Mouawad F, Rysman B, Russ G, Benoudiba F, Garcia G, Abgral R, Zerdoud S, Tronche S, Pondaven S, de Mones E, Garrel R.
Cystic form of cervical lymphadenopathy. Guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery (SFORL). Part 1: Diagnostic procedures for lymphadenopathy in case of cervical mass with cystic aspect.
Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Nov;136(6):489-496. doi: 10.1016/j.anorl.2019.05.015. Epub 2019 Jun 9.
Abstract/Text
OBJECTIVES: The authors present the guidelines of the French Society of Otorhinolaryngology - Head and Neck Surgery Society on diagnostic procedures for lymphadenopathy in case of a cervical mass with cystic aspect.
METHODS: A multidisciplinary work-group was entrusted with a review of the scientific literature on the topic. Guidelines were drawn up, then read over by an editorial group independent of the work-group, and the final version was drawn up. Guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.
RESULTS: In adults presenting a cystic cervical mass, it is recommended to suspect cervical lymphadenopathy: in order of decreasing frequency, cystic metastasis of head and neck squamous cell carcinoma, of undifferentiated nasopharyngeal carcinoma, and of thyroid papillary carcinoma (Grade C). On discovery of a cystic cervical mass on ultrasound, architectural elements indicating a lymph node and a thyroid nodule with signs of malignancy should be screened for, especially if the mass is located in levels III, IV or VI (Grade A). Malignant lymphadenopathy should be suspected in case of cervical mass with cystic component on CT (Grade B), but benign or malignant status cannot be diagnosed only on radiological data (CT or MRI) (Grade A), and 18-FDG PET-CT should be performed, particularly in case of inconclusive ultrasound-guided fine needle aspiration biopsy (Grade C).
Copyright © 2019 Elsevier Masson SAS. All rights reserved.
尾尻博也. 頭頸部の臨床画像診断学 改訂第4版. 南江堂, 2021.
Mondin V, Ferlito A, Muzzi E, Silver CE, Fagan JJ, Devaney KO, Rinaldo A.
Thyroglossal duct cyst: personal experience and literature review.
Auris Nasus Larynx. 2008 Mar;35(1):11-25. doi: 10.1016/j.anl.2007.06.001. Epub 2007 Aug 27.
Abstract/Text
The thyroglossal duct cyst [TDC, or thyroglossal tract remnant (TTR)] is a well recognized developmental abnormality which arises in some 7% of the population. As a consequence, it represents the most common type of developmental cyst encountered in the neck region. It typically presents as a mobile, painless mass in the anterior midline of the neck, usually in close proximity to the hyoid bone. Less often, TDCs may present with signs and symptoms of secondary infection, or with evidence of a fistula. While TDCs are most often diagnosed in the pediatric age group, a substantial minority of patients with TDCs are over 20 years of age at the time of diagnosis. The standard surgical approach to TDC, encompassing removal of the mid-portion of the hyoid bone in continuity with the TDC and excision of a core of tissue between the hyoid bone and the foramen cecum, dates back to the late 19th and early 20th centuries and is often referred to as Sistrunk's operation. Malignancy is rarely encountered in TDCs; when such rare tumors do develop (in the order of 1% or so of patients with TDCs), they usually take the form of either papillary carcinoma of thyroid origin, or squamous carcinoma.
Al-Mahdi AH, Al-Khurri LE, Atto GZ, Dhaher A.
Type II first branchial cleft anomaly.
J Craniofac Surg. 2013;24(5):1832-5. doi: 10.1097/SCS.0b013e3182997e12.
Abstract/Text
First branchial cleft anomaly is a rare disease of the head and neck. It accounts for less than 8% of all branchial abnormalities. It is classified into type I, which is thought to arise from the duplication of the membranous external ear canal and are composed of ectoderm only, and type II that have ectoderm and mesoderm. Because of its rarity, first branchial cleft anomaly is often misdiagnosed and results in inappropriate management. A 9-year-old girl presented to us with fistula in the submandibular region and discharge in the external ear. Under general anesthesia, complete surgical excision of the fistula tract was done through step-ladder approach, and the histopathologic examination confirmed the diagnosis of type II first branchial cleft anomaly.
Kawaguchi M, Kato H, Aoki M, Kuze B, Hara A, Matsuo M.
CT and MR imaging findings of infection-free and benign second branchial cleft cysts.
Radiol Med. 2019 Mar;124(3):199-205. doi: 10.1007/s11547-018-0959-3. Epub 2018 Nov 12.
