Branchial Cleft Anomalies

The branchial clefts and arches develop during the fourth week of gestation. Remnants of these structures result in branchial cleft cysts and sinuses. The most common anomalies arise from the second branchial cleft.

Second branchial cleft sinus is found as an opening from the anterior border of the lower one-third of the sternocleidomastoid muscle. It is most commonly associated with clear drainage, and its presentation is usually in childhood. Second branchial cleft cysts usually present as a mass that is anterior to and below the upper one third of the SCM. It presents in adulthood and there is an associated risk of in situ cancer.

Treatment of these anomalies consists of removal of the entire cyst and/or tract. In the setting of infection, initial treatment should consist of adequate incision and drainage (10% of cases are bilateral).

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