Congenital Cysts and Sinuses of Neck

Back To Search

Congenital Cysts and Sinuses of Neck

Pediatric Otolaryngology
Author Credentials 

William O. Collins, MD
Associate Professor
Department of Otolaryngology
University of Florida College of Medicine
Gainesville, Florida

Module Summary

Pediatric patients may commonly present with cervical masses, and it is important to distinguish their etiology. Neck masses may encompass congenital lesions, infectious etiologies, as well as neoplastic causes. Accurate diagnosis of congenital neck masses can often be accomplished with a thorough history and physical examination, augmented by selective imaging. Standard treatment usually involves antibiotics for acute infections, and surgical excision as the definitive treatment. The surgical approach is determined by the embryologic derivation of the mass, which will guide the surgeon as to the anatomic location of the mass as well as critical local structures. Complications such as cyst recurrence must be anticipated and treated appropriately.

Module Learning Objectives 
  1. Explain the embryologic development of common congenital neck masses.
  2. Describe standard treatment options for these lesions.
  3. Recognize potential complications of treated and untreated congenital neck masses.

 

Embryology

Learning Objectives 

To describe the embryologic development of:

  1. Thyroglossal duct cysts
  2. Branchial cleft cysts, sinuses, and fistulas
  3. Dermoid cysts

 

References 
  1. Lambert PR, Dodson EE. Congenital malformations of the external auditory canal. Otolaryngol Clin North Am. 1996;29:741-60.
  2. Chandler JR, Mitchell B. Branchial cleft cysts, sinuses, and fistulas. Otolaryngologic Clinics of North America. 1981;14:175-186.
  3. Work WP. Cysts and congenital lesions of the parotid glands. Otolaryngol Clin North Am. 1977;10:339-44.
  4. Hirshoren, N, Neuman, T, Udassin, R, Elidan, J, and Weinberger, JM. The imperative of the Sistrunk operation: Review of 160 thyroglossal tract remnant operations. Otolaryngol Head Neck Surg. 2009;140:338-342.

Anatomy

Learning Objectives 

To describe the anatomic course of congenital neck masses, and how these relate to surgical dissection and removal:

  1. Thyroglossal duct cysts
  2. Branchial cleft anomalies
    1. 1st arch anomalies
    2. 2nd arch anomalies
    3. 3rd arch anomalies
    4. 4th arch anomalies

 

References 
  1. Cunningham MJ. Congenital malformations of the head and neck. In: Cotton RT, Myer III CM, editors. Practical pediatric otolaryngology. Philadelphia: Lippincott-Raven Publishers; 1999:663-80.
  2. Nguyen Q, deTar M, Wells W, et al. Cervical thymic cyst: case reports and review of the literature. Laryngoscope. 1996;106:247-52.
  3. Work WP. Cysts and congenital lesions of the parotid glands. Otolaryngol Clin North Am. 1977;10:339-44.
  4. Work WP. Newer concepts of first branchial cleft defects. Laryngoscope. 1972;82:1581-593.

Basic Science

Learning Objectives 

To understand the histologic cell types in common congenital neck masses and how that pertains to clinical presentation.

 

References 
  1. Chandra RK, Maddalozzo J, Kovarik P. Histological Characterization of Thyroglossal Tract: Implications for Surgical Management. Laryngoscope. 2001;111:1002-1005.

Incidence

Learning Objectives 

To describe the incidence of common congenital neck masses.

  1. Thyroglossal duct cysts
  2. Branchial cleft anomalies
  3. Dermoid cysts

 

References 
  1. Karmody CS. Developmenatal Anomalies of the Neck. In Pediatric Otolaryngology: fourth edition. Bluestone CD, Stool SE, Alper CM, et al. Saunders, Philadelphia, PA; 2003:1648-1663.

Patient Evaluation

Learning Objectives 

To know the pertinent portions of the history and physical exam when evaluating a pediatric patient with a neck mass.

 

References 
  1. Chandler JR, Mitchell B. Branchial cysts, sinuses and fistulas. Otolaryngol Clin North Am. 1981;14:175-86.
  2. Civantos FJ, Hollinger LD. Laryngoceles and saccular cysts in infants and children. Arch Otolaryngol Head Neck Surg. 1992;118:296-300.
  3. Cunningham MJ. Congenital malformations of the head and neck. In: Cotton RT, Myer III CM , editors. Practical pediatric otolaryngology. Philadelphia: Lippincott-Raven Publishers; 1999:663-80.
  4. DeMello DE, Lima JA, Liapis H. Midline cervical cysts in children. Thyroglossal anomalies. Arch Otolaryngol Head Neck Surg. 1987;113:418-20.
  5. Johnson IJ, Soames JV, Birchall JP. Fourth branchial arch fistula. J Laryngol Otol. 1996;110:391-93.
  6. Lambert PR, Dodson EE. Congenital malformations of the external auditory canal. Otolaryngol Clin North Am. 1996;29:741-60.
  7. Noyek AM, Friedberg J. Thyroglossal duct and ectopic thyroid disorders. Otolaryngol Clin North Am. 1981;14:187-201.
  8. Meier JD, Grimmer JF. Evaluation and management of neck masses in children. Am Fam Physician. 2014;89(5):353-358.

