Median cyst of the neck in a child. Median cyst of the neck in a child Median cyst of the neck in a teenager

The median cyst of the neck is a benign formation with liquid or jelly-like contents. It is a congenital pathology and is formed against the background of abnormal development of the embryo in the womb. It does not differ in progressive growth, and therefore for many years it may not manifest itself in any way.

General information

Cysts appear as dense formations with an elastic membrane and smooth walls. Painless on palpation. They can grow up to several centimeters in diameter. Such formations are located on the front surface of the neck, along the midline. They are mobile and their displacement is especially pronounced when saliva or food is swallowed, since they have a connection with the hyoid bone.

The cyst may also be located near the root of the tongue, causing it to rise slightly and cause problems with speech and swallowing. As it grows, it can compress nearby tissues and cause unpleasant pain in the neck.

These formations can suppurate, thereby provoking the occurrence of serious health problems. If the patient is not provided with timely assistance during suppuration of the cyst, abscess and sepsis begin to develop in a few hours.

When such processes occur in the tumor, the amount of pus in it increases and there is a need for its release. For this, the cyst forms a fistula, with the help of which it gets rid of purulent contents.

The fistulous tract can be located both on the neck and in the oral cavity in the region of the tonsils or the root of the tongue. Its sizes can be different - from point and barely noticeable to clearly visible. And if there are slight difficulties with the diagnosis of education, then when a fistula appears, there is no doubt about the diagnosis. The occurrence of a breakthrough is always accompanied by external changes in the skin. They turn red, swollen and covered with crusts.

An additional examination in this case is carried out in order to confirm the diagnosis, since the clinical manifestations of the cyst are often confused with a dermoid tumor. In addition, the symptoms of this formation may also resemble the development of lymphangioma and lipoma. And in order to make the correct diagnosis, an ultrasound examination is prescribed.

During ultrasound, the cysts have even and clear boundaries. Other types of tumor formations, as a rule, do not have clear contours, and their consistency is more dense.

Reasons for development

A cyst in a child occurs even in the womb in the first trimester of pregnancy as a result of violations of embryonic development. This happens with incomplete reduction of the thyroid-lingual duct. With normal development, it should disappear on its own by another 5-8 weeks of pregnancy. And when this does not happen, a closed cavity is formed, which begins to accumulate secretory fluid in itself.

These cysts can become infected with the subsequent occurrence of purulent processes as a result of:

• Reduced immunity.
• Development of viral and bacterial diseases.
• Taking certain medications.
• The presence of dental diseases, etc.

Clinical manifestations

Cyst formation is rarely accompanied by overt symptoms. It is characterized by slow growth, and therefore it is very problematic to detect it in a child immediately after birth. As a rule, this pathology makes itself felt at school age, when children are often in stressful situations (new environment, strong mental stress, overwork, worries about grades, etc.), which is an excellent impetus for active tumor growth.

During this period, external changes in the neck can be observed. A movable ball appears, which is easily palpable. It does not cause pain, is soft to the touch and has clear boundaries. In this case, the child may complain of discomfort when swallowing food or talking. Speech defects usually occur when the cyst is located very close to the root of the tongue.

When the formation suppurates, the skin in its projection turns red and swells. The tumor itself increases several times and becomes painful. After a certain time, a small hole appears in this place, through which pus flows out. If you click on it, the amount of purulent content released increases.

The skin itself around the fistula becomes very vulnerable to infections. It becomes inflamed, wounds and cracks appear on it, which are an excellent passage for pathogenic bacteria. The use of any ointments and gels of antibacterial or anti-inflammatory action in this case is useless. They only help reduce pain, but do not relieve redness, and do not stop inflammation. You can get rid of the fistula only by surgical removal.

Consequences and complications

The occurrence of the main symptoms of a neck tumor in children and adults should be a serious reason to see a doctor. If you do not pay attention to it in time, and do not undergo a course of appropriate treatment, then this can adversely affect your overall health.

Important! It must be understood that these formations are prone to infection, which is fraught with the development of abscess and sepsis. This is very dangerous, because in just a few hours they can provoke sudden death.

