatens the breathing process, the operation is carried out regardless of age. The complexity of surgical intervention lies in the age of small patients and the anatomical proximity of the cyst with important organs, 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 characteristic for the treatment of adult patients. Nevertheless, surgery remains the only possible method of treatment of cystic tumors in childhood, the only option can be puncture of purulent cyst, anti-inflammatory conservative therapy and surgery in a later period, provided that the tumor does not cause discomfort and does not provoke functional disorders.

[8], [9], [10]

Cyst in the neck in an adult

The frequency of cysts in the neck in adults is quite high. This is an argument in favor of one of the versions explaining the etiology of development of benign neoplasm of the neck. According to some researchers, more than half of the cysts can not be considered congenital, in patients aged 15 to 30 years, branhyogenous and median neoplasms and fistulas are diagnosed 1, 2 times more often than in children aged 1 to 5 years.

The cyst on the neck of the adult develops faster than the child, it has larger dimensions, sometimes reaching 10 centimeters. The median cysts are prone to frequent suppuration, and lateral tumors are accompanied by more severe symptoms and are more often adjacent to fistulas (fistulae). In addition, cysts in the neck in children are less often malignant, according to statistics, only 10% of all clinical cases. In adult patients older than 35 years, the frequency of degeneration of the cyst of the neck in a malignant process reaches a ratio of 25/100, that is, for every hundred cases there are 25 diagnoses of a particular type of cancer. As a rule, this is explained by the neglect of the disease, which lasts for a long period without clinical signs and is symptomatic at the later stages of development. Most often malignancy of the cyst is a metastasis in the lymph nodes of the neck and branhyogenic cancer. Timely diagnosis at an early stage helps to eliminate the cyst of the neck 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 the lymph nodes. This is a direct indication of the search for a primary focus of oncoprocess. In addition, any visible seal on the neck with a size of more than 2 centimeters can also indicate a serious pathology and requires a very thorough complex diagnosis. Exclusion of threatening pathology can be considered an indication for a fairly simple operation to remove the lateral or middle 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, it is necessary to visit the attending physician regularly to monitor the recovery process.

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

Dermoid cyst on the neck

Dermoid cyst, wherever it is localized, for a long time develops asymptomatically. An exception can 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 ingestion of food. The dermoid is an organoid innate formation, which, like the middle and lateral cyst, is formed from the remains of embryonic tissues - the parts of the ectoderm displaced into one or another zone. The capsule of the cyst is formed from connective tissues, inside 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 chin bone. When the cyst is enlarged, its growth occurs, as a rule, in the internal direction, in the hyoid area. Less commonly, the cyst can be seen as an atypical convex neck formation, thus, the dermoid on the neck is considered a rather rare pathology. The dermoid grows very slowly, can manifest itself as a symptom in the period of hormonal changes - in puberty, with menopause. Painful sensations of the cyst, as a rule, does not cause, suppuration for it is uncharacteristic. In the clinical sense, the dermoid cyst of the neck is very similar to the other cysts of this region, it is not welded to the skin, it has a typical rounded shape, the skin over the cyst does not change. The only specific sign of the dermoid may be its more dense consistency, which is determined by a primary examination with the help of palpation. Dermoid cysts differentiate during the diagnosis with atheromas, hemangiomas, traumatic epidermal cyst and lymphadenitis.

The dermoid cyst is treated only surgically, the earlier the lesion is removed, the less is the risk of malignancy of the dermoid. The suppurative 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 extracted within the boundaries of healthy skin, after the procedure the wound is quickly tightened, practically without scarring. In adults, surgical treatment of the dermoid cyst on the neck is performed under local anesthesia, children undergo general anesthesia after 5 years. Dermoid treatment, as a rule, does not cause complications, but the neck area is an exception. Surgical intervention in this zone is often difficult, because the cyst has a close anatomical connection with the muscles and functionally important arteries. It happens that, along with neoplasm, the fistulous passage, the hyoid bone, is also removed to exclude the risk of recurrence. The prognosis of treatment of the dermoid on the neck is favorable in 85-90% of cases, postoperative complications are extremely rare, and relapses with incomplete removal of the cyst capsule are more often diagnosed. Absence of treatment or refusal of surgery on the part of the patient can lead to inflammation, suppuration of the neoplasm, which, moreover, in 5-6% is prone to overgrowth in a malignant tumor.

