From the Guidelines
Treatment for neck cysts typically involves surgical removal, especially for persistent or symptomatic cysts, as it is the most effective way to prevent recurrence and potential malignant transformation, as suggested by the clinical practice guideline: evaluation of the neck mass in adults 1. The specific approach depends on the cyst type, with branchial cleft cysts, thyroglossal duct cysts, and sebaceous cysts being most common.
- For small, non-infected cysts, observation may be appropriate.
- If infection is present, antibiotics like amoxicillin-clavulanate (875/125 mg twice daily for 7-10 days) or clindamycin (300 mg four times daily for 7-10 days) should be given before surgery to reduce inflammation, as stated in the guideline 1.
- The definitive treatment is complete surgical excision to prevent recurrence.
- For thyroglossal duct cysts, the Sistrunk procedure is preferred, which removes the cyst, tract, and central portion of the hyoid bone, as it is the most effective way to prevent recurrence, as suggested by the guideline 1. Recovery typically takes 1-2 weeks, with suture removal after 5-7 days.
- Patients should watch for signs of infection (increased pain, redness, drainage) and follow up with their surgeon as directed. Surgery is recommended because incomplete removal often leads to recurrence, and some cysts can become infected or rarely undergo malignant transformation if left untreated, as highlighted in the guideline 1. It is essential to note that the guideline recommends against routine antibiotic therapy for patients with a neck mass unless there are signs and symptoms of bacterial infection, as stated in the guideline 1. The guideline also emphasizes the importance of fine-needle aspiration (FNA) and imaging studies in the evaluation of neck masses, especially for patients at increased risk for malignancy, as suggested by the guideline 1. Overall, the treatment of neck cysts should be individualized based on the specific type of cyst, the presence of infection, and the patient's overall health status, as recommended by the guideline 1.
From the Research
Treatment Options for Neck Cysts
The treatment of neck cysts depends on the type and location of the cyst. The following are some of the treatment options:
- Aspiration: This is a procedure where the fluid is drained from the cyst using a needle 2.
- Surgery: Surgical excision is the recommended treatment for some types of neck cysts, such as thyroglossal duct cysts and bronchogenic cysts 3, 4.
- Sclerotherapy: This is a procedure where a solution is injected into the cyst to shrink it. It is commonly used to treat cystic thyroid nodules and macrocystic lymphatic malformations 2.
- Antibiotics and aspiration or incision and drainage: This is the recommended treatment for inflamed cysts, such as branchial cysts 5.
- Total surgical excision: This is the recommended treatment for hydatid cysts in the neck 6.
Specific Treatment Options for Different Types of Neck Cysts
- Branchial cysts: Treatment of inflamed branchial cysts consists of intravenous antibiotics, followed by aspiration or surgical exploration in non-resolving cases. Interval excision after six weeks is also recommended 5.
- Thyroglossal duct cysts: The Sistrunk procedure is the recommended treatment, which involves removal of the cyst, central portion of the hyoid bone, and a central core of deep tongue musculature 4.
- Bronchogenic cysts: Surgical excision is the elective treatment to prevent complications such as infection, compression symptoms, and malignant transformation 3.
- Hydatid cysts: Total surgical excision of all cysts is the recommended treatment, with intensive care not to spread the disease 6.