• Korean Journal of Bronchoesophagology
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• v.18 no.2
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• pp.60-63
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• 2012

Second branchial cleft cysts are usually present as a fluctuant neck mass along the anterior border of the sternocleidomastoid muscle. When they are found in this typical location, accurate diagnosis on initial presentation is not difficult. Parapharyngeal presence of the branchial cleft cyst is very rare. We report a case of second branchial cleft cyst presenting as a parapharyngeal cystic mass in 51-year-old male. Before coming to our clinic, the patient had been diagnosed as parapharyngeal abscess, resulting in several attempts at removal. However, symptoms and parapharyngeal abscess recurred. We performed complete surgical resection of the parapharyngeal cystic mass via transoral approach only with oropharyngeal incision. The cystic mass was located in the parapharyngeal space and did not have tract-like structure. Histopathologic examination confirmed that the excised cyst was branchial cleft cyst. Patient discharged without any surgical complication and there was no evidence of recurrence for 2 years follow-up.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.12 no.1
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• pp.180-186
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• 1990

This is a case report of first branchial cleft cyst in 56 year old male patient, which was tentatively diagnosed as acute right submandibular abscess resulted from the periapical lesion of the lower right second molar. The results are as follows, 1. The accompanying ipsilateral inflammatory swelling resulted from the periapical lesion of lower right second molar tooth makes the diagnosis difficult. 2. The onset of this case was very late in comparison to the mean discovering age of branchial cleft cysts. 3. The plain radiography using contrast media is helpful for the diagnosis of cystic lesions within soft tissues. 4. This case in a first branchial cleft cyst(Type I) which occurs less than 1% of all branchial cleft anomalies.

• Korean Journal of Head & Neck Oncology
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• v.21 no.1
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• pp.53-56
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• 2005

The branchial anomaly is a lateral neck mass commonly seen by otolaryngologists. Depending on its anatomic location, branchial anomaly can be classified into first, second, third and fourth. The fourth branchial cleft anomaly is very rare entity and until now, only 35cases have been reported worldwide. It may present as neck cyst, recurrent neck abscess, thyroiditis. Combined with barium swallow esophagogram and computed tomography scan can aid in diagnosis of this rare disease entity. Complete excision of the entire epithelial tract combined with ipsilateral thyroid lobectomy remains the mainstay of treatment. Authors experienced a case of lateral neck mass which was anatomically presumed to be the fourth branchial cleft cyst. We report this case with the related literature.

• Journal of Korean Academy of Oral and Maxillofacial Radiology
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• v.23 no.2
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• pp.365-372
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• 1993

Branchial cleft cyst is the most common lateral neck cyst; the vast majority are of the second branchial cleft origin. This presumably reflects the greater depth and longer persistence of the second cleft, compared with the first, third, and fourth clefts. We experienced a 49-year-old male whose chief complaint was a abnormal mass of the left parotid gland area and neck. As a result of careful analysis of clinical, radiological, and histopathological findings, we diagnosed it as a second branchial cleft cyst in the neck and obtained results as follows: 1. In clinical examination, there was a 10×15㎝ sized, fluctuant painful mass in the left neck and parotid area. 2. In radiographic examination, a low echogenic mass with internal cystic change in the inferior parotid gland area was noted sonographically. Computed tomograph showed a 3×4㎝ sized, well-defined cystic mass with heterogenous solid component in the anterior border of sternocleidomastoid muscle. MRI revealed 5×6㎝ sized, well-marginated multi separated mass in the same area. 3. In histopathological examination, lining of cyst was stratified squamous epithelium with typical lymph node pattern and inflammatory cell infiltration.

• Korean Journal of Bronchoesophagology
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• v.8 no.2
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• pp.43-46
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• 2002

Branchial cleft cysts are most common neck masses in adults. Most are second branchial cysts, which occur in the neck, anterior to sternocleidomastoid muscle at the mandibular angle. Rarely these cysts may be present in the parapharyngeal space. We report a case of a second branchial cleft cysts in the parapharyngeal space of 32-year-old female, which was misdiagnosed as peritonsillar abscess. It was excised via transoral and transcervical approach.

