THROAT - Branchial cyst

Synoynm:  Lateral cyst of the neck.

What is branchial cyst?

Cystic swelling arising in connection with persistent portion of a part or whole of ectoderm lined cervical sinus. 

Site: Along the anterior border of sternomastoid  usually ill the region of the angle of jaw.

 Formation: The appendages of the ectodermal lined enclosed space (cervical sinus), sweat and sebaceous glands continue their secretions which gradually distends the space to form the cyst.

Lining : Lined by squamous epithelium.

Contents : Tooth paste like material rich in cholesterol.

 What are the clinical features of  branchial cyst?
                                   
1)      Age: Late childhood and young adults M=F
2)      Symptom: Usually painless. Painful only if infected.
3)      Local signs:
a)       Swelling at level of angle of mandible behind anterior border of the          junction of upper and lower 2/3 rd of sternomastoid muscle.
b)      Smooth, ovoid in size
c)       Fluctuation positive.
d)      Transillumination negative.
e)       Non compressible
f)       Non palpable cervical lymph nodes.

Relations of the Cyst:

Superficial to the internal carotid , glossopharyngeal nerve,  stylopharyngeus, muscle. (Structures derived from the third arch). Deep to the lesser cornu of the hyoid bone, stylohyoid ligament

posterior belly of digastric muscle, facial nerve and external carotid artery.
(S tructures derived from the third arch).

Diagnostic Criteria: Cholesterol crystals present in aspirated material.

Differential diagnosis: Tuberculous lymphadenitis.

Complication: Recurrent infection.

What is the treatment of  branchial cyst?

Excision of the cyst
While dissection one must avoid injury to:

a)       External and internal carotid arteries
b)      Pharyngeal wall
c)       Accessory and hypoglossal nerve.

 




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