Symptoms Of Branchial Cleft Cyst: Complications And Treatment

A branchial cleft cyst is an epithelial cyst, which is congenital; i.e. it is present at birth and forms on the lateral aspect of your neck because of a failure of elimination or an incomplete involution of the 2nd branchial cleft during the embryonic development.

A branchial cleft cyst is seen as a lump / mass which forms in the neck or just beneath the clavicles.

It is a birth defect. The wall of the cyst comprises of squamous cells or columnar cells with lymphoid infiltrate, with noticeable germinal layers. A brachial cleft cyst contains keratinaceous and granular material.

This birth defect appears as an open space known as a cleft sinus, which may develop unilaterally or bilaterally. A branchial cleft cyst develops from the fluid that drains from the sinus. The cyst or sinus may get infected.

Sign And Symptoms Of Branchial Cleft Cyst

Most branchial cleft sinuses are asymptomatic, i.e. there is no presenting feature; however, they may get infected.

  • The cyst is seen as a smooth, non-painful, slowly enlarging lump or mass on the neck which may increase in size after upper respiratory tract infection.
  • There may be tiny lumps, or pits or skin tags on either side of the neck or beneath the collarbone.
  • There could be fluid drainage from a pit.
  • The lump may get tender and painful if it gets secondarily infected. In association with a sinus tract, there will be some discharge onto the skin or into your pharynx.
  • Infrequently, the cysts have been reported as fluctuant nodules in the thorax and posterior mediastinum.

Complications Of Branchial Cleft Cyst

  • The commonest complication is that the cyst or sinus may get infected if it is not eliminated. An untreated cyst is prone to frequent bouts of infection and formation of abscesses with scar formation, and it could also compromise the adjacent structures.
  • There have been rare reports of malignancy in branchial cleft cysts too, and this could be a grave complication.
  • In case an abscess forms, it can spontaneously rupture and this could result in a draining sinus in to the pharynx or on to the skin.
  • Depending up on the size and the exact anatomical position of the lump, clinical features such as –breathlessness, dysphagia, dysphonia, and stridor, may occur.
  • Certain complication could occur too after surgical excision has been carried out. Complications of surgical excision of a branchial cleft cyst results from some damage to the surrounding vascular and / or neural structures-the carotid vessels and the hypoglossal, facial, vagus, and lingual nerves.

Treatment Of Branchial Cleft Cyst

Your health care provider will examine thoroughly and also order the following tests:

  1. MRI scan
  2. CT scan
  3. Ultrasound
  • Antibiotics will be prescribed to manage the infections and abscesses related to the branchial cleft cyst / sinus.
  • By and large, surgery is indicated to eliminate a branchial cyst and to ward off the complications, such as infections. Since a total surgical excision is a little complex, given the very close nearness to the internal jugular vein and the carotid vessels which are present just below the swelling, the cysts are known to recur.
  • Post-operatively, you must be monitored for a recurrence. Some patients have bilateral branchial cleft cysts; hence the contralateral side has to be examined as well.