Definition

A branchial cyst is a fluid filled sac occurring in the neck usually in the upper half.

Incidence/Age

Branchial cysts are uncommon and can occur at any age; most commonly in young adulthood rather than in childhood.

Causes

The cause of branchial cysts is unknown. There are a number of theories, one of which is that it is a remnant of the gill slit in the embryo. It is probably more likely that the majority arise from lymph nodes, since they are not often present at birth.

Signs/Symptoms

Patients with branchial cysts usually develop a neck lump in the upper half of the neck a short distance below the jaw. They are usually painless but can sometimes present by becoming infected in which case they become swollen, painful and tender. They tend to grow slowly and may fluctuate in size a little.
Complications

If a branchial cyst becomes infected it may turn into an abscess requiring surgical treatment

Tests

Diagnosis of branchial cyst is often made without the need for extensive investigation. It may be appropriate to needle them to send some of the contents to the laboratory. CT scanning or ultrasound may be used to delineate the anatomy. The definitive diagnosis is examination of the cyst wall under the microscope after the cyst has been removed.

Treatment

No treatment

This is not usually recommended because cysts can enlarge or become infected. Branchial cysts are completely benign and fairly easy to diagnose but it is necessary to exclude the small possibility of a malignant neck lump.

Medical

Antibiotics may be helpful if the cyst is painful and infected.

Surgery

This is the definitive treatment for branchial cysts. The operation is performed under a general anaesthetic and takes about one hour with a 24 hour hospitalisation. An incision is made in the skin crease in the neck over the lump. The lump is exposed and dissected out. Occasionally they may be found to have a tract connecting them to the tonsil or other part of the throat. The wound is usually drained by means of a plastic tube which is removed the following day.

Time off work/school

About 2 weeks.

Complications of Surgery

These are usual potential complications of any neck operation. They include the slight possibility of damage to other structures such as nerves in the neck and the risk of postoperative infection or bleeding. If the cyst is incompletely removed there is a slight risk of recurrence.


Source: medicaldirect.co.uk
Last Editorial Review: 25/1/2010