In addition, cysts in adults can degenerate into cancerous tumors. And their treatment does not always give a 100% guarantee of complete recovery. Often, the use of only one operation in this case is insufficient. Additionally, chemotherapy or radiation will be required, which also negatively affects the general state of health.

Difficulties with swallowing and chewing food, which occur against the background of the proximity of the tumor to the root of the tongue, leads to digestive problems.

Diagnostics

To confirm the diagnosis, the following studies are used:

• visual inspection.
• Palpation.
• Sounding.
• Puncture with further cytological study of the contents of the formation.

Since the treatment of a median tumor is carried out only by surgery, a general examination of the patient is mandatory, which allows an assessment of his state of health. For this purpose, such diagnostic methods are used as:

• Biochemical analyzes of blood and urine (determination of the level of red blood cells, white blood cells, hemoglobin, hormones, etc.).
• Taking allergy tests (performed if the patient has not previously been given general anesthesia).

As mentioned above, cyst therapy is carried out only surgically. During the operation, a complete excision of the pathological formation is carried out along with the tissues that were damaged during its growth. Depending on the size of the tumor, all surgical manipulations can be performed either through the oral cavity or on the neck through an incision in the skin. As soon as the neoplasm is removed, sutures and a sterile dressing are applied to the surgical wound.

During the surgical intervention, not only the cyst, but also the fistula lends itself to resection. However, its removal is accompanied by some difficulties, since it has thin and sinuous walls. It is for this reason that a probe is inserted into it during surgery or stained with special solutions. If the fistula is not removed, the risk of recurrence of the disease remains.

In the case when at the time of the planned operation the cyst festered, its removal is not carried out, since there is a high risk of blood infection. In this case, a puncture is made, during which all the purulent contents are pumped out of the tumor and its walls are washed with aseptic solutions. And the removal of the cyst itself is carried out after 1 - 2 months, and this is done without fail, since the neoplasm can fester again.

Puncture is also performed in cases where there are contraindications to direct surgical intervention, for example, with poor blood clotting or in elderly people suffering from hypertension. But it should be noted that this method is ineffective and after its implementation the risks of recurrence of the disease remain.

It must be understood that cysts can lead to serious health problems. Therefore, it is impossible to delay with their treatment in any case. Do not trust folk remedies or local healers. They won't be able to help. The only and effective way to get rid of this pathology is surgery.

A neck cyst is a tumor-like formation of a hollow type, which is located on the lateral or anterior surface of the neck, most often of a congenital nature, but may be the result of a congenital fistula of the neck. Lateral cysts are the result of a congenital pathology of the development of the fetus, while the median cyst of the neck in a child is diagnosed at the age of 4 to 7 years, and can often be asymptomatic. In half of the cases, the neoplasm suppurates, which leads to the emptying of the abscess and the formation of a fistula.

Treatment is surgical only. Puncture is used extremely rarely, since the accumulation of liquid or mushy mass occurs again after a while. According to the international classification of diseases, this pathological process belongs to other congenital anomalies of the face and neck. The ICD-10 code is Q18.

Etiology

The lateral or branchial cyst of the neck, in most cases, is a congenital pathology and is diagnosed at birth. This happens due to improper development of the gill slit and arches, the formation of a hollow neoplasm occurs at 4–6 weeks of gestation.

It should be noted that the lateral cyst of the neck is more dangerous than the median form, since in most cases, in the absence of timely treatment, it degenerates into a malignant formation. Also, when growing, this form of a neck cyst can compress the nerve endings and nearby organs, which can lead to concomitant pathological processes. As well as other forms of hollow tumor-like formations, it can spontaneously open and lead to non-healing gill fistulas.

The median cyst in adults (thyroglossal) may be the result of such etiological factors:

• the development of the oncological process in the body;
• injury;
• infection.

In 60% of cases, the median cyst of the neck suppurates, which can cause impaired swallowing function and speech. In some cases, such a neoplasm spontaneously opens, which leads to the formation of a fistula.

The exact causes of the development of the pathology of the gill gap and arches during fetal development have not been established. However, clinicians identify such possible predisposing factors:

• genetic predisposition - if there is such a pathological process in the anamnesis of the parents or one of them, a similar clinical manifestation can be observed in the newborn;
• strong, constant nervous tension of the mother during childbearing;
• alcohol abuse and smoking;
• treatment with "heavy" drugs during pregnancy, especially in the early stages. This should include antibiotics, anti-inflammatory, painkillers, corticosteroids;
• systemic diseases in the mother;
• the presence of chronic diseases.