[16], [17]

Branhiogenic cyst of neck

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

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

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

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

Signs of cyst growth may be difficulty in swallowing food, periodic pain in the neck due to tumor pressure on the vascular nerve junction. An unidentified cyst can grow to the size of a large walnut, when it becomes visually visible, forming a characteristic convexity from the side.

The main symptoms of a formed branhyogenic 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 is opened independently from the oral cavity, the symptomatology temporarily subsides, but the fistula remains.
• When the cyst is large (more than 5 cm), the voice of the patient may change, and hoarseness may develop.
• An autopsy cyst 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 such pathologies of the CHO and the neck: 

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

Branhyogenic tumor of the neck is treated only by radical operational methods, any conservative methods can not be effective and often result in relapses.

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

Congenital cyst of the neck

Congenital cysts and fistulas in the neck are conventionally divided into two types - medial and lateral, although there is a more detailed classification, usually used in otolaryngology and dentistry. The congenital cyst of the neck can be located in different zones, have a specific histological structure, due to the embryonic source of development.

In the sixties of the last century, following a study of several hundred patients with pathological neoplasms of the neck, such a scheme was drawn up:

Kind of cyst	A source	Surface area of the neck	The location on the neck (half)	Depth of location
Middle cyst	Ductus thyroglossus	In the middle, the front zone	Top of the neck	Deep
Brancheogenic cyst	Arcus branchialis - gill arches (rudiments)	Side, closer to the front zone	Upper or closer to the middle of the side	Deep
Timofaringeinal cyst	Rudiments of ductus thymo-pharyngeus - thymopharyngeal duct	Sideways	Between the 2nd and 3rd fascia of the neck	Deep on the vascular-neural bundle
Dermoid cyst	Rudiments of embryonic tissues	In any zone	Bottom half	Superficial

The congenital cyst of the neck is diagnosed relatively rarely and amounts to no more than 5% of all tumorous neoplasms of the CHL (maxillofacial region). It is believed that the lateral, branhyogenic cysts are formed less often than the median, although there are no reliable statistical data to date. This is associated with a small number of clinically manifested cysts at an early age, with a rather large percentage of errors in the precise diagnosis of these pathologies and, to a large extent, that the cyst of the neck is in principle poorly understood as a specific disease.

[24], [25], [26],

Congenital cysts and neck fistulas

Congenital cysts and fistulas in the neck are considered as embryonic developmental anomalies, which are formed during the period from the 3rd to the 5th week of pregnancy.

Lateral, gill cysts and fistulas develop from parts of the gill arches, less often from the third pharyngeal sinus. Branhyogenic tumors are most often unilateral, that is, they form on one side of the neck. Localization of lateral neoplasms is typical - in the area of the surface of the nodding muscle, in structure they are elastic, fairly dense, with palpation do not cause pain. The lateral cyst can be diagnosed at an early age, but cases of its detection in a later period are frequent, in 3-5% of the cyst it is determined in patients older than 20 years. Diagnosis of the lateral tumor is difficult due to nonspecificity, and sometimes lack of symptoms. The only clear criteria are the localization of the cyst and, of course, the data of the diagnostic measures. Determine the branhyogenic cyst with the help of ultrasound, fistulogram, probing, contrasting, staining puncture. The lateral cyst is treated only surgically, the entire capsule and its contents are removed, until the end of the fistula opening in the tonsils zone.

Median congenital cysts and fistulas also have an embryonic origin, most often they are caused by dysplasia of the pharyngeal pouch, an uncomplicated thyroid-lingual duct. The localization of the middle 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 persist for a long period in a latent state, not manifesting clinically. If the middle cyst grows or increases, especially during the initial stage of inflammation, the patient may feel discomfort at eating, tolerating a tolerable pain.

Median neoplasms on the neck are also treated operatively. Radical excision of the cyst along with the capsule and part of the hyoid bone guarantees no relapse and a favorable outcome of the operation.

