BRANCHIAL CLEFT CYST

Author
Chih-Ho Hong, MD, FRCPC Clinical Assistant Professor, Department of Dermatology and Skin
Science, University of British Columbia, Canada

BACKGROUND
Branchial cleft cysts are congenital epithelial cysts, which arise on the lateral part of the
neck from a failure of obliteration of the second branchial cleft in embryonic development.[1]
Phylogenetically, the branchial apparatus is related to gill slits. In fish and amphibians, these
structures are responsible for the development of the gills, hence the name branchial (branchia is
Greek for gills).

PATHOPHYSIOLOGY
At the fourth week of embryonic life, the development of 4 branchial (or pharyngeal)
clefts results in 5 ridges known as the branchial (or pharyngeal) arches, which contribute to the
formation of various structures of the head, the neck, and the thorax. The second arch grows
caudally and, ultimately, covers the third and fourth arches. The buried clefts become ectoderm-
lined cavities, which normally involute around week 7 of development. If a portion of the cleft
fails to involute completely, the entrapped remnant forms an epithelium-lined cyst with or
without a sinus tract to the overlying skin.[2, 3, 4, 5]

EPIDEMIOLOGY
Frequency

The exact incidence of branchial cleft cysts in the US population is unknown. Branchial
cleft cysts are the most common congenital cause of a neck mass. An estimated 2-3% of cases
are bilateral. A tendency exists for cases to cluster in families.[6]
Race

No ethnic predilection has been reported for branchial cleft cysts.

Sex

No sexual predilection is recognized for branchial cleft cysts.

Age

Branchial cleft cysts are congenital in nature, but they may not present clinically until
later in life, usually by early adulthood.
References
1. Wagner AM, Hansen RC. Neonatal skin and skin disorders. Schachner LA, Hansen RC,
eds. Pediatric Dermatology. 2nd ed. New York, NY: Churchill Livingston; 1995. Vol 1:
291-3.
2. Doi O, Hutson JM, Myers NA, McKelvie PA. Branchial remnants: a review of 58
cases. J Pediatr Surg. 1988 Sep. 23(9):789-92.
3. Little JW, Rickles NH. The histogenesis of the branchial cyst. Am J Pathol. 1967 Mar.
50(3):533-47.
4. Rickles NH, Little JW. The histogenesis of the branchial cyst. II. A study of the lining
epithelium. Am J Pathol. 1967 May. 50(5):765-77.
5. Telander RL, Deane SA. Thyroglossal and branchial cleft cysts and sinuses. Surg Clin
North Am. 1977 Aug. 57(4):779-91.
6. Anand TS, Anand CS, Chaurasia BD. Seven cases of branchial cyst and sinuses in four
generations. Hum Hered. 1979. 29(4):213-6.
7. Vemula R, Greco G. An unusual presentation of presentation of a branchial cleft cyst. J
Craniofac Surg. 2012 May. 23(3):e270-2.
8. Rashid A, Ahmad V, Qazi S, Billoo AG, Rashid S, Saleem AF. Posterior mediastinal
branchial cleft cyst: an unusual site. J Coll Physicians Surg Pak. 2014 May. 24 Suppl
2:S117-8.
9. Bloch R. Images in emergency medicine. Branchial cleft cyst. Ann Emerg Med. 2006
Mar. 47(3):291, 308.
10. Rosa PA, Hirsch DL, Dierks EJ. Congenital neck masses. Oral Maxillofac Surg Clin
North Am. Aug/2008. 20:339-52.
11. Donegan JO. Congenital neck masses. Cummings CW, Schuller DE, eds. Otolaryngology
- Head and Neck Surgery. 2nd ed. St. Louis, Mo: Mosby; 1993. 1554-9.
12. Chen LS, Sun W, Wu PN, Zhang SY, Xu MM, Luo XN, et al. Endoscope-assisted versus
conventional second branchial cleft cyst resection. Surg Endosc. 2012 May. 26(5):1397-
402. [Medline].
13. Chen L, Huang X, Lou X, Xhang S, Song X, Lu Z, et al. [A comparison between
endoscopic-assisted second branchial cleft cyst resection via retroauricular hairline
 approach and conventional second branchial cleft cyst resection]. Lin Chung Er Bi Yan
Hou Tou Jing Wai Ke Za Zhi. 2013 Nov. 27(22):1258-62.
14. Kim MG, Kim SG, Lee JH, Eun YG, Yeo SG. The therapeutic effect of OK-432
(picibanil) sclerotherapy for benign neck cysts. Laryngoscope. 2008 Dec. 118(12):2177-
81.
15. Kim JH. Ultrasound-guided sclerotherapy for benign non-thyroid cystic mass in the
neck. Ultrasonography. 2014 Apr. 33(2):83-90