Branchial cleft cyst

Branchial arch fistula
Fistulography of a right branchial cleft sinus.
Classification and external resources
ICD-10	Q18.0 (ILDS Q18.020)
OMIM	113600
DiseasesDB	1588
MedlinePlus	001396
eMedicine	derm/61 radio/107

A branchial cleft cyst is a congenital epithelial cyst that arises on the lateral part of the neck due to failure of obliteration of the second branchial cleft (or failure of fusion of the second and third branchial arches) in embryonic development.

Pathology

The cyst wall is composed of either squamous or columnar cells with lymphoid infiltrate, often with prominent germinal centers. The cyst may contain granular and keratinaceous cellular debris. Cholesterol crystals may be found in the fluid extracted from a branchial cyst.

Pathophysiology

Branchial cleft cysts are remnants of embryonic development and result from a failure of obliteration of one of the branchial clefts, which in fish develop into gills.^[1][2]

Types

• First branchial cleft fistulae typically originate in the angle of the mandible and extend to the external auditory canal. They are often associated with the facial nerve. Rare ~5%.
• Second branchial cleft fistulae are most common (~95%). They are found along the anterior border of the Sternocleidomastoid muscle, pass through the carotid bifurcation and into the tonsillar pillar.
• Third and fourth branchial cleft fistulae are rare. The external opening occurs about 2/3 of the way down the SCM anteriorly, similar to second branchial cleft cysts. The tract ascends along the carotid sheath posteriorly to the internal carotid artery, under the glossopharyngeal nerve, and over the vagus nerve and hypoglossal nerve to open into the piriform sinus.

Symptoms

Most branchial cleft fistulae are asymptomatic, but they may become infected. The cyst, however, usually presents as a smooth, slowly enlarging lateral neck mass that may increase in size after an upper respiratory tract infection.^[3]

Treatment

Bilateral branchial cleft sinuses during surgery.

Conservative (i.e. no treatment), or surgical excision. As complete surgical excision may be difficult (due to the close proximity of the internal jugular vein and carotid vessels that lie deep to the swelling), they can recur.^[4]

See also

• Cutaneous columnar cyst
• Cystic hygroma
• Ranula
• Thyroglossal duct cyst

References

External links

• Cervical Cysts, Sinuses, and other Neck Lesions
• Pictures and Imaging of Branchial Cleft Cysts
• Additional Images of Branchial Cleft Cysts

  Congenital malformations and deformations of face and neck (Q18, 744.4–744.9) Face jaw: Otocephaly mouth: Macrostomia Microstomia lip: Macrocheilia Microcheilia chin: Microgenia multiple/other: Hallermann–Streiff syndrome Branchial cleft cyst Neck Webbed neck Ungrouped Preauricular sinus and cyst Index of the mouth Description Anatomy Development Disease Congenital face and neck cleft digestive system Neoplasms and cancer Other Symptoms and signs Treatment Procedures periodontology Drugs