Common congenital anomalies of the neck. Embryology and surgical anatomy.

A good knowledge of embryology and surgical anatomy allows for the anticipation of intraoperative findings, and, hence, for safer and more efficient care of patients with congenital anomalies of the neck. Presumptive thyroglossal anomalies that are at or above the level of the hyoid mandate extra vigilance: the patient may not have sufficient thyroid tissue in the usual thyroid location. The discontinuous character of thyroglossal tracts, related to ontogenesis, ordains dissection to the lingual mucosa. First branchial cleft cysts and fistulas require knowledge of facial nerve anatomy; in some of these cases, the facial nerve is best identified in the temporal bone. Branchial cysts, sinuses, and fistulas only can be assigned to a specific pouch-cleft by their anatomic relations to cervical structures.