KidsMD Health Topics

Branchial Cleft Remnant

  • A branchial cleft remnant is a birth defect that occurs in your child's neck.

    • During the fifth week of fetal development, major head and neck structures are formed.
    • The five pharyngeal arches (bands of tissue) are important structures that are formed. These arches contain primitive connective tissue that becomes cartilage, bone, muscle and blood vessels.
    • Incomplete, failed or persistent embryonic development of these arches results in several anomalies or defects in the neck.

    Two common congenital problems that can occur from this abnormal development are branchial cleft sinuses and cysts.


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  • What kind of branchial cleft remnant does my child have?

    • First branchial cleft anomalies - This type is rare but occurs as cysts that lie in front, behind or below the earlobe or under the jaw. A first branchial sinus has an external opening below the jaw and above the hyoid bone (a bone in the neck just above the voice box).
    • Second branchial cleft sinuses - This type occurs as sinus tracts with an opening on the skin of the neck during the first 10 years of life, and as cysts during the second 10 years. A skin tag or abnormal cartilage may occasionally be present at the opening of the sinus, and occasionally the tract may be felt as a band in the neck.
    • Third branchial cleft sinuses - This type is extremely rare and is often located near the thyroid and along the front part of the muscle in the neck that attaches to the collar bone.
    • Fourth branchial cleft sinuses - This type is also rare and is located low in the neck (similar to the third cleft sinuses).

    Is a branchial cleft remnant dangerous?

    Rarely, but it can be irritating. Your child's doctor will often recommend removing it.

    • Drainage of saliva from a sinus on to the neck is unsightly and can cause chronic irritation of the skin. Removal will stop this problem.
    • Cysts and sinuses frequently get infected. Removal is performed to prevent this problem.
    • Though it doesn't happen often, branchial cleft remnants have been the site of development of malignant tumors in adults.
  • How will my child's doctor diagnose a branchial cleft remnant?

    Your child's physician will be able to diagnose them after a thorough physical exam.

    There are two easily identifiable signs:

    • Infection or drainage from small openings on the neck
    • Swelling in the neck is another indicator.
  • What is the treatment for branchial cleft remnant?

    Complete surgical removal of branchial remnants should be performed.

    • The operation is usually done as a day surgery procedure under general anesthesia.
    • An overnight stay may be needed for operations done deep in the neck.

    What happens after the surgery?

    • Your child should not do any strenuous exercise for five to seven days after the surgery.
    • Your child should not bathe until three days after the surgery.
    • Bandage or Steri-strips should remain in place for five to seven days after the surgery.

    Recurrence of the cyst or sinus is possible, and is more common when the operation is done at the time of an active infection.

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