Median cyst of the neck

Congenital malformations in children are rare, benign tumors, cysts that fall into the category of pathologies of embryogenesis, according to statistics, constitute no more than 5% of tumors of the maxillofacial area (maxillofacial area), but they are quite serious diseases that occur asymptomatically, in addition, difficult to diagnose. The median cyst of the neck can be formed at an early stage of embryo development - from the 3rd to the 5th week of pregnancy, it is clinically manifested at any age, but more often during intensive growth or during hormonal changes in the body. The median cyst in medical practice is often called thyroglossal, this is due to its etiology and pathogenetic specificity of development.

[1], [2], [3], [4], [5], [6], [7]

Causes of the midline cyst of the neck

The aetiology of the middle cyst is still subject to scientific discussions, obviously, this is due to the fact that such a congenital anomaly is rare. Statistically, the midline cyst occupies no more than 2-3% of the total number of tumors of the neck, therefore, it is not possible to fully study the new formation and to confirm its etiology with multiple clinical observations. It is believed that thyoglossal benign tumors are the pathology of the embryonic basis for the formation of the maxillofacial region, that is, the anomaly of the gill apparatus.

1. Some doctors support the version stating that the causes of the middle cyst of the neck lie in the uninfected

Timely ductus thyreoglossus - thyroid-lingual duct or duct of the thyroid gland. This theory in the XIX century put forward a famous German physician, anatomist, expert in the study of embryogenesis, Wilhelm Gies. His name also called a specific channel connecting the embryo of the thyroid gland and the oral cavity, which is reduced in the last period of intrauterine development. A canal or a thyroid-lingual duct can be the source of the formation of cysts and middle, thyreoglossal fistulas.

2. Causes of the middle neck cyst may also be explained by another version, which is also noteworthy. At the end of the XIX century, the outstanding surgeon Venglovsky proposed his own version, explaining the etiology of development of thyroglossal tumors, according to which they are formed from the cells of the epithelium of the oral cavity, while the thyroid-lingual duct is replaced by a strand.

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

However, the first variant of the Hypos is more statistically significant - more than 55% of the diagnosed cases showed a close connection of the middle cyst with the hyoid bone and foramen cecum linguae, a blind opening of the tongue that fully corresponds to the topography of the ductus thyreoglossus - the thyroid gland.

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Symptoms of the midline cyst of the neck

Clinical manifestations of congenital malformations of the neck are almost always hidden in the initial period of development. Very rarely there are cases when the symptoms of the middle cyst of the neck are visible with the naked eye in the first months after birth. Much more often the cyst is manifested between the ages of 5 to 14-15 years and older. The feature of almost all types of benign tumors of the neck is an asymptomatic course that can last for many years. The median cyst in the latent state is not manifested by pain sensations, does not provoke the dysfunction of nearby structures. The start of its development can give an inflammatory disease of acute form, as well as periods of hormonal changes in the body, for example, pubertal period. Even manifested, the cyst grows very slowly, with palpation is defined as a rounded elastic formation on the median line of the neck, the tumor is not welded to the skin, while swallowing can move up along with the hyoid bone and nearby tissues. Objective complaints from the patient begin when the cyst becomes infected, inflames and interferes with food intake. The tumor can be opened out, less often into the mouth, releasing purulent exudate, but the fistulous course never overgrows independently and remains as a permanent channel for the flow of the inflammatory secretory fluid. Exudate yield 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, breaking speech (diction), in rare cases - malignancy, that is, development into a malignant process.

The median cyst of the neck in a child

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

The symptomatology of the middle cyst in a child is rarely manifested in the first years of life, more often the tumor is diagnosed in the period of intensive growth - at the age of 4 to 7-8 years and later, in the pubertal period.

The etiology of the middle cysts is presumably due to incomplete fusion of the thyoglossal duct and a close connection with the hyoid bone.

As a rule, in the initial period of development, the midline cyst on the neck in the child is diagnosed at random examinations, when the attentive doctor carefully palpates the lymph nodes and neck. Palpation passes painlessly, the cyst is probed as a dense, clearly defined rounded formation of a small size.

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

A nasal cavity cyst is very similar to an abscess, especially if it is opened and releases purulent contents. However, unlike the classical abscess, the middle cyst is not capable of resorption and healing. In any case, the tumor requires careful differential diagnosis when it is separated from symptomatic atheroma, cysts of the sub-frontal zone, dermoid, lymphadenitis.

