Branchial Cyst

Question 1

What is a branchial cyst

Answer 1

Thought to develop because of a failure of fusion of the embryonic second and third branchial arches.

Also thought to be an acquired condition due to cystic degeneration in cervical lymphatic tissue.

The cysts are lined by squamous epithelium.

Question 2

Who usually presents with a branchial cyst

Answer 2

Young adults 20-30 y/o

Question 3

Where is a branchial cyst found

Answer 3

Anterior triangle of the neck, in front of the upper or middle third of the sternocleidomastoid

Question 4

Where is the anterior triangle of the neck

Answer 4

Superiorly – Inferior border of the mandible

Laterally – Medial border of the sternocleidomastoid

Medially – Imaginary sagittal line down midline of body

Question 5

What are the features of a branchial cyst

Answer 5

Smooth

Firm

Ovoid shape - long axis running forwards and downwards

Fluctuant on palpation

Opaque on transillumination - due to desquamated epithelial cell contents

Question 6

What would a branchial cyst feel like if there is recurrent infection

Answer 6

Hard

Fixed to surrounding structures

Question 7

How would you diagnose a branchial cyst

Answer 7

Clinical examination

Fine-needle aspiration - opalescent fluid containing cholesterol crystals or pus

Question 8

How would you treat a branchial cyst

Answer 8

Non-surgical:-

• Treat infections with antibiotics

Surgical:-

• Surgical excision

Question 9

What are the complications of branchial cyst excision

Answer 9

Recurrence

Development of a chronic, discharging sinus