If your child has this symptom, you should immediately consult a doctor. It is extremely dangerous to ignore such a clinical manifestation, since there is a high probability of the neoplasm degenerating into a malignant tumor.

Classification

There are two main types of neoplasms on the neck:

• lateral or branchiogenic;
• median or thyroglossal.

Lateral cysts, in turn, are divided into:

• single chamber:
• multi-chamber.

According to the structure and principle of education, the following forms of neoplasms are distinguished:

• dermoid cyst of the neck - refers to congenital pathologies, lies on the surface, does not attach to the pharynx. As a rule, such a neoplasm is filled with cells of the sebaceous and sweat glands, hair follicles;
• gill - located in the area of ​​\u200b\u200bthe bone under the tongue, consists of the epithelium of the pockets of the gills.

The following classification of neck cysts can also be used, according to the nature of education and localization:

• - soft and smooth formation, which is located in the lower cervical region;
• venous hemangioma;
• primary - a group of soldered compacted nodes;
• neurofibroma - motionless, dense in consistency formations, diameter from 1 to 4 centimeters;
• thyroid-lingual - can be localized in the larynx and neck, moves up or down during swallowing;
• fatty tumors.

Regardless of the etiology of the neoplasm, it is subject to surgical removal, since there is almost always a risk of transition to a malignant form.

Symptoms

Some forms of neoplasms on the neck in children or adults may be asymptomatic for a long time. As the tumor grows, the following symptoms may be present:

• inability to fully flex the neck;
• on palpation of the neoplasm, pain is felt;
• the tumor is mobile, the skin is unchanged, but redness is possible;
• the child cannot hold his head;
• weakness, lethargy;
• subfebrile body temperature, local temperature increase is also possible;
• body - nausea, vomiting, general malaise.

If the process of suppuration has begun, then the following symptoms of the clinical picture may be present:

• local redness of the skin, swelling;
• increased body temperature;
• weakness, dizziness;
• severe pain on palpation;
• purulent exudate flows out, less often into the oral cavity;
• the skin around the mouth may be covered with crusts.

In the presence of such clinical signs, medical attention should be sought immediately. The purulent process can lead to an abscess, and other life-threatening diseases.

It should be understood that the release of purulent exudate cannot be regarded as recovery and the exclusion of the need to see a doctor. The formed fistula never heals on its own, and the accumulation of fluid in the tumor almost always occurs again after a while. In addition, the risk of malignancy increases significantly.

Diagnostics

First of all, a physical examination of the patient with palpation of a cyst on the neck is performed. Also during the initial examination, the doctor should collect a personal and family history.

To clarify the diagnosis, the following laboratory and instrumental research methods can be carried out:

• puncture of fluid from a hollow formation for subsequent histological examination;
• blood test for tumor markers;
• neck ultrasound;
• fistulography;
• CT if necessary.

General clinical blood and urine tests, in this case, are not of diagnostic value, therefore, they are carried out only if necessary.

Treatment

In this case, the treatment is only operable, conservative methods are not effective. The puncture is used only in the most extreme cases, when the operation is not possible for medical reasons. Most often this applies to older people. In this case, aspiration of the contents of the tumor is carried out, followed by washing with antiseptic solutions.

As for the traditional removal of a neck cyst, such an operation is performed under anesthesia, excision can be carried out both through the mouth and externally, depending on clinical indicators. To prevent recurrence, excision is carried out together with the capsule.

Removal of lateral tumors is more difficult, since the neoplasm is localized near the vessels and nerve endings.

If the patient was admitted already with a purulent process and formation, then the tumor will be opened and drained, followed by removal of the fistulas. All fistulas, even thin and inconspicuous, are subject to excision, as they can cause a relapse. To clarify their localization, the surgeon may first inject a coloring agent (methylene blue, brilliant green).

After the operation, the patient is prescribed anti-inflammatory and antibacterial therapy. Regular dressings should also be carried out with the obligatory treatment of the oral cavity with antiseptic substances.

