A second branchial cleft cyst, a case report.

Abstract

Branchial fistulas and cysts are uncommon anomalies of embryonic development that involve soft tissues of the neck. According to Bailey-Proctor classification, second BCCs are classified into four types: Type-I cysts are situated along the anterior border of the sternocleidomastoid muscle beneath the superficial cervical fascia. Type-II ones are the most common and lie just laterally to great vessels beneath enveloping fascia of the neck. Type-III ones pass between internal and external carotid arteries. Type-IV cysts are situated in the pharyngeal mucosal space just deep to the palatine tonsil and medial to great neck vessels, often extending upward towards the skull base. Most second BCCs comprise the first three types, while type-IV cysts are extremely rare. 17years old male patient from Baghdad/Iraq, single, a student, and living with his family. The patient presented to Al-kindy Teaching Hospital for general surgery consultation due to the presence of a lump in the upper third of the anterior border of the sternocleidomastoid muscle for several years ago, the lump was painless but gradually increase in size with discomfort but without fever, anorexia or weight loss. There were no relieving factors. Regarding the review of systems nothing positive and the history was negative also patient had no past drug history and no psychological illness. Physical examination of the lump showed a smooth, non-tender, fluctuant cyst located at the upper third of the anterior border of the left sternocleidomastoid muscle about 7×4cm and there were no enlarged lymph nodes. Regarding examination of the other systems there was nothing positive. Laboratory and radiological investigation showed that the cystic lesion mostly was a branchial cyst, so the operation is done for the patient by complete excision of the cyst with its tract which was located between external and internal carotid vessels. A histopathological study revealed a squamous epithelium-lined cyst with lymphoid infiltration, consistent with a branchial cleft cyst. The patient was discharged without any complication or any evidence of recurrence for 14months follow-up. Branchial anomalies remain asymptomatic and can present later in life. They can be misdiagnosed. CT scans and MRI neck are helpful in the diagnosis of the cyst and its anatomical extensions. A proper history and physical examination are required to look for other anomalies like craniofacial syndromes. The treatment of branchial cyst is complete surgical excision to prevent recurrence and removal of these lesions at an earlier stage will increase the quality of life of the patient. In addition, since they are rarely malignant, more successful results will be obtained with early diagnosis and treatment.