Branchial Cleft Cyst

What is a branchial cleft cyst?

Branchial cleft cysts are small, fluid-filled sacs that appear under your skin on one or both sides of your neck. You can usually see them somewhere between your jaw and collarbone. Healthcare providers may refer to branchial cleft cysts as pharyngeal cleft cysts or as a type of neck mass.

These cysts are congenital, meaning you’re born with them. It’s possible to have a branchial cyst for many years and not know it. Some people only realize they have a cyst if it gets infected.

Branchial cleft cysts are typically benign (noncancerous). In very rare instances, these cysts can turn into cancer. Even if the branchial cyst doesn’t cause issues, you might need surgery to remove it and prevent future infections.

Types of branchial cleft cyst

Healthcare providers categorize branchial cleft cysts according to where they develop:

• First branchial cleft cysts: Located between your ear and the area just below your jaw on either side, these make up about 5% to 25% of all branchial cleft cases.
• Second branchial cleft cysts: These cysts usually appear under the skin of your neck muscles on either side. They’re the most common type of branchial cleft cyst, representing between 40% to 95% of cases.
• Third branchial cleft cysts: These cysts form on the left side of your neck near your thyroid gland. They’re less common than first and second branchial cleft cysts.
• Fourth branchial cleft cysts: Located on the lower left side of your neck, these cysts are rare.

How common are branchial cleft cysts?

Branchial cleft cysts are one of the most common types of neck masses, especially in children. Overall, it’s hard to know exactly how many people have branchial cysts because they don’t always cause symptoms.

What are the symptoms of a branchial cleft cyst?

Sometimes, branchial cleft cysts don’t cause symptoms. It’s possible to have one and not know it.

If you do develop branchial cleft cyst symptoms, they could include:

• A lump on your neck that might grow larger over time.
• Neck swelling that gets worse after upper respiratory infections.
• Painful swallowing.
• Small pits or openings on your neck that may or may not drain fluid.
• Stridor (noisy breathing).

If you have an infected branchial cleft cyst, you might have:

• Difficulty swallowing.
• Irritated or itchy skin.
• Neck pain.

What causes a branchial cleft cyst?

Unexpected changes during fetal development cause branchial cleft cysts. Tissues around the fetus’s neck and collarbone area don’t form correctly. When this happens, it creates empty spaces. Fluid fills these empty spaces, causing cysts to form.

What are the complications of branchial cleft cysts?

Untreated branchial cysts can cause several complications like:

• Abscesses.
• Difficulty breathing.
• Difficulty swallowing.
• Secondary hypertension if a cyst presses on blood vessels.
• Repeated infections.

How are branchial cleft cysts diagnosed?

Healthcare providers will examine your neck and ask about your symptoms. They might need to take imaging tests like:

• CT scans (computed tomography scans).
• MRI (magnetic resonance imaging).
• Chest X-ray.
• Ultrasound.

If you have a first branchial cleft cyst, your healthcare provider may also do a hearing test. That’s because these cysts form near your ear and may affect nearby structures.

How are branchial cleft cysts treated?

Branchial cleft cyst treatment depends on the type of cyst, its location and whether it’s infected. Options include:

• Antibiotics to treat infected cysts.
• Surgery to remove the cysts.
• Partial thyroidectomy to treat third/fourth branchial cleft cysts near your thyroid.

Complications of branchial cleft cyst surgery

Like any surgical procedure, removing a branchial cleft cyst comes with some risk. Possible complications include:

• Excessive bleeding.
• Nerve damage.
• Reactions to anesthesia.
• Scarring.
• Recurrence

Your healthcare provider can help you weigh the risks and benefits of surgery. Talk to them if you have questions about your treatment plan.

Can branchial cleft cysts be prevented?

You can’t prevent branchial cleft cysts because they form during fetal development. There’s no way to keep them from occurring. If your baby was born with a branchial cyst, it’s not because of something you did or didn’t do. It’s just something that happens.

What can I expect if I have a branchial cleft cyst?

If you have a branchial cleft cyst that doesn’t cause problems, you might not need to do anything. But if it gets infected, you’ll need antibiotics. If the infection keeps returning, your healthcare provider might recommend surgery to remove it. Very few branchial cysts recur (come back) after surgery.

What’s the outlook for branchial cleft cysts?

The outlook is good. Most people who have cyst removal surgery recover with good results and no complications.

When should I see my healthcare provider?

If you’ve had surgery to remove a branchial cleft cyst, let your healthcare provider know if you develop:

• A fever higher than 101 degrees Fahrenheit (38.3 degrees Celsius).
• Pain that doesn’t get better with medication.
• More drainage or swelling than you expected.

What questions should I ask my doctor?

If you or your child has branchial cleft cysts, here are some questions you might want to ask your healthcare provider:

• Why did I develop this cyst?
• Is the cyst cancerous?
• Can this cyst become cancerous?
• Will the cyst go away on its own?
• What treatment do you recommend?
• What are typical treatment side effects?