Abstract/Text
PURPOSE: The present study aimed to assess CT and MR imaging findings of infection-free and benign second branchial cleft cysts (SBCCs).
METHODS: Eleven patients with histopathologically confirmed infection-free and benign SBCCs underwent preoperative contrast-enhanced CT (CECT) and/or MR imaging. We assessed qualitative (presence and extent of wall thickening, degree of contrast enhancement of the thickened wall on CECT images, and signal intensity of the thickened wall on T2-weighted images) and quantitative (maximum thickness of the thickened wall) imaging findings.
RESULTS: Eccentric and smooth wall thickening was observed in 11/11 (100%) patients. The wall thickening extent (percentage of the thickened wall to the circumference of the wall) was small (1%-25%) in 4/11 (36%), moderate (26%-50%) in 6/11 (54%), extensive (51%-75%) in 1/11 (9%), and diffuse (76%-100%) in 0/11 (0%) patients. Mild homogeneous enhancement of the thickened wall on CECT images was observed in 7/7 (100%) patients. The signal intensity of the thickened wall on T2-weighted images was isointense relative to that of normal lymph nodes in 7/8 (88%) and mildly hyperintense in 1/8 (12%) patient. The maximum thickness of the thickened walls ranged from 2 to 4 (mean 3.4) mm.
CONCLUSIONS: Infection-free and benign SBCCs are identifiable as cysts with eccentric and smooth wall thickening on CECT and MR images. The wall thickness was almost always less than half of the wall circumference, isointense relative to normal lymph nodes, and showed mild homogeneous enhancement.
Godart S.
Embryological significance of lymphangioma.
Arch Dis Child. 1966 Apr;41(216):204-6. doi: 10.1136/adc.41.216.204.
Abstract/Text
De Ponte FS, Brunelli A, Marchetti E, Bottini DJ.
Sublingual epidermoid cyst.
J Craniofac Surg. 2002 Mar;13(2):308-10. doi: 10.1097/00001665-200203000-00024.
Abstract/Text
Dermoid and epidermoid cysts are developmental pathologies that occur in the head and neck with an incidence ranging from 1.6 to 6.9%, and they represent less than 0.01% of all oral cavity cysts. Our purpose is to report a case of sublingual epidermoid cyst of the floor of the mouth. We studied and operated on an 18-year-old white male patient showing a large swelling of oral floor. His main symptoms were difficulty breathing, swallowing, and speaking. At his birth the patient's tongue was adherent to the floor of the mouth. His father had the same problem at birth. Both father and son underwent surgical separation of tongue, during the post-neonatal period. After the surgical removal of the swelling, under general anesthesia, all the patient's symptoms were missed. Histological examination of the mass confirmed the diagnosis of an epidermoid cyst. No relapse of the lesion was present in ten months of follow-up. Many theories are proposed on the etiology of the epidermoid and dermoid cyst. In this case a traumatic event can be found, such as an operation of the tongue in neonatal age. However a multifactorial origin must be assumed for justifying the fact that the patient's father did not develop a dermoid cyst although he had the same problem of an adherent tongue and was operated on.
Kim JP, Lee DK, Moon JH, Park JJ, Woo SH.
Transoral Dermoid Cyst Excision: A Multicenter Prospective Observational Study.
Otolaryngol Head Neck Surg. 2018 Dec;159(6):981-986. doi: 10.1177/0194599818791772. Epub 2018 Aug 28.
Abstract/Text
OBJECTIVE: Transoral surgery is becoming a preferred technique because it does not leave any scar after surgery. However, transoral surgery for a dermoid cyst of the oral cavity is not standardized yet, due to the anatomic complexity of this region. The aim of this study was to evaluate the safety and efficacy of a transoral dermoid cyst excision.
STUDY DESIGN: Multicenter prospective observational study.
SETTING: University hospital.
SUBJECTS AND METHODS: This study was designed as a 4-year prospective multicenter evaluation of dermoid cyst excisions within the floor of mouth. Clinical outcomes and complications related to procedures were evaluated among patients. The primary outcome was the efficacy of the procedure, and the secondary outcome was cosmetic satisfaction of each procedure.
RESULTS: Twenty-one patients underwent transoral dermoid cyst excisions, and 22 underwent transcervical excisions. In the transoral surgery group, the mean size of the dermoid cyst was 5.35 cm (95% CI, 4.79-5.91), and in the transcervical surgery group, it was 6.19 cm (95% CI, 5.67-6.71). There was no significant differences with respect to overall demographic characteristics between the groups. However, the duration of the operation was shorter with the transoral group than with the transcervical group ( P = .001), and cosmetic satisfaction was much better in the transoral group ( P < .001).
