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November 27, 2016 00:17

Cervical cyst

Congenital lateral neck cyst is considered to be benign tumors that are diagnosed very rarely - only 2-3 cases per 100 diagnoses related to neck tumors.Etiology of neck cysts so by not verified, although its pathogenesis has been studied for two centuries.To date, all existing versions of concern violations of embryogenesis process, ie, birth defects, fetal anomalies.Formation begins tumors at an early stage of pregnancy, cysts development occurs in 90% of asymptomatic, which greatly complicates timely diagnosis and differentiation of benign tumor from the side on the basis of similar neck diseases.

Side cyst in most cases not dangerous, but it is assumed that the latent, hidden form, inflammation and festering, the tumor can develop into a malignant tumor.

The International Classification of Diseases (ICD-10) cyst and fistula gill slits are block Q10-Q18 - congenital anomalies (birth defects) of the face and neck.

reasons lateral neck cyst

Lateral neck cyst not accidentally get a more accurate

name - branchial closely connected with the most authentic version, which explains the appearance of such tumors.Vranchia - it gills, really, since the fourth week of gestation, the embryo is formed by the so-called gill apparatus.It consists of five pairs of specific cavities (gill pockets), gill slits and joining their arch (arcus branchialis).Moving along the ventrolateral plane gill apparatus tissue cells form the basis for the formation of Chloe - maxillofacial baby.If this process is crashing, gill arches are not completely obliterating, leaving cavities and holes in these areas can develop cyst and accompanying her fistula (fistula).Kista consists of ectodermal tissue, and fistula - from the endoderm, the appropriate tissue pharyngeal pocket.

Types embryonic branchial violations:

  • cyst.
  • complete fistula, open on two sides.
  • incomplete fistula with a single output.
  • combination of lateral cysts and fistulas.

The most common causes of lateral neck cysts associated with vestigial remains of the second pocket, which should form the tonsils.Such a cyst in the 60-65% accompanied by a fistula, the external opening of which can go in any zone on the edge of the sternocleidomastoid muscle, and the fistula is located along the carotid artery, sometimes crossing it.Branchial cyst because of their origin is localized deep enough, in contrast to the atheroma or hygroma, and in most cases detected in children older than 10 years and adult patients.Side fistula is defined before - in infants and children up to 5-7 years, especially if it is characterized as a complete, has two openings, one of which goes to the side of the pharynx, and the second - in Musculus sternocleidomastoideus zone - sternal clavicular-mastoid muscle.Furthermore, it causes cysts cause side and its structure inside neoplasm consists of stratified squamous epithelium, or cylindrical cells, and lymphatic tissue that is the primary source for formation of pockets and gill arches.

Symptoms lateral neck cyst

Clinical signs of branchial cysts are not specific and are similar to the symptoms of benign tumors of the median on the neck.However, unlike tireoglossalnoy cysts, cyst lateral neck symptoms occur more rapidly, in addition, always localized tumor gill side, between 2 and 3 fascia adjacent to the front zone sternocleidomastoid muscle.

Symptoms lateral neck cysts often debut as a result of a general infection or inflammation after injury and may be such as:

  • cyst can appear as a small, almost imperceptible swelling in the area of ​​the carotid artery ( "sleepy triangle").
  • On palpation of the lateral cyst feels like a flexible, mobile and painless tumor.
  • Lateral neck cyst often increases during acute or prolonged, a chronic inflammatory process in the body (acute respiratory viral infection, acute respiratory infections, flu).
  • Increased tumor, it becomes visible to the naked eye, bulging and sometimes reaching 10 centimeters in diameter 10 cm.
  • When inflammation of the lateral cysts can increase a nearby lymph node neck.
  • Increased cyst provoked the displacement of the larynx.
  • cyst may put pressure on the neurovascular bundle and cause recurrent pain.
  • cyst infection is accompanied by suppuration and abscess formation.
  • acute form branchial cyst inflammation may be accompanied by cellulitis and related symptoms - general intoxication, fever, lesions of sternocleidomastoid muscle and neck immobility.
  • purulent inflammation of the cyst can cause an independent break walls and selection of fluid through the fistula.
  • Side cyst can disrupt the process of swallowing food, cause a feeling of heaviness in the esophagus (dysphagia).
  • cyst larger provokes violation diction makes it difficult to breath.
  • Gill cyst located in the larynx area, can provoke a characteristic whistling sound when breathing - wheezing.

