What neck masses do we treat?

The most common types of neck masses we treat in the Division of Pediatric Surgery at Johns Hopkins All Children's Hospital are enlarged lymph nodes and congenital abnormalities like epidermoid cysts, thyroglossal duct cyst and branchial cleft cyst. Some of these cysts are just under the skin and others have tracts that extend into the neck and need to be removed along with the cyst. If cysts are infected when they are first diagnosed, surgical drainage may need to be done first and removal of the cyst at a later time. We also treat masses in the thyroid and parathyroid glands.

How is the surgery done ?

These procedures are done under general anesthesia, often on an outpatient basis.

Epidermoid cysts

An incision is made over the cyst and the cyst is then dissected out from its attachments in the subcutaneous tissue. The incision is closed, usually with absorbable, buried sutures so that no stitches need to be removed.

Thyroglossal duct cysts

These cysts are located in the midline of the neck, above the larynx. An incision is made over the cyst and the front part of the cyst dissected out of the subcutaneous tissue. The deep part of the cyst has a tract that extends through the hyoid bone in the front of the neck toward the base of the tongue, so the central part of the hyoid bone and the deep tract need to be removed as well. The hyoid bone is a point of muscle attachment in the neck, and removing a part of it does not affect function or appearance. After the cyst and tract are removed, the incision is closed with several layers of absorbable sutures. The skin is usually closed with buried stitches so no skin stitches need to be removed.

Branchial cleft cysts

These cysts are located off the midline in the front of the neck. The higher ones may have a tract that extends deep into the neck toward the throat cavity. The lower ones, near the head of the collar bone, usually extend only into the subcutaneous tissue. Some of these cysts have cartilage remnants attached to them. An incision is made over the cyst, with excision of any skin opening that may be present. The cyst and its deep tract are then dissected out and the incision closed. Sometimes one or two additional “stepladder” incisions are needed higher in the neck to follow and remove the deep tract.

Thyroid and parathyroid masses

These masses are usually approached through a low collar incision in the skin creases at the base of the neck. Thyroid masses are usually removed with about half of the thyroid gland and if a mass proves malignant, then the entire gland needs to be removed. Care is taken during the surgery to protect the nerves that supply the vocal cords and to protect the parathyroid glands. There are usually four parathyroid glands, and usually a mass involves only one, so it is removed and the other glands left alone. Incisions are generally closed with absorbable sutures. Learn more about how we treat thyroid conditions.

What is recovery like?

Most patients are discharged the day of surgery. Thyroid and parathyroid surgery patients generally stay overnight following surgery and go home the next day. Pain around the incision is minimized with local anesthesia injected around the incision at the end of the operation and is easily controlled with pain medicine prescribed by the doctor. The doctor will specify how long activity needs to be restricted. After thyroid and parathyroid surgery, some blood tests may be necessary to check on function of remaining glands, and thyroid hormone or calcium may be prescribed.