eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Head & Neck Surgery

Neck, Cysts: Workup

Author: Jonathan C Smith, MD, Voluntary Attending, Clinical Assistant Professor, Department of Otolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center
Coauthor(s): Jonas T Johnson, MD, FACS, Chairman, Department of Otolaryngology, The Eugene N Myers, MD, Professor and Chairman of Otolaryngology, Professor, Department of Radiation Oncology, University of Pittsburgh School of Medicine; Professor, Department of Oral Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine
Contributor Information and Disclosures

Updated: Aug 5, 2009

Workup

Laboratory Studies

  • To avoid complications, consider several studies in the preoperative evaluation of a thyroglossal duct cyst (TGDC). Confirmation of a normally functioning thyroid gland is important; therefore, always palpate the thyroid gland during the physical examination. If the gland is not palpated, ultrasonography or CT scanning may be valuable. If an ectopic thyroid gland is mistakenly diagnosed as a TGDC and removed, the patient requires lifelong thyroid replacement to prevent myxedema and complications of hypothyroidism.
  • Although not always the case, the patient with an ectopic thyroid often is hypothyroid and consequently has elevated thyroid-stimulating hormone (TSH). If hypothyroidism is suggested by the history, then a TSH test may be useful; however, an ectopic thyroid gland cannot be ruled out even in the presence of reference range TSH levels and a clinically euthyroid history. For this reason, ultrasonography, CT scanning, thyroid scanning, or MRI may be warranted to document a normal thyroid gland.

Imaging Studies

  • Preoperative imaging studies, including high-resolution CT scanning, contrast fistulography, and barium swallow esophagraphy, may be helpful in selective cases. These studies may be useful in defining the exact location, size, and course of the branchial cleft anomaly.
    • CT scanning is helpful in most situations.
    • In the presence of an external sinus or fistula in the neck, fistulography may provide additional information on the course of the tract.
    • In a patient with a history of recurrent lateral neck abscess, in which a branchial cleft anomaly with a possible internal sinus opening is suspected, a barium swallow esophagraphy may provide helpful information.

Other Tests

  • A thorough history and physical examination is usually all that is necessary to diagnose anomalies of the branchial cleft and thyroglossal duct. The history of a patient with a branchial cleft anomaly usually reveals a neck mass that may have fluctuated in size and level of pain and discomfort.
  • In adults with a cystic mass in the neck, obtain a careful history of squamous cell cancer risk factors. A complete physical examination of the head and neck must be performed on all patients.
    • Perform a direct laryngoscopy in all patients who might have a metastatic cervical neck cyst secondary to an unknown primary squamous cell carcinoma.
    • Direct laryngoscopy with hypopharyngoscopy and barium swallow esophagraphy often are useful in the treatment of a patient with a history of recurrent lateral neck abscess in whom a branchial cleft anomaly with a possible internal sinus opening is suspected.
    • If an internal opening is observed on laryngoscopy, intubate the tract with a probe or a balloon embolectomy catheter. This facilitates identification and dissection of the sinus tract or fistula at the time of surgery.
  • Movement of the mass with deglutition and tongue protrusion is suggestive but not 100% sensitive or specific for a thyroglossal duct cyst (TGDC).

Diagnostic Procedures

If the mass is infected, a fine-needle aspiration can be performed to obtain a culture to direct antibiotic therapy; however, if too much fluid is aspirated, future dissection may be more difficult.

More on Neck, Cysts

Overview: Neck, Cysts
Workup: Neck, Cysts
Treatment: Neck, Cysts
Follow-up: Neck, Cysts
Multimedia: Neck, Cysts
References
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References

  1. Saylam G, Tanrikulu S, Dursun E, Iriz A, Eryilmaz A. A mass at fat density in the parotid gland: dermoid cyst or lipoma. B-ENT. 2009;5(1):43-5. [Medline].

  2. Sandborn WD, Shafer AD. A branchial cleft cyst of fourth pouch origin. J Pediatr Surg. Feb 1972;7(1):82. [Medline].

  3. Verret DJ, McClay J, Murray A, Biavati M, Brown O. Endoscopic cauterization of fourth branchial cleft sinus tracts. Arch Otolaryngol Head Neck Surg. Apr 2004;130(4):465-8. [Medline].

  4. Martin H, Morfit HM, Ehrlich H. The case for branchiogenic cancer (malignant branchioma). Ann Surg. Nov 1950;132(5):867-87. [Medline].

  5. Batsakis JG. Metastatic neoplasms to and from the head and neck. In: Tumors of the Head and Neck: Clinical and Pathological Considerations. 2nd ed. Baltimore, Md: Williams & Wilkins; 1979:244-245.

