Although most cystic lesions in young adults represent a branchial cleft cyst, the bronchial cervical cyst is not rare (Acta Oto-Laryngologica 2010;130:300). Surgical excision is both diagnostic and curative and also eliminates the risk of infection or recurrence. As we have all known, it is hard to protect some important structures in an inflamed tissue, especially in infants. However, a correct approach can avoid this kind of iatrogenic injury. An accurate diagnosis is always by pathologic examination. The diagnosis can be made before operation when finding cartilage in the nodule. We present the preoperative diagnosis by finding gas in the nodule and removed it by inner cyst approach without surrounding tissue injury.