Lump in the middle of the neck
A swelling in the middle of the front of the neck that does not hurt and rises when swallowing. In a review of 24 studies (1371 patients), neck cyst was the main manifestation in 75%.
CONDITION / JAWS, MOUTH AND NECK
Median cyst and fistula of the neck.
The median cyst of the neck is a congenital cavity with fluid in the front in the middle of the neck, which remained from the duct through which the thyroid gland descended in the fetus. It is removed as planned, together with the course and the middle part of the hyoid bone.
CONCEPTUAL VISUALIZATION- What it is
- A congenital cyst in the front in the middle of the neck is a remnant of the thyroid duct.
- How common
- Most often, congenital formation of the neck — both in children and in adults.
- The main feature
- Swelling in the middle of the neck that does not hurt and rises when swallowing.
- Treatment
- Systrank operation - when there is no inflammation.
01 / WHAT IS ITWhat is
What is
median cyst of the neck.
The thyroid gland is formed in the embryo near the root of the tongue and descends to the neck through a narrow passage - the thyroglossal duct. Usually the duct disappears. If it has not completely disappeared, fluid accumulates in the residue and a cyst is formed. Therefore, it is also called thyroglossal - "thyroglossal".
This is most often a congenital formation of the neck. More than 70% of formations on the front of the neck in children are precisely such remnants of the duct; in adults - 7%. A characteristic feature is that the cyst rises during swallowing. The cyst is connected to the hyoid bone, a small bone between the chin and the larynx, so during the operation, its middle part is also removed.
Sometimes a hole with secretions appears on the skin above the cyst - a fistula. The cyst is removed routinely when there is no inflammation. Cancer in such a cyst is rare and is usually detected only under a microscope after surgery.
This is general information. What will suit you or your child, the doctor will tell after the examination.
02 / SIGNSHow
How
median cyst presents.
The cyst is found in both children and adults: in a series of 106 patients, the average age of children was 7 years, adults - 36.
Inflammation
The cyst can be red, painful and suppurate. In a series of 391 children, there were 30.2% of recurrent neck inflammations before surgery.
A hole in the skin
A fistula is an opening above a cyst from which fluid is released. In a study of 131 children, such an opening before surgery was an independent risk factor for cyst recurrence.
Adults have other complaints
In a series of 106 patients, adults more often than children came not because of a lump or inflammation, but because of pain, difficulty swallowing, voice change, or fistula.
03 / REASONSWhy does it occur?
Why does it occur?
and why it returns.
The defect itself is laid before birth. Whether the cyst will return depends on the operation and what happened before it.
The rest of the channel
A cyst occurs when the thyroid-lingual duct has not completely disappeared.
Removal without bone
If only the cyst is removed, without the middle part of the hyoid bone, the cyst returns more often: in a series of 227 children — in 29% versus 6.9% after Systrank surgery.
Inflammation and fistula
Recurrent inflammation before surgery increases the risk of recurrence, according to a review of 16 studies in children. Fistula on the skin, according to another study, too.
Size and previous operations
In a series of 391 children, the cyst returned more often if it was larger than 2 cm, had unclear borders, or had already been operated on.
There is another defect on the side of the neck
A cyst on the side of the neck is most often lateral (gill). It is examined and removed differently.
Lateral cyst of the neck
04 / SEEK MEDICAL ADVICE
When to seek medical advice?
A median cyst is a planned situation, it usually does not require emergency care. An inflamed cyst is dangerous if the infection spreads. Call 103 if a child or adult has at least one of these signs:
103 immediately if:
- difficulty breathing;
- a person cannot swallow;
- swelling inside the mouth or throat;
- it is difficult for a person to speak;
- the mouth is difficult to open;
- a child under the age of 5 breathes very often or with effort: croaks, the stomach sinks under the ribs during inhalation;
- the skin, lips, or tongue are blue, gray, pale, or mottled (on dark skin, look at the hands and feet);
- the rash does not disappear if you press on it;
- a temperature of 38 °C and above in an infant up to 3 months or 39 °C and above — in 3–6 months;
- a child under 5 years old is cold to the touch, shivering or has a temperature below 36 °C;
- the child cries weakly, shrillly or without stopping;
- the child reacts sluggishly, refuses to eat, is sleepy or difficult to wake up;
- a child under the age of 5 did not urinate for 12 hours;
- the skin of a child under 5 years old is cold and moist (sticky);
- a child under the age of 5 has fainted or does not wake up;
- convulsions began;
- an adult or a child over 5 years old breathes very often;
- an adult or a child over 5 years old is confused, speaks indistinctly or unintelligibly;
- an adult or a child over 5 years old has a very high or very low temperature, fever or severe chills.
