Congenital Cystic Lesions of the Head and Neck
Section snippets
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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