Branchial Cleft Anomalies: Embryogenesis, Clinical Features, Diagnosis, and Management

Branchial cleft anomalies are congenital head and neck lesions that arise from incomplete maturation of the branchial apparatus during fetal development. The branchial arches are the precursors of the face, neck and pharynx, and disturbances in embryogenesis can present clinically as cysts, sinus tracts, and fistulas in predictable anatomic locations. However, there remains controversy regarding the precise embryogenesis of branchial cleft anomalies with several competing theories. These lesions often evade diagnosis in early childhood and may present in a delayed fashion after multiple failed interventions. Various diagnostic modalities have been described to facilitate clinical workup. Definitive treatment is complete surgical excision of the lesion. We present a comprehensive review of the literature along with several illustrative cases that highlight the unique challenges of diagnosis and surgical management of branchial cleft anomalies.

Branchial Sinus with Cyst - Two Case Reports with Review of Literature

Branchial cleft anomalies are well described, with the second arch anomaly being the commonest. Remains of cervical sinus of His may persist as a branchial cyst. A branchial sinus is formed when 2nd branchial arch fails to meet the 5th pharyngeal arch. Peak age for presentation of branchial cysts is in the third decade and that of the congenital sinuses and fistulae is at birth. The association of a branchial cyst with branchial sinus is very rare. We are presenting two cases had branchial cyst along with branchial sinus. It was managed successfully with complete excision. Histopathological examination confirmed the association. Keywords: Branchial Sinus, Branchial cyst,

Type I second branchial cleft cyst in an adult patient

Branchial cleft anomalies are rare diseases of head and neck region. Second branchial cleft anomalies represent more than 95% of all branchial cleft anomalies. Second branchial cleft cyst is a benign developmental cyst due to the incomplete obliteration of pharyngeal cleft. A 46-year-old female patient reported to hospital with a complaint of swelling over the left side of the neck since 4 to 5 months. On clinical examination, swelling was seen below and behind the angle of mandible on the left side. The patient was evaluated using ultrasound and contrast enhanced computerized tomography (CECT) of neck which revealed second left bronchial cleft cyst/enlarged cystic lymph-node. Fine needle aspiration cytology of the swelling showed features of cystic lesion. Type-I branchial cleft cyst is a rare condition with a significant risk of misdiagnosis. To avert misdiagnosis and surgical complications, thorough investigation must be performed prior to surgical intervention.

First branchial cleft anomaly extending to parapharyngeal space

First branchial cleft anomalies are quite rare, and the majority of them are found in and around the ear canal, mostly superficial to the facial nerve. Very rarely, the anomalous tract of the first branchial cleft can go deeper to the facial nerve, necessitating a meticulous and extensive surgery. A 21-year-old student presented with slowly increasing cystic swelling in the infra-auricular region. Findings of the magnetic resonance imaging were consistent with the first branchial cleft cyst, which also exhibited a deeper extent of the lesion into the parapharyngeal space. The entire tract was excised along with the superficial parotidectomy by an open approach. In addition to illustrating the presentation and management of this peculiar case, the present report also reviews the latest literature around their management.