Do not delay a visit to the doctor:
On the same day: the cyst is red, painful, swollen or hot to the touch; redness spreads around; pus flows from the opening above the cyst; fever or chills appeared. The inflammation is treated first, and the cyst is removed later. In the coming days: a lump on the neck is growing, hard or does not move; in an adult, it lasts more than 2 weeks; the cyst reappeared after surgery. Planned: a lump in the middle of the neck that does not hurt and rises when swallowing - make an appointment for a consultation; operate when there is no inflammation.
05 / DIAGNOSTICSAs confirmed
As confirmed
diagnosis
- Review
The doctor checks whether the lump rises when swallowing, whether there is a hole in the skin, whether there has been inflammation and previous operations.
- Ultrasound of the neck
Basic examination before surgery: shows the cyst and whether the thyroid gland is in its usual place. In a review of 18 studies (823 patients), ultrasound confirmed the diagnosis in 66.1%.
- Scintigraphy — if necessary
Radioisotope imaging of the thyroid gland is useful if displaced (ectopic) glandular tissue is suspected. If the gland is normal on ultrasound, it is usually not needed.
- Puncture with a fine needle
If a tumor is suspected: Most cancers in such cysts are papillary, and puncture can help spot them before surgery.
- Researching the deleted
During the operation, the surgeon cannot reliably distinguish the cyst from another formation, so the removed one is examined under a microscope.
06 / TREATMENTHow we treat
How we treat
median cyst of the neck.
The main method is the Systrank operation. It is done according to plan: first, inflammation is treated, if it is present, and the cyst is completely removed only after that.
01
Operation Systrank
The cyst, the duct, and the middle part of the hyoid bone are removed in one block.
- Why along with the bone
- The authors of a review of 24 studies concluded that Systrank surgery is the best choice to keep the cyst from returning.
- Relapse
- In a review of 24 studies (1,371 patients), after various methods of treatment, the cyst returned in an average of 11%. In a meta-analysis of 5 studies (937 children) after the modified Systrank operation — in 4%.
- Complications
- Most often — wound infection: in a review of 1371 patients — 4%, in a meta-analysis of 937 children — 6%. In a series of 91 children, complications were in 26.4%; the most severe are bleeding and removal of part of the thyroid cartilage.
02
If the cyst has returned
- Repeat operation
- After repeated operations, the cyst returns more often: in a review of 16 studies in children (according to 5 studies where repeated operations were counted separately) — in 20%.
03
Sclerosis
Option without an incision — only when cancer is reliably excluded.
- How do they do it?
- Alcohol (ethanol) or OK-432 is injected into the cyst — this is called chemical ablation. The method is also used for other benign neck cysts.
- The result
- In a meta-analysis of 7 studies (129 patients), success was 70%, serious complications - 0.9%. There are still few studies.
04
If cancer is found in the cyst
- How common
- Cancer is found in 1–2% of such formations. In a review of 164 patients, the average age was 39.5 years, 92.1% had papillary cancer; in 73.3% it was discovered only after surgery.
- What's next
- The basis is the same Systrank operation. Whether to remove the thyroid gland as well is decided by an endocrine surgeon or an oncologist: in a review of 484 cases, cancer was present in the gland at the same time in 34.6%. Overall survival is 99.1%.
07 / AT THE VALIKHNOVSKYI INSTITUTE
How
How
we treat it.
Parents with children and adults are referred to "Surgery of birth defects" with median neck cyst. If cancer is found in the cyst, treatment of the thyroid gland is planned together with an endocrine surgeon or oncologist.
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 of a surgeon — the doctor finds out the situation, functional needs and possible limitations of you or the child.
- Personal plan — the pretreatment team discusses steps, sequencing, and recovery.
- Microsurgical technique — scales and thin suture material help to carefully match the tissues so that the scar is less noticeable.
- Hospital for children — parents are next to the child; how many days depends on the operation.
- Adults — adults who did not undergo an operation in childhood or who need a correction also apply.
Rostislav Valikhnovskyi
Plastic surgeon, candidate of medical sciences, founder of Dr. Valikhnovskyi Institute of Surgery.
How treatment works with us
- Photo and ultrasound onlineSend a photo of the neck and the conclusion of the ultrasound, if there is one - the doctor will tell in advance what examinations are still needed.
- ConsultationExamination of the neck, discussion of inflammation and previous operations.
- PlanWhen to treat — without inflammation; whether ultrasound of the thyroid gland or puncture is necessary.
