Scarless Excision of Second Branchial Cleft Cyst via Retroauricular Hairline Incision.

BACKGROUND: Second branchial cleft cyst (2nd BCC) is treated by complete excision. Conventional transcervical skin incision on the lesion may leave a prominent scar in the cosmetically sensitive area. The retroauricular hairline incision (RAHI) approach may maintain neurological, mobility, and cosmetic functions of the neck and face after excision. This study evaluated the clinical outcomes and disease control of scarless surgery via RAHI in 57 consecutive patients with 2nd BCC. METHODS: The patients received the prospective evaluation of postoperative neurological, subjective pain, swallowing, neck motion, and cosmetic functions. Postoperative complications, subjective satisfaction, and recurrence were also assessed in each patient. RESULTS: Excision was performed in all cases without injury to the facial nerve or other neurological complications and conversion to other incisions or approaches with a median operation time of 44 min. Complications were minimal, without dysphagia, neurological deficits, or limited neck motion. Postoperative incision scars in the postauricular and hairline region were commonly invisible. Subjective satisfaction with the scar and facial deformity was high after surgery. No patients had a recurrence for a median follow-up of 66 months. CONCLUSION: The RAHI approach for 2nd BCC has excellent cosmetic, functional, and disease control outcomes. This can be safely applied to the treatment of 2nd BCC. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

CT and MR imaging findings of infection-free and benign second branchial cleft cysts.

PURPOSE: The present study aimed to assess CT and MR imaging findings of infection-free and benign second branchial cleft cysts (SBCCs). METHODS: Eleven patients with histopathologically confirmed infection-free and benign SBCCs underwent preoperative contrast-enhanced CT (CECT) and/or MR imaging. We assessed qualitative (presence and extent of wall thickening, degree of contrast enhancement of the thickened wall on CECT images, and signal intensity of the thickened wall on T2-weighted images) and quantitative (maximum thickness of the thickened wall) imaging findings. RESULTS: Eccentric and smooth wall thickening was observed in 11/11 (100%) patients. The wall thickening extent (percentage of the thickened wall to the circumference of the wall) was small (1%-25%) in 4/11 (36%), moderate (26%-50%) in 6/11 (54%), extensive (51%-75%) in 1/11 (9%), and diffuse (76%-100%) in 0/11 (0%) patients. Mild homogeneous enhancement of the thickened wall on CECT images was observed in 7/7 (100%) patients. The signal intensity of the thickened wall on T2-weighted images was isointense relative to that of normal lymph nodes in 7/8 (88%) and mildly hyperintense in 1/8 (12%) patient. The maximum thickness of the thickened walls ranged from 2 to 4 (mean 3.4) mm. CONCLUSIONS: Infection-free and benign SBCCs are identifiable as cysts with eccentric and smooth wall thickening on CECT and MR images. The wall thickness was almost always less than half of the wall circumference, isointense relative to normal lymph nodes, and showed mild homogeneous enhancement.

Huge second branchial cleft cyst: A case report.

INTRODUCTION AND IMPORTANCE: Second branchial cysts are benign dysembryological cystic tumors that develop in the antero-lateral part of the neck. They represent 2 % of laterocervical tumors of the neck and are usually diagnosed before adulthood. The cysts can increase in size and cause multiple complications. Ultrasound and MRI (Magnetic Resonance Imaging) confirm their cystic nature. Treatment consists of surgical excision. CASE PRESENTATION: We report the case of a 31-year-old woman who presented with a left laterocervical swelling measuring 8 cm, which had been present for 18 months without any other associated symptoms. An exploratory cervicotomy was performed, and the histological diagnosis was a second branchial cleft cyst without signs of malignancy. CLINICAL DISCUSSION: The definitive diagnosis of a second branchial cleft cyst is confirmed by anatomopathological examination. Therapeutic management is always surgical and should be performed as early as possible to limit the risk of complications. CONCLUSION: Second branchial cleft cysts are relatively uncommon malformations. Diagnosis is suspected based on physical examination, guided by imaging data, and confirmed by anatomopathological examination. Treatment is surgical, with complete removal of the cyst being necessary to prevent recurrence.

Unusual location of a second branchial cleft cyst presenting in the suprasternal notch.

BACKGROUND: Second branchial cleft cysts (SBCCs) are congenital benign tumors that comprise up to 90% of all branchial cleft anomalies. SBCCs typically present in the lateral neck along the anterior border of the upper third of the sternocleidomastoid muscle. We describe a case of a SBCC presenting in an unusual location in the lower neck close to midline. METHODS: An 18-year-old male presented with a 2-year history of a neck mass in the suprasternal notch. Imaging findings were reviewed with a head and neck radiologist who felt that the findings were highly suggestive of a fourth branchial cleft cyst. RESULTS: The patient underwent surgical excision of the mass. Final pathologic evaluation confirmed the diagnosis of a second branchial cleft cyst. CONCLUSIONS: Though extremely uncommon, second branchial cleft cysts can extend to the suprasternal notch and should not be excluded from the differential diagnoses of lower neck masses.

Branchial cleft cyst.

Branchial cleft cysts are benign lesions caused by anomalous development of the brachial cleft. This report describes a 20-year-old girl with swelling on the right lateral aspect of the neck, which expanded slowly but progressively. The clinical suspicion was that of a branchial cleft cyst. Sonography revealed a homogeneously hypo- to anechoic mass with well-defined margins and no intralesional septa. Color Doppler reviewed no internal vascularization. The ultrasound examination confirmed the clinical diagnosis of a second branchial cleft cyst, demonstrating the cystic nature of the mass and excluding the presence of complications. For superficial lesions like these, ultrasound is the first-level imaging study of choice because it is non-invasive, rapid, low-cost, and does not involve exposure to ionizing radiation.

Second branchial cleft cyst of the neck: report of two cases

Parapharyngeal Second Branchial Cleft Cyst Extending to the Skull Base: A Lateral Transcranial Infratemporal fossa Approach

Branchial cleft cysts, sinuses, and fistulae are classified as first, second, third and fourth branchial cleft anomalies. They represent the congenital anomalies resulting from defects in the normal maturation of the branchial apparatus. Second branchial cleft anomalies occur more commonly than other branchial cleft anomalies. Most branchial cysts from the second branchial cleft are found deep in the sternocleidomastoid muscle or along its anterior border. Recognizing and diagnosing lateral neck cysts correctly are not difficult for an expert physician, although an unusual localization may cause problems in differential diagnosis. Complete excision of branchial cleft cysts is necessary to avoid recurrence. Approaches to the lesions are depending on the location and extent of the lesion. This article presents an unusual case of parapharyngeal branchial cleft cyst extending the skull base. Excision of the lesion was achieved via the lateral transcranial infratemporal fossa approach with zygomato-temporal craniotomy. This approach provides access not only to all of the subcranial tissues that underlie the middle cranial fossa, but to the maxillary or sphenoid sinus.