Removal of Congenital Neoplasms (Cysts, Fistulas, Fistulae in the Head and Neck Area) 

Removal of Congenital Lesions of the Head and Neck

Cysts, Sinuses, and Fistulas

Congenital neck cysts and fistulas, as well as dermoid and epidermoid cysts of the face, are lesions that form during intrauterine development. They are present from birth, but are often first detected in childhood or adulthood, when they begin to grow or become inflamed.

At Iskusstvo Clinic in Moscow, such lesions are removed surgically on a planned basis, before complications develop.

Types of Congenital Lesions

Midline Neck Cysts and Fistulas

A midline neck cyst, or thyroglossal duct cyst, is a lesion located along the midline of the neck and associated with remnants of the thyroglossal duct. It often becomes inflamed and may suppurate.

A fistula, or persistent duct, opens onto the skin of the neck and periodically discharges contents.

Treatment is surgical only. During surgery, the cyst is removed together with the tract up to the base of the tongue, often with part of the hyoid bone. This is known as the Sistrunk procedure.

Lateral Neck Cysts and Fistulas

A lateral neck cyst, or branchial cleft cyst, is a remnant of the branchial apparatus and is located along the anterior border of the sternocleidomastoid muscle.

A lateral fistula may open onto the skin and/or into the pharynx. When inflamed, it may mimic an abscess.

Removal requires careful excision of the entire tract, which helps prevent recurrence.

Dermoid and Epidermoid Cysts

Dermoid cysts are most often located near the outer corner of the eye, on the bridge of the nose, or under the tongue. Epidermoid cysts may occur in any area of the face and neck.

They contain keratinous material, hair follicles in dermoid cysts, or detritus in epidermoid cysts.

They are removed as a single block together with the capsule. Incomplete removal leads to recurrence.

Ranulas

A ranula is a retention cyst of the sublingual salivary gland located under the tongue. A plunging ranula extends into the fascial spaces of the neck.

Treatment involves excision of the cyst together with the sublingual salivary gland.

Neck Teratomas

These are congenital lesions containing tissues from all three germ layers. They are most often detected in newborns, may reach significant size, and can impair breathing.

They require urgent surgical treatment.

Why Removal Is Necessary

Congenital cysts and fistulas do not resolve on their own. Without treatment, they may:

Become repeatedly inflamed and suppurate

Increase in size

Increase the risk of malignant transformation with long-term presence, although this is rare

Make surgery significantly more difficult after suppuration and spontaneous opening due to scar changes

Planned removal during a “cold,” or non-inflamed, period is technically easier and provides a better cosmetic result.

Course of Surgery

Small cysts and fistulas are removed under local anesthesia or intravenous sedation. Large lesions, plunging ranulas, and neck teratomas are removed under general anesthesia.

The surgeon excises the lesion completely together with the capsule and, if necessary, with the fistulous tract. Partial removal leads to recurrence.

The surgical approach is planned along natural skin folds.

The duration of surgery ranges from 30 minutes for small cysts to 2–3 hours for extensive lesions with branching fistulous tracts.

Rehabilitation

After removal of small lesions, the patient is discharged on the day of surgery or the following day.

After procedures performed under general anesthesia, hospitalization usually lasts 1–3 days.

Swelling resolves within 1–2 weeks. The scar is usually located in a natural neck fold and becomes less noticeable over time.

Contraindications

Acute inflammation or suppuration of the cyst makes surgery during this period undesirable. First, the abscess is opened and drained, followed by planned removal after 2–3 months.

General contraindications include severe systemic diseases in the stage of decompensation.

Frequently Asked Questions

Can Surgery Be Postponed If the Cyst Does Not Cause Discomfort?

Technically, yes, but it is undesirable. Sooner or later, the cyst may become inflamed, and surgery will become more difficult.

Planned removal during a “quiet” period provides a better result with a lower risk of complications.

Can Recurrence Occur After Removal?

When the cyst is completely removed together with the capsule and fistulous tract, recurrence is rare.

If removal is incomplete, recurrence is possible. This is why it is important that the operation is performed by a surgeon experienced specifically with these lesions.

Is General Anesthesia Required?

Small superficial cysts are removed under local anesthesia.

For deep lesions, complex fistulous tracts, and in children, general anesthesia is preferable.

The final decision is made by the surgeon together with the anesthesiologist.

Book a Consultation

Book a consultation. The surgeon will assess the lesion and recommend a removal plan.