Branchial Cleft Cysts and Sinus Tracts | Symptoms & Causes

What are the signs and symptoms of a branchial cleft cyst or sinus tract?

The specific signs and symptoms of a branchial cyst or sinus tract depend upon the branchial arch or cleft of origin. As a result there are several types of branchial cleft cysts and sinus tracts.

First branchial cleft cysts and sinus tracts

First branchial cleft cysts occur just in front (of) or below the ear at the angle of the jawline. The external sinus tract opening can be above the jawline (type I) or below the jawline in the upper neck above the level of the hyoid bone (type II). If there is an internal opening, it will be inthe ear canal.

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Second branchial cleft cysts and sinus tracts

Second branchial cleft cysts occur in the upper lateral neck. The external sinus tract opening will be in the upper lateral neck between the hyoid and thyroid cartilages, just anterior to a large neck muscle known as the sternocleidomastoid (SCM) muscle. If there is an internal opening, it will be in the back of the throat in the tonsil region.

Third and fourth branchial cleft cysts and sinus tracts

Third and fourth branchial cleft cysts occur in the lower lateral neck. The external sinus tract opening will be in the lower lateral neck below the thyroid and cricoid cartilages, just anterior to the SCM muscle. If there is an internal opening, it will be deep within the throat in a region called the pyriform sinus.

Sometimes third and fourth branchial anomalies can have only an internal opening with no external opening. In such circumstances, they can present as recurrent neck infections in the region of the thyroid gland.

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What are the causes?

Branchial cleft cysts and sinus tracts are congenital anomalies, meaning they result from an unexpected change in the womb before birth. Although most commonly unilateral (occurring on one side of the neck), they can be bilateral (both sides of the neck). When bilateral, they can be associated with other congenital anomalies. For example, if your child has bilateral branchial cleft sinus tracts in the neck and in front of the ears (pre-auricular), they may have branchio-oto-renal (BOR) syndrome, which can be associated with hearing loss or kidney abnormalities.