It should be noted that the clinical manifestations branchial cyst depend on its localization and size and is often not detected for a long period of exposure up to a factor provoking - inflammation or injury.Scanty symptoms, slow the development of cysts creates certain difficulties in its diagnosis, especially in differentiation.

Lateral neck cyst in a child

Gill neck cyst is most commonly diagnosed in children older than 7 years, in general, congenital anomalies in the anatomical area are extremely rare and occur closer to puberty.Lateral neck cyst in young children, especially in infants usually have a latent form, and does not show clinical signs until the effects of a provoking factor - injuries, respiratory infections or general inflammation in the body.Some experts link the debut of symptoms gill cysts with typical age-periods when the body is hormonal changes.Statistical data on this disease is extremely scarce and can not claim to be the objective, confirmed by clinical data, however, practitioners, surgeons say the prevalence of boys among patients with branchial cyst.

development of cervical cyst in a child is almost always preceded by acute respiratory infections, flu less often.The close connection of tumors with lymph pathways contributes to the smooth penetration of pathogenic microbes into the cavity of the cyst, inflammation which 75% is accompanied by suppuration.

potential danger presents itself like the enlarged cyst and its complications - abscess, cellulitis neck.It should be noted that a quarter of patients with primary children gill cysts detection was associated precisely with reference to the doctor about the neck abscess.There is also the danger of malignancy branchial cysts, although branchiogenous childhood cancer does not occur, it is diagnosed in male patients over the age of 55 years.Nevertheless, given the ability of lateral cysts develop asymptomatic for decades, the importance of early detection of cancer is undeniable.

not manifest specific symptoms and can not bother him for a long time in the clinical sense of the lateral neck cyst in a child.Only an increase in inflammation and tumors cause problems with eating, pain in the tumor area, difficulty breathing.Cyst large abscess or cellulitis provokes symptoms of general intoxication, a child's body temperature rises, there is a whistling sound (stridornoe breath), increased lymph nodes, possible nausea and vomiting.

Treat side cysts in children and adults only surgically outside the acute stage.Purulent cyst is subject to puncturing and anti-inflammatory treatment, then after decrease in acute inflammation signs it is removed.Operations carried out for children older than 3 years, but the removal of the cyst can be displayed and at a younger age in the case of threat of serious complications and the baby lives.

Lateral neck cyst is considered to be more complex in terms of the operation than the median, as the wall of the tumor in close contact with the neurovascular bundle and anatomically related to the carotid artery.However, removal of the side of the tumor in the presence of high-precision surgical devices and instruments is not harmful to the child's health.The operation is performed under a general or local anesthesia, it depends on the patient's age, the size of the cyst and the presence of a fistula (fistula).The recovery period, scarring of wounds in less than 2 weeks.As a small incision is made, a cosmetic, a few months later on the neck seam is almost invisible, and as the child grows and disappears.

Diagnostics lateral neck cyst

before, make a differential diagnosis of neck cysts, determine its location.Branchial tumor is always located on the side, hence its name - a lateral cyst.Diagnosis of lateral neck cysts often carried out at the moment of complications when the cyst increased in size, and is accompanied by an abscess or cellulitis.On the one hand, the clinical manifestations are clear, on the other - they are similar to symptoms of other diseases of the neck, which may introduce difficulties in the process of diagnosis.In addition, branchial cyst anatomically closely connected with the edge of the Musculus sternocleidomastoideus - sternocleidomastoid muscle, carotid artery and other large vessels, with a portion of the hyoid bone, which provokes inflammation with a simultaneous increase and cysts, and lymph nodes.Therefore, lateral cyst is often mistakenly taken as lymphadenitis, its festering quite often defined as an abscess, respectively, treatment is not quite adequate.

It should be noted that the differential diagnosis of a lateral neck cyst from other types of congenital cysts is not critical, since they are all, one way or another, are subject to rapid removal.Much more significant is considered a timely statement of fact, the presence of cysts as a benign tumor, specification of its size, shape and the presence of fistula.

How to identify lateral neck cyst?

  • Medical history, including hereditary, as gill abnormalities can be transmitted genetically recessive type.
  • inspection and palpation of the neck lymph nodes.
  • neck ultrasound.
  • Computed tomography of the neck in a contrast mode on the testimony - clarification of the tumor localization, size, cavity content consistency, type of fistula (complete or incomplete).
  • puncture cyst indicated.
  • Fistulogramma (fistulous staining).