• Advances in pediatric surgery
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• v.17 no.2
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• pp.162-169
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• 2011

Branchial cleft anomalies are the second most common head and neck congenital lesions seen in children. Amongst the branchial cleft malformations, second cleft lesions account for 95 % of the branchial anomalies. This article analyzes all the cases of second branchial cleft anomalies operated on at Seoul National University Hospital from September 1995 to February 2011. We analyzed sex, age, symptom and sign, accompanied anomaly, diagnosis, treatment, pathologic report and outcome via retrospective review of medical records. In this series, we had 61 patients (27 female and 34 male). The mean age at the time of operation was 38 months. 31 lesions were on the right, 20 were on the left and 10 were bilateral. The most frequent chief complaints at presentation were non-tender mass and cervical opening without any discharge. According to anatomic type, 29 patients had branchial cleft sinuses, 14 had cysts, 14 had fistulas and 4 had skin tags. Complete excision was attempted if possible and antibiotics challenged when infection was suspected. Complete excision was achieved in 96.7 % of cases. Incision and drainage was done in 2 cases due to severe inflammation, and both recurred. Postoperative complications included wound infection in 2 cases. Microscopic examonation revealed squamous epithelium in 90.2 % and squamous metaplasia in one case in the branchial cleft cyst wall. In summary, second branchial anomaly is found more frequently on right side of neck. Fistulas are diagnosed earlier than cystic forms. Most cases could be diagnosed by physical examination. The definitive treatment is complete excision and sufficient antibiotics coverage for cases with inflammation. After drainage of infected lesions, follow up excision after 1 year might be beneficial for preventing recurrence.

• Korean Journal of Head & Neck Oncology
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• v.24 no.1
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• pp.53-56
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• 2008

Objectives：The purpose of this study was to evaluate the variable sonographic features in addition to classic findings and to find the helpful characteristic findings for diagnosis of branchial cleft cysts. Subjects and Methods：We retrospectively analyzed the sonographic finding of 16 histopathologically proven branchial cleft cysts. Assessment involved the following variables : location related to carotid artery, size, cyst wall, border, margin, shape, internal echotexture, post echoic enhancement, orientation of longitudinal axis relative to the long axis of the neck, and tapering edge. Results：Most branchial cleft cysts were seen as well defined(15/16), oval shape(13/16), smooth inner (12/16) and outer margin(13/16), and post echoic enhancement(16/16). Their diameter varied from 1 to 6cm (mean 3.3cm). The branchial cleft cysts showed variable internal echopatterns；hyperechogenicity or pseudosolid appearance(1/16), heterogeneous echogenicity(4/16) in addition to classic form of anechoic(5/16) or hypoechoic internal echogenicity(6/16). Longitudinal axis of most branchial cleft cysts were arranged in the direction of the long axis of the neck(13/16) and some branchial cleft cysts had tapering edge(6/16). Conclusion：If both atypical sonographic findings and location are showed, longitudinal arrangement of long axis and tapering edge of branchial cleft cysts are helpful findings for differential diagnosis.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.22 no.4
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• pp.442-448
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• 2000

Developmental anomalies arising from the branchial apparatus include cysts, external sinuses, internal sinuses, and complete fistulas. Second branchial cleft cysts are by far the most common among these anomalies. It may occur at any age, being most common in the third decade, and more frequent in the male than in the female. It usually presents a smooth, round, nontender fluctuant mass located between the level of the tragus and the clavicle along the anteromedial border of the sternocleidomastoid muscle. It is lined by respiratory or squamous epithelium unless inflammation is present. The considerable amount of lymphoid tissue may be found beneath the epithelium. The treatment of choice of branchial cleft cyst is surgical excision. If the lesion is acutely infected, however, it is essential to relieve the infection prior to the surgery. This report deals with two cases of second branchial cleft cyst. In case 1, the cyst had rapidly increased in size over pregnant period. In case 2, the patient presented the swelling in the left neck, and had the history of incision and drainage because of misdiagnosis as submandibular space abscess. The infection was treated by antibiotic therapy in the first place, and then complete surgical excision was made. There was no evidence of any recurrence or complications for these $3{\sim}4$ years.

