Neck Cyst (Lateral and Median Neck Cyst): Examination and Surgery
A neck cyst is a benign, fluid-filled swelling in the neck that develops during foetal development. It may be located on the side of the neck (lateral neck cyst) or in the midline (median neck cyst) and is often only discovered when it becomes swollen in connection with an infection.
At Charlottenlund Private Hospital, neck cysts are examined using ultrasound and fine-needle biopsy, and the cyst can be surgically removed. This page is part of the neck lump section, where other causes of neck swelling are described.
What is a neck cyst?
A neck cyst is a remnant from foetal development that later in life fills with fluid. According to a 2023 review article in Ugeskrift for Læger, median neck cysts are the most common congenital neck swelling: evidence of a median neck cyst is found in around 7% of people in autopsy studies, although far fewer ever develop symptoms. Lateral neck cysts are the second most common type.
The cysts grow slowly and are typically noticed in childhood, adolescence or early adulthood – often after a cold or throat infection, when the cyst suddenly becomes swollen. Neck cyst surgery at Charlottenlund Private Hospital is offered to adults; children with neck cysts are referred to hospital.
What is the difference between a lateral and a median neck cyst?
A lateral neck cyst develops when the branchial structures formed during foetal development do not disappear completely. It can be felt as a soft, painless swelling on the side of the neck, just below the angle of the jaw and in front of the large oblique neck muscle.
A median neck cyst develops along the tract through which the thyroid gland descends during foetal development. It is located in the midline close to the hyoid bone and moves upwards when you swallow or stick out your tongue – unlike a lymph node, which remains in place. Some cysts have a small opening in the skin, known as a fistula, from which fluid may drain.
Lateral neck cyst
- On the side of the neck, beneath the angle of the jaw
- Soft and painless – may become tender when inflamed
- Often discovered in early adulthood
- The entire cyst and any fistula are removed
Median neck cyst
- In the midline near the hyoid bone
- Moves upwards when you swallow
- Often discovered in childhood or adolescence
- The cyst is removed together with the central part of the hyoid bone
What symptoms can a neck cyst cause?
Neck cysts are benign, but they may become inflamed repeatedly. During an infection, the cyst becomes tender, red and swollen, and an abscess may develop. Large cysts can cause pressure, mild difficulty swallowing or cosmetic concerns.
According to Ugeskrift for Læger, the general recommendation is therefore to remove a neck cyst once the diagnosis has been established – and to perform the operation during a symptom-free period when the cyst is not inflamed.
How is a neck cyst examined?
A neck cyst is examined with an ear, nose and throat examination, an ultrasound scan of the neck and often a fine-needle biopsy. The ultrasound scan shows whether the lump is a cyst and how it is positioned in relation to blood vessels and nerves. The thyroid gland is also examined at the same time.
In the case of a median neck cyst, ultrasound is necessary before surgery because, in rare cases, the cyst may contain thyroid tissue. During a fine-needle biopsy, a small amount of fluid is removed from the cyst using a thin needle, and the cells are examined by a pathologist.
At Charlottenlund Private Hospital, the ultrasound examination and fine-needle biopsy are performed by the specialist during the preliminary examination. CT and MRI scans are not performed at the hospital – patients are referred elsewhere if these are required.
Why is age important if you have a cyst on the side of the neck?
In adults under 40, a cyst on the side of the neck is most often a benign lateral neck cyst. In adults over the age of 40, however, a cyst on the side of the neck should, according to Danish recommendations, always be investigated through a fast-track pathway at an ENT department in a hospital – even if the fine-needle biopsy shows benign cells – because a cyst in this age group may have another underlying cause that needs to be ruled out.
This investigation is not carried out at Charlottenlund Private Hospital. Your GP or an ENT specialist can refer you directly.
How is the operation performed?
The operation is performed under general anaesthesia through an incision in a natural skin crease in the neck so that the scar is as discreet as possible.
For a lateral neck cyst, the cyst is carefully separated from the blood vessels and nerves around it and removed in full. If there is a fistula, this is removed as well.
For a median neck cyst, the cyst is removed together with the central part of the hyoid bone and the tract from which the cyst originates. This does not cause problems afterwards and is important for reducing the risk of recurrence. According to Ugeskrift for Læger, recurrence occurs in around 6% of cases after surgery for a median neck cyst.
The cyst is always sent for microscopic examination. Depending on the procedure, the operation is performed as an outpatient procedure or with one overnight stay at the hospital.
What can you expect after the operation?
For the first few days, there will usually be some tenderness and mild swelling around the wound, and you may feel some tightness when swallowing or turning your head.
Some patients have a thin drain placed in the wound. This is usually removed the following day, in which case you will stay overnight at the hospital. The surgeon will provide instructions about wound care, showering and physical activity during the initial recovery period.
Increasing swelling, redness, warmth or fever after surgery may be signs of infection and should be assessed by a doctor.
The treatment pathway at Charlottenlund Private Hospital
The treatment pathway consists of a preliminary examination, surgery and follow-up. During the preliminary examination, the specialist reviews your medical history, examines the neck, performs an ultrasound scan and, if necessary, takes a fine-needle biopsy.
If the cyst is inflamed, the infection is treated first by your GP, and surgery is planned once the inflammation has settled.
The operation is performed in the surgical department in Charlottenlund. At the follow-up appointment, the results of the microscopic examination are reviewed and the wound is checked. The specialists are presented on the staff page.
Referral and payment
Most patients at Charlottenlund Privathospital come through health insurance; insurers typically require a referral from your GP and prior authorisation. If you are paying for treatment yourself, no referral is required, and prices are listed in the price list.
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Frequently asked questions
What is a lateral neck cyst?
A lateral neck cyst is a fluid-filled “sac” that develops on the side of the neck. It occurs because a small remnant of tissue from foetal development does not close completely and later forms a cyst.
The cyst is often not visible and may cause no symptoms, but it can sometimes be felt as a small swelling in the neck. In most cases, it does not cause any problems. However, if it becomes infected, it may become red, swollen and painful.
If the cyst causes discomfort or becomes infected, it can be removed surgically. In general, a lateral neck cyst is a benign condition.
What is a midline neck cyst?
A median neck cyst is a benign, fluid-filled lump that can develop at the front of the neck, usually just beneath the skin in the midline. It occurs because of an abnormality in the development of the structures of the neck during foetal development.
Symptoms include a visible swelling in the neck, which is usually painless but may become tender if the cyst becomes infected. This often happens in connection with an infection.
Treatment usually involves surgery, during which the cyst is removed together with part of the hyoid bone from which the cyst originates.
Is a neck cyst dangerous?
No, neck cysts are benign. However, they can become inflamed repeatedly, so removal is generally recommended.
Why is part of the hyoid bone removed?
A median neck cyst develops from a tract that passes through the hyoid bone. Removing the central part of the bone as well reduces the risk of the cyst returning. This does not usually cause any problems afterwards.
What applies if you are over 40?
A cyst on the side of the neck in adults over the age of 40 is always investigated through a fast-track hospital pathway. Your GP or an ear, nose and throat specialist can refer you.