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

Neck, Cysts: Follow-up

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

Outcome and Prognosis

With no history of infection or prior surgery, the recurrence rate after operating on a branchial cleft anomaly is approximately 3%. The recurrence rate increases to approximately 20% after prior unsuccessful attempts at surgical removal. The recurrence rate associated with simple excision of a thyroglossal duct cyst (TGDC) is approximately 50%. The recurrence rate with a formal Sistrunk procedure is approximately 5%.

Future and Controversies

Branchial cleft anomalies

The risk of malignancy arising from a branchial cleft cyst has been a topic of debate for years. Von Volkmann first described branchial cleft cyst carcinoma in 1882; however, the consensus today is that branchial cleft carcinoma rarely, if ever, occurs.

In 1950, Martin et al reviewed the literature and rejected all of the previous reports of branchial cleft cyst carcinoma.4 They proposed that most of these patients had a metastatic squamous cell carcinoma cyst from an undiagnosed primary lesion. Before diagnosing a patient with a branchial cleft cystic carcinoma, the patient must meet the following criteria:

  • The cystic tumor must be located along the line from anterior to the tragus, downward along the anterior border of the sternocleidomastoid muscle, to the clavicle.
  • Histologic examination reveals cancer developing in the wall of an epithelial-lined cyst. Transition from benign cyst epithelium to squamous cell carcinoma along the wall of the cystic cavity is evident.
  • The patient must have survived at least 5 years without developing any other lesions that could possibly be the primary tumor.

In 1979, Batsakis estimated that, even when including questionable cases of branchial cleft carcinoma, the incidence of branchial cleft carcinoma is approximately 0.3% of all malignant head and neck neoplasms.5 On the other hand, metastatic cystic lymph nodes are quite common; therefore, patients with cystic carcinoma in the neck are assumed to have carcinoma metastatic to cervical lymph nodes from an unknown primary site.

Thyroglossal duct cysts

Literature regarding carcinoma arising from a thyroglossal duct cyst (TGDC) does not share the same controversy as reports of branchial cleft cyst carcinoma. In 1925, Ashurst and White first reported a case of carcinoma arising in a thyroglossal duct remnant.6 Since that time, more than 100 cases have been reported, with the overall incidence of TGDC cancer being less than 1%. For unclear reasons, cancer in a TGDC is more common in females than in males. The diagnosis of carcinoma arising in a TGDC is usually made histologically only after the tumor has been removed.

 


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References
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References

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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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