First Branchial Cyst: Is Imaging Necessary to Diagnose This Masquerading Anomaly?

Abstract

Objective: First branchial cyst anomalies are an uncommon cause of postauricular cyst and upper lateral neck masses in the parotid region. Most were misdiagnosed and underwent multiple surgeries. Imaging will help preoperative diagnosis and surgical planning. We aim to determine if imaging is really necessary preoperatively. Method: Retrospective analysis of all patients with first branchial cysts treated between 2003 to 2010. Results: Seven patients, 3 male and 4 female, aged between 10 months and 10 years, underwent excision of first branchial cyst. Four were Work type 1, and 3 were Work type 2. Two patients had CT scan preoperatively, and they were all type 2 variant. Imaging was performed because the initial diagnosis was cholesteatoma. Complete excisions were performed for all type 1 variant. Most cases were misdiagnosed and, hence, operated without scans. Nevertheless, most were completely excised except in one patient when the cyst was too near the facial nerve. There was no recurrence if resection was complete. Conclusion: Complete excision is achievable without preoperative scan in type 1 variant. However, imaging is recommended in type 2 variant to delineate its relation to facial nerve. Consent for superficial parotidectomy with facial nerve monitor is recommended in type 2 variant for complete excision.