The median cyst of the neck refers to congenital anomalies and is a pathological cavity filled with liquid or semi-liquid contents.. It is located on the front surface of the neck, usually grows slowly and painlessly, occurs more often in children and young people.. Capable of suppuration, in this case, pain occurs, difficulty in swallowing appears, fistulas form. The treatment of the neoplasm is only surgical, according to the online edition for girls and women from 14 to 35 years old Pannochka. net The median whale of the neck is more common in young patientsCauses of the median cyst of the neckThe formation of median (thyroid-lingual, thyroglossal) cysts and fistulas of the neck is most directly related to the violation of the embryonic development of the thyroid gland, hyoid bone, tongue. Pathology is congenital, many factors contribute to its occurrence during gestation, including:.

hereditary predisposition;

stress loads;

smoking;

alcohol abuse;

industrial hazards;

taking medications that have a teratogenic effect.

The implementation of the negative impact is carried out in the early stages of pregnancy.

The mechanism of the formation of a thyroglossal cyst of the neck. As the tongue develops, it descends onto the neck, remaining connected to the blind lingual foramen.. At the same time, the hyoid bone is formed. The duct passes near or through it.

Normally, the thyroglossal duct should be gone by the time the gland reaches the cervical surface.. Pathological cavity formations are formed in case of its non-closure. This happens when the descending process stops for some reason, and the duct is not obliterated at any level of migration: from the blind hole in the root of the tongue to the isthmus of the thyroid gland. As a result, a closed cavity is formed in which a secret accumulates, and when it is opened, a fistula.

Congenital fistula is not an independent disease, but is always combined with a lateral or median cervical formation. There are complete and incomplete types of fistulas. The former have two outlets: on the skin of the anterior surface of the neck and oral mucosa, the latter have only one. If it is located on the skin, then an incomplete fistula is called external, if in the region of the blind opening of the root of the tongue - internal.

Symptoms of a thyroglossal cyst of the neck Thyroglossal cavity formations are located deep in the thickness of the soft tissues of the neck. Despite the presence of pathology in the fetus already at birth, the median cyst of the neck in a child is found, as a rule, at an older age.. This is because the severity of subcutaneous fat in infants makes it very difficult to visualize it, and there are no clinical manifestations..

The appearance of complaints is due to the development of complications.

Type of complication.

Clinical manifestations.

infection.

An increase in cystic formation in size, redness of the skin over it, the appearance of pain, local edema, weakness, an increase in body temperature to subfebrile numbers.

Opening of a festering cavity.

If pus breaks into the oral cavity, then the appearance of an unpleasant aftertaste (sometimes iron) in the mouth, the appearance of nausea, vomiting; with the outflow of purulent contents to the outside - hyperemia, crusts, irritation of the skin.

Formation of the fistula.

The location of the external opening of the fistula, punctate or wide, between the thyroid cartilage and the hyoid bone, internal - along the front surface of the tongue, on the border between its root and body; redness, maceration, scarring of the skin; when the fistula is opened, the discharge of pus, when the inflammatory process subsides - a scanty mucous discharge.

Compression of nearby organs with a significant size of the formation.

The occurrence of neck deformity when localized in the hyoid bone, when located in the region of the root of the tongue - difficulty in the process of swallowing, impaired speech, in some cases even breathing.

The median cyst of the neck in adults is also accompanied by complaints if it suppurates.. This is facilitated by a decrease in overall immunity, often provoked by:.

hypothermia;

infectious disease;

trauma;

oncological process.

Clinical manifestations are similar to those in children and adolescents.

Diagnosis of median cystic formations on the neck Diagnosis begins with a survey and examination of the patient. Thyroglossal cyst in most cases is a rounded formation with clear boundaries, having an elastic or densely elastic consistency, located along the midline of the neck. Since its dimensions rarely exceed 2-3 cm, it does not hang down, but is determined in the thickness of the tissues.. Palpation is painless in the absence of complications..

The mobility of the thyroid-lingual cyst is limited and due to the connection with the hyoid bone. The displacement of the cystic formation upwards following the hyoid bone during swallowing is a differential diagnostic sign of its median nature.. When localized at the root of the tongue, speech impairment and difficulty swallowing attract attention.

More than half of thyroglossal cysts suppurate. In this case, the characteristic clinical signs of infection come to the fore, and the specialist focuses on them when making a diagnosis..

As additional instrumental methods, the following are most often used:.

ultrasound procedure;

magnetic resonance imaging;

computed tomography;

cytological analysis of the contents obtained by puncture;

cystography (X-ray examination with the introduction of contrast into the cavity);

probing and fistulography (X-ray with contrast fistulous tract).

With ultrasound on the monitor and photo, the thyroid cyst looks like a rounded, anechoic or hypoechoic avascular formation with a clear and even contour, with acoustic amplification behind. There may be hyperechoic inclusions in the cavity without acoustic shadowing.

Differential diagnosis of a thyroid cyst When making a diagnosis, a thyroglossal cyst should be distinguished from tumors of the neck and cavitary formations of another etiology.

Pathological formation of the neck.

Characteristic distinguishing features.

Dermoid cyst.

It is located more superficially, has a denser consistency, is not connected with the hyoid bone, therefore it does not move during swallowing movements.

Struma, or goiter of the tongue.

A malformation of embryonic development, which is rare, is an accessory or abnormally located thyroid gland: a tumor-like formation on a wide base in the region of the root of the tongue, which has a mucous membrane and a dense vascular network.

cystic hygroma.

Benign neoplasm, the result of a violation of the processes of formation of the lymphatic system: an asymmetric cystic formation with thin walls and internal partitions, not associated with the lymphatic system, often infiltrating soft tissues, subcutaneous adipose tissue, skin.

Adenopathy of the cervical lymph nodes.

An inflamed lymph node, painful on palpation, is a formation with an uneven surface, dense or densely elastic consistency.; the skin over it is stretched, often hyperemic, temperature increase is possible.

Treatment of a thyroglossal cyst The treatment tactics for detecting a thyroid cyst involves surgery, it is necessary to prevent infection, as well as eliminate a small possible risk of malignancy (about 1%).

The operation is not indicated only during the period of exacerbation of the inflammatory process, during which the following is performed:.

punctuation;

removal of mucopurulent contents;

drainage;

washing the cavity with antiseptic solutions;

dressings.

The operation is performed after the complete elimination of inflammatory phenomena..

Operation The optimal period for surgical treatment of children is the age of 9-10 years.. Carrying out a planned intervention at an earlier age is considered inappropriate due to the technical difficulties that arise during the resection of the hyoid bone, and it is the main condition for the radicalness of the surgical operation..

Removal of the cyst is performed under endotracheal anesthesia. The incision is made along the skin fold. Together with the formation, a part of the hyoid bone is resected, which prevents the development of recurrence. After removal of the head of the hyoid bone, the muscles are brought together and sutured with non-absorbable threads.. Sometimes a safety drain is required.

The introduction of a 1-2% alcohol solution of brilliant green into the cavity of a cyst or fistula before surgery clearly stains the shell of the formation and facilitates the detection of all fistulous branches.

Possible postoperative complications Very rarely, bleeding from the wound surface leading to the formation of a hematoma is possible.. Careful hemostasis and placement of a drain to control prevent this complication.. Possible damage to the thyroid gland, cartilage of the larynx, nerves. To exclude them, a highly qualified surgeon and experience in such operations are required..

Relapses are usually due to incomplete removal of pathologically altered tissue and inadequate resection of the hyoid bone..

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