CONCLUSION: Transoral dermoid cyst excision is a potentially safe and effective method that can lead to easy and quick removal of an oral cavity dermoid cyst, with excellent cosmetic outcomes.
Lee DH, Jung SH, Yoon TM, Lee JK, Joo YE, Lim SC.
Preoperative computed tomography of suspected thyroglossal duct cysts in children under 10-years-of-age.
Int J Pediatr Otorhinolaryngol. 2013 Jan;77(1):45-8. doi: 10.1016/j.ijporl.2012.09.027. Epub 2012 Oct 4.
Abstract/Text
OBJECTIVE: The purpose of this study was to evaluate the preoperative computed tomography (CT) features of thyroglossal duct cysts (TDCs), with the main purpose of evaluating criteria helpful in differentiating TDCs from other lesions in children under 10-years-of-age.
METHODS: A retrospective chart review was performed at Chonnam National University Hospital for the period of March 2005 to June 2011. Pediatric patients under 10-years-of-age with suspected TDCs were divided into two groups depending on their histopathologic diagnosis.
RESULTS: Of the 29 pediatric patients with suspected TDCs, 16 patients (55%) had histopathologically confirmed TDCs. Thirteen patients (45%) had dermoid cysts (n=6), ranula (n=3), and inflammatory lesions (n=4). There were no statistically significant differences between the preoperative CT findings and the final histopathologic diagnosis of TDC. There were no major complications resulting from surgical interventions.
CONCLUSION: CT is not helpful in differentiating TDC from other lesions in children under 10-years-of-age. Therefore, we suggest that preoperative CT of suspected TDCs in children should be performed more selectively.
Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Foley DS, Fallat ME.
Thyroglossal duct and other congenital midline cervical anomalies.
Semin Pediatr Surg. 2006 May;15(2):70-5. doi: 10.1053/j.sempedsurg.2006.02.003.
Abstract/Text
Thyroglossal duct anomalies and dermoid cysts comprise the vast majority of congenital midline cervical masses seen in children. Unusual lesions of the midline neck include ranulae and midline cervical clefts. Workup and management is lesion-dependent, and an accurate preoperative diagnosis is essential for planning and performing an appropriate surgical procedure. This discussion presents an overview of the relevant embryology, pathophysiology, and diagnostic modalities for these congenital midline cervical anomalies. Additionally, the current principles of surgical management are described.
Tracy TF Jr, Muratore CS.
Management of common head and neck masses.
Semin Pediatr Surg. 2007 Feb;16(1):3-13. doi: 10.1053/j.sempedsurg.2006.10.002.
Abstract/Text
Head and neck masses are a common clinical concern in infants, children, and adolescents. The differential diagnosis for a head or neck mass includes congenital, inflammatory, and neoplastic lesions. An orderly and thorough examination of the head and neck with an appropriate directed workup will facilitate the diagnosis. The most common entities occur repeatedly within the various age groups and can be differentiated with a clear understanding of embryology and anatomy of the region, and an understanding of the natural history of a specific lesion. Congenital lesions most commonly found in the pediatric population include the thyroglossal duct cyst and the branchial cleft and arch anomalies. The inflammatory masses are secondary to local or systemic infections. The most common etiology for cervical adenopathy in children is reactive lymphadenopathy following a viral or bacterial illness. Persistent adenopathy raises more concerns, especially enlarged lymph nodes within the posterior triangle or supraclavicular space, nodes that are painless, firm, and not mobile, or a single dominant node that persists for more than 6 weeks should all heighten concern for malignancy. In this review, we discuss the current principles of surgical management of the most common head and neck masses that present to pediatricians and pediatric surgeons.
Rohof D, Honings J, Theunisse HJ, Schutte HW, van den Hoogen FJ, van den Broek GB, Takes RP, Wijnen MH, Marres HA.
Recurrences after thyroglossal duct cyst surgery: Results in 207 consecutive cases and review of the literature.
Head Neck. 2015 Dec;37(12):1699-704. doi: 10.1002/hed.23817. Epub 2014 Sep 25.
Abstract/Text
BACKGROUND: A thyroglossal duct cyst is the most common form of congenital anomaly in the neck. Surgical removal is very effective. However, in some cases, a cyst recurs. The purpose of this study was to identify factors that predispose to recurrence of a thyroglossal duct cyst.
METHODS: A retrospective study was conducted of consecutive patients who underwent surgical resection for histologically confirmed thyroglossal duct cysts between 1998 and 2013 in a tertiary referral center.
