Lump on the side of the neck
A round formation on the side of the neck; as long as there is no inflammation, it usually does not hurt.
CONDITION / JAWS, MOUTH AND NECK
Lateral cyst of the neck.
A lateral neck cyst is a congenital growth on the side of the neck: a cyst, a fistula with a tiny opening in the skin, or both. It is removed routinely when there is no inflammation, and in adults, the tumor must first be excluded.
CONCEPTUAL VISUALIZATION- What it is
- Congenital cyst or fistula on the side of the neck.
- How common
- Gill anomalies are the second most common congenital malformation of the head and neck in children.
- The main thing is adults
- A growth on the neck in an adult is considered a possible tumor until the examination proves otherwise.
- Treatment
- Complete removal of the cyst and course when there is no inflammation.
01 / WHAT IS ITWhat is
What is
lateral cyst of the neck.
In the embryo, the neck and part of the face are formed from folds and slits, which doctors call the gill apparatus. If part of such a gap does not heal, a cavity with fluid (cyst), a passage opening on the skin (sinus), or a passage through the skin to the throat (fistula) remains. Therefore, the cyst is also called branchiogenic, that is, gill cyst.
Gill anomalies are the second most common congenital malformation of the head and neck in children, after median neck cyst. Most often, they come from the second gill slit and give a typical lump on the side of the neck. Less common options are from the first slit (near the ear and at the angle of the jaw) and from the third-fourth pocket (from the throat).
Such defects occur in children and occur in adults. In a child, this is usually a benign defect that is removed on a planned basis. In an adult, a similar "cyst" may turn out to be a metastasis of a tumor in a lymph node, so it is first examined.
This is general information. What will suit you or your child, the doctor will tell after the examination.
02 / SIGNSHow
How
side cyst presents.
The formation may not hurt for a long time until it becomes inflamed. Fistulas are usually noticed earlier than cysts.
A tiny hole in the skin
An opening in the neck from which fluid is occasionally released. Fistulas and sinuses appear at an earlier age than cysts.
Recurrent inflammation
The bump reddens, hurts, swells, sometimes suppurates. The more inflammation there was before the operation, the more often the cyst returns after it.
Near the ear or under the jaw
Anomaly of the first fissure: in a series of 100 children, 90% had recurrent painful swelling at the angle of the jaw near the ear, 62% had a skin pit or discharge, and 8% had purulent discharge from the ear.
Fistula in front of the earDifficulty breathing in an infant
Rarely, a course from the throat gives a cyst that presses on the respiratory tract. In a review of 56 newborns with this problem, 76.8% had a lump on the neck, 55.4% had noisy breathing, and 17.9% had cyanosis.
03 / REASONSWhy does it occur?
Why does it occur?
and that increases the risk.
The defect itself is laid before birth. Whether she will come back after surgery depends on how she was treated before.
Congenital defect
A study by the London Children's Hospital indicated that 95% of gill abnormalities occur in the second cleft. The anomaly occurs on both sides: in a series of 80 children — 12 out of 62 with a defect of the second cleft.
Hereditary syndromes
If there are also changes in the auricle or a similar defect in relatives, the doctor may prescribe an additional examination: such a defect is part of the branchio-oto-renal syndrome, which affects the ears and kidneys.
Opening of the abscess
In a cohort of 421 operated patients, the probability of recurrence was 3.4 times higher in those who had an abscess opened before surgery.
Age over 40 years
The most common permanent formations on the neck in adults are tumors. In a series of 67 adults with a suspected lateral cyst, the risk of malignancy was higher at age >40 years and when lymph nodes were present on imaging.
Neoplasm of the neckIn the middle of the neck is another defect
A cyst in the middle of the front of the neck is most often a median cyst. This is another flaw with another operation, a separate page about it.
Median cyst and fistula of the neck
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
The side cyst itself usually does not require emergency care. Two things are dangerous: an infection of the cyst, which can spread to the neck, and in adults, a tumor disguised as a cyst. Call 103 if a child or adult has at least one of the following:
103 immediately if:
- it is difficult to breathe;
- cannot swallow;
- swelling inside the mouth or throat;
- difficult to speak;
- it is difficult to open the mouth;
- in a child under 5 years of age, breathing is very frequent or difficult - he croaks or the stomach is pulled under the ribs during inhalation;
- blue, gray, pale or marbled skin, lips or tongue (on dark skin it is more noticeable on the palms and feet);
- a rash that does not fade when pressed;
- a child under 3 months has a temperature of 38 °C and above, at 3–6 months — 39 °C and above;
- a child under 5 years of age has a temperature below 36 °C, is cold to the touch or shivers;
- weak, shrill or continuous crying;
- the child does not react as usual, does not eat, is difficult to wake up or is sleepier than usual;
- a child under the age of 5 has not urinated for 12 hours;
- in a child under 5 years old, the skin is cold and moist (sticky) to the touch;
- a child under the age of 5 has fainted or cannot be woken up;
- the child started convulsing;
- a child over 5 years old or an adult has very frequent breathing;
- in a child from 5 years old or an adult - confusion, slurred speech or incomprehensible words;
- a child over 5 years old or an adult has a very high or very low temperature, fever or chills.
