Branchial Cleft Cyst : Causes, Symptoms, Treatment, Prognosis, Diagnosis

Branchial cleft cyst (branchial cleft remnant) is a type of birth defect where there is formation of a lump on one or both the sides of the neck or under the collarbone (clavicle). Branchial cleft cyst develops during the embryonic/developmental stage when there is improper or abnormal development of the tissues in the collarbone and neck. Branchial cleft cyst can be visible as an opening on one side or both sides of the patient’s neck. There is draining of fluid from these openings, which leads to formation of a cyst or a pocket. Infection can also occur in this cyst or pocket and ooze out of the opening in the skin.

Majority of the times, a branchial cleft cyst is not harmful; however, the drainage from the cyst can cause skin irritation. The branchial cleft cyst can also become infected which results in difficulty with breathing and swallowing. There are chances of malignant tumors developing at the site of branchial cleft in adults; however, this is very rare.

Complete physical exam helps in making the diagnosis of branchial cleft cyst. Antibiotics are prescribed if there is infection. The branchial cleft cyst may need to be removed surgically for treatment and prevention of recurrent infections.

Branchial Cleft Cyst is a congenital birth defect, which develops in the embryonic stage of the fetus. Formation of important neck structures occur during the fifth week of development of the fetus. There is formation of pharyngeal arches, which are five bands of tissue, during this time. These vital structures consist of tissues, which later on develop into cartilage, blood vessels, bone and muscles. When there is improper development of these arches, it results in various defects in the neck including the Branchial Cleft Cyst. The cause of branchial cleft cysts is improper development of the tissues which form the neck and throat. This leads to formation of open spaces known as cleft sinuses on one or both the sides of the neck. There is drainage of fluids from these sinuses leading to formation of cysts. Infection may also occur in these sinuses or cysts.

• The first type of branchial cleft abnormality is rare and occurs as cysts under the jaw or around the earlobe with an opening under the jaw and above the voice box (larynx).
• The second type of branchial cleft abnormality is the most common type and consists of sinus tracts which open on the lower side of the neck and may reach out to the tonsil region. They can be viewed as skin tags or as a ring in the patient’s neck. This type of branchial cyst usually occurs after the age of 10 years.
• The third type of branchial cleft abnormality is very rare and consists of sinuses, which are present close to the thyroid gland in the anterior region of the muscle, which is attached to the collarbone.
• The fourth type of branchial cleft abnormality is also rare and consists of sinuses present under the neck.

• A branchial cleft cyst is often painless unless it’s infected, upon which the patient feels pain.
• Symptoms of branchial cleft cyst include appearance of a lump, skin tag or dimple on the patient’s neck, just under the collarbone or upper shoulder.
• The branchial cleft cyst is usually soft, smooth and oval in shape.
• Symptoms of tenderness and swelling are felt in the neck, which commonly is seen with an upper respiratory infection.
• There is a feeling of pressure in the affected region.
• There is draining of fluid from the patient’s neck.

Physical exam is often enough for a diagnosis of branchial cleft cyst. Other than this, diagnostic imaging tests which can be done to view the exact location of the cyst and other internal structures include:

• Ultrasound.
• CT scan.
• MRI scan.
• Fine needle aspiration can be done of the fluid of the cyst and sent to lab for testing.
• Biopsy is a test where a sample of the tissue from the cyst is taken and sent to lab for testing.

• Antibiotics are prescribed if the branchial cleft cyst is infected.
• Painkillers can also be given to relieve pain associated with branchial cleft cyst.
• The fluid will be drained from the cyst to ease the swelling.
• Surgery is needed to remove the branchial cleft cyst especially to prevent recurrent infections. The surgery for branchial cleft cyst will often be done on an outpatient basis. The patient will need to rest for a few days and the sutures and bandages will be removed in five days to a week after the surgery.

Prognosis of Branchial Cleft Cyst is often good with surgery where complete excision of the cyst is done. However, there is a chance of recurrence of the cysts, especially if the surgery is done during an ongoing infection in the cyst. Doctor’s instructions should always be followed for a speedy recovery and a good prognosis.

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• Branchial Fistulas: Symptoms, Causes, Treatment, Diagnosis, Epidemiology