Branchial Cleft Anomalies

Branchial cleft cysts are congenital anomalies arising from the first through fourth pharyngeal clefts. The most common type of branchial cleft cyst arises from the second cleft, with anomalies derived from the first, third, and fourth clefts being rarer. As this is a congenital anomaly, brachial cleft cysts are present at birth, although they may not be obvious or symptomatic until later. The majority of lesions present in childhood as a visible punctum on the skin of the anterior neck with or without periodic drainage; however, they may present as a neck mass or as recurrent abscesses due to infections within the tract. Branchial cleft anomalies occur in 1 of 3 forms: cysts, sinuses, or fistulae. Cysts are epithelial-lined structures that do not have external openings that connect to the skin or pharynx, and as such, may be asymptomatic and only noticed incidentally. Such cysts may not present until adulthood. Sinus tracts connect either the skin or the pharynx to a blind pouch. Sinus tracts may communicate externally with skin as a visible punctum or internally with the pharynx or larynx, where the punctum opening will only be visible on endoscopy. Branchial cleft fistulae are true communications connecting the pharynx or larynx with the external skin.