Do not delay a visit to the doctor:
On the same day: the lump on the neck is red, painful, swollen or hot; redness or swelling spreads further from the bump; pus flows from the hole in the neck or from the ear; fever or chills appeared. If the abscess has to be opened, tell the doctor that it may be a cyst. In the coming days: in an adult, a lump on the side of the neck does not go away in 2 weeks, grows, is hard or does not move, appeared again after removal; enlarged nodes above or below the collarbone; night sweats Do not postpone the examination: first, the tumor must be excluded. Planned: a soft bump that doesn't bother you or a tiny hole in the child's neck that sometimes oozes fluid — make an appointment; the cyst is removed when there is no inflammation.
05 / DIAGNOSTICSAs defined,
As defined,
what kind of formation is this
- Discussion and review
When a bump or a hole appeared, whether there were inflammations, whether an abscess was opened; examination of the neck and ears.
- Ultrasound, CT or MRI
The pictures show where the formation lies and where the movement is going. Adults with an increased risk of tumors are prescribed CT or MRI of the neck with contrast.
- Puncture with a fine needle
In adults, instead of an open biopsy, the contents are taken with a fine needle, preferably under ultrasound control. The authors of a cohort of 436 patients advise testing the contents for human papillomavirus (HPV) prior to removal.
- Examination of the throat and larynx
If there is a risk of a tumor, the mucous membrane of the larynx, the root of the tongue, and the pharynx are examined; if the source is not found - examination under anesthesia.
- Research after surgery
The final diagnosis is made when the removed is examined under a microscope.
06 / TREATMENTHow we treat
How we treat
lateral cyst of the neck.
The main method is complete removal of the cyst along with the course of the fistula when there is no inflammation. If the cyst is inflamed, the infection is treated first. In adults, the tumor is excluded before surgery.
01
Surgery
The authors of the review call complete removal a curative method.
- Cyst and course
- The cyst is removed together with the wall and the entire course of the fistula. In a series of 80 children, it was possible to completely remove the defect of the second cleft in all but one, who needed a repeat operation.
- When to operate
- Not during inflammation: antibiotics first, then planned removal. In a cohort of 421 patients, early surgery resulted in no more complications.
- Near the ear
- The defect of the first cleft is removed, finding and protecting the facial nerve. In a series of 100 children, temporary weakness of facial muscles was present in 11, and all of them resolved within 6 months.
- Cut
- The usual approach is an incision on the neck, after which a visible scar remains. In a meta-analysis of 3 studies, an incision behind the ear gave a higher appearance score, but the operation took longer; there were just as many complications.
02
Movement from the throat
- Endoscopic cauterization
- Fistulas from the third-fourth gill pocket open in the throat. The authors of the systematic review advise starting with cauterization of this hole through the endoscope: relapses seem to be the same as after surgery, and complications are fewer.
03
The result
- Relapse
- In a cohort of 421 patients among 358 who underwent first-time surgery, the defect returned in 3.6%—an average of 47.1 months.
- Complications
- In the same cohort, complications occurred in 2% of patients.
04
If a tumor is found
- Metastasis in the form of a cyst
- In a cohort of 436 patients operated on for a lateral cyst, tumor metastases were found in 13 (3%); among adults — 3.3%. There were no malignant changes in children in the cohort of 421 patients.
- "Cancer from a cyst" is a dubious diagnosis
- In a database of 1,070 adults with this diagnosis, 94.4% had another head and neck cancer before or within 5 years. Therefore, if cancer is found in the "bone", the primary tumor is looked for, and the treatment is conducted by an oncologist.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
With a lateral neck cyst, both parents of children and adults who have not had the defect removed in childhood turn to the "Congenital Defects Surgery" department. An ENT doctor or an oncologist conducts an examination to rule out a tumor in an adult; if a tumor is found, the oncologist continues the treatment.
CLINIC SERVICE
Surgery of birth defects
Congenital defects of the face and body in children and adults — from the first operation to the correction of the consequences.
View service
What we do for this condition
- Consultation and assessment — the doctor finds out the clinical situation, functional needs and possible limitations.
- Personal plan — the next steps, sequence of stages and recovery are discussed in advance.
- Microsurgical technique — magnifying optics and thin suture material help to accurately match the tissues and make the scar less noticeable.
- Inpatient — if the child is operated on, the parents are nearby; duration depends on the operation.
- Adult patients — the direction also accepts adults who did not undergo surgery or needed correction in childhood.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photos and extracts onlineSend a photo of the neck and the results of ultrasound or other examinations - the doctor will pre-evaluate the situation.
- ConsultationReview, talk about inflammation in the past; in an adult, an examination plan to rule out a tumor.
- PlanWhen to treat — without inflammation; which examinations are still needed and which doctors are involved.
- TreatmentAccording to the agreed plan; removed is examined under a microscope.
