Second branchial cleft cyst
Updates to Article Attributes
Second branchial cleft cysts are a cystic dilatation of the remnant of the 2nd branchial apparatus, and along with 2nd branchial fistulae and sinuses accounts for 95% of all branchial cleft anomalies.
Clinical presentation
Although a congenital abnormality, they tend to present in early adulthood (10-40 years of age) often after minor trauma on infection. Second branchial cleft sinus or fistulas on the other hand present earlier. Fistulas extends from skin surface anterior to the mid SCM and pass between ICA and ECA and eventually drain into the tronsillar fossa.
Typically second branchial cleft cysts present as a rounded swelling just below angle of mandible, anterior to sternocleidomastoid (although the position is variable - see classification below).
Pathology
The cyst is typically filled with mucoid material, is well circumscribed and other than presenting as a swelling, is asymptomatic. However, if infected then surrounding fat stranding and skin changes are evident.
Location
Cysts can occur anywhere along the course of the second branchial apparatus, from the pharyngeal wall to the skin, as it passes laterally and inferiorly between the internal and external carotid arteries. The angle of the mandible is a frequent location.
Classification
Radiographic features
CT
- rounded or spheric, sharply circumscribed
- fluid density centrally
- thin wall
- extension of the cyst wall between the ICA and ECA just above the carotid bifurcation (features sometimes referred to as the notch sign, tail sign or beak sign 6), a long-established as ´pathognomonic´, is still highly suggestive of the diagnosis. Down-classification due to an example of Schwannoma mimicking a branchial cleft cyst in rarity section 7.
Ultrasound
- sharply demarcated
- posterior acoustic enhancement: 70% 3
- imperceptible walls: 82%
- echogenicity is variable 3
- anechoic: 41%
- homogeneously hypoechoic with internal debris: 24%
- pseudosolid: 12%
- heterogeneous: 23%
MRI
-
T1: variable signal dependant on protein content
- high protein content: high signal
- low protein content: low signal
- T2: usually high signal
- T1 C+ (Gd): no enhancement in uncomplicated lesions
Treatment and prognosis
Complications
- superimposed infection
Differential diagnosis
- paramedian thyroglossal duct cyst
-
cystic lymph nodes
- necrotic nodal metastases, especially SCC and papillary thyroid cancer
- tuberculous adenitis
- vascular lesions
- jugular vein thrombosis
- mycotic aneurysm of the neck
- neurogenic tumours
- cervical dermoid cyst
- cavernous lymphangioma
- thyroid nodule/cyst
-<p><strong>Second branchial cleft cysts</strong> are a cystic dilatation of the remnant of the 2<sup>nd </sup><a href="/articles/branchial-apparatus">branchial apparatus</a>, and along with 2<sup>nd</sup> branchial fistulae and sinuses accounts for 95% of all <a href="/articles/branchial-cleft-anomalies">branchial cleft anomalies</a>.</p><h4>Clinical presentation</h4><p>Although a congenital abnormality, they tend to present in early adulthood (10-40 years of age) often after minor trauma on infection. <a href="/articles/2nd-branchial-cleft-sinus">Second branchial cleft sinus</a> or <a href="/articles/2nd-branchial-cleft-fistula">fistulas</a> on the other hand present earlier.</p><p>Typically second branchial cleft cysts present as a rounded swelling just below angle of mandible, anterior to <a href="/articles/sternocleidomastoid">sternocleidomastoid</a> (although the position is variable - see classification below). </p><h4>Pathology</h4><p>The cyst is typically filled with mucoid material, is well circumscribed and other than presenting as a swelling, is asymptomatic. However, if infected then surrounding fat stranding and skin changes are evident.</p><h5>Location </h5><p>Cysts can occur anywhere along the course of the second branchial apparatus, from the pharyngeal wall to the skin, as it passes laterally and inferiorly between the internal and external carotid arteries. The angle of the mandible is a frequent location.</p><h5>Classification</h5><ul><li><a href="/articles/bailey-classification-of-second-branchial-cleft-cysts">Bailey classification (1929)</a></li></ul><h4>Radiographic features</h4><h5>CT</h5><ul>- +<p><strong>Second branchial cleft cysts</strong> are a cystic dilatation of the remnant of the 2<sup>nd </sup><a href="/articles/branchial-apparatus">branchial apparatus</a>, and along with 2<sup>nd</sup> branchial fistulae and sinuses accounts for 95% of all <a href="/articles/branchial-cleft-anomalies">branchial cleft anomalies</a>.</p><h4>Clinical presentation</h4><p>Although a congenital abnormality, they tend to present in early adulthood (10-40 years of age) often after minor trauma on infection. <a href="/articles/2nd-branchial-cleft-sinus">Second branchial cleft sinus</a> or <a href="/articles/2nd-branchial-cleft-fistula">fistulas</a> on the other hand present earlier. Fistulas extends from skin surface anterior to the mid SCM and pass between ICA and ECA and eventually drain into the tronsillar fossa.</p><p>Typically second branchial cleft cysts present as a rounded swelling just below angle of mandible, anterior to <a href="/articles/sternocleidomastoid">sternocleidomastoid</a> (although the position is variable - see classification below). </p><h4>Pathology</h4><p>The cyst is typically filled with mucoid material, is well circumscribed and other than presenting as a swelling, is asymptomatic. However, if infected then surrounding fat stranding and skin changes are evident.</p><h5>Location </h5><p>Cysts can occur anywhere along the course of the second branchial apparatus, from the pharyngeal wall to the skin, as it passes laterally and inferiorly between the internal and external carotid arteries. The angle of the mandible is a frequent location.</p><h5>Classification</h5><ul><li><a href="/articles/bailey-classification-of-second-branchial-cleft-cysts">Bailey classification (1929)</a></li></ul><h4>Radiographic features</h4><h5>CT</h5><ul>
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