Cystic swellings of the neck

Abstract Cystic neck swellings in the neck arise from a diverse range of tissues and pathological disorder. The approach to diagnosis relies on a thorough history and an appropriate examination including the internal ENT to exclude an occult primary malignancy. The typical feature of fluctuance is often not elicited because the contents of the cyst can be under tension and transillumination is seldom performed these days. Aspiration and ultrasonography are usual but other imaging such as CT and MRI scanning can be indicated. Definitive treatment is usually surgical excision but with benign disease repeat aspiration can be considered. No intervention can be an option if there is significant co-morbidity, absence of functional or cosmetic impairment or there is reluctance by the patient to undergo surgery.