Branchial Cleft Cysts and Sinus Tracts | Diagnosis & Treatment

How are branchial cleft cysts and sinus tracts diagnosed?

External branchial cleft sinus tracts are readily apparent on physical examination. Most are diagnosed in infancy. Special imaging studies using dye placed through the external opening are sometimes used to determine the depth of the tract.

Sinus tracts with only an internal opening are much more challenging to identify. A special examination under anesthesia called endoscopy is often necessary to confirm the diagnosis.

Branchial cleft cysts are often discovered during a physical examination in a child who is showing no other symptoms. Either the family or the physician detects a mass in the upper or lower lateral neck.

As mentioned previously, an infected branchial cleft cyst may present as a suddenly enlarging tender neck mass. Recurrent neck infections (abscesses) should raise concern of a branchial cleft cyst with an internal communication to the throat.

Since a variety of different masses can occur in the neck, an imaging study often needs to be performed. Generally the initial study is a cervical ultrasound, although a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan may be necessary for further anatomical definition of the cyst in preparation for future surgical excision.

There are other congenital cystic neck masses that can closely resemble a branchial cleft cyst. The most common is a dermoid cyst. Sometimes a dermoid cyst cannot be distinguished from a branchial cleft cyst based on the combination of the physical examination and imaging studies, and the answer is not known until the mass is removed and examined by a pathologist.

How are branchial cleft cysts and sinus tracts treated?

The treatment for branchial cleft cysts and sinus tracts is surgical removal.

There is no known medical therapy with the exception that infected branchial cleft cysts and sinus tracts do require initial antibiotic treatment. The infection should be resolved before surgery is performed.

Branchial cleft sinus tracts often have drainage of mucous-like material. This material is produced by glands that line the sinus tract. Although not truly a sign of infection, excessive drainage can be bothersome, prompting surgical intervention.

Treatment requires complete surgical removal of the cyst and possibly the sinus tract. The exact procedure performed depends upon the anatomical location and type of the branchial cleft abnormality. Some operations can be very straightforward and others quite complicated. The operative removal of type II first branchial cleft abnormalities is particularly challenging, requiring partial removal of the parotid gland for identification and preservation of the facial nerve.

Complications include those common to any open neck operation such as hematoma, seroma, postoperative infection and a neck scar. In specific cases, nerve weakness or paralysis is a risk as well.