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Branchial Cleft Cyst Treatment & Management

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

Medical Care

Antibiotics are required to treat infections or abscesses related to branchial cleft cysts.

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Surgical Care

Surgical excision is definitive treatment for branchial cleft cysts.[11] A series of horizontal incisions, known as a stairstep or stepladder incision, is made to fully dissect out the occasionally tortuous path of the branchial cleft cysts. Branchial cleft cyst surgery is best delayed until the patient is at least age 3 months. Definitive branchial cleft cyst surgery should not be attempted during an episode of acute infection or if an abscess is present. Surgical incision and drainage of abscesses is indicated if present, usually along with concurrent antimicrobial therapy.

The traditional surgical approach has the main downfall of relatively significant scarring. Alternatives to the open surgical method have been proposed, including a retroauricular approach, a facelift approach, and endoscopic-assisted removal. All of the newer surgical methods may be limited in the full visualization of the lesion. A recent case-controlled study suggested that an endoscopic retroauricular approach may provide good surgical clearing with minimal scarring for second branchial cleft cysts.[12, 13]

Sclerotherapy with OK-432 (picibanil) has been reported to be an effective alternative to surgical excision of branchial cleft cysts by some groups,[14] including those using ultrasound guidance.[15]

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Consultations

Referral to an otolaryngologist for surgical excision is indicated.

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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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