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1st Branchial Cleft Cyst
Eunice Y. L. Dai, MBBS, FRCR; Yolanda Y. P. Lee, MBChB, FRCR; Simon S. M. Wong, MBBS, FRCR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Synonyms

                • Branchial apparatus cysts
              • Definitions

                • Most common 1st branchial cleft anomalies (BCAs) are branchial cleft cysts (BCCs) or sinuses
                • 1st BCC: Benign, congenital cyst in or adjacent to parotid gland, external auditory canal (EAC), or pinna
                  • Remnant of 1st branchial apparatus: Most commonly used classification
                    • Work type I: Duplication of membranous EAC; ectodermal (cleft) origin
                    • Work type II: Duplication of membranous EAC and cartilaginous pinna
                      • Skin (ectodermal cleft) and cartilage (mesodermal arch) origin
                      • May also have contribution from 2nd arch
                • 1st branchial cleft sinus tract opens near parotid gland, EAC, parapharyngeal space (PPS), or anterior triangle of neck

              IMAGING

              • Ultrasonographic Findings

                • CT Findings

                  • MR Findings

                    • General Features

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              • Microscopic Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          Selected References

                                          1. Bansal AG et al: US of pediatric superficial masses of the head and neck. Radiographics. 38(4):1239-1263, 2018
                                          2. ScienceDirect: Type II first branchial cyst and sinus excision with preservation of facial nerve and parotid gland. https://doi.org/10.1016/j.epsc.2013.02.008. Reviewed November 1, 2018. Accessed November 1, 2018.
                                          3. Adams A et al: Branchial cleft anomalies: a pictorial review of embryological development and spectrum of imaging findings. Insights Imaging. 7(1):69-76, 2016
                                          4. Ankur G et al: First branchial cleft cyst (type II). Ear Nose Throat J. 88(11):1194-5, 2009
                                          5. Gupta AK et al: Bilateral first and second branchial cleft fistulas: a case report. Ear Nose Throat J. 87(5):291-3, 2008
                                          6. Martinez Del Pero M et al: Presentation of first branchial cleft anomalies: the Sheffield experience. J Laryngol Otol. 121(5):455-9, 2007
                                          7. Schroeder JW Jr et al: Branchial anomalies in the pediatric population. Otolaryngol Head Neck Surg. 137(2):289-95, 2007
                                          8. Koch BL: Cystic malformations of the neck in children. Pediatr Radiol. 35(5):463-77, 2005
                                          9. Gritzmann N et al: Sonography of soft tissue masses of the neck. J Clin Ultrasound. 30(6):356-73, 2002
                                          10. Nicollas R et al: Congenital cysts and fistulas of the neck. Int J Pediatr Otorhinolaryngol. 55(2):117-24, 2000
                                          11. Robson CD et al: Nontuberculous mycobacterial infection of the head and neck in immunocompetent children: CT and MR findings. AJNR Am J Neuroradiol. 20(10):1829-35, 1999
                                          12. Sichel JY et al: Clinical update on type II first branchial cleft cysts. Laryngoscope. 108(10):1524-7, 1998
                                          13. Triglia JM et al: First branchial cleft anomalies: a study of 39 cases and a review of the literature. Arch Otolaryngol Head Neck Surg. 124(3):291-5, 1998
                                          14. Nofsinger YC et al: Periauricular cysts and sinuses. Laryngoscope. 107(7):883-7, 1997
                                          15. Van der Goten A et al: First branchial complex anomalies: report of 3 cases. Eur Radiol. 7(1):102-5, 1997
                                          16. Arndal H et al: First branchial cleft anomaly. Clin Otolaryngol. 21(3):203-7, 1996
                                          17. Choi SS et al: Branchial anomalies: a review of 52 cases. Laryngoscope. 105(9 Pt 1):909-13, 1995
                                          18. Mukherji SK et al: Evaluation of first branchial anomalies by CT and MR. J Comput Assist Tomogr. 17(4):576-81, 1993
                                          19. Benson MT et al: Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy. Radiographics. 12(5):943-60, 1992
                                          20. Doi O et al: Branchial remnants: a review of 58 cases. J Pediatr Surg. 23(9):789-92, 1988
                                          21. Finn DG et al: First branchial cleft cysts: clinical update. Laryngoscope. 97(2):136-40, 1987
                                          22. Graham MD et al: First branchial cleft cyst presenting as a mass within the external auditory canal. Am J Otol. 6(6):500-2, 1985
                                          23. Sherman NH et al: Ultrasound evaluation of neck masses in children. J Ultrasound Med. 4(3):127-34, 1985
                                          24. Harnsberger HR et al: Branchial cleft anomalies and their mimics: computed tomographic evaluation. Radiology. 152(3):739-48, 1984
                                          25. Olsen KD et al: First branchial cleft anomalies. Laryngoscope. 90(3):423-36, 1980
                                          26. Wilson DB: Embryonic development of the head and neck: part 2, the branchial region. Head Neck Surg. 2(1):59-66, 1979
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Synonyms

                                                        • Branchial apparatus cysts
                                                      • Definitions

