Branchial Cleft Cyst

Aka: Branchial Cleft Cyst, Branchial Cleft Sinus, Branchial Cleft, Branchial Cyst, Branchial Sinus, Congenital Branchial Cleft Cyst

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II. Pathophysiology

  1. Congenital remnant of Branchial Cleft
  2. Branchial Clefts embyogenesis
    1. Composed of 5 paired arches in lateral foregut wall
    2. Arches are separated by clefts
    3. Clefts usually obliterated with development

III. Types

  1. First Branchial Cleft
    1. Associations
      1. External auditory canal
      2. Parotid Gland
  2. Second Branchial Cleft
    1. Associations
      1. Superior pole of Tonsil
    2. Location
      1. Anterior border of sternocleidomastoid Muscle
    3. Course
      1. Between internal and external carotid arteries
      2. Opens into Tonsillar fossa
  3. Third Branchial Cleft
    1. Associations
      1. Pyriform Sinus
    2. Location
      1. Anterior border of sternocleidomastoid Muscle
    3. Course
      1. Posterior to common Carotid Artery
      2. Opens in Pyriform sinus

IV. Signs

  1. Lateral Neck Mass in distribution as above
    1. Most common at anterior border of sternocleidomastoid
    2. Sinus communicates fully between skin and airway
  2. May present with infection

V. Complications

  1. Secondary infection with neck abscess
  2. Branchial Cleft Cyst wall carcinoma (rare)

VI. Differential Diagnosis

  1. See Neck Masses in Children
  2. See Neck Masses in Adults
  3. Squamous Cell Carcinoma of Tonsil or Tongue base

VII. Radiology

  1. CT Neck
  2. Fistulogram

VIII. Management

  1. Surgical Excision of cyst and sinus tract

IX. References

  1. Noble (2001) Primary Care, Mosby, p. 1772
  2. Townsend (2001) Sabiston Surgery, Saunders, p. 547
  3. Hong (1999) J Laryngol Otol 113(11):1031-3 [PubMed]
  4. Mandell (2000) Otolaryngol Clin North Am 33(6):1309-32 [PubMed]
  5. Palacios (2001) Ear Nose Throat J 80(5):302 [PubMed]

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