Branchial Cleft Cyst Treatment

Branchial cleft cysts in children grow during fetal development (gestation). An area of tissue called the branchial apparatus makes up cartilage, bone, blood vessels and muscles in the head and neck. This apparatus has six tissue ridges (arches) and five inward folds (clefts).

When the arches don’t grow together, it can cause branchial cleft cysts. There are different types of these cysts, depending on where they grow in the head and neck, like:

• First branchial cleft cysts: Grow between the ear and the area between the lower jaw and the hyoid bone in the middle of the neck. They affect the middle or outer ear.
• Second branchial cleft cysts: Start under the skin in the neck muscle on either side of the neck. They’re the most common type.
• Third and fourth branchial cleft cysts: Found under the skin on the neck’s left side or by the collarbone. They can affect the thyroid.

Often, branchial cleft cysts in children don’t have symptoms. But you or your child might notice a lump or swollen area on their neck. It may or may not hurt. And might even have fluid oozing out of it. They may also have problems swallowing. If these cysts become large enough, they can sometimes affect your child’s breathing. These are signs it’s time to get things checked out by an expert pediatric head and neck team.

What to expect at your child’s first visit

During your child’s first appointment, their provider will spend time learning more about what’s been going on. They’ll ask questions like:

• Does your child have a bump in their neck?
• When did you first notice the bump?
• Does the bump hurt or have fluid coming out of it?
• How has the bump affected your child’s life?
• Are you worried about your child’s swallowing or breathing?

Your child will also have a physical exam so their provider can check out their general health — and gently feel the bump if your child has one. They may also order imaging tests, like an ultrasound, CT scan or MRI, to get a closer look at the cyst. If the branchial cleft cyst is by their ear (first branchial cleft cyst), we may also do some hearing tests.

All this information is important to confirm a diagnosis. And it helps your child’s care team create an individualized treatment plan.

Meet Our Branchial Cleft Cyst in Children Team

Cleveland Clinic Children’s focuses on team-based care. That means your child has the support and combined experience of pediatric providers from many specialties. We build this care team based on your child’s needs so they can get the best treatment and results. Our pediatric otolaryngologists will lead this team and work with other providers like:

• Pediatric endocrinologists.
• Pediatric neurologists.
• Pediatric speech-language pathologists.
• Pediatric audiologists.
• Pediatric anesthesiologists.
• Pediatric radiologists.
• Child life specialists.

The providers on your child’s care team work together to craft the most personalized treatment plan for the best possible results.

The main treatment for branchial cleft cysts in children is surgery. Your child’s care team will likely recommend this because these cysts are prone to infection. And infections can cause painful complications.

If the cyst is infected, your child may take antibiotics to treat it before surgery. During surgery, they’ll get anesthesia and fall asleep, so they won’t feel any pain or discomfort during the procedure.

If the cyst affects their thyroid (third and fourth branchial cleft cysts), we may also remove part of their thyroid (partial thyroidectomy).

Life After Treatment for Branchial Cleft Cysts in Children

After surgery, your child will have regular follow-up appointments with their pediatric team. We want to be sure the cyst doesn’t return. They rarely do. But if it happens, we can start treatment right away. They may also have speech therapy if the cyst affected their hearing or ability to swallow.

Taking the Next Step

If your child has a lump on their neck, it’s easy to jump to conclusions. But branchial cleft cysts in children are benign. And when we do surgery to remove them, they usually don’t grow back. But we know it can be stressful sending your child into an operating room. You can rest easy knowing they’re in the best hands at Cleveland Clinic Children’s. Our pediatric head and neck team focuses on their needs (and your family’s) as your child goes through treatment. From answering pressing questions to walking you through what to expect, to getting expert, personalized care for your child — you can count on us.