Summary about Disease
A branchial cleft cyst is a fluid-filled sac that develops in the neck or upper chest due to incomplete closure of the branchial arches during embryonic development. These arches are structures that contribute to the formation of the head and neck. The cyst is typically benign and may present as a painless lump. However, it can become infected, leading to pain, swelling, and redness.
Symptoms
A small, soft, painless lump in the neck, usually below the angle of the jaw or along the front edge of the sternocleidomastoid muscle (the large muscle running from behind the ear to the collarbone).
Drainage of fluid from an opening in the skin of the neck.
Infection of the cyst, which can cause redness, swelling, pain, and tenderness.
Difficulty swallowing or breathing (rare).
Fever (if infected).
Causes
Branchial cleft cysts are congenital, meaning they are present at birth. They occur when the branchial arches, which are embryonic structures that form the head and neck, fail to close completely during fetal development. This incomplete closure leaves behind remnants of tissue that can develop into cysts.
Medicine Used
Antibiotics: Used to treat infection of the cyst. Common antibiotics include cephalexin, clindamycin, or amoxicillin-clavulanate.
Pain relievers: Over-the-counter pain relievers like ibuprofen or acetaminophen can help manage pain and discomfort.
Surgical Removal: Complete surgical excision is the definitive treatment for branchial cleft cysts.
Is Communicable
No, branchial cleft cysts are not communicable. They are developmental abnormalities and cannot be spread from person to person.
Precautions
Keep the area clean and dry: If the cyst is draining, gently clean the area with mild soap and water to prevent infection.
Avoid squeezing or picking at the cyst: This can increase the risk of infection.
Seek medical attention for signs of infection: Redness, swelling, pain, tenderness, or fever warrant prompt medical evaluation.
Follow up with a physician or surgeon: If diagnosed, discuss treatment options and potential complications.
How long does an outbreak last?
Branchial cleft cysts are not characterized by outbreaks. However, if a cyst becomes infected, the infection can last for several days to weeks, depending on the severity and the effectiveness of treatment with antibiotics. The cyst itself will persist unless surgically removed.
How is it diagnosed?
Physical exam: A doctor will examine the neck and feel for a lump.
CT scan or MRI: These imaging tests can help visualize the cyst and surrounding structures.
Ultrasound: May be used, especially in children, to differentiate a cyst from other neck masses.
Fine-needle aspiration (FNA): A small needle is used to withdraw fluid from the cyst, which is then analyzed in a laboratory.
Branchiography: A contrast dye is injected into the opening of the sinus or fistula and then X-rays are taken to visualize the tract.
Timeline of Symptoms
Birth/Early Childhood: Often the cyst is present at birth or detected in early childhood. It may be small and asymptomatic initially.
Childhood/Adolescence: The cyst may enlarge over time or become noticeable due to an upper respiratory infection, causing inflammation and swelling.
Any Age: Infection can occur at any time, leading to acute symptoms like pain, redness, and drainage.
Important Considerations
Complete Excision: Surgical removal is usually recommended to prevent recurrent infections and rule out other possible diagnoses.
Recurrence: Even after surgical removal, there is a small risk of recurrence if the entire cyst tract is not removed.
Differentiation from Other Neck Masses: Important to distinguish branchial cleft cysts from other neck masses, such as lymph nodes, dermoid cysts, or tumors.
Surgical Expertise: Surgical removal should be performed by an experienced surgeon (ENT specialist or pediatric surgeon) to minimize the risk of complications, such as nerve damage or scarring.
Associated Anomalies: In rare cases, branchial cleft cysts can be associated with other congenital anomalies.