28.03.2024

Cyst of neck: origin, types, symptoms and treatment

Cyst of the neck can be located on the side of the neck or in the middle. Such side education identify almost immediately after birth, the median can diagnose as its growth and development, or they identify by chance during diagnostic examinations in adults.

Cyst of the neck is called the hollow of the pathological formation located in the neck and containing the liquid or mass, similar to the homogeneous (uniform) porridge. It is a congenital disease that occurs due to failures in prenatal development of the fetus.

By itself, the pathology does not pose any danger, but it is rather unpleasant complication is the abscess, a fistula, and rebirth into a malignant tumor.

If the cyst of the neck does not interfere with the patient, watching her. But in most cases, such entities are subject to surgical removal. Puncture and emptying cysts of the neck did not practice because after some time in her cavity again accumulate pathological content.

General data

The cyst neck is not a tumor, although in some specifications similar to it. Tumor is a hollow structure, which is a kind of “bag” with liquid or pasty content.

Often the cyst of the neck develops when the failure of the early stages of embryonic development of the unborn child.

In some cases, a cyst of the neck can be combined with a congenital neck fistula, or fistula (abnormal passage that passes in the thickness of the tissue). In other cases, such a fistula is formed in childhood or in adulthood – if the cyst of the neck down to the abscess, the contents of the “eats” its way into the tissues, thus forming pathological course. In other words, these two diseases are often “inseparable”, so if there is a cyst of the neck, it is necessary to carry out diagnostic activities to identify the fistula of the neck, and Vice versa.

Approximately 90-100 10-11 of patients with lateral cyst at the same time developing and congenital fistula of the neck. And approximately half of the cases the cyst undergoes suppuration, and fistula of the neck is formed as a result of the evacuation of the resulting abscess through the soft tissue of the neck on the skin or in the oral cavity.

Rarely the lateral cyst of the neck diagnosed with late – competent professionals detect them in the early days from the moment of birth of the child. The same education with the median location is detected, usually in children 4-7 or 10-14 years – it is in this age range appears clinical symptoms of this disease.

In childhood, boys and girls suffer from approximately the same frequency in adulthood cyst neck a few rarely diagnosed in women, but the difference in incidence is small. It is assumed that women have small cysts of the neck can grow and due to this appear less frequently than men.

Reasons

On the neck of the fetus are the so-called Gill furrows, between which there is a cavity. With the development of the unborn child of the furrow must be overgrown. If not, the cavity remains, forming a lateral cyst of the neck. It usually occurs in the fourth to sixth weeks of pregnancy.

Such a failure on the part of the fetal development may occur under the influence of pathogenic factors on the organism of future mother – most often it is:

  • injuries to the abdomen;
  • the radiation exposure;
  • intoxication – as exogenous (intake of toxic substances from outside into the mother’s bloodstream, and then into the bloodstream of the fetus) and endogenous (production of toxins in the body pregnant due to any abnormalities, infectious, metabolic, etc.);
  • intake of drugs not under the supervision of a physician;
  • harmful habits of the mother

and others.

The median cyst of the neck is structurally similar to the lateral cyst of this location, but the immediate causes others. This kind of education described is formed due to the fact that the rudiment of the thyroid gland migrates (moves) from the place of its formation to the front surface of the neck, the so-called thyroid-lingual duct, which occurs during fetal development. As a rule, the median cyst of the neck is formed somewhat later than the side of the cyst – most often at the sixth-seventh weeks of pregnancy.

Congenital fistula of the neck is not formed as an independent disease, it is always accompanied by the formation of side or median neck cysts.

Such fistulas are of two types:

  • full that have two holes on the skin and the mucous membrane of the mouth;
  • incomplete – one end of the fistula ends in a stalemate in the soft tissues of the neck, and the other opens to the hole. Such a hole can be formed on the skin of the neck and the mucosa of the oral cavity.
The development of the pathology

Lateral cysts of the neck occur in approximately in 1.5 times more often than those of education with the median location – approximately 60% of all diagnosed cysts of the neck. Lateral cysts are located mainly on the anterolateral surface of the neck in its upper or middle thirds. They are anterior to the sternocleidomastoid muscle and are located directly on the neurovascular bundle, almost next to the internal jugular vein.

Lateral cysts of the neck can be:

  • single chamber – as one big cavity;
  • multi-camera to single cavities, which have a common entrance, so this multi-chambers highly conditional.

The median cyst located in the midline of the anterior surface of the neck. Most often they are single chamber. As a rule, such education grows no more than 2 cm in diameter. It is welded with the body of the hyoid bone, but to a lesser extent mobile. In some cases, cystic formation is formed in the tongue.

Symptoms

Quite often the side the cyst is located in the soft tissues of the neck without any impact on them. If there is suppuration of the cyst contents is either missing pressure on the neurovascular bundle in these cases, the cyst does not manifest itself, so diagnosing it more difficult.

Often the only symptom of lateral cysts of the neck can be minor discomfort in the area of education, when the patient turns his head to the side.

