Branchial Cleft Cyst Definition, Symptoms, Diagnosis and Treatment

Second Branchial Cleft Cyst

Type 2 Branchial Cleft Cyst

What is the branchial cleft cyst?

Branchial cleft cysts are usually a developmental abnormality on the neck of the neck and on the side of the neck. It develops as a result of inadequate growth of the tissues forming the neck and throat during the early embryonic development. They can be mouthed out of the neck and they are called sinuses, and if they do not mouth, they are seen as cysts in the neck. It is a fluid filled swelling in the cyst. The fistula is where the other end of the opening in the skin is associated with the mouth or ear cavity. It usually occurs congenitally.

What causes branchial pathologies?

Branchial clefts (embryological tissues in which some anatomical structures develop in the neck) become temporarily void and then closed. In case these gaps are not closed, branchial pathologies occur. Approximately 37% of the masses in the lateral region of the neck are cysts and the remaining 63% are fistulas. Branchial anomalies are the developmental anomalies of the branchal apparatus formed by 6 mesodermal arcs divided into sections by ectoderm of the ectoderm called branchial cleft. The second branchal anomalies are the most common branchal anomalies. There is no gender predisposition. Diagnoses are made clinically.

Are there any types of pathologies (sinuses, cysts)?

Yes, they are classified according to the embryological development. During the embryo development, there are 6 brankial arteries, 5 branchial clefts and 5 branchial sacs on both sides of the embryo during 2-7 weeks. Different anatomical structures develop from each of these. Their settlements also differ depending on the embryological structure in which they develop.

Generally, the most common among branchial cleft cysts are present at birth, it is the second branchial cleft cyst. It can grow after upper respiratory tract infections. It may have an outward opening. The channels of the second branchial clefts are usually opened to the tonsils or the pharynx. The right image shows the cyst canal.

How are the locations of branchal pathologies located?

The most common pathologies may consist of 4 different branch fractures. 1. The branchial arch is located in front of or under the ear. It extends from the parotid gland to the external ear canal after the facial nerve. 2. The cyst formed on the branchial arch shows placement under the chin by the upper side of the neck. It extends from the inside and outside carotid veins to the tonsils. In the third branchal cyst, the cyst is located in the middle side of the neck, from where it extends forward to the tip, to the sinus region. 4. The cyst in the branchial arch is located in the lower side of the neck. From here, they extend to the tip of the sinus piriformis following the carotid sheath. The second most common branchial arch is cyst. But rarely others can be seen.

What are the symptoms of branchial cysts and sinuses?

The first finding is that when the baby is born, there is a small needle head size around the neck or neck, and sometimes it can be clear as tears. Sometimes the cyst can become infected after respiratory infections. There may be swelling on the neck, redness and sometimes purulent discharge due to infection. In case of infection, ear infections occur when the ear is opened. If it is not infected, it is seen as neck masses of different sizes depending on the size of the cyst.

Swellings that you can see around the neck and head are the first messengers of the disease. These cysts, which can be seen as harmless in the past, can be self-growth. This disease, which spreads over the body over time, often causes pain and prevents you from moving your other organs, can be extremely dangerous if it gets infected. If untreated, repetitions and surgical removal are more difficult.

Symptoms of second branchial cleft cysts

The second branchial cleft anomalies are seen along the front border of the SKM muscle, mostly in the lower 1/3 section. The most common symptoms were seen as mass (80%), pain (30%), intermittent swelling (20%), infection (15%) and compression symptoms (7%). In palpation, 70% cystic 30% solid mass is detected. Especially, the anomalies of the structures that develop from the first and second branchal arches can be detected in the pathologies of conduction or sensorineural hearing loss. The internal walls of the branchal anomalies are covered with respiratory or squamous epithelium. Cysts are usually squamous epithelium, sinus and fistulas are ciliated with silial columnar epithelium. Sudden changes and growth are secondary to upper respiratory tract infection and trauma

When are branchial cysts noticed?

If cysts are often not considered because they are small in early childhood and are not noticed if it will not be infected. Most of the time they swell and become noticeable if the cyst is infected during the upper respiratory tract infection.

The diagnosis of cysts is between late childhood and 30 years of age. 60% in men and 40% in women.