In the postoperative period, the patient should follow a diet that includes the following:

• from the diet for the period of treatment, it is necessary to exclude acidic, spicy and too salty, coarse food;
• drinks and dishes should be consumed only warm;
• dishes should be liquid or puree.

If surgery is carried out in a timely manner, then the risk of recurrence or the development of an oncological process is practically absent. Long-term rehabilitation is not required.

Prevention

Unfortunately, in this case there are no effective methods of prevention. It is strongly recommended not to self-medicate and consult a qualified doctor in a timely manner. In this case, the risk of complications is minimal.

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The median cyst of the neck refers to congenital developmental anomalies, which are quite rare in medical practice. This is a serious disease that is asymptomatic, which complicates its diagnosis. The anomaly is formed from the 3rd to the 5th week of embryogenesis. Symptoms can appear at any age. Most often this happens during periods when the child is growing rapidly, or during hormonal changes in the body.

Doctors often call the median cyst in children thyroglossal, which is explained by its causes and pathogenesis of development.

What provokes / Causes of the Median cyst of the neck in a child:

Doctors still do not have a common opinion about the causes of the median cyst, since this is a rare anomaly. According to statistics, cases of median cysts account for less than 2-3% of the total number of neck tumors. Thyroglossal benign tumors belong to the anomalies of the gill apparatus.

One of the theories of the origin of this pathology says that the causes of the median cyst of the neck are the thyroid-lingual duct that was not overgrown in time. This assumption appeared in the nineteenth century, the author is the German physician Wilhelm Gies (specialist in the study of embryogenesis). A specific channel is named in his honor, which connects the embryo of the thyroid gland and the oral cavity. The His canal or the thyroid-lingual duct may be the source of the formation of cysts and median, thyroglossal fistulas.

The second theory was put forward at the end of the nineteenth century by Venglovsky. He believed that tumors are formed from the cells of the epithelium of the oral cavity, while the thyroid-lingual duct is replaced by a cord.

These two theories have not been confirmed and need further study.

Symptoms of the median cyst of the neck in a child:

At the beginning of the development of congenital malformations of the neck, symptoms do not appear. Cases when there are any manifestations in the first months after birth are quite rare. More often, a cyst is found when a child is 5, 14-15 years old or more. Education grows slowly. Palpation can determine the elastic formation on the midline of the neck. The tumor is not soldered to the skin. May move upward when swallowed, along with the hyoid bone and tissues that are nearby.

Complaints in a child appear if the cyst becomes inflamed, an infection gets into it, or when it is so large that it interferes with food intake. The tumor can open outward, less often into the oral cavity, releasing purulent exudate. But the fistulous tract cannot overgrow on its own, it remains a channel for a constantly flowing inflammatory secretory fluid. When the exudate is released, the cyst decreases to some extent, but does not resolve. A large median cyst of the neck in a child can lead to serious problems with speech, swallowing. Rarely, it can become malignant - become malignant.

Symptoms include subfebrile body temperature. The cyst may occasionally hurt. The voice of the child may seem hoarse, but not at the beginning of the manifestation of the pathology.

Diagnostics of the Median cyst of the neck in a child:

How is a median cyst diagnosed?

Thyroglossal congenital anomalies do not manifest themselves in any way in about 80% of cases. Diagnosis includes examination of the ears, throat, nose, lymph nodes. Careful palpation by a competent specialist is necessary. As with a lateral cyst of the neck, with a median cyst, an ultrasound of the neck and lymph nodes is done, the doctor may prescribe an x-ray.

In the diagnosis of a median cyst of the neck in a child, fistulography plays a role. This is probing with a coloring contrast agent. According to the indications, computed tomography and puncture of the cyst are performed.

Since the median cyst is similar to many diseases of the maxillofacial region, an experienced doctor should examine the child. The median cyst is differentiated with such diseases:

• Atheroma
• Congenital dermoid cyst of the neck
• Struma language
• Adenophlegmon
• Lymphadenitis

Treatment of the Median cyst of the neck in a child:

Cystic tumors of the neck in children are treated only with surgical methods. Cystectomy is needed to treat a cyst, even if this pathology is small. An inflamed cyst with pus should first be treated conservatively, the purulent exudate should be drained. When the acute process is left behind, an operation is performed.