[27], [28], [29],

Lymph node cyst in the neck

The cyst of the lymph cervical node does not always belong to the category of congenital neoplasms, although it is often detected immediately after the birth of the child or at the age of up to 1.5 years. The etiology of the cyst of the lymph node is unspecified and is still the subject of study by ENT doctors. During embryogenesis, the lymphatic system undergoes repeated changes, the congenital etiologic factor is evidently due to the transformation of lymph nodes into oval multi-compartment formations due to embryonic cell dysplasia. Lymphangioma - the cyst of the lymph node on the neck is specific in structure, has very thin walls of the capsule, which is lined with cells of the endothelium. The typical localization of the lymphangioma is from the side of the neck to the side, with an increase in the cyst, it can spread to the facial tissues, up to the day of the oral cavity, to the anterior mediastinum (in adult patients). The structure of the lymph node cyst can be as follows:

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

The cyst is formed in the deep layers of the neck, squeezing the trachea, in newborn babies it can provoke asphyxia.

Diagnosis of cyst lymph nodes on the neck is quite simple, in contrast to the definition of other types of congenital cysts. To clarify the diagnosis, ultrasound is performed, a puncture is considered mandatory.

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

In infants, treatment consists of puncturing and aspiration of lymphangioma exudate, if the cyst of the lymph node is diagnosed as multi-chamber, the puncture will not work, the tumor needs to be excised. Removal of the cyst suggests excision of a small number of nearby tissues to neutralize the pressure on the respiratory tract. In the future, a radical surgery can be performed after improving the condition of the patient at an older age.

Diagnosis of the cyst of the neck

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

• Extremely poor information about the pathology in general. The information exists in single variants, it is poorly systematized and does not have an extensive statistical base. At best, researchers give examples of studying diseases of 30-40 people, which can not be considered an objective generally recognized information.
• Diagnosis of the cyst of the neck is difficult due to the unexplained issue of the etiology of the disease. Existing versions and hypotheses about the pathogenesis of congenital cysts of the neck are still the subject of periodic discussions among practitioners.
• Despite the existing international classification of diseases, ICD-10, the cyst of the neck remains insufficiently systematized and classified by type of disease.
• Clinically, there are only two general categories of cysts - median and lateral, which clearly can not be considered the only specific categories.
• The most difficult in the sense of diagnosis are the lateral, gill cysts, since they are very similar in clinic to other tumor pathologies of the neck.

Differential diagnosis of the cyst of the neck is very important, as it determines the correct and accurate tactics of surgical treatment. However, the only possible way of treatment can be considered both a hardship and a relief, since any kind of cystic education in the BLO is usually to be removed, regardless of differentiation.

Diagnostic measures assume the use of such methods:

• Visual examination and palpation of the neck, including lymph nodes.
• Ultrasound.
• Fistulogram.
• Puncture according to indications, puncture possible with the use of contrast medium.

As specific diagnostic criteria, the following data can be used:

Localization	Location description
Lateral localization
Cysts, provoked by abnormalities of the gill apparatus, branhyogenic cysts	The anterior zone of the sternocleidomastoid muscle, between the larynx and the styloid process
Middle zone:
Cyst of thyroid-lingual duct Deep cystic formation of the hyoid Dermoid cyst Cyst of goiter	Sealing with a tumor with a zone of the middle of the neck with an abutment to the hyoid bone The middle of the neck down to the bottom of the mouth Elastic formation in the chin zone, under it Below the middle of the neck
The whole neck
Lymphangioma Invasive hemangioma	Multichamber education, determined by ultrasound In the zone of the stair, trapezoid or sternomastoid muscle

Congenital cysts of the neck should be differentiated from such diseases:

• Tuberculosis of the lymph nodes of the neck.
• Lymphogranulomatosis.
• Aneurysm.
• Hemangioma.
• Lymphomas.
• Cyst of the thyroid gland.
• Abscess.
• Lymphadenitis.
• Struma of the tongue.