The thyoglossal cyst in a child is treated surgically, as well as a cyst in an adult patient. Kystectomy is performed under local anesthesia, the capsule and the contents of the tumor are completely removed, and a separate part of the hyoid bone can be resected. If the cyst is suppressed, first it is drained, inflammatory symptoms are removed, and the operation is performed only in a state of remission. Surgical treatment of the middle cyst in children is shown from the age of 5, but sometimes such operations are carried out in an earlier period, when pathological formation interferes with the process of breathing, eating, and cysts with a size of more than 3-5 centimeters.

Median cyst of neck in adults

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

The median cyst of the neck in adults develops without clinical manifestations for very long, its latent state can last for tens of years. Provoke an increase in cyst traumatic factors - strokes, bruises, as well as inflammation associated with ENT organs. Cyst increases in size due to the accumulation of inflammatory exudates, often pus. The first noticeable clinical sign is a swelling in the middle zone of the neck, then there are painful sensations, difficulty in swallowing food or fluids, less often - voice voice changes, dyspnea, dyskinesia. A serious complication of the median cyst of the neck is the compression of the trachea and the degeneration of the tumor cells into atypical, malignant ones.

The thyoglossal cyst is treated exclusively surgically, puncture, conservative methods are ineffective and even delay the process, provoking various exacerbations. The earlier the operation is performed to remove the cyst, the faster the recovery. The prognosis of treatment of the middle cyst in adult patients is mostly favorable, provided that the tumor is detected and radically removed in a timely manner.

Diagnosis of the midline cyst of the neck

[9], [10], [11], [12]

How to determine the middle cyst?

Thyreoglossal congenital anomalies in 75-80% develop without obvious clinical signs. Diagnosis of the middle cyst of the neck may initially be aimed at examining the ENT organs, lymph nodes, in which case the neoplasm is diagnosed in passing, with careful palpation.

Primary observations and information are confirmed by such methods: 

• Ultrasound of the neck, lymph nodes.
• X-ray.
• Fistulography (sounding and application of contrasting coloring matter).
• Computed tomography according to indications.
• Puncture.

Since the diagnosis of the middle cyst of the neck is quite difficult due to the similarity of the signs of many diseases of the CHO (maxillofacial area), the doctor requires not only theoretical knowledge, but also a great practical experience. The choice of the treatment method depends on how correctly the diagnosis is made.

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

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

Treatment of the median cyst of the neck

Treatment of congenital cystic tumors of the neck is currently performed exclusively surgically. The median cyst is also subject to cystectomy regardless of its size and condition. An inflamed cyst containing pus is first treated symptomatically, purulent exudate drained. After neutralizing the acute process, adult patients are shown surgery. Surgical treatment of the middle cyst on the neck in a child can be delayed for several years until reaching a more mature age and the ability to postpone the operation adequately. This is possible only if the cyst does not increase and does not interfere with the functioning of the entire maxillofacial area.

The median cyst in the remission stage is subject to radical removal, regardless of its location - above the hyoid bone or under it. Kystectomy is performed under local anesthesia by layer-by-layer dissection of tissues and resection of the tumor itself together with the body or part of the hyoid bone. Often, the thyreoglossal cyst is combined with a fistula, which is also excised, pre-filled with a contrast agent to visually determine the fistulous course. The difficulty of treating the middle cyst of the neck lies in its proximity to important organs - the larynx, pharynx, large vessels. Also, embarrassments of the fistula that can not be seen during the operation can cause difficulties. Incomplete removal of all structural parts of the cyst can provoke a relapse, when the operation has to be repeated 3-4 months later. Therefore, preliminary examinations of the tumor, including a fistulogram with contrast agents, showing all possible fistulous courses, are so important.

When carrying out all diagnostic measures, correct and accurate operation, recovery occurs very quickly. In addition, such operations are referred to as "minor surgery" and have almost 100% favorable prognosis.

Removal of the middle cyst of the neck

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

Preference for removal rather than resolving therapy is associated with the etiology of cyst formation - all of them are considered as congenital anomalies of embryogenesis, therefore the only way to eliminate the consequences of a reduction in the reduction of the gill apparatus is surgery.

The removal of the thyoglossal cyst is performed under endotracheal or intravenous anesthesia. Careful excision of all parts of the cyst, as well as fistula, fistula and a certain zone of the hyoid bone, guarantees almost a hundred percent recurrence-free recovery. In contrast to the removal of the lateral cysts, the cystectomy of the median neoplasms is considered less traumatic and has a favorable prognosis.

