Branchial cyst

Branchial cyst

A branchial cyst ( Figure 52.63 ) develops from the vestigial remnants of the second branchial cleft, is lined by squamous epithelium and contains thick, turbid fluid. The cyst usually presents in the upper neck in early or middle adulthood and is found at the junction of the upper third and middle third of the sternomastoid muscle at its anterior border. It is a fluctuant swelling that may transilluminate and is often soft in its early stages so that it may be di ffi cult to palpate. Summary box 52.15 Diagnosis of a lump in the neck /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF If the cyst becomes infected, it becomes erythematous and tender and the di ff erential diagnosis is broadened. Ultrasound and fine-needle aspiration both aid diagnosis and treatment is by complete excision, which is best undertaken when the lesion is quiescent. It passes superficial to the hypoglossal and glossopharyngeal nerves, but deep to the posterior belly of the digastric. These structures and the spinal accessory nerve must be positively identified to avoid damage. In patients over 35 years of age, a high index of suspicion for a necrotic metastatic lymph node should exist and malignancy should be excluded before excision.

History Physical signs Size Fixation: deep/super /f_i cial Site Pulsatility Shape Compressibility Surface Transillumination Consistency Bruit

Branchial cyst

A branchial cyst ( Figure 52.63 ) develops from the vestigial remnants of the second branchial cleft, is lined by squamous epithelium and contains thick, turbid fluid. The cyst usually presents in the upper neck in early or middle adulthood and is found at the junction of the upper third and middle third of the sternomastoid muscle at its anterior border. It is a fluctuant swelling that may transilluminate and is often soft in its early stages so that it may be di ffi cult to palpate. Summary box 52.15 Diagnosis of a lump in the neck /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF If the cyst becomes infected, it becomes erythematous and tender and the di ff erential diagnosis is broadened. Ultrasound and fine-needle aspiration both aid diagnosis and treatment is by complete excision, which is best undertaken when the lesion is quiescent. It passes superficial to the hypoglossal and glossopharyngeal nerves, but deep to the posterior belly of the digastric. These structures and the spinal accessory nerve must be positively identified to avoid damage. In patients over 35 years of age, a high index of suspicion for a necrotic metastatic lymph node should exist and malignancy should be excluded before excision.

History Physical signs Size Fixation: deep/super /f_i cial Site Pulsatility Shape Compressibility Surface Transillumination Consistency Bruit