What is a Lateral Cyst of the Neck in Children?
The lateral cyst of the neck is a congenital benign neoplasm, which is rarely fixed in medical practice. Of a hundred diagnoses related to neck tumors, a lateral cyst is only 2-3 cases. The pathogenesis of this disease has been considered by specialists for 2 centuries, but the reasons are still not exactly named.
The versions that exist in science today relate to abnormalities in the development of the fetus, that is, processes that are associated with impaired embryogenesis. A neoplasm is formed when pregnancy is just beginning. A cyst develops without causing symptoms in more than 90% of cases. Diagnostic difficulties are associated with this, as some neck diseases have similar symptoms.
The lateral cyst of the neck in children is almost always not dangerous. But some scientists say that, growing in a latent form, with suppuration and inflammation, the neoplasm can become a malignant tumor. According to ICD-10, the cyst and fistula of the gill slit belong to congenital anomalies of the face and neck.
Causes of the Lateral Neck Cyst in Children
More precisely, the lateral cyst in children is called branchiogenic, which explains the appearance of formations of this type. Branchia translates as “gills.” From the 4th week of gestation, the gill apparatus is formed in the embryo. It includes five pairs of specific cavities, which are called gill pockets, gill slits and arches that connect them.
The cells of the tissues of the gill apparatus move along the ventrolateral plane and form the basis for the formation of the maxillofacial zone of the baby. If the process fails, cysts and fistulas (fistulas) are likely to develop in these areas. Ectodermal tissue forms the basis of the cyst, and the fistula consists of an endoderm, which corresponds to the tissue of the pharyngeal pocket.
Types of embryonic branchiogenic disorders:
- An open fistula on both sides.
- Incomplete fistula with one exit.
- The combination of a lateral cyst and fistula.
The etiology of the lateral cyst of the neck in children is usually associated with the rudimentary remains of the second pocket, from which the tonsils of the unborn child should form. In more than half of cases, a cyst of this type is accompanied by a fistula. Fistula in this case is located along the carotid artery, and sometimes crosses it. The branchiogenic cyst is deep, which distinguishes it from hygroma or atheroma. Usually it is found in children from 10 years. Doctors can detect a lateral fistula earlier, even in newborns, especially if it has 2 holes.
Its structure also depends on the causes of the lateral cyst. From the inside, it consists of a stratified squamous epithelium or cylindrical cells, lymphatic tissue. The latter is the primary source for the formation of gill arches and pockets.
Symptoms of the Lateral Neck Cyst in Children
The branchiogenic cyst does not have specific symptoms, and those that are detected are similar to those with an average benign neoplasm on the neck. But the symptoms of the lateral cyst of the neck are more intense. The gill tumor in all cases is located on the side, between the 2nd and 3rd fascia, near the anterior zone of the sternocleidomastoid muscle.
Symptoms of a lateral cyst of the neck usually manifest as a result of an infectious inflammatory process or as a result of injury. A cyst may look like a swelling invisible to the eye in the area of the carotid artery. Palpation allows you to determine its elasticity, mobility, no pain. During infectious diseases of the child, the lateral cyst of the neck, as a rule, increases. After increasing it can already be easily observed. Sometimes it becomes 10 centimeters in diameter.
With inflammation of the lateral cyst, the nearby lymph node of the neck may increase. Due to the enlargement of the cyst, the larynx of the child is displaced. A neoplasm can put pressure on the neurovascular bundle, due to which pain appears periodically. Cysts infected by infection can fester, an abscess forms. In an acute form of inflammation of the branchiogenic cyst in children, phlegmon can also occur, the following symptoms appear:
- general intoxication of the body
- stillness of the neck
- damage to the sternocleidomastoid muscle
With purulent inflammation of the cyst, a spontaneous breakthrough of the walls can occur, exudate will be released through the fistula. Due to the lateral cyst of the neck in children, the process of swallowing food may be disturbed, heaviness occurs in the esophagus, which is called dysphagia. With a large cyst, symptoms such as impaired diction and breathing complications are also noted. The gill cyst, located in the larynx, can provoke a characteristic wheezing sound when breathing – stridor.
As with many other neoplasms, the symptoms of a lateral cyst depend on its location and size. Often, the child’s parents may not be aware of such a problem until the child is injured or becomes ill with an inflammatory disease.
Diagnosis of the Lateral Cyst of the Neck in Children
The location of the lateral cyst of the neck should be determined. Branchiogenic tumor is always located on the side, from where its name follows. Symptoms of the cyst are obvious, but, on the other hand, they are similar to the manifestations of other neck diseases, which can complicate the diagnostic process. The branchiogenic cyst is anatomically closely connected with the edge of the sternocleidomastoid muscle, the carotid artery and other large vessels, therefore, with inflammation, lymph nodes can simultaneously increase, which should also be taken into account by the doctor in the diagnosis. The lateral cyst is differentiated with lymphadenitis, its suppuration is confused with an abscess, which leads to inadequate treatment.
