The following article presents information on the symptoms, causes, types, diagnosis, and treatment of branchial cleft cysts. This is a kind of a birth defect in which a lump is formed on one or both sides of the neck or beneath the collarbone.
It is described as a remnant, which is derived from the fusion planes lying between the developing fetal neck and head. Under normal circumstances, these fusion planes blot out. However, they sometimes persist as a potential space, which can be filled with fluids prone to infection.
Appearing as small pits, pockets, skin tags, or lumps, the cyst enlarges and becomes oval in shape, as the child grows and reaches adolescence. Furthermore, it may also become enlarged, inflamed, or abscessed if the child suffers from some sort of ailment of the upper respiratory tract. The lump sometimes enlarges to such an extent that it causes difficulty in swallowing, troublesome breathing, and hoarseness of voice. When the symptoms are severe, fluid drainage from the pit on the neck is observed. This is a condition of medical emergency.
Causes
Branchial cleft cysts form during the stages of embryonic development. They happen to occur when the tissues in the neck and collarbone area, also known as branchial cleft, fail to develop as they do in normal cases. As has already been mentioned, they appear as open spaces on either or both sides of the neck. These open spaces are called cleft sinuses. These cysts may form from the fluid drained from a sinus.
Types
There are basically two types of these cysts, primary and secondary. They are grouped in accordance with their embryologic derivation. The primary type are found in the preauricular area. They are not painful to touch. The secondary type are present anywhere along the anterior margin of the sternocleidomastoid muscle. They are tender, particularly when infected. The infected branchial cleft cysts must be treated with antibiotics immediately.
Diagnosis
Generally, the diagnosis takes the medical history, physical examination, and ancillary tests into consideration. These include a CT scan, MRI scan, and an ultrasound. These cysts can develop and show their presence at any age. In majority of the cases, they are found to occur in childhood or early adulthood. They are often found to be associated with urinary tract infections. They can spontaneously fall back or persist. Quite commonly, they become infected, painful, and cause drainage through the skin.
For diagnosis, the doctor first and foremost inquires about urinary tract disorders and hearing problems as branchial cleft cysts can be expressions of Branchio-Oto-Renal syndrome. He also focuses on any kind of rise in the risk for head and neck malignancies. The cysts are soft, non-tender, and mobile masses. They give rise to skin discoloration only when infected. The doctor conducts the physical examination of the cysts too, to rule out other reasons behind the occurrence of the mass in the neck. The ultrasound test can confirm the presence; hence, it is necessary to be done.
Treatment
In case of absence of symptoms, the otolaryngologist keeps the patient under observation for 10-12 days. This allows him to collect sufficient data about the neck mass. The patients with suspected cysts of this type, which show the symptoms that do not regress in 7-10 days, are brought either under specialty medical care to head and neck surgery, or to general operation. When the cysts are infected, they are cured with a round of antibiotics.
However, the definitive management of such a neck mass is a complete surgical removal. It can be performed only when the infection has been treated completely. The surgery involves a set of horizontal incisions to take out the cyst. Surgical treatment is not recommended for patients who are under the age of three months. Fortunately, such cases are rare.
There are a few cases reported to have shown failure towards surgery. Such patients have to undergo sclerotherapy, a type of cosmetic therapy, with a specific sclerosing agent, OK-432. It involves complete removal of fluid from the cyst, followed by the injection of the sclerosing agent. This results in disappearance of the cyst.
Branchial cleft cysts are prone to infections. This aggravates the discomfort and uneasiness caused. Therefore, if you notice the symptoms in your neck or collarbone, you need to immediately book an appointment with an otolaryngologist. Timely medical intervention will treat it effectively.
Disclaimer: This article is for informative purposes only, and should not be used as a replacement for expert medical advice.
