A branchial cleft cyst is a congenital abnormality that occurs due to the incomplete closure of the branchial clefts during embryonic development. The branchial clefts are tiny grooves or pouches that form on the sides of the neck of a developing fetus. They are typically obliterated the seventh week of gestation but may persist in some cases.
The exact cause of branchial cleft cysts is not well understood, but it is believed to be related to abnormalities in the development of the branchial arches, which are structures that form the lower part of the face and neck in the embryo. These cysts can occur in both children and adults, showing different clinical characteristics and treatment approaches.
When the branchial clefts do not close properly, a cyst can form. These cysts are usually found along the anterior border of the sternocleidomastoid muscle, which is located in the neck. They may also appear in other regions, such as the tonsillar fossa, tongue base, or intralaryngeal area. In some cases, branchial cleft cysts can present as neck masses that are visible or palpable.
The most common type of branchial cleft cyst is a second branchial cleft cyst, accounting for 95% of cases. It is usually located anterior to the sternocleidomastoid muscle and presents as a smooth, painless, soft, and fluctuant mass. Second branchial cleft cysts are typically lined squamous or respiratory epithelium and are associated with a sinus tract, which opens externally or internally. These sinus tracts can become infected, resulting in abscess formation and recurrent neck infections.
Third and fourth branchial cleft cysts are rare and have distinct presentations. Third branchial cleft cysts are typically found in the thyroid cartilage level, deep in the neck. They are often associated with recurrent suppurative thyroiditis. Fourth branchial cleft cysts are located near the piriform sinus. They can also be associated with recurrent neck infections.
Diagnosis of branchial cleft cysts is primarily based on clinical evaluation and imaging studies. Physical examination may reveal a cystic mass in the neck region, while imaging techniques like ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) can provide further detailed information about the size, location, and relationship to adjacent structures.
Ultrasound is often the initial imaging modality of choice due to its accessibility, cost-effectiveness, and ability to differentiate cystic from solid masses. It can also help identify internal septations and vascularity within the cyst. CT scans are useful for assessing the extent of the cyst and its relationship with surrounding structures, while MRI is beneficial in cases where there is uncertainty regarding the diagnosis or when the presence of associated anomalies needs to be evaluated.
Once a branchial cleft cyst has been diagnosed, surgical excision is the preferred treatment option. Complete excision of the cyst and any associated sinus tract is necessary to prevent recurrence. The surgery should be performed an experienced head and neck surgeon to minimize the risk of complications.
During the surgery, the cyst and the entire tract are carefully dissected and removed. It is important to ensure that the cyst is not ruptured during the procedure to prevent spillage of its contents, which may lead to inflammation and infection. In cases where the cyst is infected, antibiotics may be prescribed before surgery to reduce inflammation and minimize the risk of complications.
A branchial cleft cyst is a congenital abnormality resulting from the incomplete closure of the branchial clefts during fetal development. It is most commonly found as a neck mass and is usually diagnosed based on clinical evaluation and imaging studies. Surgical excision is the recommended treatment to prevent recurrence and potential complications. If you suspect you or your child may have a branchial cleft cyst, consult with a qualified healthcare professional for a proper evaluation and appropriate management.