If the lateral cysts of the neck reach large size, they can compress:

  • blood vessels;
  • nerve branches.

When constriction of blood vessels occurs tissue hypoxia – violation will be observed from those organs and tissues, the blood supply of which is suffering. So, when squeezing the carotid arteries that supply blood to the brain, observed:

and so on.

When compression of the nerve branches may develop paresthesia – numbness of the skin, which manifests itself in the form of:

  • numbness;
  • “running ants” on the skin.

If the median neck cyst reaches a large size, it may compress nearby organs of the neck, in particular the respiratory tract that is manifested by deterioration in ventilation (ventilation) the lungs.

A patient with a midline cyst of the neck is often complained of:

  • feeling short of breath;
  • speech disorders;
  • the difficulty in swallowing.

The last two signs appear for the reason that in the presence of midline cysts of the tongue is lifted.

The most common clinical symptoms appear when complications from cysts of the neck – mostly with abscess formation (suppuration).

The patient complains of:

  • pain;
  • persistent purulent discharge that appear on the skin at the site of the projection of cysts or mouth (these allocations appear from the fistulous).

Characteristics of pain:

  • localisation – on the side or front of the neck;
  • distribution radiating (give) in the adjacent soft tissues of the neck, lower jaw;
  • nature – twitch, bursting;
  • intensity – first unspoken, then grow to the extent of accumulation of pus in the cavity of the cyst;
  • the occurrence often appear in the formation of the first portions of pus.

When abscess of large cysts there is a violation of the General condition of the patient:

  • hyperthermia (increased body temperature). Can reach 38,5-39,0 degrees Celsius;
  • weakness;
  • lethargy;
  • the worsening of the disability.
Diagnosis

The diagnosis of cysts of the neck are put on the basis of complaints of patient, anamnesis data (if the cyst detected in a child, ask clarifying questions of the parents), and additional methods of examination – physical, instrumental, laboratory.

From the anamnesis important are the following:

  • when the formation of the neck;
  • whether it has changed its properties – primarily, the size and soreness;
  • were there attempts to cure the cysts, if there was any attempt “vyhrievane” arising “bumps” in the home.

Data of physical examination with lateral cyst of the neck, the following:

  • during the inspection – if the cyst is large, on the lateral surface of the neck visible swelling of the soft tissue, which even more clearly contoured, when the patient turns his head to the side opposite the affected side. For small cysts the swelling can be seen only with careful examination and evaluation of the symmetry of both halves of the neck. Skin over the swelling is not changed;
  • palpation (feeling) is detected by the circular or oval formation, like a tumor, which when turning the patient’s head strained under the fingers palpiruemam. It is a painless, elastic consistency, mobile, not welded to the skin. In case of large cysts is determined by the fluctuation – “rolling” waves under your fingers palpiruemam, which indicates the presence of liquid content. Fluctuation is absent if the cyst cavity is filled with a pasty content.

When suppuration of lateral cysts of the neck data of physical examination are as follows:

  • during the inspection even if the inspection uncomplicated cyst was not determined, when the abscess is visualized it because of its zoom. The skin over the education become erythematous (red), marked swelling of the tissues;
  • palpation – painful cystic formation, if earlier, on palpation fluctuation was not observed when the abscess it appears. Palpation confirms the swelling of the surrounding tissues.

Data of physical examination at a median cyst of a neck to get the same as in the side, but during the inspection and palpation determined the changes in the midline of the neck. Also in the case of median cysts during examination noticed the fact that education will shift when swallowing.

In the formation of a fistula from the physical methods of examination is the informative inspection. The results depend on the type of cysts.

If formed, the fistula side of the cyst, then:

  • at the opening on the skin in the region of the front edge of the sternocleidomastoid muscle is seen the hole (the mouth of the fistula), from which stands out clear liquid with no odor. Around this hole there is hyperemia (redness) of the skin, their hyperpigmentation (dark coloration) and maceration (skin corrosion), skin covered with crusts is dried purulent contents;
  • at autopsy the mucous membrane of the oral cavity fistula mouth is located in the upper pole of one of the tonsils. The mouth can be of different size from pinpoint to wide.

If formed fistula midline cysts:

  • at the opening of the abscess with skin fistula mouth is located on the front of the neck, between thyroid cartilage and hyoid bone;
  • at the break of abscess in the oral cavity the mouth found on the surface of the tongue (usually on the border between the root and body).

Instrumental methods of examination, which are involved in the diagnosis of cysts of the neck, the following:

  • puncture – a puncture needle on the syringe tumoroids to detect in this content. Thus aspirated turbid yellowish liquid with a dirty tone (like water from the pool), sometimes it can be stringy. The fluid is sent to the laboratory for further study. In the presence of mushy content to suck it in the syringe will only traces of the liquid portion of the contents of the cyst;
  • ultrasound of the neck (ultrasound) – when conducting this method of examination to assess the size and shape of the education, its content;
  • sensing is conducted in the presence of a fistula. In fistulous course place the probe, determine its depth. This method of examination is carried out carefully, immerse the probe without excessive effort not to hurt the fabric and will not artificially create a wound channel;
  • fistulografiya with a radiopaque substance in fistulous course injected radiopaque substance and then perform x-rays. In the picture to be rendered fistulous course.