  6. Ashhurst AP, White CY. Carcinoma in an aberrant thyroid at the base of the tongue. JAMA. 85:1219-1220.

  7. Acierno SP, Waldhausen JH. Congenital cervical cysts, sinuses and fistulae. Otolaryngol Clin North Am. Feb 2007;40(1):161-76, vii-viii. [Medline].

  8. Allard RH. The thyroglossal cyst. Head Neck Surg. Nov-Dec 1982;5(2):134-46. [Medline].

  9. Belenky WM, Medina JE. First branchial cleft anomalies. Laryngoscope. Jan 1980;90(1):28-39. [Medline].

  10. Belmont JR, Grundfast KM. First branchial cleft anomalies: a unifying concept. Paper presented at: Eastern Section Meeting of the American Laryngological, Rhinological, and Otological Society. January 29, 1988; New York, NY.

  11. Bennett KG, Organ CH Jr, Williams GR. Is the treatment for thyroglossal duct cysts too extensive?. Am J Surg. Dec 1986;152(6):602-5. [Medline].

  12. Bloom DC, Perkins JA, Manning SC. Management of lymphatic malformations. Curr Opin Otolaryngol Head Neck Surg. Dec 2004;12(6):500-4. [Medline].

  13. Chandler JR, Mitchell B. Branchial cleft cysts, sinuses, and fistulas. Otolaryngol Clin North Am. Feb 1981;14(1):175-86. [Medline].

  14. Cinberg JZ, Silver CE, Molnar JJ, Vogl SE. Cervical cysts: cancer until proven otherwise?. Laryngoscope. Jan 1982;92(1):27-30. [Medline].

  15. Colletier PJ, Garden AS, Morrison WH, Goepfert H, Geara F, Ang KK. Postoperative radiation for squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary site: outcomes and patterns of failure. Head Neck. Dec 1998;20(8):674-81. [Medline].

  16. Cunningham MJ. The management of congenital neck masses. Am J Otolaryngol. Mar-Apr 1992;13(2):78-92. [Medline].

  17. English JS, Al-Hussani A. Recurrent suppurative thyroiditis due to pyriform fossa--thyroid fistula. J Laryngol Otol. Jun 1983;97(6):557-9. [Medline].

  18. Farrior JB, Santini H. Facial nerve identification in children. Otolaryngol Head Neck Surg. Apr 1985;93(2):173-6. [Medline].

  19. Giguere CM, Bauman NM, Smith RJ. New treatment options for lymphangioma in infants and children. Ann Otol Rhinol Laryngol. Dec 2002;111(12 Pt 1):1066-75. [Medline].

  20. Giguère CM, Bauman NM, Sato Y, Burke DK, Greinwald JH, Pransky S. Treatment of lymphangiomas with OK-432 (Picibanil) sclerotherapy: a prospective multi-institutional trial. Arch Otolaryngol Head Neck Surg. Oct 2002;128(10):1137-44. [Medline].

  21. Grundfast KM, Harley E. Vocal cord paralysis. Otolaryngol Clin North Am. Jun 1989;22(3):569-97. [Medline].

  22. Hall SF, Dexter DF. Cystic cervical metastases are not branchiogenic carcinomas. J Otolaryngol. Jun 1993;22(3):184-9. [Medline].

  23. Hawkins DB, Jacobsen BE, Klatt EC. Cysts of the thyroglossal duct. Laryngoscope. Nov 1982;92(11):1254-8. [Medline].

  24. Hockstein NG, Samadi DS, Gendron K, et al. Pediatric submandibular triangle masses: a fifteen-year experience. Head Neck. Aug 2004;26(8):675-80. [Medline].

  25. Karmody CS. Developmental anomalies of the neck. In: Bluestone CD, Stool SE. Pediatric Otolaryngology. Philadelphia, Pa: Saunders; 1990:1497-1511.

  26. Martinez Del Pero M, Majumdar S. Bateman N, Bull PD. Presentation of first branchial cleft anomalies: the Sheffield experience. J Laryngol Otol. May 2007;121(5):455-9.

  27. Maturo SC, Michaelson PG, Faulkner JA. Primary branchiogenic carcinoma: the confusion continues. Am J Otolaryngol. Jan-Feb 2007;28(1):25-7. [Medline].

  28. May M, D'Angelo AJ Jr. The facial nerve and the branchial cleft: surgical challenge. Laryngoscope. May 1989;99(5):564-5. [Medline].

