These can have several locations: along or adjacent to the anterior sternocleidomastoid border or at any point throughout the length of a second branchial fistula, extending from the skin of the lateral neck, between the external and internal carotid, and finally in the palatine tonsil. Sinuses only possess a single internal opening, whereas fistulae have multiple internal as well as external openings. type 1: these are situated close to the external auditory meatus. Onwypracowanie , it looks like a round or oval cystic mass, which can be situated either within, supercial to, or deep to the parotid gland or along the external auditory canal. The type 2 anomalies are greater in number and manifest as a replication of the membranous as well as cartilaginous elements of the external auditory canal. This variant of branchial cleft cysts makes up approximately 95% of all branchial anomalies. As per a case report regarding an oropharyngeal branchial cleft cyst, by Choo et al., the cystic mass was misdiagnosed as a mucocele.
If it looks like a pseudo-solid heterogenous mass with internal debris and septa, the list of differentials would include lymphadenopathy, lipoma, nerve sheath tumour, inflammatory lesions, carotid body tumour, external laryngocele, and cystic hygroma. On USG, it looks like an anechoic mass or chiefly hypoechoic cystic mass, with faint internal debris and posterior enhancement. The location, clinical picture, and radiological correlation, along with a strong degree of suspicion for the condition, facilitates the diagnosis of this relatively common embryological anomaly. The third arch forms the stylopharyngeus, thymus, inferior aspect of the thyroid gland, and some parts of the hyoid bone, along with the internal and common carotid arteries. Occasionally, a sinus tract extending to the hyoid bone may be detected. On examination, they look like a fistula or a cystic mass, situated behind the pinna and concha. They can be situated at any point in the tract that extends posterior to the carotid arteries and pierces the thyrohyoid membrane and enters the larynx, thus terminating on the lateral aspect of the pyriform sinus.
They are typically situated in the thyroid gland and mediastinum. The origins of type 1 and type 2 lesions are different. type 2: these correspond to the submandibular gland and may be observed in the anterior triangle of the neck. It is a possible differential for cystic lesions observed in the parotid or peri-parotid regions. It is normally delayed until the age of two to three years. The first three arches lead to the formation of structures above the larynx, while the fourth and fifth arch form structures below the larynx and contribute to the formation of tracheal structures. Recurrent parotid abscesses are commonly observed in patients of first branchial cleft cyst. It is pathognomonic of a type 3 second branchial cleft cyst. In cases of isolated type 4 second branchial cleft cyst, an intraoral approach can be considered. type 4: positioned in the pharyngeal mucosal space, medial to the carotid sheath. Eventually, the second arch overgrows downwards towards the fifth pharyngeal arch, which then leaves a depression, i.e.
These abscesses are indifferent towards antibiotics or incision and drainage.rozprawkahas no contribution towards the development of any structure. Occasionally, a curved rim of tissue, inclined in a way that is similar to pointing between the internal and external carotid arteries medially, also known as the beak sign, can be observed on CT or MRI. Fourth branchial cleft cysts are sparsely prevalent and sporadically observed cases. Definitive management for third branchial cleft cysts includes surgical excision. Imaging modalities are imperative for the diagnosis and management of these cysts. The cysts are characteristically located deep to the sternocleidomastoid. In a large number of cases they are located inferior and posterior to the tragus. Like third BCCs, these are common on the left aspect. Dyes like methylene blue and gentian violet can be employed to facilitate identification of the tract. The nerves and arteries travel downwards to occupy their final positions in the thorax.
Due to their rare occurrence, there are no concretely established procedures outlined for their management. Current management of congenital branchial cleft cysts, sinuses, and fistulae. This review article aims to elaborate the anatomical and radiological features of all the variants of branchial cleft cysts in order to help clinicians to identify and diagnose them accurately, and thus opt for the requisite management remedies appropriately. The prime diagnostic interventions are CT and MRI, in order to gauge the depth and extent of the branchial cleft cysts. However, on failure to obliterate, it can lead to the formation of branchial abnormalities like cysts (approx. Third branchial cleft cysts are rarely encountered. Fourth branchial cleft cyst. The fourth arch sinuses arise from the apex of the pyriform sinus, continue inferior to the superior laryngeal nerve, and go down the tracheoesophageal groove. The third arch sinuses originate from the base of the pyriform sinus and proceed superior to the superior laryngeal nerve and hypoglossal nerve, but inferior to the glossopharyngeal nerve, and continue posteriorly to the carotid artery. The surgical method is unique for every case of this anomaly because it is imperative that the integrity and patency of the tract be maintained for complete excision.
