BRANCHIAL CYST

                                                              BRANCHIAL CYST

Like any other cyst this is just a fluid filled cavity that arises from the embryological remnants of the pharyngeal clefts, most commonly the second pharyngeal cleft. Obliterated pharyngeal clefts are what makes us one step less close to the Pisces family, as the gills of fish are basically persistent pharyngeal clefts. So when one of our 4 pharyngeal clefts fail to close at the prescribed intrauterine age of 7weeks, voila –you are one step closer to becoming a fish!

HISTORY:

So these pharyngeal arches develop during the 4^th week of embryonic life and develop into various structures in the head and neck. The pharyngeal clefts which are the depressions between each pouch are normally supposed to obliterate, except the first one which develops into the external auditory canal. When the cleft persists, the person develops an epithelium bound cavity that is pretty much harmless and asymptomatic unless a sinus tract develops.

CLINICAL ASPECTS:

A branchial cyst presents mostly as an asymptomatic, unilateral neck swelling in the early adulthood. It may present also as a tender mass when it is associated with an upper respiratory tract infection and so must be distinguished from lymphadenitis. Like any other neck swelling it may produce a mass effect causing symptoms of dysphagia, dysphonia. But the common complaint that mandates a consultation is usually a draining sinus in the skin. Imagine your neck behaving like a leaky faucet, you’ll definitely visit the doctor for that one. The complications of leaving it untreated are increased risk for infections and scarring and a very slight chance of developing a malignancy. But then again surgical treatment also poses serious risk of damage to the vital neck structures.

DIAGNOSIS:

On examination we could find a cystic, fluctuant and transilluminant mass along the lower one third of the anterior border of the sternocleidomastoid that may be associated with a mucoid or purulent discharge if a sinus is present.

Common investigations include Ultrasound scans or Contrast CTs or a Sinogram if a sinus tract is present. For histological examination, samples may be collected by FNAC or biopsy and the lining the epithelium could be found as stratified squamous or ciliated columnar and occasionally keratin debris might also be found.

TREATMENT:

Initially antibiotics are administered to control the infection followed by surgical excision. Stepladder incisions are made to completely excise the sometimes tortuous path of the cyst. Off late, for cosmetic reasons, retroauricular and endoscopic approaches are preferred. Latest non-surgical advancement is the use of a sclerosing drug called PICBANIL to cause fibrosis of the cyst.