* Fistula = non-natural, tubular or tubular network-like connection between an internal hollow organ and other organs or the body surface

°° Cyst = a tissue cavity closed by an epithelium (membrane), which may consist of several chambers and contains fluid

 

Neck fistulas * and neck cysts °° are caused by congenital maldevelopment of the intestines of the neck. A distinction is made between median neck cysts and lateral neck cysts.

 

The so-called median neck cyst or neck fistula is located in the middle of the front of the neck in the area of the hyoid bone, an arch-shaped bone above the larynx. It is an abnormal development of the thyroid duct, of which residual parts remain and can become enlarged and inflamed. It is the most common tissue change in the midline of the neck and occurs mainly at a young age (in boys). As a rule, median neck cysts remain asymptomatic, but infections with redness and increased swelling occur in just under 10 - 30% of children. Unfortunately, these inflammatory processes can recur.

Lateral neck cysts are also residues of a maldevelopment in the neck area, the so-called "gill arches", pockets and folds (structures that play a role in the development of the embryo). They develop along these neck structures. In most cases, they are located on the lateral neck below a specific muscle (sternocleidomastoid muscle) and are more common on the right side. They are the second most common congenital malformations of the head and neck after median neck cysts. In many cases, they are not noticed until school age or young adulthood.

 

Neck cysts can be palpable as a thickening on the neck. However, they can also form so-called fistulas*, which can radiate in many directions, for example from the vicinity of the tonsils to the area of the collarbone. These fistulas can regularly secrete fluid. Throat cysts can become inflamed and form encapsulated inflammations (abscesses).

Due to the risk of infection and possible fistula formation, neck cysts are usually surgically removed after diagnosis. This also applies to neck fistulas without a cyst.

The first contact is usually made through an outpatient information meeting in our pediatric surgery outpatient clinic (see below for contact details). Please bring all existing examination results (e.g. ultrasound findings or, if performed, cross-sectional imaging (computed tomography or magnetic resonance imaging)) to the first outpatient consultation. However, the diagnosis is made clinically during an examination at our clinic. We often repeat an ultrasound of the neck in order to be able to visualize the extent and position of the cyst more precisely. Only in exceptional cases do we consider further diagnostics (e.g. sectional imaging) to be indicated.

In an initial consultation, the treatment options are presented and your questions are discussed in detail. In the case of acute inflammation or an abscess, this is treated with antibiotics, painkillers and antipyretic medication. However, this is not effective in the long term and does not prevent the infection from recurring. Therefore, neck cysts or fistulas must be surgically removed.

 

 

During the operation (under general anesthesia), the neck cyst and any attached fistula tract are removed. In the case of median neck cysts, the middle part of the hyoid bone must also be removed (so-called sistrunk procedure), as otherwise the fistula will recur more frequently (recurrences). In the case of lateral neck cysts, the neck muscle (sternocleidomastoid muscle) located there is pushed aside after the skin incision. The cyst or fistula tract can then usually be dissected free and removed. Sometimes several skin incisions have to be made to expose the entire fistula tract. However, these incisions are made in the course of the natural skin folds so that the remaining scars are only line-shaped and hardly noticeable later on.

After the procedure, your child will initially remain in the recovery area, where you will be able to sit up in bed again. You will then be transferred to the normal ward. A few hours after the operation, your child will usually be able to eat again. If your child feels well after the operation, you can be discharged home on the evening of the operation (outpatient operation). In individual cases, however, observation may be necessary until the following day.

As a rule, you will not be seen again for a follow-up examination by us, but by the colleagues who referred you to us for surgery. However, if you still have questions regarding the operation itself or if we consider an earlier follow-up examination with us to be appropriate in individual cases, you can arrange an outpatient appointment at any time.

Newborns with esophageal atresia have to stay in hospital for about 14 days after the operation. During this time, the child and mother are cared for by our pediatric nurses and medical team. In the first few days after the operation, your child will not yet be fed by mouth, but via the stomach tube inserted during the operation. In individual cases, the child may also be fed intravenously, i.e. via a drip. The feeding tube will be left in the child's stomach for a few days after the operation for feeding purposes.

A few days after the operation, your child can be fed by mouth. However, it is not possible to predict how long it will take for the oesophagus to function normally. Every child takes its own time. If your child drinks the food completely and gains weight steadily, the feeding tube will be removed and you can be discharged home.

Follow-up treatment is usually necessary for several years, for which regular check-ups are scheduled in our gastroenterology consultation. Our Clinical Department works closely with the parents' initiative KEKS e.v. http://www.keks.org/. Every patient receives a specially developed follow-up book (similar to the yellow check-up booklet) for standardized and thorough follow-up care, in which all upcoming check-ups can be planned and managed.

Typical long-term problems include tracheomalacia*, gastroesophageal reflux disease °° or narrowing (stenosis) of the esophageal suture. The lethality (mortality) of esophageal atresia depends on concomitant malformations and birth weight. It is less than 5 % with a birth weight over 1500 g and without major heart defects.

* Tracheomalacia (Latin for "soft windpipe") is a condition characterized by a slackening of the windpipe (trachea). This is caused by a lack of stability of the cartilage clasps in the trachea, which leads to a collapse of the trachea, typically during the inhalation phase.

Gastroesophageal reflux disease with reflux esophagitis refers to a disease of the esophagus caused by an abnormally long reflux of gastric acid.