Branchial cleft anomaly

Background

During the 4th week of embryonic development, there are five branchial arches that grow into distinct parts of the head and neck, all of which consist of arteries, nerves, muscles, and skeletal tissue. If the branchial arches fail to fuse, a soft tissue anomaly on the lateral aspect of the neck may form, which is called a branchial cleft anomaly. The range of anomalies include cysts (most common), fistulas, and sinus tracts. The second branchial cleft anomalies are the most common.

Clinical Features

• First branchial cleft cyst
  • Lump in parotid/auricular region
  • Facial nerve palsy

• Second branchial cleft cyst
  • Present in late childhood or early adulthood
  • Swelling below angle of mandible and anterior to sternocleidomastoid
  • Sinus tracts will travel into the deep neck and drain into tonsillar fossa

• Third and fourth branchial cleft cyst
  • Difficult to differentiate between the two
  • Located lower in neck, possibly posterior to sternocleidomastoid

Evaluation

• Ultrasound
• CT
• MRI