Hydrocele Of The Neck

There are other cystic tumors of the neck which are congenital, being noticed at birth, and which grow to a large size. They are often wide-spread, extending not only between the tissues of the neck below the deep fascia but even into the axilla. Their walls are thin, consisting sometimes only of a layer of lining epithelium and the surrounding tissues. On this account it is. impossible to dissect them out. The use of injections and setons has been abandoned as too dangerous. They rarely require treatment, as they tend to disappear spontaneously. Mr. J. Bland Sutton ascribes their origin first to congenitally dilated lymph-spaces; second as resembling the cervical air-sacs that exist in the howling monkeys; and third that possibly some of them may be related to a persistence of some portion of a branchial cleft.

Median cervical fistulae and cysts originate in connection with the thyroglossal duct. This, in the embryo, leads from the foramen caecum at the root of the tongue through to the posterior surface of the hyoid bone and thence downward and forward to the isthmus of the thyroid gland. It begins to atrophy in the fifth week and is obliterated by the eighth. According to Sutton these cysts are never congenital but occur soon after birth or as late as the fourteenth year. They appear as rounded, cystic tumors just below the hyoid bone or over the thyroid cartilage. They either inflame and break of their own accord, discharging externally, or are opened by the surgeon and, contrary to what is the case in hydroceles of the neck, never tend to disappear, but a sinus remains. At times it almost heals, then the contents accumulate and a cyst forms, this again breaks and a sinus results as before. In attempting a cure by operation the sinus should be followed up behind the hyoid bone. In one case after two failures of attempted excision a cure was obtained by destroying the tract by introducing a small galvanocautery point. Unless every portion of the lining membrane be completely destroyed the cells will go on secreting and reproduce, in a short time, the original condition. Failure to cure these sinuses and cysts by excision often occurs, notwithstanding the exercise of the greatest care.

The lower portion of the thyroglossal duct may persist in the form of the pyramid or third lobe of the thyroid gland, which arises from the isthmus or from the left side and ascends as far as the hyoid bone, to which it is attached.