Surgical Treatment of Neck Cysts

Because congenital neck cysts do not disappear on their own and can swell again with every infection, their permanent treatment is surgery. The aim is to remove the cyst in one piece, together with the duct or tract it arises from, while protecting the surrounding vessels, nerves and organs. This page describes the general principles of neck cyst surgery and the process ahead of you.

Why is surgery recommended?

• The cyst does not regress on its own; it grows as its content accumulates or as it becomes inflamed.
• Repeated infections cause the cyst to stick to the surrounding tissue and make later surgery more difficult.
• Sinuses or fistulas opening onto the skin lead to constant leaking and recurring inflammation.
• Pathological examination of the removed tissue provides the definitive diagnosis.

Medication and drainage of pus relieve only the acute phase; as long as the cyst wall remains in place, the swelling can return.

Timing of surgery

Where possible, surgery is planned for a period when the cyst is quiet and free of inflammation. If there is an active infection, the inflammation is treated first and a few weeks are allowed to pass, because in inflamed tissue the borders of the cyst cannot be made out and the chance of incomplete removal rises. In small children, surgery may be postponed to a suitable age depending on the child’s general condition and the problems the cyst is causing.

How is the operation performed?

The procedure is performed under general anaesthesia. The incision is placed in the natural skin creases of the neck so that the scar fades over time. The method differs according to the type of cyst:

• In branchial cleft cysts, the cyst and its tract, if present, are followed and removed as far as the part extending towards the throat; if the tract reaches the tonsil bed, an approach through the mouth may also be needed.
• In thyroglossal duct cysts, the cyst, the duct and the middle portion of the hyoid bone are removed together (Sistrunk operation).
• In dermoid cysts, the cyst is removed in one piece with its wall intact; for cysts in the floor of the mouth, the approach through the mouth may be preferred.

The large vessels of the neck and the nerves that move the face, tongue, vocal cords and shoulders pass close to the operating field. Identifying and protecting these structures is the most important stage of the operation; nerve monitoring devices are used when required.

What to expect after surgery

• Mild pain, swelling and tenderness on swallowing in the neck last a few days and gradually subside.
• In some operations, a thin drain is placed to remove collecting fluid and is taken out shortly afterwards.
• After a short period of observation you can return home; soft foods are recommended in the first days.
• You will be asked to keep the incision area clean and dry and to avoid heavy exercise for a few weeks.
• The removed tissue is sent for pathological examination; the result is shared with you at the follow-up visit.

Possible risks

As with any operation, bleeding, wound infection and problems with the scar can occur. Temporary weakness in the nerves next to the cyst occurs rarely and usually resolves with time. The most common problem is recurrence due to remnants left behind; this risk is minimised by removing the cyst during a quiet period and together with its tract.

When should you see a doctor?

If, after surgery, you notice increasing redness or discharge at the incision, fever, or difficulty breathing or swallowing, you should inform your doctor without delay.