Conditions: Branchial Cleft Abnormalities (Branchial Cleft Cysts, Branchial Cleft Fistulas)
what is a branchial cleft cyst or fistula?
Branchial cleft cysts and branchial cleft fistulas are benign (noncancerous) neck abnormalities that arise from the incomplete closure of the branchial clefts during embryonic development (the period before birth when the neck is forming). Branchial cleft cysts account for almost 20% of neck masses in children. Most branchial cleft cysts present in late childhood or early adulthood as a solitary, painless mass. Often the mass, went previously unnoticed until it becomes infected (typically after an upper respiratory tract infection such as a cold). A fistula, if present, is usually asymptomatic (causes no symptoms) until infection arises.
Branchial cleft cysts are typically felt as painless, soft masses along the front border of the sternocleidomastoid muscle (the large muscle on the side of the neck), while branchial cleft fistulas are characterized by a small opening in the skin near the front edge of the sternocleidomastoid muscle that drains mucoid or purulent (pus-like) fluid. Both conditions can lead to recurrent infections and inflammation if left untreated.
how is a branchial cleft cyst diagnosed and differentiated from other neck masses?
Accurate diagnosis of a branchial cleft cyst (or fistula) depends on your physician taking a thorough medical history and performing a complete head and neck examination. The diagnosis of branchial cleft cysts is typically made by history and physical exam alone, due to their relatively consistent location in the neck, typically in front of the sternocleidomastoid muscle.
For masses that first appear in adulthood, doctors assume the mass may be a cancer until proven otherwise, since carcinomas of the tonsil, base of the tongue and thyroid can also present as cystic masses of the neck. A branchial cleft cyst should be a single mass; the presence of multiple neck masses is not consistent with this diagnosis.
Examination of the throat, sometimes with a thin, flexible camera called a fiberoptic endoscope, may also help identify findings that support or argue against the diagnosis. A tumor in the throat, for example, would suggest that the neck mass is spread of the throat tumor to a lymph node in the neck. Imaging, such as an ultrasound or CT scan, may be performed. In some cases, a fine needle aspiration biopsy (using a thin needle to remove a small sample) may be performed to analyze the contents of the cyst and rule out other potential causes, such as cancer.
Consulting with an otolaryngologist — head and neck surgeon (an ear, nose, and throat specialist) can further aid in accurately diagnosing and distinguishing a branchial cleft cyst from other neck masses and in providing appropriate surgical management.
HOW TO GET THE MOST FROM YOUR APPOINTMENT
Appointment time is valuable. Below are some suggestions to make the most of your appointment. This preparation will help you and your doctor maximize efficiency and accuracy, freeing up time for questions and answers.
• Click here to prepare for your neck mass/swelling/lump appointment.
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