- TreatmentYes, as agreed at the consultation; removed tissues must be sent for histological examination.
- Follow-upFollow-up: in a series of 391 children, recurrences occurred between 0.5 and 34 months after surgery.
08 / QUESTIONS AND ANSWERSCommon
Common
questions
Short answers. What is right for you, the doctor will tell you during the consultation.
What is Operation Systrank?
The cyst is removed in one block together with the rest of the duct and the middle part of the hyoid bone. So the cyst returns less often than after the removal of the cyst itself.
Is it possible to remove only the cyst, without the bone?
It is possible, but the cyst then returns more often: in a series of 227 children — in 29% versus 6.9% after Systrank's operation.
Can a median cyst be cancer?
Rare: cancer is found in 1-2% of such formations, most often it is papillary cancer with a favorable prognosis - in a review of 484 cases, the overall survival rate was 99.1%.
Why ultrasound before surgery?
To see the cyst and make sure that the thyroid gland is in its usual place, and the displaced tissue of the gland is not mistaken for a cyst.
The cyst is inflamed - what to do?
See a doctor the same day. The inflammation is treated, and the cyst is removed later. Repeated inflammation before surgery increases the risk that the cyst will return.
Does the result depend on the age of the child?
In a study of 131 children, age did not affect the risk of cyst recurrence, but skin fistula did.
What is the difference between a median cyst and a lateral one?
The middle one is in the front in the middle of the neck and is connected to the hyoid bone, the lateral one is on the side. Examinations and operations are different for them; there is a separate page about the lateral cyst.
Sources
19 sources · reviews, guidelines and researchshowCollapse
- Clinical presentation and treatment outcomes of thyroglossal duct cysts: a systematic reviewInternational Journal of Oral and Maxillofacial Surgery, 2015doi:10.1016/j.ijom.2014.07.007 ↗
- Risk of recurrence in children operated for thyroglossal duct cysts: A systematic reviewJournal of Pediatric Surgery, 2013doi:10.1016/j.jpedsurg.2012.10.060 ↗
- Outcomes of Modified Sistrunk Procedure for Pediatric Thyroglossal Duct Cyst Removal: Systematic Review and Meta-AnalysisOTO Open, 2026doi:10.1002/oto2.70308 ↗
- Thyroglossal duct remnant carcinoma: Beyond the Sistrunk procedureSurgical Oncology, 2014doi:10.1016/j.suronc.2014.07.002 ↗
- Thyroglossal Duct Cyst Carcinoma: A Systematic Review of Clinical Features and OutcomesOtolaryngology–Head and Neck Surgery, 2017doi:10.1177/0194599817696504 ↗
- Thyroglossal duct cyst carcinomas — a retrospective study and systematic review of the literatureVirchows Archiv, 2025doi:10.1007/s00428-025-04125-2 ↗
- Diagnostic utility of thyroid scan and ultrasound in managing thyroglossal cysts: a systematic literature reviewJournal of Medicine and Life, 2025doi:10.25122/jml-2025-0006 ↗
- Management of suspected thyroglossal duct cystsJournal of Pediatric Surgery, 2018doi:10.1016/j.jpedsurg.2017.11.019 ↗
- Evaluation of preoperative cutaneous fistula as a risk factor for recurrence of thyroglossal duct cyst in childrenEuropean Journal of Pediatrics, 2022doi:10.1007/s00431-022-04511-x ↗
- Modified Sistrunk Procedure in 391 Pediatric Thyroglossal Duct Cyst Cases: Clinical Analysis of Efficacy and Recurrence RiskEar, Nose & Throat Journal, 2024doi:10.1177/01455613241257353 ↗
- Presentations and management of thyroglossal duct cyst in children versus adults: a review of 106 casesOral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 2011doi:10.1016/j.tripleo.2010.10.029 ↗
- Pediatric thyroglossal duct cysts: Post-operative complicationsInternational Journal of Pediatric Otorhinolaryngology, 2019doi:10.1016/j.ijporl.2019.05.035 ↗
- Chemical ablation using ethanol or OK-432 for the treatment of thyroglossal duct cysts: a systematic review and meta-analysisEuropean Radiology, 2021doi:10.1007/s00330-021-08033-2 ↗
- Sclerotherapy for Benign Cystic Lesions of the Head and Neck: Systematic Review of 474 CasesOtolaryngology–Head and Neck Surgery, 2021doi:10.1177/01945998211000448 ↗
- 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 ↗
- 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 in the middle
neck?
Send a photo of the neck and the conclusion of the ultrasound. The doctor will tell if it looks like a median cyst and what to do next.