Laboratory methods used in the diagnosis of cysts of the neck, the following:

  • General blood analysis – increased number of white blood cells and ESR may indicate about the development of the inflammatory process in the cyst, their sharp increase is observed with abscess formation;
  • cytological examination of punctate contents of the cyst examined under a microscope, it discovers the lymphoid elements and the cells of stratified squamous epithelium. After removal of the cyst, and its contents (liquid or pasty) also examined under a microscope.
Differential diagnosis of

Differential diagnosis of lateral cysts of the neck carried out with such diseases and pathological conditions, such as:

  • lymphoma – a disease in which tumor cells are formed of Mature cells of the lymphoid tissue;
  • tumors of the neck – as good and malignant.

In the latter case, the differential diagnosis of lateral cysts of the neck are often carried out with benign tumors is:

  • lipoma – a tumor arising from the adipose tissue;
  • neuroma – a tumor formed of nerve structures;
  • myoma – a tumor of muscle tissue.

Differential diagnosis of median cysts of the neck are often carried out with such diseases and pathological conditions, such as:

  • Struma language adenomatous overgrowth of tissues;
  • dermoid cyst – abdominal tumor formation, which is in violation of embryogenesis (fetal development of the unborn child at the embryo stage);
  • lymphadenitis;
  • adenoma abnormally located thyroid gland – its glandular swelling;
  • non – malignant and malignant tumors of the neck.

If the cyst is festering, the differential diagnosis often carried out with the following diseases:

  • lymphadenitis – inflammation of lymph nodes;
  • lymphangitis is an inflammatory process by lymphatic ducts;
  • adenolipoma – purulent inflammation of the subcutaneous fat that develops due to the spread of her infection from previously affected lymph node.
Complications

Lateral and median cysts often accompanied by such complications as:

  • noninfectious inflammation may occur if the infectious agent has not penetrated into the cavity of the cyst, so I developed aseptic inflammatory process;
  • the abscess is formation of pus inside the cyst, which occurs when penetrating into its cavity pathogenic flora. Median cysts undergo suppuration more frequently than side – their abscess formation is observed in approximately 60% of all diagnosed cysts of the median;
  • malignancy (malignant transformation) refers to the shell of the cyst, in comparison with non-infectious inflammation or abscess formation was observed less frequently.
Treatment

To save the patient from cysts of the neck only operational method – no “resolving” of ointments, creams, poultices and lotions will not cause its return development and disappearance. Moreover, this local treatment may provoke the development of complications from this disease.

Indications for surgical removal of neck cysts are:

  • all the side of the cyst;
  • median cysts of any size, found in children;
  • median cyst diameter greater than 1 cm in adults.

If you are performing surgery to remove side cyst can occur vnutrikorporativnye technical difficulties, as near cyst are blood vessels and nerve branches.

If performed surgery to remove cysts the median, while it also removed part of the hyoid bone, to which the cyst is attached by connective tissue strand.

In the case of formation of a cyst at the root of the tongue can be removed through an incision in the skin and with operating access through the mouth.

With festering cysts it not remove, open, clean and drained of purulent content (to introduce the ends of the PVC tubes, the other ends of which are output to drain residual discharge).

This operation is carried out on an emergency basis. After:

  • rinsed the cavity of the cyst through the drainage with antiseptic solutions;
  • prescribe antibiotic and anti-inflammatory drugs.

If there are median and lateral fistula of the neck, they also must be carved. In advance of conducting a contrast study to navigate as is the fistulous course, and before the operation, it is administered in a staining medium (the usual “green” or methylene blue). Are subject to removal smallest branching sinus tracts, or may relapse. Excision of lateral fistula of the neck is quite difficult, as it often is between the internal and external carotid arteries.In some cases after the operation, the cyst may eventually heal, but in most cases observed its recurrence. So after emergency surgery to remove the pus 2-3 months after inflammation the cyst radically cut.

After the puncture and emptying cysts in the majority of cases experience a recurrence; therefore, short-term effectiveness this method is not practiced. The exception is the presence of cysts of the neck in people who have contraindications to surgery because of the risks – advanced age, severe somatic diseases, and so on. These patients spend suctioning the contents of the cyst and irrigation of the cavity with antiseptics, if necessary, the procedure was carried out again.

Prevention

As the cyst neck is congenital disorders, specific methods of prevention does not exist. The risk of such congenital disorders can be reduced if to provide normal conditions of pregnancy – the expectant mother must:

  • to avoid the influence of pathogenic factors, can trigger a violation of fetal development;
  • follow a healthy lifestyle.
Forecast

The prognosis of the cyst neck generally favorable. Quite often, this pathology is not concerned about it “holder” for many years.

Prognosis worsens with the development of complications, therefore the cyst of the neck should be promptly removed surgically.

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