- Follow-upFollow-up: In a cohort of 421 patients, recurrence occurred at an average of 47.1 months.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
Is a lateral neck cyst dangerous?
In a child, this is usually a benign defect. Dangerous inflammation that can spread to the neck, and in adults - a tumor in the form of a cyst, so the adult is examined first.
Can a cyst turn into cancer?
True "cyst cancer" is a dubious diagnosis: in a database of 1,070 adults with it, 94.4% had other head and neck cancers. Therefore, if cancer is found in the "bone", it is considered a metastasis until proven otherwise, and the primary tumor is looked for - in the throat or thyroid gland.
Can a cyst be cured with antibiotics?
Antibiotics treat inflammation, but not the defect itself. Without signs of infection, the guidelines do not recommend prescribing them to adults with a tumor on the neck. Vadu is removed by complete removal.
Is it possible to remove a cyst during inflammation?
Usually no: the infection is treated first, then the cyst is removed as planned. If the abscess was opened, the cyst often returns.
Can the cyst return after surgery?
This is possible. In a cohort of 421 patients among 358 operated on for the first time, the defect returned in 3.6%; more often - in those who had an abscess opened before the operation.
The child has a tiny hole in the neck - what to do?
If it is not lit, make an appointment for a scheduled consultation. Redness, pain, swelling or pus is a reason to see a doctor the same day.
How does a lateral cyst differ from a median cyst?
The lateral lies on the side of the neck, the middle lies in the front in the middle. These are different defects, and they are removed in different ways; there is a separate page about the median cyst.
Sources
20 sources · reviews, guidelines and researchshowCollapse
- Clinical Practice Guideline: Evaluation of the Neck Mass in AdultsOtolaryngology–Head and Neck Surgery, 2017doi:10.1177/0194599817722550 ↗
- Congenital Neck MassesNeoReviews, 2023doi:10.1542/neo.24-10-e642 ↗
- Branchial Cleft Anomalies and Thymic CystsOtolaryngologic Clinics of North America, 2015doi:10.1016/j.otc.2014.09.002 ↗
- Second branchial cleft anomalies in children: a literature reviewPediatric Surgery International, 2018doi:10.1007/s00383-018-4348-8 ↗
- Branchial anomalies in childrenInternational Journal of Pediatric Otorhinolaryngology, 2011doi:10.1016/j.ijporl.2011.05.008 ↗
- Branchial arch anomalies: Recurrence, malignant degeneration and operative complicationsInternational Journal of Pediatric Otorhinolaryngology, 2017doi:10.1016/j.ijporl.2017.03.014 ↗
- Congenital first branchial cleft anomalies in children: a study of 100 surgical cases and a review of the literatureEuropean Archives of Oto-Rhino-Laryngology, 2023doi:10.1007/s00405-022-07607-0 ↗
- Postauricular Incision Versus Conventional Transcervical Incision in Second Branchial Cleft Cyst Excision: A Systematic Review and Meta-AnalysisJournal of Craniofacial Surgery, 2022doi:10.1097/SCS.0000000000008741 ↗
- Prevalence of cystic metastases in a consecutive cohort of surgically removed branchial cleft cystsActa Oto-Laryngologica, 2022doi:10.1080/00016489.2021.2016951 ↗
- Assessment and management of presumed branchial cleft cysts: our experienceB-ENT, 2016pubmed.ncbi.nlm.nih.gov/29709133 ↗
- Branchial Cleft Cyst Carcinoma Remains Grossly Over Diagnosed: A Large Database AnalysisThe Laryngoscope, 2026doi:10.1002/lary.70060 ↗
- Surgery versus endoscopic cauterization in patients with third or fourth branchial pouch sinuses: A systematic reviewThe Laryngoscope, 2016doi:10.1002/lary.25321 ↗
- Neonatal respiratory distress due to a third or fourth branchial pouch sinus: A systematic reviewInternational Journal of Pediatric Otorhinolaryngology, 2021doi:10.1016/j.ijporl.2021.110922 ↗
- Kystes et fistules congénitaux du cou chez l’adulte (Congenital cysts and fistulas on the neck in adults)La Presse Médicale, 2019doi:10.1016/j.lpm.2018.09.019 ↗
- Congenital Cervical Cysts, Sinuses, and Fistulae in Pediatric SurgerySurgical Clinics of North America, 2012doi:10.1016/j.suc.2012.03.015 ↗
- LumpsNHS, 2024nhs.uk/symptoms/lumps ↗
- Swollen glandsNHS, 2023nhs.uk/symptoms/swollen-glands ↗
- Skin abscessNHS, 2026nhs.uk/conditions/skin-abscess ↗
- TonsillitisNHS, 2024nhs.uk/conditions/tonsillitis ↗
- SepsisNHS, 2026nhs.uk/conditions/sepsis ↗
The figures on the page are from these sources.
A bump or a hole
on the side of the neck?
Send photos and test results. The doctor will tell you what else needs to be checked and when to plan treatment.