What is a Branchial Cleft Cyst?

The human neck includes multiple blood vessels, muscles, bones, as well as our breathing and swallowing components. During the first few weeks of development of an embryo, the precursor of our neck is actually more similar to the gills on the fish. In fish embryos, these same structures eventually do develop into mature gills. However, in mammals these structures usually resorb and there are no remnants by the time a fully mature baby is born.

Occasionally, an irregularity of development could result in remnants of those primordial structures still to be present at the time of birth. These structures are called branchial clefts. These could manifest externally as a pit in the skin with occasional drainage. Otherwise, a sack of fluid could be felt under the skin of the neck on either side. Branchial cleft cysts are felt to be congenital (present at birth). However, often times they happen to be completely flat and asymptomatic. At some point, during later development, these cysts can accumulate more liquid and become noticeable externally. Occasionally, the cyst fluid can also get infected and the patients then present with rapid swelling accompanied by fever and redness.

If the patient initially presented with rapid signs of infection, it is important to get the infection under control. This is usually done with a course of oral antibiotics. Occasionally, incision and drainage of pus from inside the cyst might be necessary as well.

CT scan image of a branchial cleft cyst

CT scan image of a branchial cleft cyst

Your doctor might prefer to perform a CT scan of the neck or other similar imaging to confirm the diagnosis based on characteristic cyst features. A needle aspiration biopsy often yields straw colored liquid if the cyst is not actively infected.

The recommended treatment for a branchial cleft cyst is surgical excision. This is usually done under general anesthesia and involves skin incision directly over the cyst. Most patients can be released home the same day or the following day, and should expect return to work or school within a couple of days.

Resected branchial cleft cyst

Resected branchial cleft cyst

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Posted in: Neck

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