How is the diagnosis of branchial cysts made?

Most of the time, a history and physical examination is sufficient. However, neck ultrasound, MRI and contrast-enhanced fistula graphy may be performed if the physician deems it necessary to reveal the anatomy.

In addition to the clinical appearance of the mass in the preoperative diagnosis, it is seen as a well-defined, thin-walled hypo-anechoic mass compressing the surrounding structures. Computed tomography is typically confined to a thin-walled, uniformly hypodense cystic mass that is well-circumscribed and does not develop complications. In deep magnetic resonance imaging, the cyst is better described. The cyst content is considered to be hypo-isointense on T1-weighted sequences and hyperintense on T2-weighted sequences. Increases in peripheral contrast enhancement of thickening of cyst wall in inflammatory events.

Why imaging modalities are needed for diagnosis?

Significant variations in the anatomical course of the branchial cleft anomalies result in the necessity of additional imaging modalities. In pre-operative study, sinograms with contrast material to assist surgical planning are useful in reducing the recurrence by distinguishing sinus and fistula by showing the extension of the tract. Complete excision of the cyst and fistula together with the trachea in surgical treatment is important in reducing relapse. For this reason, fluoroscopic and computed tomography fistulographies can help the surgeon to fully evaluate the spread of the lesion and the direction of the tract.

The second branchal arch anomalies are frequently diagnosed in the first and second decades. Although the clinical examination is important in the diagnosis, the imaging can be guided in terms of surgery and may provide additional anomalies. Contrast-enhanced investigations increase the clinical value of imaging, resulting in a reduction in complications and relapses.

Differantial diagnosis for branchial cleft cysts

Often a good story and physical examination does not get too involved. However, the following pathologies should be considered; Cystic hygroma, hemangioma, thyroglossal cyst, dermoid cyst, teratoma, lipoma, fibroma, lymphadenopathies.

What is the treatment of branchial cleft cyst?

Standard treatment is surgical excision. If there is an infection, this is primarily treated. Then the subject should be removed by a specialist surgeon. Care should be taken when removing the vein nerves, which are common in neck diseases, and should be completely removed. In the photo above, the photos of the patient with branchial cleft cyst which is operated before and after the operation can be seen.

What causes problems if branchial cleft cysts are not surgically removed?

It can cause recurrent infections, which can sometimes become systemic. Lung and middle ear inflammation, of course, the opposite is also the case. If these cysts are not removed, they may become cancerous in later life.

Branchial cleft cyst operation and what are the complications that may develop?

When the operation is performed by experienced people, the risk is low. However, some temporary and permanent complications may occur. These; infection, recurrence of the pathology, bleeding, respiratory distress and especially temporary or permanent nerve damage, especially facial paralysis.

How is a branchial cleft cyst operated?

It is usually done in the form of out-patient surgery. The patient's surgery preparations and examinations are performed and the operation is performed on the same day. The patient can be discharged 4-6 hours after surgery.

Preoperative preparation for branchial cleft cyst surgery?

First of all, a good story should be taken and a general physical examination should be done. If the patient is ill, the family (mother and father) should be well informed about the pre-operative, operative and post-operative period. If the child is older, the child is included. A number of tests are carried out, these tests are not general and are determined by the patient. The patient is also seen by the anesthesiologist and the family and the child are informed about the anesthesia process. The patient is fasted for 4 hours before the operation.

Healing process after branchial cleft cyst surgery

Four  hours after the operation, the patient is fed according to the doctor and / or nurse directives. Babies over 2 years old can be sent home after 4-6 hours. After the operation, the patient receives only pain medication according to the recommendations of the doctor, sometimes only prophylactic antibiotic treatment is given and the patient does not need to take any additional medication. The patient is seen by the doctor 48-72 hours later, without the need for dressing, the stitches are self-melting and do not need to be taken. The patient continues his normal active life after the doctor's recommendations.

Similar link >> Lipoma On The Neck Symptoms, Causes, Diagnosis and Treatment / Thyroglossal Duct Cyst Definition, Symptoms, Diagnosis and Treatment

Source links >> Branchial Cleft Cyst / Branchial Cleft Cyst: Background, Pathophysiology, Etiology

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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