For diagnosis, an anamnesis is important, including hereditary factors, as gill anomalies can be transmitted from generation to generation. The doctor examines and palpates the neck and lymph nodes. An ultrasound of the neck is performed. According to the testimony, a CT scan of the neck is performed in contrast mode. This is necessary to clarify the location of the tumor, its size, the consistency of the contents of the cavity, the type of fistula (complete or incomplete). In some cases, cyst puncture and fistulogram are important for diagnosis.
Differential diagnosis of a lateral neck cyst is carried out with such diseases:
- Dermoid of the submandibular salivary glands
- Lymphadenitis, including non-specific tuberculosis
- Thyroid Cancer Metastases
- Lipoma neck
- Vascular aneurysm
- Branchiogenic Carcinoma
- Teratoma of the neck
Treatment of Lateral Cysts of the Neck in Children
Surgical methods are necessarily used to treat cysts. The conditions are stationary or outpatient, which depends on many factors:
- The age of the patient. The prognosis is worse for children under 3 years.
- Diagnosis period of the lateral cyst of the neck (prognosis is better with early detection)
- The location of the neoplasm (the operation is complicated if the cyst is close to the nerves, large vessels)
- Tumor size (surgery is prescribed if the cyst is at least 1 cm in diameter)
- Complications accompanying this disease
- Cyst form – inflamed, with suppuration
- Type of fistula
When a branchiogenic cyst is removed, a radical preparation of all fistulous passages, cords, up to part of the hyoid bone, is carried out. Sometimes a parallel tonsillectomy may be necessary. A recurrence of the disease can only be if the doctors during the operation did not completely excise the fistulous course or if there is a proliferation of the epithelium of the cyst in nearby tissues.
Inflamed, festering cysts are not subject to surgery, first conservative treatment methods, including antibiotics, are used. In the remission stage, the cyst must be removed. If the rotten cyst itself has opened, the scars that form on this site will subsequently have a bad effect on the course of the operation, therefore the treatment should not be postponed.
During the procedure, it is often necessary to remove part of the os hyoideum – hyoid bone, and tonsils, and even resect part of the jugular vein in contact with the fistulous course. Thanks to modern methods of surgery, lateral cysts are successfully removed even in small patients, although only 15 years ago a cystectomy was performed for children who have reached a minimum of 5 years of age.
Maximum anesthesia – local or general anesthesia, minimal trauma during surgery allows patients to recover as soon as possible. A very small incision is made, the scar of which resolves after the operation in a short time, almost no trace remains.
Stages of the operation to remove the lateral cyst of the neck:
- Entering a staining substance into the fistula to clarify and visualize its course. Sometimes – insertion of the probe into the fistula
- Making a cut along the conditional lines on the skin of the neck
- If a fistula is detected, a cut of its outgoing external opening, overlapping a ligature on the fistula
- Dissection of the tissues of the neck in layers to achieve the fistulous course, which is determined by palpation
- Mobilization of the fistula, isolation in the cranial direction with the continuation of the process through bifurcation of the carotid artery towards the tonsil fossa, ligation of the fistula in this zone and its cutting
- Sometimes an operation requires 2 incisions
The duration of the operation is 30-60 minutes. After removal of the cyst, antibacterial anti-inflammatory drugs are usually used, physiotherapy is also used: UHF, microcurrents. Sutures are removed on the 5-7th day, dispensary observation is carried out for 12 months in order to notice a relapse in time, if any.
Prognosis of the lateral cyst of the neck
The prognosis of a lateral cyst of the neck in children is most often favorable. There is virtually no risk of developing branchiogenic cancer. Fistulous passages are most difficult to excise even with preliminary staining, this is due to the complex anatomical structure of the neck and the tight connection of the tumor with large vessels, lymph nodes, hyoid bone, neurovascular bundle, tonsils and facial nerve.
Prevention of Lateral Neck Cysts in Children
Prevention of the development of gill cysts in children is not developed. This is a question for geneticists and specialists studying the pathogenesis and causes of congenital malformations of the embryo. If the cyst was detected in a child under 3 years old, and it does not become inflamed and there is no tendency to increase, then an examination is recommended every 3 months until the child is 3 years old. A regular visit to an ENT doctor, otolaryngologist is the only way to control the development of a tumor, which should be removed as soon as possible, thereby eliminating the risk of suppuration and various complications in the form of an abscess or phlegmon.
It is important to systematically take a healthy child for examinations to doctors, including an otolaryngologist, in order to identify any abnormalities in time.