Surgery for the middle neck cyst

How is the operation performed with the middle neck cyst:

1. After a thorough examination, the patient undergoes anesthesia, usually a local anesthetic.
2. After the introduction of an anesthetic, a layerwise incision of the cyst localization zone is performed. The incisions pass along the natural folds, therefore the postoperative scars are almost invisible.
3. The walls, the capsule of the cyst are extracted, the contents of the tumor, depending on the consistency, are drained or washed away.
4. When a concomitant fistula is identified, part of the hyoid bone is also resected, as the fistula's lobe is located in this zone.
5. The fistula is removed simultaneously with the cyst, it is pre-visualized with methylene blue.
6. The surgical wound is sewn up with neat cosmetic sutures.

Modern surgical technologies, techniques and equipment allow for the removal of the middle cyst as safely and with little trauma. Stitches are applied from the inside of the wound, this allows to achieve a good cosmetic effect, when after half a year the patient has almost no external post-operation scars or scars on the neck.

The operation with the middle cyst lasts an average of 30 minutes to one and a half hours in extreme, complicated cases. Complexity of surgical intervention and the scope of the procedure may depend on the size of the tumor and its contents. The purulent middle cyst is removed longer, as it requires drainage and thorough post-operative revision. If parts of the cyst, fistulas do not dissect completely, relapses are possible, therefore, due to the doctor's care, a favorable outcome of the operation depends. But even relapses are not considered a threatening complication, as a rule, a repeat operation is shown 2-4 months after the primary and ends at 100% safely. The recovery period lasts no more than a week, after which the patient can return to normal life and perform all the necessary functions, both domestic and workers. During the month, edema is possible at the site of the incision, but they disappear without a trace if all the medical recommendations are observed. Complete recovery depends on the general health and regenerative properties of the body.

Prevention of the midline cyst of the neck

Unfortunately, it is not possible to say that the development of the middle cyst can be prevented. Preventive measures are not taken for various reasons, but the main ones are congenital etiological factors. Developmental anomalies in the prenatal period are in principle considered difficult to predict, these issues are dealt with by genetics. Some scientists have put forward a version about the inheritance of congenital tumors of the CHO (maxillofacial area), however this information is controversial and not confirmed statistically. Prophylaxis of the middle neck cyst may consist of standard recommendations that apply to any disease in principle: 

• Clinical examinations should be systematic, regular.
• All children should be examined from the moment of birth.
• Earlier detection of tumor formations helps to take timely measures to stop the process and plan for surgical intervention.
• Diagnosis of the middle cyst at an early stage avoids the volumetric operation, which is indicated by the removal of large, inflamed neck tumors.
• Self-examination can also help in identifying cysts at an early stage of development. In this sense, even the so-called "false alarm" is much better than the later detection of a purulent, developed cyst.
• The thyoglossal cyst has the property of malignancy. The percentage of such cases is small, nevertheless, the risk of developing a malignant process exists. Therefore, a visit to the ENT doctor, dentist should be planned in the regime - once in six months.
• In some cases, the increase and suppuration of the middle cyst provokes neck injuries, which is a complex and vulnerable part of the body. Therefore, the prevention of injuries, bruises and strokes in this zone helps reduce the risk of developing and inflammation of latent latent tumors.

Prognosis of the midline cyst of the neck

Virtually 100% of operations to remove the middle cyst on the neck end safely. Of course, surgical intervention in this anatomical zone can not be considered completely safe, but modern equipment, the use of new methods, medical experience and developments in the field of otolaryngology allow us to speak about a favorable outcome of treatment.

The prognosis of the middle cyst of the neck is usually favorable. The risk of malignancy of the tumor is possible only in rare cases, when the neoplasm is clinically manifested, but not treated. A triggered process, concomitant inflammation, infection of the cyst can lead to the transformation of tumor cells into malignant ones. There is no confirmed and indisputable statistics on this issue, it is believed that the middle cyst rarely degenerates into cancer, according to some information in just 1 case for 1500 diagnoses. The most dangerous thyroglossal cyst in infancy, especially if it reaches a large size and squeezes the airways.

The median cyst of the neck is a congenital anomaly that is currently successfully operated and does not represent a difficulty in terms of treatment. The only "dark spot" in its history is not fully understood etiology and pathogenesis. However, the study process is not stopped, and now many genetics, doctors continue to accumulate clinically reliable information to come to a consensus in determining the root cause of congenital tumors, and therefore, to new, more advanced methods of their treatment.