Cysts and Sinuses of the Head and Neck - Children's Hospital Boston

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My Child Has:

Cysts and Sinuses of the Head and Neck

Programs that treat this condition

General Otolaryngology Program

What are cysts and sinuses of the head and neck?

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Cysts and sinuses of the head and neck describe a variety of soft, usually nontender benign lumps or masses that are congenital (developed prior to birth) and are found below the skin (subcutaneous) in different locations on the face, scalp, neck or ear.

While most do not pose a health risk, some can become infected and must be surgically removed, some can become the site for cancer in adults, and others can be surgically removed for cosmetic reasons. The following are the most common types of such growths:

Dermoid Cyst

A dermoid cyst is a slow-growing mass most often found on the scalp, face (usually beneath the eyebrow or near the bridge of the nose) or the neck. It is made up of skin breakdown products. Because this kind of a cyst (a cyst is an isolated mass with no drainage tracts) grows progressively, you child's doctor will refer you to a pediatric surgeon for further evaluation. If the dermoid cyst is located on the scalp, the surgeon will to see whether it extends through the cranium. For that reason, a child with a dermoid cyst on the scalp will probably undergo an X-ray of the skull. A consultation with a neurosurgeon may be needed and further imaging studies may be necessary. Dermoid cysts, because of their nature to grow progressively, should be removed surgically.

Preauricular Sinus or Skin Tag

A preauricular sinus is a little tube located where the upper part of the ear's auricle (the outside part of the ear) joins the head. (A sinus is a saclike structure with a single drainage site ) A skin tag is a tiny mass of skin in the same location. The sinus can become pussy and has been associated with sinus tract infections. The preauricular skin tag can be surgically removed for cosmetic reasons and the sinus should be removed if an infection has developed.

Neck Lumps

A neck lump may be located anywhere from the top of the neck, in front of or behind an ear, to the bottom of the neck, just above the collarbone. The most common of these is an enlarged lymph node (a small pea-sized knot of tissue that produces lymphocytes - a type of white blood cell typically infected or enlarged due to reaction to an infectious agent.) Enlarged lymph nodes, which are usually harmless, are referred to as lymphadenitis. Lymphadenitis is produced by bacteria, cat scratch fever, and even atypical tuberculosis. If your child's doctor is concerned, he/she may prescribe antiobiotics or if the lump appears worrisome, may refer your child to a pediatric surgeon to have a biopsy (removal and analysis of a tissue sample from the lump).

Another type of neck lump is a branchial cleft cyst or sinus. This congenital lesion is most frequently found in the neck of children 2-10 years old and it represents an embryologic error in the development of the neck. They generally change in size and shape and are often first detected after an upper respiratory tract infection, which causes enlargement of the mass. Most branchial cleft cysts are located in front of the stenocleidomastoid muscle in the lower neck and they may have an external opening or pore from which drains a mucus-like material. Branchial cleft cysts or sinuses should be removed to assure the diagnosis, improve appearance, prevent infection, and prevent it as being a site for a potential cancer in adulthood.

A thyroglossal duct cyst, a mobile, soft nontender, round swelling, is also found in the center of the neck. It arises as a congenital remnant of the thyroglossal duct, which is a temporary duct, that, during fetal stages, connects the developing thyroid gland and the tongue. Once the thyroid gland descends from its original location, this duct normally closes. A child with this kind of cyst may undergo diagnostic imaging studies such as an ultrasound of the neck to determine whether the thyroid gland is in its normal position. Your child's doctor will probably want to have this kind of a cyst and its underlying attachment to the hyoid bone (located at the base of the tongue to support the tongue) surgically removed, to prevent infection and degeneration to malignancy in adulthood.



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