                                                        • Most common 1st branchial cleft anomalies (BCAs) are branchial cleft cysts (BCCs) or sinuses
                                                        • 1st BCC: Benign, congenital cyst in or adjacent to parotid gland, external auditory canal (EAC), or pinna
                                                          • Remnant of 1st branchial apparatus: Most commonly used classification
                                                            • Work type I: Duplication of membranous EAC; ectodermal (cleft) origin
                                                            • Work type II: Duplication of membranous EAC and cartilaginous pinna
                                                              • Skin (ectodermal cleft) and cartilage (mesodermal arch) origin
                                                              • May also have contribution from 2nd arch
                                                        • 1st branchial cleft sinus tract opens near parotid gland, EAC, parapharyngeal space (PPS), or anterior triangle of neck

                                                      IMAGING

                                                      • Ultrasonographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • General Features

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      • Microscopic Features

                                                                        CLINICAL ISSUES

                                                                        • Presentation

                                                                          • Demographics

                                                                            • Natural History & Prognosis

                                                                              • Treatment

                                                                                DIAGNOSTIC CHECKLIST

                                                                                • Consider

                                                                                  Selected References

                                                                                  1. Bansal AG et al: US of pediatric superficial masses of the head and neck. Radiographics. 38(4):1239-1263, 2018
                                                                                  2. ScienceDirect: Type II first branchial cyst and sinus excision with preservation of facial nerve and parotid gland. https://doi.org/10.1016/j.epsc.2013.02.008. Reviewed November 1, 2018. Accessed November 1, 2018.
                                                                                  3. Adams A et al: Branchial cleft anomalies: a pictorial review of embryological development and spectrum of imaging findings. Insights Imaging. 7(1):69-76, 2016
                                                                                  4. Ankur G et al: First branchial cleft cyst (type II). Ear Nose Throat J. 88(11):1194-5, 2009
                                                                                  5. Gupta AK et al: Bilateral first and second branchial cleft fistulas: a case report. Ear Nose Throat J. 87(5):291-3, 2008
                                                                                  6. Martinez Del Pero M et al: Presentation of first branchial cleft anomalies: the Sheffield experience. J Laryngol Otol. 121(5):455-9, 2007
                                                                                  7. Schroeder JW Jr et al: Branchial anomalies in the pediatric population. Otolaryngol Head Neck Surg. 137(2):289-95, 2007
                                                                                  8. Koch BL: Cystic malformations of the neck in children. Pediatr Radiol. 35(5):463-77, 2005
                                                                                  9. Gritzmann N et al: Sonography of soft tissue masses of the neck. J Clin Ultrasound. 30(6):356-73, 2002
                                                                                  10. Nicollas R et al: Congenital cysts and fistulas of the neck. Int J Pediatr Otorhinolaryngol. 55(2):117-24, 2000
                                                                                  11. Robson CD et al: Nontuberculous mycobacterial infection of the head and neck in immunocompetent children: CT and MR findings. AJNR Am J Neuroradiol. 20(10):1829-35, 1999
                                                                                  12. Sichel JY et al: Clinical update on type II first branchial cleft cysts. Laryngoscope. 108(10):1524-7, 1998
                                                                                  13. Triglia JM et al: First branchial cleft anomalies: a study of 39 cases and a review of the literature. Arch Otolaryngol Head Neck Surg. 124(3):291-5, 1998
                                                                                  14. Nofsinger YC et al: Periauricular cysts and sinuses. Laryngoscope. 107(7):883-7, 1997
                                                                                  15. Van der Goten A et al: First branchial complex anomalies: report of 3 cases. Eur Radiol. 7(1):102-5, 1997
                                                                                  16. Arndal H et al: First branchial cleft anomaly. Clin Otolaryngol. 21(3):203-7, 1996
                                                                                  17. Choi SS et al: Branchial anomalies: a review of 52 cases. Laryngoscope. 105(9 Pt 1):909-13, 1995
                                                                                  18. Mukherji SK et al: Evaluation of first branchial anomalies by CT and MR. J Comput Assist Tomogr. 17(4):576-81, 1993
                                                                                  19. Benson MT et al: Congenital anomalies of the branchial apparatus: embryology and pathologic anatomy. Radiographics. 12(5):943-60, 1992
                                                                                  20. Doi O et al: Branchial remnants: a review of 58 cases. J Pediatr Surg. 23(9):789-92, 1988
                                                                                  21. Finn DG et al: First branchial cleft cysts: clinical update. Laryngoscope. 97(2):136-40, 1987
                                                                                  22. Graham MD et al: First branchial cleft cyst presenting as a mass within the external auditory canal. Am J Otol. 6(6):500-2, 1985
                                                                                  23. Sherman NH et al: Ultrasound evaluation of neck masses in children. J Ultrasound Med. 4(3):127-34, 1985
                                                                                  24. Harnsberger HR et al: Branchial cleft anomalies and their mimics: computed tomographic evaluation. Radiology. 152(3):739-48, 1984
                                                                                  25. Olsen KD et al: First branchial cleft anomalies. Laryngoscope. 90(3):423-36, 1980
                                                                                  26. Wilson DB: Embryonic development of the head and neck: part 2, the branchial region. Head Neck Surg. 2(1):59-66, 1979