Side cyst differentiates neck with such diseases:

  • Lymphadenitis, including non-specific form of tuberculosis.
  • dermoid submandibular salivary glands.
  • lymphangioma.
  • metastasis in thyroid cancer.
  • chemodectoma (glomus tumor or vagus nerve).
  • lymphosarcoma.
  • abscess.
  • Lipoma neck.
  • teratoma neck.
  • branchial carcinoma.
  • aneurysm vessels.

Treatment lateral neck cyst

only generally accepted method, which involves the treatment of lateral neck cyst is surgery.Surgical treatment is carried out as an inpatient and outpatient basis, it all depends on such factors:

  • diagnosis period, determining a lateral cyst.It is believed that the sooner it is detected, the more successful and the resulting is its treatment.
  • Age of the patient.The hardest hit are operated by small children under the age of 3 years.Such operations are indicated for cysts large, threatening the process of respiration and of common intoxication.
  • size of the tumor.Cyst operate shown when its size is greater than 1 centimeter in diameter.
  • Localization lateral cysts.The closer it is to large vessels, nerves, the more complex and voluminous surgery.
  • cyst form - inflammation, with suppuration.
  • complications that accompany the development of cysts.Related abscess or cellulitis require additional anti-inflammatory treatment.
  • type of fistula, which in most cases is detected the surgical removal of the cyst.Partial or complete fistula difficult to treat, because it has passages that are closely in contact with the pharynx, major vessels, the hyoid bone.

When you delete a branchial cyst performed radical dissection of sinus tracts, cords, up to the part of the hyoid bone.In some cases, carried out in parallel and tonsillectomy.Thorough and complete removal of all parts of cysts leads to hastily result, relapses are possible only in case of incomplete excision of the fistulous or proliferation of epithelial cysts in the surrounding tissues.

inflamed, festering cysts do not operate, they are pre-treated with conservative methods, including using antibacterial therapy.After calming down of the inflammatory symptoms, achieving remission cyst can be removed.

Remove the cysts lateral neck

Remove the cysts, including the lateral neck cyst - is the most common method of treatment of benign cystic tumors.Operate branchial cyst is necessary as soon as possible, without waiting for its inflammation, suppuration and related complications.Even if spontaneous breaks in the form of pus revealed the external abscess, cysts before removing it helps to avoid the risk of malignancy.In addition, the scars left after opening the abscess, significantly complicate the surgery is inevitable in the long term, since technically similar to excise the tumor is already difficult.

Removing lateral neck cysts suggests its radical excision, and includes fistula.The better part of all epithelial tumor tissue is removed, the lower the risk of recurrence of the cyst, the frequency of which is 10 cases per 100 operations.The process of removing gill tumors is quite complicated, due to the anatomical connection with cysts such important parts of the neck and the body as a whole:

  • arteria carotis externa - carotid artery.
  • nerve nodes.
  • venae jugulares - jugular veins.
  • hyoid bone.
  • musculus sternocleidomastoideus - sternocleidomastoid muscle.
  • processus styloideus - styloid process.

During the procedure, often have to be removed and part os hyoideum - hyoid and tonsils, and even to resect part of the jugular vein in contact with Svishchev swing.All this shows the complexity and seriousness of the surgery, although such procedures are classified as "small" surgery.It should be noted that the equipment, tools and new operational techniques can remove cysts side even in young children, if earlier, only 15 years ago, cystectomy was performed only after 5 years of age, currently cyst excised even three-year kids.Maximum anesthesia - local or general anesthesia, minimal trauma during surgery allows patients to recover as soon as possible, a cosmetic incision is almost imperceptible, and the scar quickly absorbed, leaving little trace.

Operation at the side of the neck cyst

operation to remove a cyst branchial administered to patients starting with 3-hletnego age.The volume of surgical intervention, the duration is determined by the clinical picture of the disease and the results of the diagnostic test.

Operation at the side of the neck cyst is not currently considered to be difficult, but it requires care, since any lagged behind of the tumor epithelium may then trigger a relapse, consequently, re-surgical treatment.

total operation scheme is as follows:

  • After preparation of the patient is carried out anesthesia, most often intubation (endotracheal anesthesia).