• Korean Journal of Head & Neck Oncology
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• v.10 no.2
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• pp.122-127
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• 1994

One hundred fifty four cases of branchial anomaly treated from January 1987 to July 1993 were analysed to determine clinical features, embryologic and anatomic types of the branchial cleft anomaly, to investigate the differences between adults and pediatrics, and to establish the appropriate treatment plan. The male to female ratio was not signifiacntly different in pediatric and adult patients. The mean symptom duration was 0.5 years(range 0.08-14 years) in pediatric patients and 1.67 years (0.7-7 years) in adult patients. The clinical presentations of these anomalies were lateral neck mass in 112(72.7%), infected discharge in 22(14.3%), non-infected discharge in 6(3.9%), and abscess in 14 cases(9.l%). Sites of the lesions were upper third of the neck in 93(60.3%), infraauricular in 35(22.7%), middle third of the neck in 17(11.0%) and inferior third of the neck in 9 cases(5.8%). The anatomic types were cystic form in 117(75.9%), sinus in 24(15.5%), and fistula in 13 cases(8.4%). Embryologic classification were 124 second branchial cleft anomalies(80.5%), 29 first branchial cleft anomalies(18.8%), and 1 third branchial cleft anomaly(0.6%). Immediate surgery under the uncontrolled infection in 17 cases result in 82.4% recurrent rate(14 cases), and 17.6% cure rate(3 cases). Delayed surgery under the controlled infection in 8 cases recurrent rate(1 case), and 87.5% cure rate(7 cases). In summary, the most common branchial cleft anomaly is second type cyst both in pediatric and adult group, delayed surgical exterpation after infection control with I & D or antibiotics may give a good chance for care and may reduce the recurrence.

• Korean Journal of Head & Neck Oncology
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• v.8 no.1
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• pp.6-13
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• 1992

Branchial apparatus anomaly is rarely encountered congenital neck disease, it presents a palpable non-tender mass or fistulous opening existed at any site from external auditory canal or mandible angle to lower part of neck We have reviewed the records of 50 patients operated upon for branchial cleft anomaly, at Department of Surgery, Inje University Hospital, between 1981 and 1990, and the following results were obtained. I) In the classificiation of branchial cleft anomaly, first branchial fistula was 1 case, second branchial cyst 32 cases, second branchial sinus 11 cases, second branchial fistula 5 cases and third branchial fistula 1 case. 2) There were 20 men and 30 women in this series and male to female ratio was 2:3. 3) The age at first clinical presentation was 1st decade 15 cases, 2nd decade 10 cases, 3rd decade 17 cases, 4th decade 5 cases and 5th decade 3 cases. The peak age incidence was 3rd decade in overall, but the cyst was most common in 2nd decade, and majority of sinus or fistula was seen below 10 years old age. 4) The prevalent side of this anomaly was right side in 19 cases, left side in 29 cases and bilateral 2 cases, and so left side was more common than right. 5) The clinical presentation was characterized by the lesion along anterior border of sternocleido muscle, non-tender palpable mass were 28 cases, drainage sinus 18 cases, recurrent abscess and drainage 5 cases and intermittent ear discharge 1 case. 6) The mean size of cyst was about 4cm that containing turbid white-yellowish fluid but discharge from sinus or fistula was clear mucoid. 7) The culture of cyst fluid was no bacteria, but 2 cases showed staphyloccoci suggesting secondary infection. 8) The surgical procedure were complete excision of cyst 32 cases, sinus excision 11 cases, fistula excision 6 cases and I&D 1 case. And the recurrent 1 case was that fistula tract could not be identified due to severe scar from previous several operations.