  29. Myers EN. Branchial cleft cysts and sinuses. In: Myers EN, ed. Operative Otolaryngology: Head and Neck Surgery. Philadelphia, Pa: Saunders;1997:638-647.

  30. Myers EN. Thyroglossal duct cyst. In: Myers EN, ed. Operative Otolaryngology: Head and Neck Surgery. Philadelphia, Pa: Saunders;1997:630-637.

  31. Olsen KD, Maragos NE, Weiland LH. First branchial cleft anomalies. Laryngoscope. Mar 1980;90(3):423-36. [Medline].

  32. Pelausa ME, Forte V. Sistrunk revisited: a 10-year review of revision thyroglossal duct surgery at Toronto's Hospital for Sick Children. J Otolaryngol. Dec 1989;18(7):325-33. [Medline].

  33. Rood SR, Johnson JT, Lipman SP. Diagnosis and management of congenital head and neck masses. SIPC. 2nd ed. American Academy of Otolaryngology - Head and Neck Surgery; 1988.

  34. Rood SR, Johnson JT, Myers EN, Lipman S. Congenital masses of the head and neck. Postgrad Med. Nov 1982;72(5):141-5, 148-9. [Medline].

  35. Schroeder JW Jr, Mohyuddin N, Maddalozzo J. Branchial anomalies in the pediatric population. Otolaryngol Head Neck Surg. Aug 2007;137(2):289-95. [Medline].

  36. Sistrunk WE. The Surgical Treatment of Cysts of the Thyroglossal Tract. Ann Surg. Feb 1920;71(2):121-122.2. [Medline].

  37. Taylor WE Jr, Myer CM 3rd, Hays LL, Cotton RT. Acute suppurative thyroiditis in children. Laryngoscope. Nov 1982;92(11):1269-73. [Medline].

  38. Wasson J, Blaney S, Simo R. A third branchial pouch cyst presenting as stridor in a child. Ann R Coll Surg Engl. Jan 2007;89(1):W12-4. [Medline].

  39. Work WP. Newer concepts of first branchial cleft defects. Laryngoscope. Sep 1972;82(9):1581-93. [Medline].

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Further Reading

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Keywords

neck cysts, branchial cleft cysts, branchial anomalies, thyroglossal duct cysts, TGDC, neck masses, congenital neck masses, metastatic squamous cell carcinoma, acquired laryngoceles, cystic schwannomas, lymphatic malformations, benign inflammatory lesions, thyroid gland anomalies, lymphangioma, cystic hygroma, macrocystic lymphatic malformations

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Contributor Information and Disclosures

Author

Jonathan C Smith, MD,  Voluntary Attending, Clinical Assistant Professor, Department of Otolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center
Jonathan C Smith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Laryngological Rhinological and Otological Society
Disclosure: Nothing to disclose.

Coauthor(s)

Jonas T Johnson, MD, FACS, Chairman, Department of Otolaryngology, The Eugene N Myers, MD, Professor and Chairman of Otolaryngology, Professor, Department of Radiation Oncology, University of Pittsburgh School of Medicine; Professor, Department of Oral Maxillofacial Surgery, University of Pittsburgh School of Dental Medicine
Jonas T Johnson, MD, FACS is a member of the following medical societies: Allegheny County Medical Society, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Cancer Research, American Bronchoesophagological Association, American College of Surgeons, American Head and Neck Society, American Laryngological Association, American Laryngological Rhinological and Otological Society, American Medical Association, American Radium Society, American Rhinologic Society, American Society of Clinical Oncology, Pennsylvania Medical Society, and Society of University Otolaryngologists-Head and Neck Surgeons
Disclosure: adams laboratory Ownership interest Board membership

Medical Editor

Benoit J Gosselin, MD, FRCSC, Associate Professor of Surgery, Dartmouth Medical School; Director, Comprehensive Head and Neck Oncology Program, Norris Cotton Cancer Center; Staff Otolaryngologist, Division of Otolaryngology-Head and Neck Surgery, Dartmouth-Hitchcock Medical Center
Benoit J Gosselin, MD, FRCSC is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, American Medical Association, American Rhinologic Society, Canadian Medical Association, Canadian Society of Otolaryngology-Head & Neck Surgery, College of Physicians and Surgeons of Ontario, New Hampshire Medical Society, North American Skull Base Society, and Ontario Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Karen Hall Calhoun, MD, Professor, Department of Otolaryngology-Head and Neck Surgery, The Ohio State University
Karen Hall Calhoun, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, American Medical Association, American Rhinologic Society, Association for Research in Otolaryngology, Society of University Otolaryngologists-Head and Neck Surgeons, Southern Medical Association, Texas Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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