The doctor may advise postponing the operation until the child is older. But, if the cyst progresses rapidly and interferes with swallowing, it is not advisable to postpone surgical treatment. The median cyst in remission is subject to radical removal, regardless of its location - above the hyoid bone or below it.

The operation is called a cystectomy, it is performed under general anesthesia, the tissues are dissected in layers and the tumor itself is resected along with the body or part of the hyoid bone. Often a thyroglossal cyst is combined with a fistula. It also needs to be excised, before filling it with a contrast agent, which allows you to visually determine the fistulous course.

The complexity of the treatment of the median cyst of the neck lies in its proximity to important organs - the larynx, pharynx, large vessels. Also, the branches of the fistula, which are not visible during the operation, can cause difficulties. Incomplete removal of all structural parts of the cyst can provoke a relapse. If the disease recurs, the operation should be repeated after 3-4 months. Proper treatment guarantees a complete cure.

Cystectomy is performed mainly in children from 3 years old, but it is rarely performed in infants. Indications in such cases are a threat to the life of the child, an extensive purulent inflammatory process and the risk of general intoxication of the baby's body. Cystectomy of median neoplasms is considered less traumatic compared to operations to remove lateral cysts. Cosmetic stitches (applied from the inside of the wound), the scar is almost invisible.

The duration of the operation to remove the median cyst of the neck in a child is at least 30 minutes, in severe cases it is an hour and a half. A purulent median cyst is removed longer, as it requires drainage and careful postoperative revision. If parts of the cyst and fistula are not completely excised, then there will be a relapse, so the doctor must be as careful as possible.

The recovery period after surgery is 1 week. After that, the child can do everything that he did before the discovery of the median cyst of the neck. There may be swelling at the incision site for 30 days. If you follow the doctor's recommendations, the swelling goes down.

The forecast of operation - recovery. But extremely rarely, the median cyst degenerates into cancer. According to some statistics, this is 1 case in 1500. The most dangerous thyroglossal cyst in infancy, especially if it is large.

Prevention of the Median cyst of the neck in a child:

The development of a median cyst in a child cannot be prevented. It is important to take the child regularly for dispensary examinations, starting from birth. The earlier the tumor is detected, the more successful the outcome of the operation, and the shorter the healing period. Self-examination is also important, which allows you to identify a cyst before it fester. The child must visit the ENT and dentist at least 1 time in 6 months.

Prevention of injuries, bruises and bumps in this area helps to reduce the risk of development and inflammation of latent neoplasms.

The median cyst of the neck can be congenital or acquired. Congenital anomalies, which are quite rare, are formed at the stage of embryonic development from 3 to 5 weeks. In the future, a neoplasm - a tumor with liquid contents appears with hormonal changes, regardless of the age of the child.

The disease can proceed without symptoms for a long time, and be diagnosed at the stage of fistula formation - during the purulent-inflammatory process.

When asked by parents: Is it possible not to operate on a cyst of the neck?”- doctors give an unambiguous negative answer. The risk of degeneration of the neoplasm into a malignant form is too high.

The mechanism of formation of a cyst on the neck in a child

A cyst on the neck is such a rare pathology that doctors have not yet been able to fully study it. Thyroglossal tumors of a benign nature are classified as rudimentary anomalies - to lay the formation of the gill apparatus.

The cause of its occurrence, Wilhelm Gies, a German physician of the 19th century, who was engaged in embryogenesis, considered an unovergrown thyroid-lingual duct. The second theory of the formation of cysts was put forward by his contemporary, the Russian doctor Venglovsky. His opinion is that the cells of the oral cavity were localized in the thyroid-lingual duct, replacing the normal tissues of this area.

Currently, there are not yet enough cases of neoplasms diagnosed to confirm or refute these theories.

Types of congenital cysts are classified according to the nature of their occurrence.

Dermoid. It is a connective tissue cell united in a capsule. The main component is the remains of embryonic tissue with formed hair follicles, sweat and sebaceous glands. The cyst is median or lateral, it is not attached to the tissues of the pharynx, it is located on the surface.

