eMedicine Specialties > Dermatology > Pediatric Diseases

Branchial Cleft Cyst

Author: Chih-Ho Hong, MD, FRCPC, Clinical Assistant Professor, Department of Dermatology and Skin Science, University of British Columbia, Canada
Coauthor(s): Richard Crawford, MD, FRCPC, Head of Dermatology, Clinical Professor, Department of Medicine, Divisions of Pathology and Dermatology, University of British Columbia
Contributor Information and Disclosures

Updated: Jun 16, 2009

Introduction

Background

Branchial cleft cysts are congenital epithelial cysts, which arise on the lateral part of the neck from a failure of obliteration of the second branchial cleft in embryonic development.1

Phylogenetically, the branchial apparatus is related to gill slits. In fish and amphibians, these structures are responsible for the development of the gills, hence the name branchial (branchia is Greek for gills).

Pathophysiology

At the fourth week of embryonic life, the development of 4 branchial (or pharyngeal) clefts results in 5 ridges known as the branchial (or pharyngeal) arches, which contribute to the formation of various structures of the head, the neck, and the thorax. The second arch grows caudally and, ultimately, covers the third and fourth arches. The buried clefts become ectoderm-lined cavities, which normally involute around week 7 of development. If a portion of the cleft fails to involute completely, the entrapped remnant forms an epithelium-lined cyst with or without a sinus tract to the overlying skin.2,3,4,5

Frequency

United States

The exact incidence of branchial cleft cysts in the US population is unknown. Branchial cleft cysts are the most common congenital cause of a neck mass. An estimated 2-3% of cases are bilateral. A tendency exists for cases to cluster in families.6

Mortality/Morbidity

  • Many branchial cleft cysts are asymptomatic. They may become tender, enlarged, or inflamed, or they may develop abscesses, especially during periods of upper respiratory tract infection, due to the lymphoid tissue located beneath the epithelium. Spontaneous rupture of an abscessed branchial cleft cyst may result in a purulent draining sinus to the skin or the pharynx.
  • Depending on the size and the anatomical extension of the mass, local symptoms, such as dysphagia, dysphonia, dyspnea, and stridor, may occur.

Race

No ethnic predilection has been reported for branchial cleft cysts.

Sex

No sexual predilection is recognized for branchial cleft cysts.

Age

Branchial cleft cysts are congenital in nature, but they may not present clinically until later in life, usually by early adulthood.

Clinical

History

  • A branchial cyst commonly presents as a solitary, painless mass in the neck of a child or a young adult. A history of intermittent swelling and tenderness of the lesion during upper respiratory tract infection may exist. Discharge may be reported if the lesion is associated with a sinus tract.
  • In some instances, branchial cleft cyst patients may present with locally compressive symptoms.
  • A family history of branchial cleft cysts may be present.

Physical

  • Primary branchial cleft cyst lesion: Branchial cysts are smooth, nontender, fluctuant masses, which occur along the lower one third of the anteromedial border of the sternocleidomastoid muscle between the muscle and the overlying skin.
  • Secondary branchial cleft cyst lesion: The lesion may be tender if secondarily inflamed or infected. When associated with a sinus tract, mucoid or purulent discharge onto the skin or into the pharynx may be present.

Causes

  • The branchial cleft cyst is a congenital lesion formed by incomplete involution of branchial cleft structures during embryonic development.

More on Branchial Cleft Cyst

Overview: Branchial Cleft Cyst
Differential Diagnoses & Workup: Branchial Cleft Cyst
Treatment & Medication: Branchial Cleft Cyst
Follow-up: Branchial Cleft Cyst
References
[ CLOSE WINDOW ]

References

  1. Wagner AM, Hansen RC. Neonatal skin and skin disorders. In: Schachner LA, Hansen RC, eds. Pediatric Dermatology. Vol 1. 2nd ed. New York, NY: Churchill Livingston; 1995:291-3.

  2. Doi O, Hutson JM, Myers NA, McKelvie PA. Branchial remnants: a review of 58 cases. J Pediatr Surg. Sep 1988;23(9):789-92. [Medline].

  3. Little JW, Rickles NH. The histogenesis of the branchial cyst. Am J Pathol. Mar 1967;50(3):533-47. [Medline].

  4. Rickles NH, Little JW. The histogenesis of the branchial cyst. II. A study of the lining epithelium. Am J Pathol. May 1967;50(5):765-77. [Medline].

  5. Telander RL, Deane SA. Thyroglossal and branchial cleft cysts and sinuses. Surg Clin North Am. Aug 1977;57(4):779-91. [Medline].

  6. Anand TS, Anand CS, Chaurasia BD. Seven cases of branchial cyst and sinuses in four generations. Hum Hered. 1979;29(4):213-6. [Medline].

  7. Bloch R. Images in emergency medicine. Branchial cleft cyst. Ann Emerg Med. Mar 2006;47(3):291, 308. [Medline].

  8. Rosa PA, Hirsch DL, Dierks EJ. Congenital neck masses. Oral Maxillofac Surg Clin North Am. Aug/2008;20:339-52. [Medline].

  9. Donegan JO. Congenital neck masses. In: Cummings CW, Schuller DE, eds. Otolaryngology - Head and Neck Surgery. 2nd ed. St. Louis, Mo: Mosby; 1993:1554-9.

  10. Kim MG, Kim SG, Lee JH, Eun YG, Yeo SG. The therapeutic effect of OK-432 (picibanil) sclerotherapy for benign neck cysts. Laryngoscope. Dec 2008;118(12):2177-81. [Medline].

  11. Thompson LD. Branchial cleft cyst. Ear Nose Throat J. Nov 2004;83(11):740. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

branchial cleft cyst, branchial cyst, lateral cervical cyst, congenital epithelial cyst

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Chih-Ho Hong, MD, FRCPC, Clinical Assistant Professor, Department of Dermatology and Skin Science, University of British Columbia, Canada
Disclosure: Nothing to disclose.

Coauthor(s)

Richard Crawford, MD, FRCPC, Head of Dermatology, Clinical Professor, Department of Medicine, Divisions of Pathology and Dermatology, University of British Columbia
Richard Crawford, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Pacific Dermatologic Association, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Medical Editor

Jean Paul Ortonne, MD, Chair, Department of Dermatology, Professor, Hospital L'Archet, Nice University, France
Jean Paul Ortonne, MD is a member of the following medical societies: American Academy of Dermatology and American Dermatological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Edward F Chan, MD, Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine
Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.