Congenital Cystic Lesions of the Head and Neck

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Embryology

During the fourth week of gestation, the thyroid gland originates as a diverticulum from the floor of the pharynx (tuberculum impar) at a site that later becomes the foramen cecum of the base of the tongue.3 The gland then grows caudally into the loose prepharyngeal connective tissues, just anterior to or through the eventual location of the hyoid bone, to rest in the lower midline of the neck. As the gland moves downward, it leaves behind an epithelial trace attached to the foramen cecum,

Branchial cleft cyst

A variety of congenital anomalies of branchial origin are found in the neck region, including sinus, fistula, or cyst.11 Branchial anomalies comprise approximately 30% of congenital neck masses.11 A branchial cyst is defined as a cyst with no internal or external openings. A branchial sinus has an external or internal opening, and may or may not have a cyst connected to it. Branchial sinuses with external openings are usually associated with the first and second branchial anomalies. Third and

Cystic hygroma

Cystic hygromas are developmental tumors of the lymphatic system that affect any anatomic subsite in the human body. Cystic hygroma usually affects the head and neck (approximately 75%), with a left-sided predilection. Cystic hygroma accounts for about 5% of benign tumors of infancy and childhood.35 Lymphangiomas are classified into 3 histologic types based on the size of the abnormal lymphatic spaces: (a) simple lymphangiomas, which have capillary size lymphatic channels, (b) cavernous

Dermoid and epidermoid cyst

Dermoid cysts account for up to 25% of midline cervical anomalies, with thyroglossal duct cyst the most common midline anomaly.41 The literature is somewhat confusing concerning the relationship between dermoid and teratoma as to origin, definition, and classification. Dermoid cysts are lined by epithelium and differ from epidermoid cysts in that they contain some evidence of epithelial appendages, such as hair, hair follicles, or sebaceous glands within the cyst wall.42 Complex dermoid cyst

Thymic cyst

Nests of thymic tissue in the neck are commonly found during autopsy, being present anywhere along a path from the angle of the mandible to the mediastinum (Fig. 22).47 However, the majority of the cervical thymic tissues remain dormant; with a scarcity of clinical cases of thymic cysts in the neck being reported in the literature. The pathogenesis of thymic cyst remains controversial, with several separate possibilities to explain their development.48 The most common theory postulates that

Cervical bronchogenic cyst

Cervical bronchogenic cysts are extremely rare. These lesions result from an anomalous foregut development, but it is unclear why these cysts reach an aberrant position in the neck. Cervical bronchogenic cysts have been reported in infants as well as in adults, and occur more commonly in males.44

Summary

A variety of congenital cystic lesions are encountered in the neck. These lesions are uncommon and are usually seen during infancy or childhood, but detection may be delayed until adulthood. Such lesions often manifest as slow-growing masses, and cause symptoms only after enlarging sufficiently or after infection. Sinuses and fistulae are usually diagnosed at an earlier age than cysts. The clinical manifestations combined with knowledge of the embryology and spatial anatomy of the head and neck

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References (54)

  • R. Allard

    The thyroglossal cyst

    Head Neck Surg

    (1982)
  • M.T. Benson et al.

    Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy

    Radiographics

    (1992)
  • H. Filston

    Common lumps and bumps of the head and neck in infants and children

    Pediatr Ann

    (1989)
  • O.E. El-Silimy et al.

    Thyroglossal tract anomalies

    Clin Otolaryngol

    (1985)
  • Y. Park

    Evaluation of neck masses in children

    Am Fam Physician

    (1995)
  • R. Telander et al.

    Thyroglossal and branchial cleft cysts and sinuses

    Surg Clin North Am

    (1977)
  • J.J. Greinwald et al.

    Hereditary thyroglossal duct cysts

    Arch Otolaryngol Head Neck Surg

    (1996)
  • A.M. Noyek et al.

    Thyroglossal duct and ectopic thyroid disorders

    Otolaryngol Clin North Am

    (1981)
  • H. Bailey

    Thyroglossal cysts and fistulae

    Br J Surg

    (1925)
  • D.J. Enepekides

    Management of congenital anomalies of the neck

    Facial Plast Surg Clin North Am

    (2001)
  • S.F. Marshall et al.

    Thyroglossal cysts and sinuses

    Ann Surg

    (1949)
  • D.J. Ostlie et al.

    Thyroglossal duct infections and surgical outcomes

    J Pediatr Surg

    (2004)
  • D. Wadsworth et al.

    Thyroglossal duct cysts: variability of sonographic findings

    AJR Am J Roentgenol

    (1994)
  • A.T. Ahuja et al.

    Thyroglossal duct cysts sonographic appearances in adults

    AJNR Am J Neuroradiol

    (1999)
  • D.L. Reede et al.

    CT of thyroglossal duct cysts

    Radiology

    (1985)
  • T. Vogl et al.

    Cystic masses in the floor of the mouth: value of MR imaging in planning surgery

    AJR Am J Roentgenol

    (1993)
  • K. Moore

    The developing human

    (1988)
  • J. Langmann

    Medical embryology

    (1975)
  • J. Golledge et al.

    The aetiology of lateral cervical (branchial) cysts: past and present theories

    J Laryngol Otol

    (1994)
  • S.N. Bhaskar et al.

    Histogenesis of branchial cysts: a report of 468 cases

    Am J Pathol

    (1959)
  • D.M. Burton et al.

    Practical aspects of managing non-malignant lumps of the neck

    J Otolaryngol

    (1992)
  • K.K. Koeller et al.

    Congenital cystic masses of the neck: radiologic-pathologic correlation

    Radiographics

    (1999)
  • H. Harnsberger et al.

    Branchial cleft anomalies and their mimics: computed tomographic evaluation

    Radiology

    (1984)
  • E. Faerber et al.

    Imaging of neck masses in infants and children

    Crit Rev Diagn Imaging

    (1991)
  • J. Whetstone et al.

    Fluoroscopic and CT fistulography of the first branchial cleft

    AJNR Am J Neuroradiol

    (2006)
  • W.P. Work

    Newer concept of first branchial cleft defects

    Laryngoscope

    (1972)
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