Branchiogenic or gill. The place of localization is in the region of the hyoid bone. Its components are the epithelium of the gill pockets, which are formed from the elements of the goiter-pharyngeal duct.

A lymphatic duct cyst is usually located at the very bottom of the neck. It can include different components, so the neoplasm can have a variety of forms: capillary-cavernous, cystic, cavernous, cystic-cavernous.

Symptoms and diagnosis of a branchiogenic cyst of the neck

The disease is diagnosed during a visual examination. It can have various forms - from lipoma to lymphadenitis.

You may encounter a cervical cyst of the following types, which should be differentiated from a branchiogenic neoplasm:

• venous hemangioma - formed from blood vessels;
• hygroma - a transparent neoplasm of soft consistency, located in the lowest cervical regions;
• lymphoma - has a lobular structure, consists of separate soldered nodes;
• thyroid-lingual cyst - very similar in structure to the median cyst, and is attached to the hyoid bone, but then it is localized in the middle of the neck and moves along the esophagus when swallowed;
• neurofibroma - also localized in the area of ​​the hyoid bone, however, it is motionless and has a fairly dense structure.

There are also lipomas - wen and hemangiomas. These tumors are benign.

Signs of a median cyst are the following symptoms:

• locomotion during swallowing;
• impaired pronunciation of sounds, which causes a speech defect;
• difficulty pushing food down the esophagus.

Palpation of the neoplasm is painless, but suppuration is diagnosed at the formation stage.

If the abscess opens spontaneously, then a fistula is formed with an orifice that extends into the front of the neck into the cartilage region near the hyoid bone. In some cases, the mouth is formed in the tongue itself, and the purulent contents are poured into the oral cavity.

Most often, suppuration of the median fistula of the neck is caused by the introduction of staphylococcus aureus.

On palpation, the median cyst looks like a lymphoma or lipoma, but has clear boundaries and small sizes.
The final diagnosis is confirmed by ultrasound - examination and magnetic resonance therapy, the results of puncture and cytological examination. If fistulas have already appeared, then it is necessary to carry out probing and fistulography.

Treatment begins after the clinical picture is clarified - it is necessary to accurately identify the anatomical features and physiology of the tissues that make up the neoplasm.

Treatment of the median cyst

Whatever the size and etiology of the neoplasm, it must be removed. Surgery to remove cysts is called a cystectomy. In some cases, if the neoplasm does not increase, they may postpone the operation until the child reaches the age of 3 years.

In the case when the cyst increases rapidly, disrupts breathing and makes sucking difficult, surgical intervention is performed immediately after the diagnosis is made.

If suppuration has already begun and a fistula has formed, treatment begins with drainage of purulent contents - it is dangerous to carry out the operation without stopping the purulent-inflammatory process.

Operations of the median and lateral cysts of the neck are performed under general anesthesia - the tissues are dissected in layers, then the tumor and part of the hyoid bone are excised. A thyroglossal cyst often forms along with a fistula, which also needs to be excised. Before surgery, the fistula is filled with a contrast agent to determine visually where the fistula duct goes.

The difficulty of the operation lies in the fact that the median cyst is located close to large vessels and the larynx, which is why, fearing to injure such important organs, the excision is not always carried out in full. This can provoke a relapse of the disease, and then a second surgical intervention is performed after 4-5 months. If the cyst has formed on the side, then its removal is even more complicated.

After removal of median neoplasms, the sutures are almost invisible - they are superimposed from the inside, the side incisions are sutured using the technology of cosmetic surgery.

Under anesthesia, the baby has to be at least 30 - but not more than 90 minutes. Purulent
a neoplasm with a formed fistula is removed after drainage and

mandatory postoperative revision, since it is required to remove all parts of the neoplasm very carefully. Repeated surgical intervention in an infant is dangerous for his life and can significantly slow down further physiological development.

The main rehabilitation period after the operation should be at least a week - this time must be spent under medical supervision, in a hospital. The seam may swell for another month, so it is very important that parents follow all medical recommendations, then there will be no consequences from surgical intervention.
Degeneration into a malignant form of a thyroglossal cyst occurs more often while the infant is in infancy, especially when it is of considerable size. If the child managed to grow up, then metastases occur in 1 out of 1500 cases.