RESULTS: Two hundred seven patients were included. The overall recurrence rate was 9.7%. The most important factor predicting recurrence was the type of resection: recurrence rate was 5.3% after the Sistrunk procedure, and 55.6% after plain excision (p < .001). The only other factor that was significantly associated with chance of recurrence was postoperative infection.
CONCLUSION: The Sistrunk procedure is the treatment of choice for thyroglossal duct cysts because it yields low recurrence and morbidity. Postoperative infections, rather than preoperative infections, are associated with recurrence.
© 2014 Wiley Periodicals, Inc.
難治性血管腫・脈管奇形・血管奇形・リンパ管腫・リンパ管腫症および 関連疾患についての調査研究. 血管腫・脈管奇形・血管奇形・リンパ管奇形・リンパ管腫症診療ガイドライン 2022（第3.1版）. 2024.
Batsakis JG, McClatchey KD.
Cervical ranulas.
Ann Otol Rhinol Laryngol. 1988 Sep-Oct;97(5 Pt 1):561-2. doi: 10.1177/000348948809700527.
Abstract/Text
Cervical ranulas, known also as plunging or burrowing ranulas, are an outcome of extravasated sublingual gland mucin that has gained access to the soft tissues of the neck. These pseudocystic lesions may be localized or extensive, and they require surgical excision of the sublingual gland for effective management.
Lomas J, Chandran D, Whitfield BCS.
Surgical management of plunging ranulas: a 10-year case series in South East Queensland.
ANZ J Surg. 2018 Oct;88(10):1043-1046. doi: 10.1111/ans.14356. Epub 2017 Dec 21.
Abstract/Text
BACKGROUND: Plunging ranulas are rare mucous extravasation pseudocysts that arise in the floor of the mouth and pass into the submandibular space of the neck. The aim of this study was to investigate the diagnosis, surgical management and outcomes of patients with a plunging ranula at our institution in South East Queensland over a 10-year period.
METHODS: A retrospective analysis of adult patients diagnosed with and treated for plunging ranula between 2006 and 2016 at Logan Hospital was conducted. Patient demographics, preoperative investigations, surgical management and post-operative outcomes were collected from medical records.
RESULTS: A total of 18 adult patients were treated for plunging ranula. Of the 18 cases, 17 were treated via transoral excision of the sublingual gland. The mean age at presentation was 28.8 years with a 3:1 female to male predominance. Fifty-six percent of patients were of Polynesian descent. The success rate was 94% with only one patient experiencing recurrence and requiring re-excision of remnant sublingual gland tissue. Three patients (17%) developed complications related to post-operative bleeding. There was a slight predominance for right-sided disease (56%) compared with left and one case of bilateral plunging ranulas in this series.
CONCLUSION: This study demonstrates that excision of the sublingual gland is an effective and safe treatment for plunging ranula. The majority of plunging ranulas occur in patients aged <30 years with a higher incidence in patients of Polynesian heritage, which is consistent with previous studies suggesting a possible underlying genetic predisposition for this condition.
© 2017 Royal Australasian College of Surgeons.
Sira J, Makura ZG.
Differential diagnosis of cystic neck lesions.
Ann Otol Rhinol Laryngol. 2011 Jun;120(6):409-13. doi: 10.1177/000348941112000611.
Abstract/Text
OBJECTIVES: In patients less than 40 years of age who present with an upper anterior triangle cystic mass, branchial cyst is the presumed clinical diagnosis. Squamous cell malignancy is the important differential diagnosis in a patient more than 40 years of age. We sought to identify the range of lesions that can be clinically mistaken for, and removed as, branchial cysts.
METHODS: We performed retrospective reviews of 29 neck masses removed as branchial cysts and 47 solitary neck masses diagnosed as cancer between January 2003 and January 2008 across two teaching hospitals in Leeds, England.
RESULTS: Of the 29 lesions removed, 23 (79.3%) were confirmed to be branchial cysts. The remainder comprised 2 thyroid papillary carcinomas (6.9%) and 4 benign lesions (13.6%; laryngocele, neurilemmoma, parotid gland cyst, and cystadenoma). Of the 47 cases of metastatic cancer, 3 lesions (6.4%) were clinically mistaken as branchial cysts but were subsequently diagnosed as squamous cell carcinomas.
CONCLUSIONS: When presented with a solitary lateral cystic mass, clinicians should consider the possibility of squamous cell carcinoma in patients more than 40 years of age, and thyroid papillary cancer should be considered particularly in the younger age groups. In our series, 30.8% of the neck lesions believed to be branchial cysts in patients over 40 were malignant, in contrast to 5.3% of those lesions in patients under 40.