Imaging

Learning Objectives 

To identify the most valuable and cost effective tests to evaluate congenital neck masses:

  1. Ultrasound
  2. CT scanning
  3. MRI scanning

 

References 
  1. Gupta P, Maddalozzo J. Preoperative sonography in presumed thyroglossal duct cysts. Arch Otolaryngol Head Neck Surg. 2001;127:200-202.
  2. Torsiglieri AJ, Tom LW, Ross AJ, et al. Pediatric neck masses: guidelines for evaluation. Int J Pediatr Otorhinolaryngol. 1988;16:199-210.
  3. Rosenberg TL, Nolder AR. Pediatric cervical lymphadenopathy. Otolaryngol Clinics NA. 2014;47(5):721-731.

Pathology

Learning Objectives 

To understand the pertinent findings on pathologic examination of surgical specimens of congenital neck masses and their clinical implications.

 

References 
  1. Chandra RK, Maddalozzo J, Kovarik P. Histological Characterization of Thyroglossal Tract: Implications for Surgical Management. Laryngoscope. 2001;111:1002-1005.

Treatment

Learning Objectives 

To describe surgical treatment options for congenital neck masses.

  1. Needle aspiration
  2. Incision and drainage
  3. Complete excision

 

References 
  1. Burton DM, Pransky SM. Practical aspects of managing non-malignant lumps of the neck. J Otolaryngol. 1992;21:398-403.

Surgical Therapies

Learning Objectives 

To describe the standard surgical approaches and strategies for common congenital neck masses.

  1. Thyroglossal duct cyst
  2. Branchial cleft anomalies
    1. 1st Arch anomalies
    2. 2nd Arch anomalies
    3. 3rd Arch anomalies
  3. Dermoid cysts
  4. Preauricular cysts & sinuses

 

References 
  1. Chandler JR, Mitchell B. Branchial cysts, sinuses and fistulas. Otolaryngol Clin North Am. 1981;14:175-86.
  2. Choi SS, Zalzal GH. Branchial anomalies: a review of 52 cases. Laryngoscope. 1995;105:909-913.
  3. Civantos FJ, Hollinger LD. Laryngoceles and saccular cysts in infants and children. Arch Otolaryngol Head Neck Surg. 1992;118:296-300.
  4. Edmonds JL, Girod DA, Woodroof JM, et al. Third branchial anomalies. Avoiding recurrences. Otolaryngol Head Neck Surg. 1997;123:438-41.
  5. Lambert PR, Dodson EE. Congenital malformations of the external auditory canal. Otolaryngol Clin North Am. 1996;29:741-60.
  6. Sistrunk WE. The surgical treatment of cysts of the thyroglossal tract. Am J Surg. 1920;70:121-26.
  7. Sullivan DP, Liberatore LA, April MM, et al. Epidermal inclusion cyst versus thyroglossal duct cyst: sistrunk or not? Ann Otol Rhinol Laryngol. 2001;110:340-44.
  8. Chandra, RK; Maddalozzo, J; Kovarik, P. Histological Characterization of Thyroglossal Tract: Implications for Surgical Management. Laryngoscope. 2001;111:1002-1005.
  9. Hirshoren, N, Neuman, T, Udassin, R, Elidan, J, and Weinberger, JM. The imperative of the Sistrunk operation: Review of 160 thyroglossal tract remnant operations. Otolaryngol Head Neck Surg. 2009;140:338-342.

Case Studies

  1. A 7 year old male presents to an outpatient clinic with a midline neck mass. What is the best imaging modality to evaluate this mass? What other structures in the neck merit close evaluation with imaging? If the child’s neck mass becomes painful, swollen and erythematous, what is the next step in management?
  2. A 10 year old female has a right preauricular mass, with extension into the postauricular region, as well as ipsilateral otorrhea. Describe the differential diagnosis. Describe the potential relationship of this mass to the facial nerve.

Complications

Learning Objectives 

To describe common complications arising from surgical excision of congenital neck masses.

 

References 
  1. Marianowskia R, Ait Amerb JL, Morisseau-Durand MP, Manachb,Y, Rassi S. Risk factors for thyroglossal duct remnants after Sistrunk procedure in a pediatric population. Int J Pediatr Otorhinolaryngol. 2003;67:19-23.
  2. Sullivan DP, Liberatore LA, April MM, et al. Epidermal inclusion cyst versus thyroglossal duct cyst: sistrunk or not? Ann Otol Rhinol Laryngol. 2001;110:340-44.
  3. Kim MK, Pawel BR, Isaacson G. Central neck dissection for the treatment of recurrent thyroglossal duct cysts in childhood. Otolaryngol Head Neck Surg. 1999;121:543-547.

Review

Review Questions 
  1. What is the differential diagnosis of a neck mass in a child based on its anatomic location?
  2. What are the respective advantages and disadvantages of the different imaging modalities available to evaluate pediatric neck masses?
  3. What are the recommended surgical approaches for a thyroglossal duct cyst? For a branchial cleft anomaly?
Resources 

Learner must Sign In to access AAO-HNSF education activities.

  1. Annual Meeting Webcast (AMW):