Summary about Disease
A first branchial cleft cyst is a rare congenital defect that arises from incomplete obliteration of the first branchial cleft during embryonic development. These cysts, sinuses, or fistulas can appear anywhere along the course of the first branchial cleft, which runs from the preauricular area (in front of the ear) to the angle of the mandible (jawbone). There are two types (Type I and Type II) with varying anatomical relationships to the facial nerve and other structures. They are typically diagnosed in childhood, but can be found in adults as well.
Symptoms
A small pit, dimple, or skin tag near the ear, angle of the jaw, or along the neck.
Intermittent swelling, redness, or drainage from the pit or skin tag, often associated with upper respiratory infections.
Ear infections (in some cases).
A painless lump in the neck or around the ear.
Facial nerve weakness (rare but can occur with infections or surgical procedures).
Causes
First branchial cleft cysts are caused by the incomplete closure of the first branchial cleft during embryonic development. During the 4th week of gestation, the six branchial arches and five branchial clefts form. Normally, these structures involute and disappear. Failure of the first branchial cleft to involute completely results in a cyst, sinus, or fistula.
Medicine Used
Antibiotics: Used to treat infections associated with the cyst. Common antibiotics may include cephalexin, amoxicillin-clavulanate, or clindamycin.
Pain relievers: Over-the-counter pain relievers such as ibuprofen or acetaminophen can be used to manage pain and discomfort.
Is Communicable
No, a first branchial cleft cyst is not communicable. It is a congenital condition and not caused by an infectious agent.
Precautions
Keep the area clean and dry.
Avoid picking or squeezing the cyst.
Seek medical attention promptly if you notice signs of infection (increased redness, swelling, pain, drainage, fever).
Follow all instructions provided by your doctor regarding antibiotics or wound care.
Post-operative care, as prescribed by the surgeon if surgery is needed.
How long does an outbreak last?
There are no "outbreaks" of first branchial cleft cysts. The cyst is a persistent structural anomaly. Symptoms like swelling, redness, or drainage may occur intermittently, especially during or after upper respiratory infections. These symptomatic periods can last from a few days to a couple of weeks, depending on the severity of the infection and the effectiveness of treatment.
How is it diagnosed?
Physical Examination: A doctor will examine the area for any visible pits, sinuses, skin tags, or masses.
Imaging Studies:
CT scan with contrast: This can help determine the size, location, and extent of the cyst and its relationship to surrounding structures.
MRI: Can provide more detailed images of soft tissues and can be useful for evaluating the facial nerve.
Ultrasound: May be used to evaluate superficial cysts.
Fistulogram: If a fistula is present, a contrast dye can be injected into the opening, and X-rays are taken to visualize the tract.
Fine Needle Aspiration (FNA): In some cases, a needle aspiration may be performed to collect fluid from the cyst for analysis.
Timeline of Symptoms
The timeline of symptoms can vary:
Birth/Infancy: Some cysts are detected at birth as small pits or skin tags.
Childhood: Many cysts are first noticed during childhood, often when they become infected after an upper respiratory infection. This presents as swelling, redness, pain, and/or drainage.
Adulthood: Some cysts may remain asymptomatic until adulthood, when they become infected or are discovered incidentally during imaging for other reasons.
Recurrent Infections: The most common pattern is intermittent swelling and drainage, usually triggered by upper respiratory infections.
Important Considerations
Surgical Excision: The definitive treatment for a first branchial cleft cyst is complete surgical excision. This is often recommended to prevent recurrent infections and to rule out other conditions.
Facial Nerve Involvement: Due to the proximity of the first branchial cleft to the facial nerve, there is a risk of nerve injury during surgery. Surgeons take special precautions to identify and preserve the facial nerve. Type II cysts pose a higher risk of facial nerve involvement.
Recurrence: Although surgical excision is usually successful, there is a small risk of recurrence, especially if the cyst is incompletely removed.
Differential Diagnosis: Other conditions that may mimic a first branchial cleft cyst include preauricular cysts/sinuses, branchial cleft cysts from other arches, lymph node enlargement, and tumors.