Foregut Duplication Cysts in the Head and Neck Presentation, Diagnosis, and Management

Objective: To review the presentation, diagnosis, and management of foregut duplication cysts of the head and neck in our institution. Design: An institutional review board approved retrospective review of all patients treated for foregut duplication cysts of the head and neck over an 18-year period. Setting: Pediatric otolaryngology tertiary referral center. Patients: Twenty-two patients with 23 pathologically confirmed foregut duplication cysts of the head and neck were identified. Fourteen patients (64%) were male. The median age at diagnosis was 1.5 years (age range, 5 days to 7 years). Main Outcome Measures: Clinical data, including age, presenting symptoms, anatomical site(s), evaluation, treatment, and complication, were recorded and analyzed. Results: Presentation varied depending on anatomical site of involvement, with 12 patients (55%) being asymptomatic. The cysts were found in the oral cavity (n=12), oropharynx (n=6), supraglottis (n=2), and neck (n=3). Imaging, which was performed in 13 patients and consisted of magnetic resonance imaging (n=8), computed tomography (n=5), and ultrasonography (n=1), demonstrated the cystic nature of the lesions. All patients underwent surgical excision, which focused on excising the cyst, while preserving surrounding normal tissues. No patient demonstrated recurrence at follow-up. Conclusions: Foregut duplication cysts of the head and neck, although uncommon, should be included in the differential diagnosis of cystic head and neck lesions. Preoperative imaging is recommended to differentiate these lesions from other congenital head and neck masses. Surgical excision biopsy with complete removal of the mucosal lining is curative, with no instances of recurrence in our series.