What is the difference between a median and lateral cyst?
The median cyst is a trace of the path along which the rudiment of the thyroid gland descended from the root of the tongue to the neck; Normally, this duct becomes overgrown. It lies in the midline, is usually associated with the hyoid bone, and characteristically moves upward during swallowing and protrusion of the tongue. The lateral cyst originates from the remains of the gill pouches and is located on the side, usually in the upper third of the neck, at the anterior edge of the sternocleidomastoid muscle. It does not move when swallowing. Both can be combined with a fistula opening on the skin.
- Median - in the center of the neck, moves when swallowing
- Lateral - on the side, at the edge of the sternocleidomastoid muscle
- Both are painless outside of inflammation
- Possible fistulas with mucus secretion
- The median is connected to the hyoid bone, which is important for surgery
Why do they arise?
This is a disorder of embryonic development and not the result of lifestyle, infection or injury. Structures that should have completely disappeared at birth are preserved as an epithelium-lined cavity. The epithelium continues to produce secretions, the cavity gradually fills, and the formation becomes noticeable - sometimes in early childhood, sometimes only in a teenager or adult. The impetus for detection is often a previous sore throat or acute respiratory viral infection, when the cyst becomes inflamed and rapidly enlarges.
- Non-closure of the thyroglossal duct - median cyst
- Remains of gill slits - lateral cyst
- Appears at any age, most often in childhood
- Not related to nutrition, injury or lifestyle
- Upper respiratory tract infections cause inflammation
Symptoms
A quiet cyst is a round elastic formation under the skin, painless, mobile, with a smooth surface, usually ranging in size from one to several centimeters. The skin over it is not changed. A large cyst may give a feeling of a lump when swallowing and discomfort when turning the head. When suppuration occurs, the picture changes quickly: the formation grows, becomes tense and painful, the skin turns red, and the temperature rises. The breakthrough of pus to the outside leaves a non-healing fistula.
- Painless round formation on the neck
- The median cyst moves when swallowing
- Feeling of a foreign body in the throat with large sizes
- With inflammation - pain, redness, temperature
- Fistula opening with scanty discharge
- In children - periodic increase after colds
Diagnostics
The first step is an ultrasound of the soft tissues of the neck: it distinguishes a liquid formation from a dense node and shows its connection with surrounding structures. In the case of a midline cyst, the thyroid gland must be evaluated to ensure that it is in place: in rare cases, the formation in the midline turns out to be the only tissue of the gland, and it cannot be removed. MRI or CT is needed for large and deep cysts, as well as before surgery to clarify the course of the fistula. In adults over forty years of age, a lateral neck mass always requires excluding tumor metastasis.
- Ultrasound of soft tissues of the neck
- Ultrasound of the thyroid gland with a median cyst
- MRI or CT scan of the neck with contrast
- Fistulography in the presence of a fistula
- Fine needle puncture with cytological examination
- Examination by an ENT doctor with endoscopy of the nasopharynx and larynx in adults
Treatment
Neck cysts do not resolve and do not go away with medications, so the only treatment is surgery. It is performed as planned, without inflammation, and it is necessary to remove not only the cavity itself, but also the entire fistulous tract. With a median cyst, the middle part of the hyoid bone is resected along with it - without this step, the cyst returns. If the cyst has festered, first relieve the inflammation with antibiotics prescribed by the doctor and drain the abscess, and complete excision is performed after a few weeks. A puncture with pumping out the contents provides only temporary relief.
- Planned complete excision of the cyst and fistula tract
- Resection of part of the hyoid bone for a median cyst
- In case of suppuration - antibiotics and drainage, then planned surgery
- Mandatory histological examination of the removed tissue
- Observation of the surgeon after the intervention
- Treatment of chronic foci of nasopharyngeal infection
