LATERAL NECK CYST AND FISTULAE
Reconstructive surgery:
This document has been conceived under the authority of the French Society of Plastic, Reconstructive and Aesthetic Surgery (SOFCPRE).
DEFINITION, AIMS AND PRINCIPLES
The cysts are swellings filled with liquid and the fistulae are paths with variable topography with a skin orifice in the neck.
- Cysts can remain more or less time visible and palpable, will present at a variable age as a swelling of the neck.
- Fistulas are present from birth and may have been ignored because of their very small size or their location only in the pharynx.
There never disappear spontaneously. The main risk is the occurrence of an infection resulting in a red swelling of the neck, associated or not with a discharge of pus in the skin. The evolution to an abscess is possible. The risk of malignant transformation is exceptional.
The aim of the operation is to remove the cyst and the whole trajectory when a fistula is present. Observation and monitoring can be proposed in a transitory way but it is always preferable to perform the resection before an added infection develops. The risk such an infection disappears after the intervention in the absence of recurrence.
BEFORE THE OPERATION
A pre-operative assessment is performed in accordance with the usual requirements.
The anaesthetist will be seeing for consultation at the latest 48 hours before surgery.
No medication containing aspirin should be taken within 10 days preceding the intervention.
Your surgeon is at your disposal to answer all your questions.
Remember to tell him if you've already presented allergic symptoms, especially to drugs, and remember to bring to the consultation with the anaesthetist and the hospital all medical records in your possession (blood checks, radiological examinations, prescriptions).
HOSPITAL STAY
The length of hospital stay is an average of 1 to 3 days.
THE PROCEDURE
This procedure is performed under general anaesthesia.
The skin incision is made over the cyst. The removal of a fistula may require the surgeon to perform multiple cervical incisions along the length and path of the fistula.
A suction drain is usually left in place for a few days.
In case of pharyngeal fistula, it may be necessary to leave in place a nasogastric tube for feeding.
At the end of surgery, a dressing is left in place in the zone of the sutures.
AFTER THE OPERATION: POSTOPERATIVE CARE AND FOLLOW-UP
The discharge will be contemplated depending on if a drain has been used.
It is frequent that there is edema and ecchymosis on the lateral side of the neck, and pain according to the extent of surgery and the existing fistula.
It must be foreseen a stop of work or school activities from 1 to 3 weeks.
The resumption of sporting activities is usually possible in the third week.
It is necessary to return to the clinic in about a week (between 7th and 10th postoperative day) after the intervention.
The deglutition and rotation movements of the neck may be sore for a few days.
THE RESULT
It is appreciated with a delay of 6 to 12 months after surgery.
During this period of healing the scars are still red or pink, and their evolution is variable depending on the thickness of the skin and the age of the patient.
POSSIBLE COMPLICATIONS
- The occurrence of bleeding after the procedure may lead to the formation of a hematoma and eventually lead to respiratory problems which may need a re-intervention.
- Infection of the operated area may occur and sometimes require a new surgical procedure.
- The appearance of a hypertrophic scar, or the formation of a keloid scar, is always possible. They would require an appropriate treatment.
- The risk of a relapse with reappearance of a mass or a fistula orifice is small but not zero.
SERIOUS AND EXCEPTIONAL COMPLICATIONS
All surgery, even if performed in terms of competence and safety in accordance with current medical science and regulations, are at risk of complications.
In case of large cyst or an added infection, of fistulas with complex paths having already been the subject of an intervention, can sometimes been observed a significant bleeding necessitating a change in operative technique or neural complication responsible for impaired mobility of the tongue, shoulder or facial region.
All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.
You can be assured that if you are operated on by a qualified Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary.
These are the facts that we wish to bring to your attention, to complement what you were told during the consultation.
Our advice is for you to keep this document and to read it and think it over carefully after your consultation.
Once you have done this you will perhaps have further queries, or require additional information.
We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia.
"Copyright", © "All Rights Reserved" SOFCPRE, any reproduction, even partial, of these texts is prohibited without permission from the French Society of Plastic Reconstructive and Aesthetic Surgery. A copy or reproduction by any means whatsoever, including photocopying, photography, screen capture, copy, paste, recording or otherwise, constitutes an infringement punishable under the Act of March 11, 1957 on the protection of copyright.
Authorization for reproduction of March 10, 2009, for: MCEI (www.chirurgiens-plasticiens.info).
This factsheet has been designed under the auspices of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as a complement to your first consultation; to try to answer any questions you can ask yourself if you intend to use a surgical lipo-filling.
The purpose of this paper is to bring you all the information necessary and essential for you to make your decision with full knowledge of the facts. So is it advisable to read with the greatest attention.