If this is not possible, lateral soft tissue x-rays of the neck can be helpful. For further evaluation of the cyst, CT scanning can be valuable in demonstrating the extent of the cyst, or when the diagnosis of the mass is in question. The use of tracheotomy is usually discussed in relationship to the pediatric patient who presents with airway obstruction. It is apparent from this great disparity that a consensus on the use of tracheotomy has not been reached. Currently, needle aspiration is considered a temporizing method in life-threatening airway obstruction.
Endoscopic treatment is the preferred method in the pediatric age group.
For this reason, Van de Water in 1973 recommended a more complete excision with stripping of the cyst lining from the cyst bed. Finally, the CO2 laser has recently been advocated as an excellent method for removing cysts with minimal trauma to surrounding tissue. These endoscopic techniques have been advocated in virtually all cysts in the pediatric population and in small ductal cysts in all age groups. In addition, they can be employed in certain cases of saccular cysts in the adult population, such as when the patient objects to a neck scar, or is felt to be medically unfit to undergo an external approach. Otherwise, the literature supports an external approach to adult saccular cysts.