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

Treatment of cysts of the neck

If a patient is diagnosed with a cyst of the neck, especially when the patient is a child, the question immediately arises - is it possible to treat this tumor in a conservative way. The answer to this question is unambiguous - the treatment of the cyst of the neck can only be surgical. Neither homeopathy, puncture of the cyst, nor the so-called alternative methods, nor compresses will yield results, moreover, they are fraught with serious complications. Even considering the rare finding of congenital cysts in the neck, we should not forget about 2-3% of the risk of malignancy of such tumors. In addition, timely operation 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 festering cysts are subject to initial anti-inflammatory therapy (opening of the abscess), when an acute period is neutralized, an operation is performed.

Treatment of the cyst of the neck is considered a small operation, which is carried out in a planned manner.

The median cyst should be removed as early as possible in order to avoid the risk of infection by hematogenesis. Extirpation of the cyst under local anesthesia, during the procedure, the tumor is excised along with the duct. If a fistula is found during the opening of the neck tissues, its course is "stained" with the introduction of methylene blue for clear visualization. If the ductus thyroglossus is not inflated (thyroid-lingual duct), it is possible to remove it to the foramen caecum-the blind hole of the tongue. Also, part of the hyoid bone is excised when it is fused with the cystic fistula. If the operation is performed carefully, and all the structural parts of the cyst are removed completely, there is no recurrence.

Branhyogenic cysts are also subject to radical extirpation. The cyst is excised together with the capsule, possibly - together with the revealed fistula. Complicated gill cysts may require simultaneous tonsillectomy. Treatment of the lateral cyst of the neck is more complicated, as its location 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 in any case remains the only generally accepted method that helps to get rid of the cyst of the neck.

Cyst removal on the neck

Congenital cysts in the neck are subject to radical removal irrespective of the species and location. The earlier removal of the cyst on the neck, the less the risk of complications in the form of an abscess, phlegmon or malignant tumor.

The median cyst of the neck is removed surgically. The operation is carried out for adults and children, starting from the age of 3 years. Babies are also shown surgical intervention, provided that the cyst is inflamed and constitutes a threat in the sense of violation of the breathing process and general intoxication of the body. In adult patients, the central cyst should be removed if it is defined as a benign cystic tumor larger than 1 centimeter in size. The cyst is excised completely, including the capsule, this ensures its total neutralization. If there are cysts in the neck, repeated relapses are possible. The scope of surgical intervention is determined by many factors - the age of the patient, the size of the formation, the localization of the cyst, its condition (simple, suppurated). If pus accumulates in the tumor, the cyst is first opened, drainage and anti-inflammatory therapy are performed. Complete removal of the cyst of the neck is possible only in the stage of abating inflammation. Also, the midline cyst may be removed along with part of the hyoid bone, if it contains a cystic or fistula.

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

Aspiration of the cysts of the neck, treatment with their antiseptics is inexpedient, since such tumors are prone to repeated relapses. Modern otolaryngology is equipped with all the novelties of surgical techniques, so the removal of the tumor is often performed on an outpatient basis with minimal trauma to the neck tissues. Inpatient treatment is indicated only for children, patients with advanced age or with complicated form of cysts. The prognosis of treatment for early diagnosis and carefully conducted radical surgery is favorable. Very rarely there is a recurrence of the process, which can be explained by inaccurate diagnosis or incorrectly chosen technique of operation.

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

Surgery to remove the cyst of the neck

Modern surgery to remove the cyst should not scare the patient, the newest techniques, including gentle transcutaneous intervention, presuppose the patient's discharge on the day after the tumor has been harvested. The meaning of the operative procedure is to excise the capsule and the contents of the cyst within the boundaries of the healthy tissues of the neck, without harm to the surrounding vascular system and nearby organs. Of course, the operation to remove the cyst is not simple. After all, the neck is anatomically linked to important arteries and many functions, including swallowing and speech. Accurate diagnosis and accurate surgical procedures are possible if the cyst is outside the inflammatory process and is not suppressed. If the inflammation is diagnosed, first an anti-inflammatory therapy is performed, acute symptomatology is removed in the form of pain, it is possible to perform an autopsy to drain the purulent contents. When the process passes into the stage of remission, the operation is performed fairly quickly and without complications. Radical excision of all parts of the cyst is the main task of the surgeon.

