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Neck: Cysts, Sinuses, and Fistulas 239

Key Summary Points
1. Branchial arches develop as six-paired structures on the side 5. The fourth to the sixth arches mingle as they produce the
of the neck of the embryo. Many congenital neck lumps and cartilages and ligaments of the larynx and pharynx (all supplied
fistulas are remnants of branchial arches. by the vagus nerve), part of the thymus, and the superior
parathyroid glands.
2. The first arch forms the skin of the lower part of face, malleus,
incus, mandible, maxilla, and muscles of mastication. 6. The thyroid gland develops from a diverticulum at the floor of
Remnants of the first branchial arch are uncommon. the mouth. Remnants of the thyroid may be found from the
base of the tongue to the pyramidal lobe of the thyroid
3. The second arch forms skin of the lateral and anterior part of
neck; the stapes, body, and lesser cornu of the hyoid bone; 7. Thyroglossal cysts are the most common congenital midline
and muscles of facial expression. Cysts (and fistulas) of the cysts. Thyroglossal cysts move with swallowing and protrusion
second arch appear at the anterior border of the sternomastoid of the tongue.
muscle. 8. Thyroglossal fistulas are best removed by the Sistrunk
4. The third arch and pouch develop into the posterior one-third operation.
of the tongue, the lower part of the hyoid bone, the thymus, 9. Extrapulmonary tuberculosis, fungi, and HIV can affect neck
and inferior parathyroid glands. External openings of remnants glands to produce discharging sinuses in the neck.
of the third arch are usually at the anterior border of the
clavicular head of the sternomastoid.

References

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