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Branchial Cleft Cyst

  • Author: Chih-Ho Hong, MD, FRCPC; Chief Editor: William D James, MD  more...
 
Updated: Aug 18, 2015
 

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).

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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]

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Epidemiology

Frequency

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]

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.

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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 Faculty of Medicine, Canada

Richard Crawford, MD, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Pacific Dermatologic Association, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

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, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

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

Disclosure: Nothing to disclose.

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

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

  3. Little JW, Rickles NH. The histogenesis of the branchial cyst. Am J Pathol. 1967 Mar. 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. 1967 May. 50(5):765-77. [Medline].

  5. Telander RL, Deane SA. Thyroglossal and branchial cleft cysts and sinuses. Surg Clin North Am. 1977 Aug. 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. Vemula R, Greco G. An unusual presentation of presentation of a branchial cleft cyst. J Craniofac Surg. 2012 May. 23(3):e270-2. [Medline].

  8. Rashid A, Ahmad V, Qazi S, Billoo AG, Rashid S, Saleem AF. Posterior mediastinal branchial cleft cyst: an unusual site. J Coll Physicians Surg Pak. 2014 May. 24 Suppl 2:S117-8. [Medline].

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

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

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

  12. Chen LS, Sun W, Wu PN, Zhang SY, Xu MM, Luo XN, et al. Endoscope-assisted versus conventional second branchial cleft cyst resection. Surg Endosc. 2012 May. 26(5):1397-402. [Medline].

  13. Chen L, Huang X, Lou X, Xhang S, Song X, Lu Z, et al. [A comparison between endoscopic-assisted second branchial cleft cyst resection via retroauricular hairline approach and conventional second branchial cleft cyst resection]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2013 Nov. 27(22):1258-62. [Medline].

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

  15. Kim JH. Ultrasound-guided sclerotherapy for benign non-thyroid cystic mass in the neck. Ultrasonography. 2014 Apr. 33(2):83-90. [Medline]. [Full Text].

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First branchial cleft cyst, type II. Contrast-enhanced axial computed tomography scan at the level of the hyoid bone reveals an ill-defined, nonenhancing, water attenuation mass (m) posterior to the right submandibular gland (g).
Second branchial cleft cyst. Contrast-enhanced axial computed tomography scan at the level of the hyoid bone reveals a large, well-defined, nonenhancing, water attenuation mass (m) on the anterior border of the left sternocleidomastoid muscle(s).
 
 
 
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