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# Thyroglossal duct cyst and branchial cleft cyst

Neck lumps present from birth that come from embryonic leftovers: a midline cyst near the hyoid or a lateral cyst along the sternocleidomastoid.

Updated 2026-11-01

## Structures involved

Tap one to see what it is and open it in 3D.

- [Hyoid bone](https://durgical.com/en/anatomy/hyoid-bone/)
- [Thyroid gland](https://durgical.com/en/anatomy/thyroid-gland/)
- [Sternocleidomastoid](https://durgical.com/en/anatomy/sternocleidomastoid-muscle/)
- [Tongue](https://durgical.com/en/anatomy/tongue/)
- [Thyrohyoid membrane](https://durgical.com/en/anatomy/median-thyrohyoid-ligament/)
- [Neck lymph nodes](https://durgical.com/en/anatomy/lymph-nodes-of-neck/)
- [Internal carotid artery](https://durgical.com/en/anatomy/internal-carotid-artery/)
- [External carotid artery](https://durgical.com/en/anatomy/external-carotid-artery/)
- [Palatine tonsils](https://durgical.com/en/anatomy/palatine-tonsil/)

## What it is

The two most common congenital neck masses. A thyroglossal duct cyst is a remnant of the tract along which the thyroid descends in the embryo and appears in the midline. A branchial (pharyngeal) cleft cyst is a remnant of the embryonic pharyngeal apparatus and appears on the side of the neck, usually in front of the sternocleidomastoid.

## Who gets it

Thyroglossal duct cysts are the most common congenital neck mass and usually show up in children, often after a respiratory infection. Branchial cleft anomalies come next and often present in older children or young adults. Both are seen worldwide without specific Colombian figures.

## Causes

- Thyroglossal duct cyst: persistence of part of the thyroglossal duct between the foramen caecum of the tongue and the [thyroid gland](https://durgical.com/en/anatomy/thyroid-gland/)
- Branchial cleft cyst: incomplete obliteration of a pharyngeal cleft or pouch, most often the second
- Infection of the cyst often follows an upper respiratory infection

## Risk factors

- Congenital, present from birth though often noticed later
- Upper respiratory infections trigger enlargement or infection

## Pathophysiology

The thyroid descends from the base of the tongue to the lower neck, passing close to the hyoid bone; if the duct does not involute, retained epithelium secretes fluid and forms a cyst attached to the hyoid, so it moves up when the tongue is protruded or on swallowing. A second branchial cleft remnant can run from the [skin](https://durgical.com/en/anatomy/skin/) in front of the sternocleidomastoid, between the internal and external [carotid arteries](https://durgical.com/en/anatomy/common-carotid-artery/), to the tonsillar fossa, forming a cyst, sinus or fistula.

## Classification

- Thyroglossal duct cyst (midline, at or below the hyoid)
- Branchial cleft anomalies: first (near the ear and parotid), second (most common, anterior border of the sternocleidomastoid), third and fourth (lower neck, may cause recurrent thyroiditis)
- Cyst, sinus or fistula

## Symptoms and signs

- Thyroglossal duct cyst: painless, round, midline neck lump near the hyoid that moves up with tongue protrusion and swallowing
- Branchial cleft cyst: smooth, painless lateral neck lump along the anterior border of the sternocleidomastoid
- A small skin pit or opening that drains mucus (sinus or fistula)
- Sudden enlargement, pain, redness and fever when infected

## Red flags

- Noisy breathing or trouble swallowing (airway compression)
- Rapid growth, a hard or fixed mass, or a new lateral neck cyst in an adult over about 40 (rule out cystic lymph node metastasis)
- Spreading neck redness, fever and toxicity (deep neck infection)
- A midline mass that may be the only thyroid tissue (ectopic thyroid)

## Diagnosis

**Clinical**
Location is the key: midline mass that rises with [tongue](https://durgical.com/en/anatomy/tongue/) protrusion suggests a thyroglossal duct cyst; lateral mass along the [sternocleidomastoid](https://durgical.com/en/anatomy/sternocleidomastoid-muscle/) suggests a branchial cleft cyst.

**Tests**
Thyroid function tests; fine-needle aspiration in adults or atypical lesions to exclude malignancy (papillary thyroid carcinoma can arise in a thyroglossal cyst).

**Imaging**
Neck ultrasound is first line and confirms a normal thyroid in its usual place before excision; CT or MRI for complex, infected or recurrent lesions and to map a fistula tract.

## Differential diagnosis

- Reactive or infected cervical lymph node
- Ectopic thyroid or thyroid nodule
- Dermoid cyst (midline, does not move with tongue)
- Lymphatic malformation (cystic hygroma)
- Cystic metastasis of squamous cell or papillary thyroid carcinoma in an adult

## Goal of treatment

Remove the lesion completely to prevent recurrent infection and recurrence, after treating any active infection and confirming normal thyroid tissue.

## Treatment

**Medical**
An infected cyst is first treated with antibiotics; incision and drainage are avoided where possible because they make later complete excision harder.

**Surgical**
Thyroglossal duct cyst: Sistrunk procedure, removing the cyst, its tract and the central part of the [hyoid bone](https://durgical.com/en/anatomy/hyoid-bone/), which greatly lowers recurrence.

**Surgical**
Branchial cleft cyst: complete excision of the cyst and any sinus or fistula tract, protecting nearby nerves and vessels.

**Follow-up**
After surgery: airway, bleeding and drain checks, wound care, and follow-up for recurrence.

## Complications

- Recurrent infection and abscess
- Recurrence after incomplete excision
- Draining fistula to the skin
- Rare malignancy in the cyst (papillary thyroid carcinoma in thyroglossal cysts)
- Nerve injury during surgery (facial, hypoglossal, accessory)

## Prognosis

Excellent after complete excision; recurrence is low with the Sistrunk procedure and higher after previous infection or simple cyst removal.

## Test yourself

Think of the answer, then tap the question to see it.

## Which neck mass moves upward when the tongue is protruded?

A thyroglossal duct cyst, because it is attached to the hyoid and the foramen caecum.

## Where does a second branchial cleft cyst typically appear?

On the lateral neck, along the anterior border of the sternocleidomastoid.

## What operation treats a thyroglossal duct cyst?

The Sistrunk procedure, which includes the central part of the hyoid bone.

## Why is a thyroid ultrasound done before excising a midline cyst?

To confirm normal thyroid tissue in its usual place, since the mass could be the only thyroid tissue.

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## Related conditions

- [Thyroid nodule](https://durgical.com/en/conditions/thyroid-nodule/)
- [Thyroid cancer (papillary)](https://durgical.com/en/conditions/thyroid-cancer/)
- [Cervical lymphadenopathy](https://durgical.com/en/conditions/cervical-lymphadenopathy/)
- [Deep neck infection and Ludwig angina](https://durgical.com/en/conditions/deep-neck-infection-and-ludwig-angina/)
- [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/)
- [Head and neck squamous cell carcinoma (oral cavity and oropharynx, HPV)](https://durgical.com/en/conditions/head-and-neck-squamous-cell-carcinoma/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Thyroglossal Duct Cyst](https://www.chop.edu/conditions-diseases/thyroglossal-duct-cyst) (Children's Hospital of Philadelphia, 2026); [Branchial cleft cyst](https://medlineplus.gov/ency/article/001396.htm) (MedlinePlus, US National Library of Medicine, 2026).

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Source: https://durgical.com/en/conditions/thyroglossal-duct-cyst-and-branchial-cleft-cyst/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/thyroglossal-duct-cyst-and-branchial-cleft-cyst/