Extirpation (removal) of the cyst on the neck refers to the so-called small operations and is performed most often under endotracheal anesthesia. The protocols of the procedure may vary depending on the type of education and its size, but in the general description the scheme is as follows:

• Endotracheal Anesthesia.
• Horizontal incision (with median cyst) in the region of formation along the surface of the cervical fold. To remove the branhyogenic cyst, the incision is made along the edge of the nodal muscle.
• Dissection of skin and fiber.
• Dissection of muscles and fascia.
• Detection of visible cystic formation and its excision together with a capsule within the boundaries of healthy tissues.
• When removing the middle cyst, resection of a part of the hyoid bone is performed.
• Sanitation of the wound.
• Hemostasis.
• Wound closure and drainage of the cavity.
• Treatment of the wound.
• Application of a fixative aseptic dressing.
• Postoperative dynamic observation.
• Control of hemodynamics and skin conditions.
• Control of swallowing and speech functions.
• Suture removal.
• Control of ultrasound after 2-3 months.

Then restorative therapy is prescribed according to indications and seam treatment with special resorbable gels, for example, Kontratubeks. Modern surgical techniques presuppose so "jeweler" cuts, that after the operation the patient practically does not have cicatricial traces.

Prevention of cysts in the neck

Since neck cysts are considered congenital, there is no recommendation for the prevention of such pathologies. Prophylaxis of the cyst of the neck in the sense of preventing suppuration, malignancy is in timely dispensary examinations. Rare cases of revealing cystic formations in the first year of life do not exclude their definition even at a later age, even in the asymptomatic course of the process. Any experienced otolaryngologist, examining the child, conducts all 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 an occasion for more detailed diagnostic measures. In spite of the fact that the cyst of the neck is treated only by surgical methods, its removal is a guarantee that in this area the pathological process will not develop, especially oncological disease.

If the cyst is manifested by severe symptoms, it hurts and swells, you should immediately consult a specialist and not engage in self-medication. Tumor formations are very sensitive to thermal procedures, so various home recipes, compresses can only aggravate the disease and lead to complications.

Prophylaxis of the cyst of the neck, although not designed as a measure of prevention of tumor formations, is still possible as usual measures to promote health and conduct a healthy lifestyle, which includes systematic examinations of the treating doctor.

Prognosis of cysts of the neck

Since the congenital cyst of the neck is treated only in the operative way, as in any other operation, the risk of complications is possible. As a rule, 95% of surgical interventions are successful, the treatment is performed on an outpatient basis and the patient does not require hospitalization. Nevertheless, the subsequent dynamic observation is shown literally to all patients, as the prognosis of the cysts of the neck depends on the postoperative recovery period. The edge of the neck is considered a specific topografoanatomical zone associated with muscles, nerve endings, vital organs, so surgery in this area is much more difficult than removing cystic formations elsewhere. This is due to the risk of damage to the large vessels of the neck, for example, with the removal of the middle cyst, which is in close contact with the carotid artery. It is also difficult to harvest a neoplasm closely interlaced with the walls with the tissues of the neck.

The volume of the surgical procedure is determined by the size of the cyst, small tumors are removed by laparoscopic method, large formations require radical excision in order to avoid relapses. The prognosis of the cyst of the neck, more precisely the prognostic assumptions based on the results of the treatment are usually favorable, except for the cases of detection of malignant foci during the operation. Branhyogenic cysts tend to be malignant, which, more often than in the middle cysts, is 1.5 times, so these types of formations should be removed as early as possible in order to prevent the development of branhyogenic cancer.

The neck cyst is considered a rather rare congenital pathology, which according to statistics is from 2 to 5 percent of all tumors of the maxillofacial region and neck requiring surgical treatment. Despite the small number, similar cystic formations are a rather complex disease, as their diagnosis is complex and needs differentiation with many diseases in this anatomical zone. The danger of congenital cysts of the neck is asymptomatic development, in addition, in 10% of cases, cysts are accompanied by fistula, and in 50% they have the property of swelling and carry the danger of spreading the infection throughout the body. Therefore, if a benign cystic tumor is detected, it is not necessary to delay with the operation, the earlier the cyst is removed, the less risk of its development into a malignant process, and the sooner the recovery will come. Timely radical cyst excretion and adequate postoperative treatment guarantees almost 100% of a favorable outcome.