Lateral cysts and fistulas of the neck.

The embryonic origin of lateral cysts and fistulas remains controversial. They are, however, located in the general anatomic pattern of the embryonic thymic duct, which starts in the lateral pharyngeal wall and passes under the sternomastoid muscle to enter the mediastinum. The cyst is a unilocular, semiattached, non-translucent mass which has a tendency to become infected in 30 per cent of cases. The preauricular sinus occurs in front of the ear and is due either to a branchial cleft or an inclusion of one of the six primitive buds which form the external ear.Cystic hygroma is due to sequestrated lymphatic channels. These are always multilocular and rather invasive and may extend into mediastinum and arms. Diagnosis and treatment are considered in this presentation.